Deep brain stimulation and motor cortex stimulation for central post-stroke pain: a systematic review and...

Area of Science:

• Neurosurgery
• Pain Management
• Neurology

Background:

• Deep brain stimulation (DBS) and motor cortex stimulation (MCS) are invasive treatments for neuropathic pain, including central post-stroke pain (CPSP).
• Comparative analyses and synthesized success rates of DBS versus MCS for CPSP are limited.
• Objective pain scores have not been consistently used to evaluate these interventions.

Purpose of the Study:

• To systematically review and compare the efficacy of DBS and MCS for treating central post-stroke pain (CPSP).
• To synthesize the success rates of these neurosurgical interventions using validated pain scales.

Main Methods:

• A systematic review and meta-analysis adhering to PRISMA guidelines was conducted.
• Searched three databases for studies published between January 2000 and October 2024.
• Analyzed studies reporting pain relief via Visual Analogue Scale (VAS) or Numerical Rating Scale (NRS) scores using random effects models.

Main Results:

• Included 32 studies with 330 patients (139 DBS, 191 MCS).
• Mean VAS score improvement was 48.6% for DBS and 53.1% for MCS.
• Pooled improvement rates were 62% for DBS (95% CI, 0.51-0.71) and 64% for MCS (95% CI, 0.53-0.74).

Conclusions:

• DBS and MCS are considered last-resort treatments for CPSP, with limited comparative research.
• Motor cortex stimulation (MCS) demonstrated a potentially slightly higher efficacy than DBS for CPSP.
• Further research is needed to establish the optimal surgical intervention for CPSP.