Motor Cortex Stimulation for Refractory Trigeminal Pain: A Case Series from Atlantic Canada

Neuromodulation is emerging as a promising intervention for intractable pain syndromes. Despite heterogeneous outcomes in the literature, motor cortex stimulation (MCS) has proven effective in addressing chronic orofacial pain. Painful trigeminal neuropathy (PTN) is characterized by constant facial pain and somatosensory signs. Refractory cases, unresponsive to medical and surgical therapies, significantly impact quality of life and pose socioeconomic challenges. This article presents a retrospective case series of five MCS patients who were treated for refractory PTN in Atlantic Canada.

Since 2021, eight cases of refractory PTN from Atlantic Canada have been recruited. Demographic and clinical characteristics were collected, with primary and secondary outcomes respectively defined as a 50% Visual Analogue Scale (VAS) reduction and a 60% reduction in morphine equivalent dose per day (MED, mg/day) at 12 months post-operation. Pain intensity was assessed preoperatively and at 6- and 12-month follow-ups, along with eating habits, return to work, and global satisfaction.

Five patients with refractory PTN were implanted with MCS, all of whom achieved the primary and secondary outcomes. Preoperatively, mean VAS was 8.4 ± 1.0, reduced to 2.0 ± 1.1 at 12 months post-MCS, corresponding to a 77 ± 13% pain reduction. Average MED/day was reduced by 93 ± 13%, with 60% of participants narcotic-free at 12 months and 80% at 18 months. There were no immediate or delayed complications related to the MCS procedure.

MCS exhibits significant potential for long-term pain relief and reducing opioid consumption in refractory trigeminal pain, emphasizing the necessity for large national multicenter trials.