Motor cortex stimulation for long-term relief of chronic neuropathic pain: A 10 year experience

@article{Rasche2006MotorCS,
  title={Motor cortex stimulation for long-term relief of chronic neuropathic pain: A 10 year experience},
  author={Dirk Rasche and Marc Ruppolt and Christoph Stippich and Andreas Unterberg and Volker M. Tronnier},
  journal={Pain},
  year={2006},
  volume={121},
  pages={43-52}
}

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SummaryThe results of Deep Brain Stimulation in deafferentation pain syndromes, in particular in thalamic pain, indicate that excellent long-term pain relief can hardly ever be achieved. We report 7
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The effect of stimulation on pain and capability of producing muscle twitch disappeared simultaneously in these cases and the effect reappeared after the revisions, indicating that appropriate stimulation of the motor cortex is definitely necessary for obtaining satisfactory pain control in these patients.
Motor cortex stimulation for neuropathic facial pain
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A long-term follow-up of two patients with unilateral facial neuropathic pain due to idiopathic trigeminal neuropathy or to surgical trauma to the glossopharyngeal nerve is presented, and electrical stimulation of the motor cortex with a quadripolar electrode contralateral to the painful area of the face resulted in immediate analgesia with more than 50% pain reduction.
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While stimulation of the first- to third-order sensory neurons at the level of the thalamic relay nucleus or below cannot bring about good pain inhibition in patients withThalamic pain, activation of hypothetical fourth- order sensory neurons through precentral stimulation may be able to inhibit deafferented nociceptive neurons within the cortex.
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Patients with peripheral deafferentation pain, including two with phantom-limb pain and two with brachial plexus injury, attained pain relief from motor cortex stimulation, with excellent results in two cases.
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TLDR
The findings suggest that the pain control afforded by MC stimulation requires neuronal circuits that are maintained by the presence of intact corticospinal tract neurons originating from the MC.
Motor Cortex Stimulation for Central and Neuropathic Facial Pain: A Prospective Study of 10 Patients and Observations of Enhanced Sensory and Motor Function during Stimulation
TLDR
These results provide further support for the use of motor cortex stimulation in facial neuropathic pain and document pain improvement as measured by multidimensional scales.
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The neuronavigator localization and guidance technique proved to be most useful identifying the appropriate portion of the motor gyrus which allowed the establishment of reliable correlations between electrophysiological-clinical and anatomical data which may be used to improve the clinical results and possibly to extend the indications of this technique.
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