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Aibar-Durán JÁ, Villalba Martínez G, Freixer-Palau B, Araus-Galdós E, Morollón Sanchez-Mateos N, Belvis Nieto R, Revuelta Rizo M, Molet Teixeido J, García Sánchez C, de Quintana Schmidt C, Muñoz Hernandez F, Rodríguez Rodríguez R. Long-Term Results of Cortical Motor Stimulation for Neuropathic Peripheral and Central Pain: Real-World Evidence From Two Independent Centers. Neurosurgery 2024; 94:147-153. [PMID: 37638720 DOI: 10.1227/neu.0000000000002638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/12/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Cortical motor stimulation (CMS) is used to modulate neuropathic pain. The literature supports its use; however, short follow-up studies might overestimate its real effect. This study brings real-world evidence from two independent centers about CMS methodology and its long-term outcomes. METHODS Patients with chronic refractory neuropathic pain were implanted with CMS. The International Classification of Headache Disorders 3rd Edition was used to classify craniofacial pain and the Douleur Neuropathique en 4 Questions Scale score to explore its neuropathic nature. Demographics and clinical and surgical data were collected. Pain intensity at 6, 12, and 24 months and last follow-up was registered. Numeric rating scale reduction of ≥50% was considered a good response. The Clinical Global Impression of Change scale was used to report patient satisfaction. RESULTS Twelve males (38.7%) and 19 females (61.3%) with a mean age of 55.8 years (±11.9) were analyzed. Nineteen (61.5%) were diagnosed from painful trigeminal neuropathy (PTN), and seven (22.5%) from central poststroke pain. The mean follow-up was 51 months (±23). At 6 months, 42% (13/31) of the patients were responders, all of them being PTN (13/19; 68.4%). At last follow-up, only 35% (11/31) remained responders (11/19 PTN; 58%). At last follow-up, the global Numeric rating scale reduction was 34% ( P = .0001). The Clinical Global Impression of Change scale punctuated 2.39 (±0.94) after 3 months from the surgery and 2.95 (±1.32) at last follow-up ( P = .0079). Signs of suspicious placebo effect were appreciated in around 40% of the nonresponders. CONCLUSION CMS might show long-term efficacy for neuropathic pain syndromes, with the effect on PTN being more robust in the long term. Multicentric clinical trials are needed to confirm the efficacy of this therapy for this and other conditions.
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Affiliation(s)
- Juan Ángel Aibar-Durán
- Neurosurgery Department, Functional Neurosurgery Section, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (AUB), Barcelona , Spain
- Universitat Pompeu Fabra (UPF), Barcelona , Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona , Spain
| | - Gloria Villalba Martínez
- Neurosurgery Department, Functional Neurosurgery Section, Hospital del Marc-Parc Salut, Universitat Autònoma de Barcelona (AUB) and Universitat Pompeu Fabra (UPF), Barcelona , Spain
| | - Berta Freixer-Palau
- Neurosurgery Department, Functional Neurosurgery Section, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (AUB), Barcelona , Spain
| | - Elena Araus-Galdós
- Neurosurgery Department, Neurophysiology Section, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (AUB), Barcelona , Spain
| | - Noemi Morollón Sanchez-Mateos
- Neurology Department, Headache-Neuralgia Section, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (AUB), Barcelona , Spain
- Universitat Pompeu Fabra (UPF), Barcelona , Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona , Spain
| | - Robert Belvis Nieto
- Neurology Department, Headache-Neuralgia Section, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (AUB), Barcelona , Spain
- Anesthesiologist Department, Pain Clinic Section, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (AUB), Barcelona , Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona , Spain
| | - Miren Revuelta Rizo
- Anesthesiologist Department, Pain Clinic Section, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (AUB), Barcelona , Spain
- Universitat Pompeu Fabra (UPF), Barcelona , Spain
| | - Joan Molet Teixeido
- Neurosurgery Department, Functional Neurosurgery Section, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (AUB), Barcelona , Spain
| | - Carmen García Sánchez
- Neuropsychology Department, Headache-Neuralgia Section, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (AUB), Barcelona , Spain
- Universitat Pompeu Fabra (UPF), Barcelona , Spain
| | - Cristian de Quintana Schmidt
- Neurosurgery Department, Functional Neurosurgery Section, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (AUB), Barcelona , Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona , Spain
| | - Fernando Muñoz Hernandez
- Neurosurgery Department, Functional Neurosurgery Section, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (AUB), Barcelona , Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona , Spain
| | - Rodrigo Rodríguez Rodríguez
- Neurosurgery Department, Functional Neurosurgery Section, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (AUB), Barcelona , Spain
- Universitat Pompeu Fabra (UPF), Barcelona , Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona , Spain
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Garcia-Larrea L, Quesada C. Cortical stimulation for chronic pain: from anecdote to evidence. Eur J Phys Rehabil Med 2022; 58:290-305. [PMID: 35343176 PMCID: PMC9980528 DOI: 10.23736/s1973-9087.22.07411-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Epidural stimulation of the motor cortex (eMCS) was devised in the 1990's, and has now largely supplanted thalamic stimulation for neuropathic pain relief. Its mechanisms of action involve activation of multiple cortico-subcortical areas initiated in the thalamus, with involvement of endogenous opioids and descending inhibition toward the spinal cord. Evidence for clinical efficacy is now supported by at least seven RCTs; benefits may persist up to 10 years, and can be reasonably predicted by preoperative use of non-invasive repetitive magnetic stimulation (rTMS). rTMS first developed as a means of predicting the efficacy of epidural procedures, then as an analgesic method on its own right. Reasonable evidence from at least six well-conducted RCTs favors a significant analgesic effect of high-frequency rTMS of the motor cortex in neuropathic pain (NP), and less consistently in widespread/fibromyalgic pain. Stimulation of the dorsolateral frontal cortex (DLPFC) has not proven efficacious for pain, so far. The posterior operculo-insular cortex is a new and attractive target but evidence remains inconsistent. Transcranial direct current stimulation (tDCS) is applied upon similar targets as rTMS and eMCS; it does not elicit action potentials but modulates the neuronal resting membrane state. tDCS presents practical advantages including low cost, few safety issues, and possibility of home-based protocols; however, the limited quality of most published reports entails a low level of evidence. Patients responsive to tDCS may differ from those improved by rTMS, and in both cases repeated sessions over a long time may be required to achieve clinically significant relief. Both invasive and non-invasive procedures exert their effects through multiple distributed brain networks influencing the sensory, affective and cognitive aspects of chronic pain. Their effects are mainly exerted upon abnormally sensitized pathways, rather than on acute physiological pain. Extending the duration of long-term benefits remains a challenge, for which different strategies are discussed in this review.
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Affiliation(s)
- Luis Garcia-Larrea
- Central Integration of Pain (NeuroPain) Lab, Lyon Center for Neuroscience (CRNL), INSERM U1028, University Claude Bernard Lyon 1, Villeurbanne, France - .,University Hospital Pain Center (CETD), Neurological Hospital, Hospices Civils de Lyon, Lyon, France -
| | - Charles Quesada
- Central Integration of Pain (NeuroPain) Lab, Lyon Center for Neuroscience (CRNL), INSERM U1028, University Claude Bernard Lyon 1, Villeurbanne, France.,Department of Physiotherapy, Sciences of Rehabilitation Institute (ISTR), University Claude Bernard Lyon 1, Villeurbanne, France
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Ramos-Fresnedo A, Perez-Vega C, Domingo RA, Cheshire WP, Middlebrooks EH, Grewal SS. Motor Cortex Stimulation for Pain: A Narrative Review of Indications, Techniques, and Outcomes. Neuromodulation 2022; 25:211-221. [DOI: 10.1016/j.neurom.2021.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
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Fried PJ, Santarnecchi E, Antal A, Bartres-Faz D, Bestmann S, Carpenter LL, Celnik P, Edwards D, Farzan F, Fecteau S, George MS, He B, Kim YH, Leocani L, Lisanby SH, Loo C, Luber B, Nitsche MA, Paulus W, Rossi S, Rossini PM, Rothwell J, Sack AT, Thut G, Ugawa Y, Ziemann U, Hallett M, Pascual-Leone A. Training in the practice of noninvasive brain stimulation: Recommendations from an IFCN committee. Clin Neurophysiol 2020; 132:819-837. [PMID: 33549501 DOI: 10.1016/j.clinph.2020.11.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 01/07/2023]
Abstract
As the field of noninvasive brain stimulation (NIBS) expands, there is a growing need for comprehensive guidelines on training practitioners in the safe and effective administration of NIBS techniques in their various research and clinical applications. This article provides recommendations on the structure and content of this training. Three different types of practitioners are considered (Technicians, Clinicians, and Scientists), to attempt to cover the range of education and responsibilities of practitioners in NIBS from the laboratory to the clinic. Basic or core competencies and more advanced knowledge and skills are discussed, and recommendations offered regarding didactic and practical curricular components. We encourage individual licensing and governing bodies to implement these guidelines.
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Affiliation(s)
- Peter J Fried
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Emiliano Santarnecchi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Andrea Antal
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany
| | - David Bartres-Faz
- Department of Medicine, Faculty of Medicine and Health Sciences & Institut de Neurociències, University of Barcelona, Institut d'Investigacions Biomèdiques (IDIBAPS), Barcelona, Spain
| | - Sven Bestmann
- Department for Movement and Clinical Neuroscience, Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, UK
| | - Linda L Carpenter
- Butler Hospital, Department of Psychiatry and Human Behavior, Alpert Medical School at Brown University, Providence, RI, USA
| | - Pablo Celnik
- Department of Physical Medicine and Rehabilitation, Johns Hopkins, School of Medicine, Baltimore, MD, USA
| | - Dylan Edwards
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA; Edith Cowan University, Joondalup, Australia
| | - Faranak Farzan
- Simon Fraser University, British Columbia, Surrey, Mechatronic Systems Engineering, Canada
| | - Shirley Fecteau
- Faculty of Medicine, Université Laval, CERVO Brain Research Center, Quebec City, Quebec, Canada
| | - Mark S George
- Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson VA Medical Center, Charlestown, SC, USA
| | - Bin He
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Letizia Leocani
- Institute of Experimental Neurology, Ospedale San Raffaele, and Department of Neurology, Vita-Salute San Raffaele University, Milano, Italy
| | - Sarah H Lisanby
- Division of Translational Research, National Institute of Mental Health, National Institutes of Health, Bethesda, MA, USA
| | - Colleen Loo
- School of Psychiatry and Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Bruce Luber
- Noninvasive Neuromodulation Unit, National Institute of Mental Health, Bethesda, MD, USA
| | - Michael A Nitsche
- Leibniz Research Centre for Working Environment and Human Factors, Dept. Psychology and Neurosciences, Dortmund, Germany
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany
| | - Simone Rossi
- Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), University of Siena, Italy
| | - Paolo M Rossini
- Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele-Pisana, Rome, Italy
| | - John Rothwell
- UCL Institute of Neurology, University College, London, UK
| | - Alexander T Sack
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands
| | - Gregor Thut
- Centre for Cognitive Neuroimaging, Institute of Neuroscience and Psychology, University of Glasgow, UK
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Ulf Ziemann
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD, USA
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife and Department of Neurology, Harvard Medical School, Boston, MA, USA; Guttmann Brain Health Institute, Institut Guttmann, Universitat Autonoma, Barcelona, Spain.
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Sokal P, Harat M, Malukiewicz A, Kiec M, Świtońska M, Jabłońska R. Effectiveness of tonic and burst motor cortex stimulation in chronic neuropathic pain. J Pain Res 2019; 12:1863-1869. [PMID: 31354335 PMCID: PMC6580141 DOI: 10.2147/jpr.s195867] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 04/08/2019] [Indexed: 12/26/2022] Open
Abstract
Background: Motor cortex stimulation (MCS) is an intracranial, invasive method for treatment of chronic pain. Main indications for MCS are central post stroke pain, neuropathic facial pain, phantom limb pain and brachial plexus or spinal cord injury pain. Spinal cord stimulation (SCS) with burst waveform has been proved to be more effective than tonic mode in chronic pain. Necessity to replace depleted batteries of motor cortex tonic stimulators gave us an opportunity of applying burst stimulation. The objective of the pilot study was to evaluate the effects of burst stimulation applied on motor cortex in patients with chronic pain syndromes as well as comparison to tonic mode. Materials and methods: We have evaluated 6 patients (females N=3, males N=3) belonging to the group of 14 cases (females N=5, males N=9) who had undergone surgical procedure of MCS in years 2005-2017. Selected for the study were 6 patients with thalamic pain N=3, with facial pain N=3 (anaesthesia dolorosa and neuropathic trigeminal neuralgia). The patients were subjected to both modes of stimulation then they chose which one was better in relieving pain: tonic or burst. Pain intensity was assessed with the visual analogue scale (VAS) before the replacement of implanted pulse generator (IPG) and after the stimulation with tonic and burst modes. Results: In the study, 5 out of 6 patients with MCS found burst mode more effective than tonic mode. Baseline VAS score in patients that had at least 3 months depleted battery of tonic IPG was 95 mm. After implantation of a new IPG mean VAS score on tonic stimulation was 72 mm, on burst 53 mm. Conclusions: The most preferred option of MCS in selected group of patients was burst stimulation. This study has shown, that the burst stimulation of cerebral cortex is a promising modality when tonic stimulation is not sufficient in refractory, neuropathic pain.
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Affiliation(s)
- Paweł Sokal
- Department of Neurosurgery and Neurology, Jan Biziel University Hospital nr 2, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Marek Harat
- Division of Preventive Medicine and Healthy Policy, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Agnieszka Malukiewicz
- Department of Neurosurgery and Neurology, Jan Biziel University Hospital nr 2, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Michał Kiec
- Department of Neurosurgery, The 10th Military Clinical Hospital, Bydgoszcz, Poland
| | - Milena Świtońska
- Department of Neurosurgery and Neurology, Jan Biziel University Hospital nr 2, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Renata Jabłońska
- Department of Neurosurgery and Neurology, Jan Biziel University Hospital nr 2, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
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Moysak GI, Rzaev DA, Dzhafarov VM, Slavin KV. [Motor cortex stimulation in deafferentation facial pain]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2019; 82:70-80. [PMID: 30137040 DOI: 10.17116/neiro201882470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To demonstrate the results of treatment of poorly controlled deafferentation facial pain using motor cortex stimulation and to review the relevant literature. MATERIAL AND METHODS The study included 8 patients (3 males and 5 females) with deafferentation facial pain who were implanted with a system of constant motor cortex stimulation at the Illinois University in Chicago in 2004-2016 and Novosibirsk Federal Center of Neurosurgery in 2017. The patients' age ranged from 37 to 81 years (mean age, 57.5 years). Scale-based assessment of the pain severity was performed at admission to hospital, at discharge, and during follow-up. The visual analogue pain scale, Barrow Neurological Institute pain scale (BNIPS), and McLaughlin scale were used. RESULTS Immediately after surgery, a significant improvement in the form of pain reduction by 80-100% occurred in 4 patients. The pain intensity at discharge from the hospital decreased by 55%, on average. During the follow-up period, the efficacy of motor cortex stimulation was assessed (McLaughlin scale) as very good by 3 of the 8 patients, as good by 4 patients, and as unsatisfactory by 1 patient. CONCLUSION Our findings and recent studies have demonstrated that motor cortex stimulation is one of the treatment options for deafferentation facial pain. Even a slight decrease in the intensity of excruciating and debilitating pain (assessed by patients as a good effect) gives grounds for application of the procedure. Further research is needed to define more precise criteria for selecting patients for this treatment and to increase the efficacy of stimulation.
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Affiliation(s)
- G I Moysak
- Federal Center of Neurosurgery, Novosibirsk, Russia; Institute of Medicine and Psychology, Novosibirsk State University, Novosibirsk, Russia
| | - D A Rzaev
- Federal Center of Neurosurgery, Novosibirsk, Russia; Institute of Medicine and Psychology, Novosibirsk State University, Novosibirsk, Russia
| | | | - K V Slavin
- Department of Neurosurgery, University of Illinois, Chicago, USA
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Fiocchi S, Chiaramello E, Ravazzani P, Parazzini M. Modelling of the Current Density Distributions during Cortical Electric Stimulation for Neuropathic Pain Treatment. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2018; 2018:1056132. [PMID: 29849746 PMCID: PMC5937624 DOI: 10.1155/2018/1056132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 02/20/2018] [Indexed: 01/25/2023]
Abstract
In the last two decades, motor cortex stimulation has been recognized as a valuable alternative to pharmacological therapy for the treatment of neuropathic pain. Although this technique started to be used in clinical studies, the debate about the optimal settings that enhance its effectiveness without inducing tissue damage is still open. To this purpose, computational approaches applied to realistic human models aimed to assess the current density distribution within the cortex can be a powerful tool to provide a basic understanding of that technique and could help the design of clinical experimental protocols. This study aims to evaluate, by computational techniques, the current density distributions induced in the brain by a realistic electrode array for cortical stimulation. The simulation outcomes, summarized by specific metrics quantifying the efficacy of the stimulation (i.e., the effective volume and the effective depth of penetration) over two cortical targets, were evaluated by varying the interelectrode distance, the stimulus characteristics (amplitude and frequency), and the anatomical human model. The results suggest that all these parameters somehow affect the current density distributions and have to be therefore taken into account during the planning of effective electrical cortical stimulation strategies. In particular, our calculations show that (1) the most effective interelectrode distance equals 2 cm; (2) increasing voltage amplitudes increases the effective volume; (3) increasing frequencies allow enlarging the effective volume; and (4) the effective depth of penetration is strictly linked to both the anatomy of the subject and the electrode placement.
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Affiliation(s)
- S. Fiocchi
- CNR Consiglio Nazionale delle Ricerche, Istituto di Elettronica e di Ingegneria dell'Informazione e delle Telecomunicazioni IEIIT, Milan, Italy
| | - E. Chiaramello
- CNR Consiglio Nazionale delle Ricerche, Istituto di Elettronica e di Ingegneria dell'Informazione e delle Telecomunicazioni IEIIT, Milan, Italy
| | - P. Ravazzani
- CNR Consiglio Nazionale delle Ricerche, Istituto di Elettronica e di Ingegneria dell'Informazione e delle Telecomunicazioni IEIIT, Milan, Italy
| | - M. Parazzini
- CNR Consiglio Nazionale delle Ricerche, Istituto di Elettronica e di Ingegneria dell'Informazione e delle Telecomunicazioni IEIIT, Milan, Italy
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Kurt E, Henssen DJ, Steegers M, Staal M, Beese U, Maarrawi J, Pirotte B, Garcia-Larrea L, Rasche D, Vesper J, Holsheimer J, Duyvendak W, Herregodts P, van Dongen R, Moens M. Motor Cortex Stimulation in Patients Suffering from Chronic Neuropathic Pain: Summary of Expert Meeting and Premeeting Questionnaire, Combined with Literature Review. World Neurosurg 2017; 108:254-263. [DOI: 10.1016/j.wneu.2017.08.168] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 08/24/2017] [Accepted: 08/26/2017] [Indexed: 10/18/2022]
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Ivanishvili Z, Poologaindran A, Honey CR. Cyclization of Motor Cortex Stimulation for Neuropathic Pain: A Prospective, Randomized, Blinded Trial. Neuromodulation 2017; 20:497-503. [PMID: 28524457 DOI: 10.1111/ner.12610] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/10/2017] [Accepted: 04/05/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Programming guidelines for motor cortex stimulation (MCS) in neuropathic pain requires further investigation. After optimizing voltage as a percentage of motor threshold, we evaluated the effect of cyclizing time of stimulation on pain relief for chronic neuropathic pain. METHODS Six patients were enrolled into this trial. In a prospective, randomized, double-blinded manner, patients were programmed to receive stimulation 100, 83.3, 66.7, or 50% of the time in 30-min intervals. Outcomes were assessed after 14 days on each setting with a visual analogue scale (VAS) for pain and the SF36 quality of life questionnaire. RESULTS There was no significant difference (p > 0.05) between the different cyclized settings as measured by the VAS, MGPQ, or SF36 in our cohort. There were two distinct subgroups: responders (n = 4) and nonresponders (n = 2) to cyclization. Responders continued to have pain relief when stimulation was reduced to only 50% of the time (15 min ON/15 min off). Interestingly, this group subjectively preferred the 50% stimulation timing compared to 100%. Nonresponders could not tolerate cyclizing because of increased pain. CONCLUSIONS In this small cohort, cyclization of MCS settings revealed two distinct subgroups: responders and nonresponders. Responders tolerated stimulation in all settings and 50% stimulation (15 min ON/15 min off) was their subjectively preferred setting. Cyclization in responders will prolong battery life and delay the need for INS replacement and may offer improved pain relief. Building from our previous work, we recommend clinicians consider following the Vancouver MCS programming algorithm presented in this manuscript.
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Affiliation(s)
- Zurab Ivanishvili
- Department of Surgery, Division of Neurosurgery, The University of British Columbia, Vancouver, Canada
| | - Anujan Poologaindran
- Department of Surgery, Division of Neurosurgery, The University of British Columbia, Vancouver, Canada
| | - Christopher R Honey
- Department of Surgery, Division of Neurosurgery, The University of British Columbia, Vancouver, Canada
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Honey CM, Tronnier VM, Honey CR. Deep brain stimulation versus motor cortex stimulation for neuropathic pain: A minireview of the literature and proposal for future research. Comput Struct Biotechnol J 2016; 14:234-7. [PMID: 27413477 PMCID: PMC4925438 DOI: 10.1016/j.csbj.2016.06.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/10/2016] [Accepted: 06/13/2016] [Indexed: 11/24/2022] Open
Abstract
The treatment of neuropathic pain remains a public health concern. A growing cohort of patients is plagued by medically refractory, unrelenting severe neuropathic pain that ruins their quality of life and productivity. For this group, neurosurgery can offer two different kinds of neuromodulation that may help: deep brain simulation (DBS) and motor cortex stimulation (MCS). Unfortunately, there is no consensus on how to perform these procedures, which stimulation parameters to select, how to measure success, and which patients may benefit. This brief review highlights the literature supporting each technique and attempts to provide some comparisons and contrasts between DBS and MCS for the treatment of neuropathic pain. Finally, we highlight the current unanswered questions in the field and suggest future research strategies that may advance the care of our patients with neuropathic pain.
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Affiliation(s)
- C. Michael Honey
- Section of Neurosurgery, University of Manitoba, Winnipeg, Canada
| | - Volker M. Tronnier
- Department of Neurosurgery, Medical Faculty Lübeck, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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