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Extradural cortical stimulation for central pain

  • Chapter
Operative Neuromodulation

Part of the book series: Acta Neurochirurgica Supplements ((NEUROCHIRURGICA,volume 97/2))

Abstract

Central pain results from a central nervous system injury and represents a challenge for the pain therapist. Human studies have shown that motor cortex stimulation (MCS), i.e. the placement of a stimulating plate on the dura overlying the motor cortex can relieve brain central pain. Studies suggest that MCS directly affects activity in the first and second order somatosensory areas, thalamic nuclei and also inhibits spinal primary afferents and spinothalamic tract neurons. The following factors have been found to predict analgesia by MCS: intact or almost intact corticospinal motor function, mild or negligible sensory loss, absence of thermal sensory threshold alteration within the painful area, positive response to the barbiturate and/or ketamine test, positive response to the propofol test, positive response to transcranial magnetic stimulation (TMS). The targeting of the cortical area is made by anatomical localization by computed tomography (CT), magnetic resonance imaging (MRI), neuronavigation, intraoperative neurophysiological recordings, functional MRI (fMRI), and intraoperative clinical assessment. We perform the procedure under local anaesthesia.We describe in detail our surgical technique and stimulation protocol. Furthermore, we review the most important studies with respect to their results, the observed side effects and complications. The future prospects and likely developments of MCS for central pain are also discussed.

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Authors and Affiliations

  1. Turin Advanced Neuromodulation Group, Cso Einaudi 2, 10128, Turin, Italy

    Sergio Canavero & V. Bonicalzi

Authors
  1. Sergio Canavero
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  2. V. Bonicalzi
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Corresponding author

Correspondence to Sergio Canavero .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, University of Athens, Athens, Greece

    Damianos E. Sakas

  2. University Hospital of Wales, Cardiff, UK

    Brian A. Simpson

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© 2007 Springer-Verlag

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Canavero, S., Bonicalzi, V. (2007). Extradural cortical stimulation for central pain. In: Sakas, D.E., Simpson, B.A. (eds) Operative Neuromodulation. Acta Neurochirurgica Supplements, vol 97/2. Springer, Vienna. https://doi.org/10.1007/978-3-211-33081-4_3

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  • DOI: https://doi.org/10.1007/978-3-211-33081-4_3

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-33080-7

  • Online ISBN: 978-3-211-33081-4

  • eBook Packages: MedicineMedicine (R0)

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