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Motor cortex stimulation for neuropathic pain

  • Chapter
Operative Neuromodulation

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

Abstract

Since the initial publication of Tsubokawa in 1991, epidural motor cortex stimulation (MCS) is increasingly reported as an effective surgical option for the treatment of refractory neuropathic pain although its mechanism of action remains poorly understood. The authors review the extensive literature published over the last 15 years on central and neuropathic pain. Optimal patient selection remains difficult and the value of pharmacological tests or transcranial magnetic stimulation in predicting the efficacy of MCS has not been established. Pre-operative functional magnetic resonance imaging (fMRI), 3-dimensional volume MRI, neuronavigation and intra-operative neurophysiological monitoring have contributed to improvements in the technique for identifying the precise location of the targeted motor cortical area and the correct placement of the electrode array. MCS should be considered as the treatment of choice in post-stroke pain, thalamic pain or facial anesthesia dolorosa. In brachial plexus avulsion pain, it is preferable to propose initially dorsal root entry zone (DREZ)-tomy; MCS may be offered after DREZotomy has failed to control the pain. In our experience, the results of MCS on phantom limb pain are promising. In general, the efficacy of MCS depends on: a) the accurate placement of the stimulation electrode over the appropriate area of the motor cortex, and b) on sophisticated programming of the stimulation parameters. A better understanding of the MCS mechanism of action will probably make it possible to adjust better the stimulation parameters. The conclusions of multicentered randomised studies, now in progress, will be very useful and are likely to promote further research and clinical applications in this field.

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Authors and Affiliations

  1. Department of Neuroscience, Unit of Stereotactic and Functional Neurosurgery, CHU Rangueil Toulouse, France

    Yves Lazorthes, J. C. Sol, S. Fowo, F. E. Roux & J. C. Verdié

Authors
  1. Yves Lazorthes
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  2. J. C. Sol
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  3. S. Fowo
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  4. F. E. Roux
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  5. J. C. Verdié
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Corresponding author

Correspondence to Yves Lazorthes .

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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Lazorthes, Y., Sol, J.C., Fowo, S., Roux, F.E., Verdié, J.C. (2007). Motor cortex stimulation for neuropathic 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_4

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  • DOI: https://doi.org/10.1007/978-3-211-33081-4_4

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-33080-7

  • Online ISBN: 978-3-211-33081-4

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