Skip to main content
SpringerLink
Log in
Book cover

Operative Neuromodulation pp 51–56Cite as

Stimulation of primary motor cortex for intractable deafferentation pain

  • Chapter

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

Abstract

The stimulation of the primary motor cortex (M1) has proved to be an effective treatment for intractable deafferentation pain. This treatment started in 1990, and twenty-eight studies involving 271 patients have been reported so far. The patients who have been operated on were suffering from post-stroke pain (59%), trigeminal neuropathic pain, brachial plexus injury, spinal cord injury, peripheral nerve injury and phantom-limb pain. The method of stimulation was: a) epidural, b) subdural, and c) within the central sulcus. Overall, considering the difficulty in treating central neuropathic pain, trigeminal neuropathic pain and certain types of refractory peripheral pain, the electrical stimulation of M1 is a very promising technique; nearly 60% of the treated patients improved with a higher than 50% pain relief after several months of follow-up and sometimes of a few years in most reports. The mechanism of pain relief by the electrical stimulation of M1 has been under investigation. Recently, repetitive transcranial magnetic stimulation (rTMS) of M1 has been reported to be effective on deafferentation pain. In the future, rTMS may take over from electrical stimulation as a treatment for deafferentation pain.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   299.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Canavero S, Bonicalzi V (1995) Cortical stimulation for central pain. J Neurosurg 83: 1117

    PubMed  CAS  Google Scholar 

  2. Carroll D, Joint C, Maartens N, Shlugman D, Stein J, Aziz TZ (2000) Motor cortex stimulation for chronic neuropathic pain: a preliminary study of 10 cases. Pain 84: 431–437

    Article  PubMed  CAS  Google Scholar 

  3. Coghill RC, Sang CN, Maisog JM, Iadarola MJ (1999) Pain intensity processing with in the human brain: a bilateral distributed mechanism. J Neurophysiol 82: 1934–1943

    PubMed  CAS  Google Scholar 

  4. Ebel H, Rust D, Tronnier V, Boker D, Kunze S (1996) Chronic precentral stimulation in trigeminal neuropathic pain. Acta Neurochir (Wien) 138: 1300–1306

    Article  CAS  Google Scholar 

  5. Franzini A, Ferroli P, Servello D, Broggi G (2000) Reversal of thalamic hand syndrome by long-term motor cortex stimulation. J Neurosurg 93: 873–875

    Article  PubMed  CAS  Google Scholar 

  6. Garcia-Larrea L, Peyron R, Mertens P, Gregoire MC, Lavenne F, Le Bars D, Convers P, Mauguiere F, Sindou M, Laurent B (1999) Electrical stimulation of motor cortex for pain control: a combined PET-scan and electrophysiological study. Pain 83: 259–273

    Article  PubMed  CAS  Google Scholar 

  7. Henderson JM, Boongird A, Rosenow JM, LaPresto E, Rezai AR (2004) Recovery of pain control by intensive reprogramming after loss of benefit from motor cortex stimulation for neuropathic pain. Stereotact Funct Neurosurg 82: 207–213

    Article  PubMed  Google Scholar 

  8. Herregodts P, Stadnik T, De Ridder F, D’Haens J (1995) Cortical stimulation for central neuropathic pain: 3-D surface MRI for easy determination of the motor cortex. Acta Neurochir [Suppl] 64: 132–135

    CAS  Google Scholar 

  9. Hirayama A, Saitoh Y, Kishima H, Shimokawa T, Oshino S, Hirata M, Kato A, Yoshimine T (2006) Reduction of intractable deafferentation pain with navigation-guided repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex. Pain 122: 22–27

    Article  PubMed  Google Scholar 

  10. Hosobuchi Y (1993) Motor cortex stimulation for control of central deafferentation pain. Electrical and magnetic stimulation of the brain and spinal cord, Raven Press, New York

    Google Scholar 

  11. Iadarola MJ, Max MB, Berman KF, Byas-Smith MG, Coghill RC, Gracely RH, Bennett GJ (1995) Unilateral decrease in thalamic activity observed with positron emission tomography in patients with chronic neuropathic pain. Pain 63: 55–64

    Article  PubMed  CAS  Google Scholar 

  12. Katayama Y, Fukaya C, Yamamoto T (1998) Poststroke pain control by chronic motor cortex stimulation: neurological characteristics predicting a favorable response. J Neurosurg 89: 585–591

    PubMed  CAS  Google Scholar 

  13. Katayama Y, Yamamoto T, Kobayashi K, Kasai M, Oshima H, Fukaya C (2001) Motor cortex stimulation for post-stroke pain: comparison of spinal cord and thalamic stimulation. Stereotact Funct Neurosurg 77: 183–186

    Article  PubMed  CAS  Google Scholar 

  14. Katayama Y, Yamamoto T, Kobayashi K, Oshima H, Fukaya C (2003) Deep brain and motor cortex stimulation for post-stroke movement disorders and post-stroke pain. Acta Neurochir [Suppl] 87: 121–123

    CAS  Google Scholar 

  15. Kimbrell TA, Little JT, Dunn RT, Frye MA, Greenberg BD, Wassermann EM, Repella JD, Danielson AL, Willis MW, Benson BE, Speer AM, Osuch E, George MS, Post RM (1999) Frequency dependence of antidepressant response to left prefrontal repetitive transcranial magnetic stimulation (rTMS) as a function of baseline cerebral glucose metabolism. Biol Psychiatry 46: 1603–1613

    Article  PubMed  CAS  Google Scholar 

  16. Lefaucheur JP, Drouot X, Menard-Lefaucheur I, Zerah F, Bendib B, Cesaro P, Keravel Y, Nguyen JP (2004) Neurogenic pain relief by repetitive transcranial magnetic cortical stimulation depends on the origin and the site of pain. J Neurol Neurosurg Psychiatry 75: 612–616

    Article  PubMed  Google Scholar 

  17. Mertens P, Nuti C, Sindou M, Guenot M, Peyron R, Garcia-Larrea L, Laurent B (1999) Precentral cortex stimulation for the treatment of central neuropathic pain: results of a prospective study in a 20-patient series. Stereotact Funct Neurosurg 73: 122–125

    Article  PubMed  CAS  Google Scholar 

  18. Meyerson BA, Lindblom U, Linderoth B, Lind G, Herregodts P (1993) Motor cortex stimulation as treatment of trigeminal neuropathic pain. Acta Neurochir [Suppl] 58: 150–153

    CAS  Google Scholar 

  19. Migita K, Uozumi T, Arita K, Monden S (1995) Transcranial magnetic stimulation of motor cortex in patients with central pain. Neurosurg 36: 1037–1040

    Article  CAS  Google Scholar 

  20. Nguyen JP, Keravel Y, Feve A, Uchiyama T, Cesaro P, Le Guerinel C, Pollin B (1997) Treatment of deafferentation pain by chronic stimulation of the motor cortex: report of a series of 20 cases. Acta Neurochir [Suppl] 68: 54–60

    CAS  Google Scholar 

  21. Nguyen JP, Pollin B, Feve A, Geny C, Cesaro P (1998) Improvement of action tremor by chronic cortical stimulation. Mov Disord 13: 84–88

    Article  PubMed  CAS  Google Scholar 

  22. Nguyen JP, Lefaucheur JP, Decq P, Uchiyama T, Carpentier A, Fontaine D, Brugieres P, Pollin B, Feve A, Rostaing S, Cesaro P, Keravel Y (1999) Chronic motor cortex stimulation in the treatment of central and neuropathic pain. Correlations between clinical, electrophysiological and anatomical data. Pain 82: 245–251

    Article  PubMed  CAS  Google Scholar 

  23. Peyron R, Garcia-Larrea L, Deiber MP, Cinotti L, Convers P, Sindou M, Mauguiere F, Laurent B (1995) Electrical stimulation of precentral cortical area in the treatment of central pain: electrophysiological and PET study. Pain 62: 275–286

    Article  PubMed  CAS  Google Scholar 

  24. Peyron R, Laurent B, Garcia-Larrea (2000) Functional imaging of brain responses to pain. A review and meta-analysis. Neurophysiol Clin 30: 263–288

    Article  PubMed  CAS  Google Scholar 

  25. Pirotte B, Voordecker P, Neugroschl C, Baleriaux D, Wikler D, Metens T, Denolin V, Joffroy A, Massager N, Brotchi J, Levivier M (2005) Combination of functional magnetic resonance imaging-guided neuronavigation and intraoperative cortical brain mapping improves targeting of motor cortex stimulation in neuropathic pain. Neurosurgery 56[Suppl 2]: 344–359

    Article  PubMed  Google Scholar 

  26. Pleger B, Janssen F, Schwenkreis P, Volker B, Maier C, Tegenthoff M (2004) Repetitive transcranial magnetic stimulation of the motor cortex attenuates pain perception in complex regional pain syndrome type I. Neurosci Lett 356: 87–90

    Article  PubMed  CAS  Google Scholar 

  27. Rainov NG, Fels C, Heidecke V, Burkert W (1997) Epidural electrical stimulation of the motor cortex in patients with facial neuralgia. Clin Neurol Neurosurg 99: 205–209

    Article  PubMed  CAS  Google Scholar 

  28. Rainov NG, Heidecke V (2003) Motor cortex stimulation for neuropathic facial pain. Neurol Res 25: 157–161

    Article  PubMed  Google Scholar 

  29. Roux FE, Ibarrola D, Tremoulet M, Lazorthes Y, Henry P, Sol JC, Berry I (2001) Methodological and technical issues for integrating functional magnetic resonance imaging data in a neuronavigational system. Neurosurgery 49: 1145–1156

    Article  PubMed  CAS  Google Scholar 

  30. Saitoh Y, Shibata M, Sanada M, Mashimo T (1999) Motor cortex stimulation for phantom limb pain. Lancet 353: 212

    Article  PubMed  CAS  Google Scholar 

  31. Saitoh Y, Shibata M, Hirano S, Hirata M, Mashimo T, Kato A, Yoshimine T (2000) Motor cortex stimulation for central and peripheral deafferentation pain. J Neurosurg 92: 150–155

    PubMed  CAS  Google Scholar 

  32. Saitoh Y, Kato A, Ninomiya H, Baba T, Shibata M, Mashimo T, Yoshimine T (2003) Primary motor cortex stimulation within the central sulcus for treating deafferentation pain. Acta Neurochir [Suppl] 87: 149–152

    CAS  Google Scholar 

  33. Saitoh Y, Osaki Y, Nishimura H, Hirano S, Kato A, Hashikawa K, Hatazawa J, Yoshimine T (2004) Increased regional cerebral blood flow in the contralateral thalamus after successful motor cortex stimulation in a patient with poststroke pain. J Neurosurg 100: 935–939

    PubMed  Google Scholar 

  34. Saitoh Y, Hirayama A, Kishima H, Oshino S, Hirata M, Kato A, Yoshimine T (2006) Stimulation of primary motor cortex for intractable deafferentation pain. Acta Neurochir Suppl 99: 1–3

    Google Scholar 

  35. Siebner HR, Filipovic SR, Rowe JB, Cordivari C, Gerschlager W, Rothwell JC, Frackowiak RS, Bhatia KP (2003) Patients with focal arm dystonia have increased sensitivity to slow-frequency repetitive TMS of the dorsal premotor cortex. Brain 126: 2710–2725

    Article  PubMed  Google Scholar 

  36. Sol JC, Casaux J, Roux FE, Lotterie JA, Bousquet P, Verdie JC, Mascott C, Lazorthes Y (2001) Chronic motor cortex stimulation for phantom limb pain: correlations between pain relief and functional imaging studies. Stereotact Funct Neurosurg 77: 172–176

    Article  PubMed  CAS  Google Scholar 

  37. Tamura Y, Okabe S, Ohnishi T, N Saito D, Arai N, Mochio S, Inoue K, Ugawa Y (2004) Effects of 1-Hz repetitive transcranial magnetic stimulation on acute pain induced by capsaicin. Pain 107: 107–115

    Article  PubMed  Google Scholar 

  38. Tasker RR (1984) Deafferentation. In: Wall PD, Melzack R (eds) Textbook of pain. Churchill Livingstone, Edinburg, pp 119–132

    Google Scholar 

  39. Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S (1993) Chronic motor cortex stimulation in patients with thalamic pain. J Neurosurg 78: 393–401

    PubMed  CAS  Google Scholar 

  40. Wassermann EM, Lisanby SH (2001) Therapeutic application of repetitive transcranial magnetic stimulation: a review. Clin Neurophysiol 112: 1367–1377

    Article  PubMed  CAS  Google Scholar 

  41. Yamamoto T, Katayama Y, Hirayama T, Tsubokawa T (1997) Pharmacological classification of central post-stroke pain: comparison with the results of chronic motor cortex stimulation therapy. Pain 72: 5–12

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery and Center for Pain Management, Osaka University Graduate School, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan

    Youichi Saitoh & T. Yoshimine

Authors
  1. Youichi Saitoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Yoshimine
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Youichi Saitoh .

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

Rights and permissions

Reprints and permissions

Copyright information

© 2007 Springer-Verlag

About this chapter

Cite this chapter

Saitoh, Y., Yoshimine, T. (2007). Stimulation of primary motor cortex for intractable deafferentation 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_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-211-33081-4_6

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-33080-7

  • Online ISBN: 978-3-211-33081-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation