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Stereotact Funct Neurosurg. 2015;93(3):199-205. doi: 10.1159/000375177. Epub 2015 Apr 21.

Long-term follow-up of motor cortex stimulation for neuropathic pain in 23 patients.

Author information

1
Department of Stereotactic and Functional Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.

Abstract

BACKGROUND:

Motor cortex stimulation (MCS) is being offered to patients suffering from neuropathic pain. Outcome prediction, programming and especially sustaining a long-term treatment effect represent major challenges. We report a retrospective long-term analysis of our patients treated with MCS over a median follow-up of 39.1 months.

OBJECTIVES:

To investigate the time course of the treatment effect in MCS for neuropathic pain.

METHODS:

Twenty-three closely followed patients treated with MCS were retrospectively analyzed. Reduction in pain measured on a visual analogue scale (VAS) was defined as the primary outcome parameter. VAS pain level and adverse events were documented at the 1-, 3-, 6-, 12-, 18- and 24-month follow-ups.

RESULTS:

The mean VAS under best medical treatment was 7.8 (SD 1.2, range 5-9) with escalation to 9.3 (SD 0.9, range 6-10) when the patients' medications were missed or delayed. About half of the patients (47.8%) experienced a satisfactory (>50%) reduction in pain during the first month of treatment. The best treatment results were seen at the 3-month follow-up (mean VAS 4.8, SD 1.9, -37.2% compared to baseline). A decline in the treatment effect was generally observed at the subsequent follow-up assessments. Six patients had their devices explanted during the follow-up period due to loss of treatment effect.

CONCLUSIONS:

In this study, MCS failed to provide long-term pain control for neuropathic pain. Many aspects of MCS still remain unclear, especially the neural circuits involved and their response to long-term stimulation. Means must be developed to overcome the problems in this promising technique.

PMID:
25895546
DOI:
10.1159/000375177
[Indexed for MEDLINE]

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