gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Motor cortex stimulation for the treatment of chronic neuropathic pain syndromes – current status in neurosurgical pain therapy

Meeting Abstract

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  • D. Rasche - Neurochirurgische Klinik, Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck
  • D. Klase - Neurochirurgische Klinik, Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck
  • V. Tronnier - Neurochirurgische Klinik, Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMI.03-02

DOI: 10.3205/09dgnc178, URN: urn:nbn:de:0183-09dgnc1784

Published: May 20, 2009

© 2009 Rasche et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: The treatment of patients with chronic pain syndromes is an ongoing problem in daily medical practice of multiple specialized clinicians. In many cases pharmacological and standard procedures are ineffective or accompanied with intolerable side effects. In a selected patient sample invasive methods are optional for different neuropathic pain syndromes. A patient sample and the current significance of epidural motor cortex stimulation (MCS) are presented and discussed.

Methods: Current publications regarding the topics were searched by medline and Cochrane database. Additionally the patient sample of the authors was evaluated retrospectively.

Results: The best results are reported for patients with chronic neuropathic pain of the trigeminal nerve (TNP) and following plexus injury (brachial plexus injury = BPI). In selected cases of central pain syndromes after stroke (post stroke pain = PSP) or ischemic lesion in the thalamic nuclei positive effect was documented. In our own patient sample 11/16 patients with TNP, 4/11 with PSP and 4/4 with BPL were positively treated and pain reduction of more than 30% in a double-blinded testing phase was achieved.

Conclusions: Epidural MCS is a safe and effective treatment option for patients with chronic neuropathic pain who are insufficiently treated pharmacologically. This operation should only be offered in neurosurgical pain centres using standardized protocols and double-blinded testing. Patients with neuropathic pain following trigeminal nerve injury, brachial plexus injury or phantom limb pain seem to profit best from this method. The need for prospective trials to gain more experience with MCS and also other invasive pain treatments must be underlined.