gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Chronic motor cortex stimulation and the predictive value of rTMS

Meeting Abstract

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  • J. Vesper - Abteilung für Stereotaxie und funktionelle Neurochirurgie, Neurochirurgische Klinik, Universitätsklinikum Düsseldorf
  • C. Wille - Abteilung für Stereotaxie und funktionelle Neurochirurgie, Neurochirurgische Klinik, Universitätsklinikum Düsseldorf
  • S. Schu - Abteilung für Stereotaxie und funktionelle Neurochirurgie, Neurochirurgische Klinik, Universitätsklinikum Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocP 098

DOI: 10.3205/11dgnc319, URN: urn:nbn:de:0183-11dgnc3191

Published: April 28, 2011

© 2011 Vesper et al.
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Outline

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Objective: Chronic motor cortex stimulation (MCS) has been used as a treatment for neuropathic pain for two decades. The aim of this study was to retrospectively analyze a patient group from two centers with long-term follow-up of 2 years and to compare MCS analgesic efficacy between "ON"- and "OFF"- stimulation.

Methods: 10 patients with chronic neuropathic pain were treated with contralateral epidural stimulation electrodes over the precentral gyrus. There were 2 cases of trigeminal neuropathic pain (TNP), 1 case of post-stroke pain (PSP), one case of a posttraumatic brachial plexus lesion and 1 case of pain post-irradiation of an AVM. 5 patients suffered from CRPS II. Preoperatively all patients underwent rTMS to estimate the MCS effect. The placement of the electrodes (Specify®, Medtronic, Minneapolis, MN, USA) was performed under local anesthesia using frame-based stereotactic neuronavigation. Placement of the electrode was confirmed using postoperative stereotactic CT and re-fusion. A test trial of three to five days including double-blind testing was conducted and pain intensity was measured using a visual analog scale (VAS) prior to stimulator insertion.

Results: We only included patients with a positive response in rTMS. In TNP and in PSP, a positive effect with a 50% pain reduction (median VAS 9 to 5) was observed. In posttraumatic pain the relief was 60% (VAS 8 to 6). Post-irradiation pain resulted in complete relief (VAS 9 to 0) of pain. In CRPS the median pain reduction was 80% (VAS 8 to 2). The overall response was 75%. The mean follow-up period was 2.6 years (range 1–4 years). No complications have occurred so far.

Conclusions: Stimulation of the motor cortex is a promising treatment option for patients with chronic neuropathic pain localized in the face, head, trunk or upper extremity. Non-responders may be identified with rTMS. It has some predictive value for the effects. Since all patients benefited from surgery, a prospective MCT is highly warranted.