gms | German Medical Science

Several groups have published reports of good outcome with deep brain stimulation (refs) comparable to the best results of motor cortex stimulation.

The selected targets appear to be different, but in reality do not appear to vary much from those described by Ron Young as the PVG and VPL. We report our experience at Oxford over the last 4 years with PVG/VPL stimulation for neuropathic pain syndromes.

35 patients underwent surgery of which 25 proceeded to full implantation. Pain relief was quantified using three methods: mean % pain relief, proportion of patients experiencing ≥50% pain relief, and a four-tiered categorisation of pain outcome. This four-tiered system is as follows: poor (<40% improvement in pain intensity), fair (40-59% improvement), good (60-79%), excellent (80-100%). Two patients were lost to follow-up, one died of an MI and one repeatedly failed to return to clinic. At a mean follow-up of 15.4months (range 1-44 months) the intensity of pain was reduced by an average of 45.3% (range 11-100%). The mean visual analogue pain score was 8.65 (SD 1.10) preoperatively, and 4.04 (SD 2.14) postoperatively (p<0.001). ≥50% pain relief was obtained in 48% of patients (12/25). Excellent pain relief was achieved in 16% (4/25), good relief in 12% (3/25), fair relief in 28% (7/25), and poor relief in 36% (9/25). Eighty eight percent of patients (22/25) complained of ‘burning pain’ preoperatively, and the severity of this component was diminished at follow-up in 77% (17/22). In 55% of these patients (12/22), this component of the pain was completely alleviated.

In this prospective, non-randomised study of deep brain stimulation, deep brain stimulation appears to be an effective therapy in a significant proportion of patients with neuropathic pain syndromes.