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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Burst Motor Cortex Stimulation neuropathischer trigeminaler Beschwerden

Meeting Abstract

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  • Yousef Abushaba - Düsseldorf, Deutschland
  • Jan Vesper - Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf, Funktionelle Neurochirurgie und Stereotaxie, Düsseldorf, Deutschland
  • Philipp Jörg Slotty - Abteilung für Stereotaxie und Funktionelle Neurochirurgie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 159

doi: 10.3205/17dgnc722, urn:nbn:de:0183-17dgnc7228

Published: June 9, 2017

© 2017 Abushaba et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Motor cortex stimulation offers a therapeutic option in patients suffering from chronic neuropathic pain unresponsive to conventional means. Although best results are commonly observed in patients suffering from trigeminal neuropathy, sufficient pain reduction cannot be achieved in all patients. Some patients report stimulation induced side effects. Burst stimulation might be an add on option to increase responder rate, therapeutic efficacy and reduce side effects.

Methods: A 39y female patient suffered from severe neuropathic trigeminal pain following repeated neurovascular decompression procedures. Tonic motor cortex stimulation lead to some pain reduction (reduction VAS 10 to 3) in the first place. Over the time of 6 months treatment efficacy was partially lost and stimulation induced side effects (unpleasant stimulation sensation) occurred. Reprogramming did not solve these. We therefore decided to switch to burst stimulation.

Results: Reprogramming was done in an inpatient setting. Classic burst stimulation as used in spinal cord stimulation was applied (40-Hz burst, 5 spikes at 500 Hz per burst) with the lead configuration unchanged and stimulation intensity set at 60% of the motor threshold. Following a latency of around 20 hours the patients reported a significant decrease in pain intensity and side effects. Although stimulation induced side effects were still palpable for the patient these were not unpleasant. Pain reduction was again at 2-3/10 on the VAS. These results were stable at three month follow-up (9 months postoperative).

Conclusion: Burst stimulation seems to be an option in patients with loss of treatment effect and stimulation induced side effect in motor cortex stimulation for trigeminal pain. Regarding long term efficacy and safety and the question whether burst should be used as a first line stimulation setting further studies will be done. One has to keep in mind that burst stimulation has a high energy consumption, rechargeable device are mandatory. Further studies are warranted to proof this concept.