Abstract
Objectives
Motor cortex stimulation (MCS) is an effective technique in treating chronic intractable
pain for some patients. However, most studies are small case series (n < 20). Heterogeneity in technique and patient selection makes it difficult to draw
consistent conclusions. In this study, we present one of the largest case series of
subdural MCS.
Materials and Methods
Medical records of patients who underwent MCS at our institute between 2007 and 2020
were reviewed. Studies with at least 15 patients were summarized for comparison.
Results
The study included 46 patients. Mean age was 56.2 ± 12.5 years (SD). Mean follow-up
was 57.2 ± 41.9 months. Male-to-female ratio was 13:33. Of the 46 patients, 29 had
neuropathic pain in trigeminal nerve territory/anesthesia dolorosa; nine had postsurgical/posttraumatic
pain; three had phantom limb pain; two had postherpetic pain, and the rest had pain
secondary to stroke, chronic regional pain syndrome, and tumor.
The baseline numeric rating pain scale (NRS) was 8.2 ± 1.8 of 10, and the latest follow-up
score was 3.5 ± 2.9 (mean improvement of 57.3%). Responders comprised 67% (31/46)(NRS
≥ 40% improvement). Analysis showed no correlation between percentage of improvement
and age (p = 0.352) but favored male patients (75.3% vs 48.7%, p = 0.006). Seizures occurred in 47.8% of patients (22/46) at some point but were all
self-limiting, with no lasting sequelae. Other complications included subdural/epidural
hematoma requiring evacuation (3/46), infection (5/46), and cerebrospinal fluid leak
(1/46). These complications resolved with no long-term sequelae after further interventions.
Conclusion
Our study further supports the use of MCS as an effective treatment modality for several
chronic intractable pain conditions and provides a benchmark to the current literature.
Keywords
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Article info
Publication history
Published online: February 19, 2023
Accepted:
January 12,
2023
Received in revised form:
January 10,
2023
Received:
October 28,
2022
Publication stage
In Press Corrected ProofFootnotes
Source(s) of financial support: The authors reported no funding sources.
Conflict of Interest: The authors reported no conflict of interest.
Identification
Copyright
© 2023 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.
