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.
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.
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- What are the results and the prognostic factors of motor cortex stimulation in patients with facial pain? A systematic review of the literature.Eur Neurol. 2021; 84: 151-156
- Motor cortex stimulation in patients suffering from chronic neuropathic pain: summary of expert meeting and premeeting questionnaire, combined with literature review.World Neurosurg. 2017; 108: 254-263
- Treatment of thalamic pain by chronic motor cortex stimulation.Pacing Clin Electrophysiol. 1991; 14: 131-134
- Motor cortex stimulation in chronic neuropathic orofacial pain syndromes: a systematic review and meta-analysis.Sci Rep. 2020; 10: 7195
- Motor cortex stimulation for pain: a narrative review of indications, techniques, and outcomes.Neuromodulation. 2022; 25: 211-221
- Quality of life after motor cortex stimulation: clinical results and systematic review of the literature.Neurosurgery. 2019; 84: 451-456
- Deep brain stimulation versus motor cortex stimulation for neuropathic pain: a minireview of the literature and proposal for future research.Comput Struct Biotechnol J. 2016; 14: 234-237
- Pre-motor versus motor cerebral cortex neuromodulation for chronic neuropathic pain.Sci Rep. 2021; 1112688
- Motor cortex and deep brain stimulation for the treatment of intractable neuropathic face pain.Curr Neurol Neurosci Rep. 2009; 9: 120-126
- Long-term effect of motor cortex stimulation in patients suffering from chronic neuropathic pain: an observational study.PLoS One. 2018; 13e0191774
- Motor cortex stimulation for deafferentation pain.Neurosurg Focus. 2001; 11: E1
- Motor cortex stimulation for refractory neuropathic pain: four year outcome and predictors of efficacy.Pain. 2005; 118: 43-52
- Combination of functional magnetic resonance imaging-guided neuronavigation and intraoperative cortical brain mapping improves targeting of motor cortex stimulation in neuropathic pain.Neurosurgery. 2005; 56 ([discussion: 344-359]): 344-359
- Motor cortex stimulation for long-term relief of chronic neuropathic pain: a 10 year experience.Pain. 2006; 121: 43-52
- Electrical stimulation of primary motor cortex within the central sulcus for intractable neuropathic pain.Clin Neurophysiol. 2008; 119: 993-1001
- Motor cortex stimulation for the treatment of refractory peripheral neuropathic pain.Brain. 2009; 132: 1463-1471
- Chapter 40 - Motor Cortex Stimulation for the Treatment of Neuropathic Pain.in: Krames E.S. Peckham P.H. Rezai A.R. Neuromodulation. Academic Press, San Diego2009: 515-526
- Motor cortex electric stimulation for the treatment of neuropathic pain.Arq Neuropsiquiatr. 2010; 68: 923-929
- Brain opioid receptor density predicts motor cortex stimulation efficacy for chronic pain.Pain. 2013; 154: 2563-2568
- Is Life better after motor cortex stimulation for pain control? Results at long-term and their prediction by preoperative rTMS.Pain Phys. 2014; 17: 53-62
- Subdural motor cortex stimulation: feasibility, efficacy and security on a series of 18 consecutive cases with a follow-up of at least 3 years.Acta Neurochir (Wien). 2014; 156: 2289-2294
- Long-term results of motor cortex stimulation in the treatment of chronic, intractable neuropathic pain.Stereotact Funct Neurosurg. 2015; 93: 212-218
- Long-term follow-up of motor cortex stimulation for neuropathic pain in 23 patients.Stereotact Funct Neurosurg. 2015; 93: 199-205
- Clinical significance of invasive motor cortex stimulation for trigeminal facial neuropathic pain syndromes.Neurosurgery. 2016; 79: 655-666
- Treatment of central deafferentation and trigeminal neuropathic pain by motor cortex stimulation: report of a series of 20 patients.J Neurol Surg A Cent Eur Neurosurg. 2016; 77: 52-58
- The effect of motor cortex stimulation on central poststroke pain in a series of 16 patients with a mean follow-up of 28 months.Neuromodulation. 2017; 20: 492-496
- Motor cortex stimulation for chronic neuropathic pain: results of a double-blind randomized study.Brain. 2021; 144: 2994-3004
- Motor cortex stimulation for chronic pain: systematic review and meta-analysis of the literature.Neurology. 2008; 70: 2329-2337
- Motor cortex stimulation in patients with deafferentation pain: activation of the posterior insula and thalamus.J Neurosurg. 2007; 107: 43-48
- Cyclization of motor cortex stimulation for neuropathic pain: a prospective, randomized, blinded trial.Neuromodulation. 2017; 20: 497-503
- Efficacy of motor cortex stimulation in the treatment of neuropathic pain: a randomized double-blind trial.J Neurosurg. 2008; 108: 698-706
- Motor cortex stimulation for neuropathic pain: a randomized cross-over trial.Can J Neurol Sci. 2015; 42: 401-409
- Motor cortex stimulation: a systematic literature-based analysis of effectiveness and case series experience.BMC Neurol. 2019; 19: 48
- Systematic review and neural network analysis to define predictive variables in implantable motor cortex stimulation to treat chronic intractable pain.J Pain. 2019; 20: 1015-1026
- Predictive value of rTMS in the identification of responders to epidural motor cortex stimulation therapy for pain.J Pain. 2011; 12: 1102-1111
- Cortical neurostimulation for neuropathic pain: state of the art and perspectives.Pain. 2016; 157: S81-S89
- Neuromodulation for medically refractory neuropathic pain: spinal cord stimulation, deep brain stimulation, motor cortex stimulation, and posterior insula stimulation.World Neurosurg. 2021; 146: 246-260
- State of the art: novel applications for cortical stimulation.Neuromodulation. 2017; 20: 206-214
- Potential mechanisms supporting the value of motor cortex stimulation to treat chronic pain syndromes.Front Neurosci. 2016; 10: 18
Published online: February 19, 2023
Accepted: January 12, 2023
Received in revised form: January 10, 2023
Received: October 28, 2022
Publication stageIn Press Corrected Proof
Source(s) of financial support: The authors reported no funding sources.
Conflict of Interest: The authors reported no conflict of interest.
© 2023 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.