Introduction: Central post-stroke pain is a neuropathic pain syndrome that can occur in 1-18% of stroke patients. When this syndrome causes chronic refractory pain motor cortex stimulation can be used, with at least 45-50% pain improvement at one year follow-up. There have also been reports of the potencial benefits of motor cortex stimulation for the rehabilitation of stroke related motor deficits.

Methods: The authors present the case of a motor and autonomic significant improvement after the implant of a left motor cortex stimulator for the treatment of severe central arm pain.

Results: 27 years old female patient, with a history of subarachnoid haemorrhage from rupture of an left ACM bifurcation aneurysm at age of 22. The patient has a right spastic hemiparesis and mild aphasia but she is independent for all daily life activities. The patient suffered from severe neurophatic pain in the distal segments of her right upper limb, refractory to medical treatment. After evaluation of a multidisciplinary pain team, the authors implanted a navigation guided subdural cortical stimulator over the left pre-central gyrus. With stimulation there was a pain improvement to an NRS of 3-4. It was also noticed an improvement in temperature sensation, colour and trophic skin signs as well as in right hand and foot strength with better functional control in arm and forearm movement.

Conclusions: Besides pain relief, motor function improvement can also be achieved after motor cortex stimulation in post-stroke pain patients. Despite the utility of the other central nervous system targets in the modulation of pain, this subset of patients might be best managed trough this technique. The motor recovery in post-stroke pain patients might be an extra argument for the use of motor cortex stimulation. Further studies are needed to confirm our observation and determine the best placement, stimulation parameters and full mechanism of action.

Patient Care: The motor recovery in post-stroke pain patients might be an extra argument for the use of motor cortex stimulation in this subset pf patients.

Learning Objectives: Describe other potential benefits of the use motor cortex stimulation in central post-stroke pain patients.

References: Klit et al - Central post-stroke pain: clinical characteristics, pathophysiology, and management - Lancet Neurol 2009; 8: 857–68