Introduction: Both motor cortex stimulation (MCS) and deep brain stimulation (DBS) of the ventralis caudalis (Vc) thalamus have been shown to be effective in chronic neuropathic pain and modulation of thalamic and thalamocortical activity is regarded as a possible mechanism. Although Vc DBS and MCS share a common analgesic mechanism, application of MCS and DBS is still considered empirical and there is no consensus on which one is better.
Methods: We performed a simultaneous trial of thalamic Vc DBS and MCS in 9 patients with chronic neuropathic pain and investigated the results of the stimulation trial and long-term pain relief.
Results: Of the 9 patients initially implanted with both DBS and MCS electrodes, 8 of them (89%) had a successful trial. Six of these 8 patients (75%) responded to MCS and two out of the 8 patients responded to Vc DBS. With long-term follow-up, the mean NRS decreased significantly (p<0.05). Percentage pain relief in the chronic MCS group and chronic DBS group was 37.9±16.5% and 37.5%, respectively, and there was no difference (p=0.157).
Conclusions: Considering the initial success rate and the less invasive nature of epidural MCS than DBS, we think MCS would be a more reasonable, initial means of trial in chronic intractable neuropathic pain.
Patient Care: This would be of help to select between MCS/ DBS in patients with chronic neuropathic pain.
Learning Objectives: to decide which method of pain treatment, MCS or DBS, would be a more reasonable approach for patients with chronic neuroapthic pain.
References: 9. Son BC, Kim MC, Moon DE, Kang JK: Motor cortex stimulation in a patient with intractable complex regional pain syndrome type II with hemibody involvement. Case report. J Neurosurg 2003;98:175-179.
17. Son B, Choi ES, JT Hong, SW Lee. Motor cortex stimulation for central pain caused by traumatic brain injury. Pain 2006
Simultaneous Trial of Thalamic Deep Brain Stimulation and Motor Cortex Stimulation in Chronic, Intractable Neuropathic Pain. Streotact Fuct Neurosurg 2014;92:218-226.