Objective: Although deep brain stimulation(DBS) and motor cortex stimulation(MCS)are effective in patients with refractory neuropathic pain, their application is still empirical; there is no consensus on which techniq...Objective: Although deep brain stimulation(DBS) and motor cortex stimulation(MCS)are effective in patients with refractory neuropathic pain, their application is still empirical; there is no consensus on which technique is better. Methods: To enhance the success rate of trial stimulation of invasive neuromodulation techniques and identify approapriate stimulation targets in individual patients, we performed a simultaneous trial of thalamic ventralis caudalis(Vc) DBS and MCS in 11 patients with chronic neuropathic pain and assessed the results of the trial stimulation and long-term analgesia. Results: Of the 11 patients implanted with both DBS and MCS electrodes, nine(81.8%)had successful trials. Seven of these nine patients(77.8%) responded to MCS, and two(18.2%) responded to Vc DBS. With long-term follow-up(56 ± 27.5 months), the mean numerical rating scale decreased significantly(P < 0.05). The degree of percentage pain relief in the chronic MCS(n = 7) and chronic DBS(n = 2) groups were 34.1% ± 18.2%and 37.5%, respectively, and there was no significant difference(P = 0.807). Five out of the seven MCS patients(71%) and both DBS patients had long-term success with the treatments, defined as >30% pain relief compared with baseline. Conclusions: With simultaneous trial of DBS and MCS, we could enhance the success rate of invasive trials. Considering the initial success rate and the less invasive nature of epidural MCS over DBS, we suggest that MCS may be a better, initial means of treatment in chronic intractable neuropathic pain. Further investigations including other subcortical target-associated medial pain pathways are warranted.展开更多
The ipsilateral motor pathway from the unaffected motor cortex to the affected extremity is one of the motor recovery mechanisms following stroke （Jang, 2011）. Because stroke patients who had shown recovery by this ...The ipsilateral motor pathway from the unaffected motor cortex to the affected extremity is one of the motor recovery mechanisms following stroke （Jang, 2011）. Because stroke patients who had shown recovery by this mechanism usually showed poorer motor function, compared with patients who showed recovery by other mechanisms, several researchers have considered this mechanism as a maladaptive plasticity （]ang, 2013）.展开更多
文摘Objective: Although deep brain stimulation(DBS) and motor cortex stimulation(MCS)are effective in patients with refractory neuropathic pain, their application is still empirical; there is no consensus on which technique is better. Methods: To enhance the success rate of trial stimulation of invasive neuromodulation techniques and identify approapriate stimulation targets in individual patients, we performed a simultaneous trial of thalamic ventralis caudalis(Vc) DBS and MCS in 11 patients with chronic neuropathic pain and assessed the results of the trial stimulation and long-term analgesia. Results: Of the 11 patients implanted with both DBS and MCS electrodes, nine(81.8%)had successful trials. Seven of these nine patients(77.8%) responded to MCS, and two(18.2%) responded to Vc DBS. With long-term follow-up(56 ± 27.5 months), the mean numerical rating scale decreased significantly(P < 0.05). The degree of percentage pain relief in the chronic MCS(n = 7) and chronic DBS(n = 2) groups were 34.1% ± 18.2%and 37.5%, respectively, and there was no significant difference(P = 0.807). Five out of the seven MCS patients(71%) and both DBS patients had long-term success with the treatments, defined as >30% pain relief compared with baseline. Conclusions: With simultaneous trial of DBS and MCS, we could enhance the success rate of invasive trials. Considering the initial success rate and the less invasive nature of epidural MCS over DBS, we suggest that MCS may be a better, initial means of treatment in chronic intractable neuropathic pain. Further investigations including other subcortical target-associated medial pain pathways are warranted.
基金supported by the DGIST R&D Program of the Ministry of Education,Science and Technology of Korea,No.14-BD-0401
文摘The ipsilateral motor pathway from the unaffected motor cortex to the affected extremity is one of the motor recovery mechanisms following stroke （Jang, 2011）. Because stroke patients who had shown recovery by this mechanism usually showed poorer motor function, compared with patients who showed recovery by other mechanisms, several researchers have considered this mechanism as a maladaptive plasticity （]ang, 2013）.
