Motor cortex stimulation in deafferentation facial pain

Moysak G.I.; Rzaev D.A.; Dzhafarov V.M.; Slavin K.V.

doi:https://doi.org/10.17116/neiro201882470

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Abstract:

Objective — to demonstrate the results of treatment of poorly controlled deafferentation facial pain using motor cortex stimulation and to review the relevant literature. Material and methods. The study included 8 patients (3 males and 5 females) with deafferentation facial pain who were implanted with a system of constant motor cortex stimulation at the Illinois University in Chicago in 2004―2016 and Novosibirsk Federal Center of Neurosurgery in 2017. The patients’ age ranged from 37 to 81 years (mean age, 57.5 years). Scale-based assessment of the pain severity was performed at admission to hospital, at discharge, and during follow-up. The visual analogue pain scale, Barrow Neurological Institute pain scale (BNIPS), and McLaughlin scale were used. Results. Immediately after surgery, a significant improvement in the form of pain reduction by 80―100% occurred in 4 patients. The pain intensity at discharge from the hospital decreased by 55%, on average. During the follow-up period, the efficacy of motor cortex stimulation was assessed (McLaughlin scale) as very good by 3 of the 8 patients, as good by 4 patients, and as unsatisfactory by 1 patient. Conclusion. Our findings and recent studies have demonstrated that motor cortex stimulation is one of the treatment options for deafferentation facial pain. Even a slight decrease in the intensity of excruciating and debilitating pain (assessed by patients as a good effect) gives grounds for application of the procedure. Further research is needed to define more precise criteria for selecting patients for this treatment and to increase the efficacy of stimulation.

Keywords:

facial pain

deafferentation pain

pain syndrome

motor cortex stimulation

neuropathic pain

Authors:

Moysak G.I.

Novosibirsk State University, Novosibirsk, Russia;
Federal Neurosurgical Center, Novosibirsk, Russia

SPIN RSCI: 3860-6567
Scopus AuthorID: 57194732532
ORCID: 0000-0002-3885-3004

Rzaev D.A.

Federal Neurosurgical Center, Novosibirsk, Russia

SPIN RSCI: 8711-4097
Scopus AuthorID: 57215895381
ORCID: 0000-0002-1209-8960

Dzhafarov V.M.

Federal Center for Neurosurgery of Healthcare Ministry of the Russian Federation, Novosibirsk, Russia

Slavin K.V.

Department of Neurosurgery, University of Illinois, Chicago, USA

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References:

Hanakawa T. Neural mechanisms underlying deafferentation pain: a hypothesis from a neuroimaging perspective. J Orthop Sci. 2012;17(3):331-335. https://doi.org/10.1007/s00776-012-0209-9
Eller JL, Raslan AM, Burchiel KJ. Trigeminal neuralgia: definition and classification. Neurosurg Focus. 2005;18:E3.
Abram SE, Haddox JD. The pain clinic manual. Philadelphia: Lippincott Williams and Wilkins; 2000.
Becker R, Uhle EI, Alberti O, Bertalanffy H. Continuous intrathecal baclofen infusion in the management of central deafferentation pain. J Pain Symptom Manage. 2000;20(5):313-315.
May A. Chronic pain may change the structure of the brain. Pain. 2008;137(1):7-15. https://doi.org/10.1016/j.pain.2008.02.034
Woolf CJ, Salter MW. Neuronal plasticity: increasing the gain in pain. Science. 2000;288:5472:1765-1768.
Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S. Chronic motor cortex stimulation for the treatment of central pain. Acta Neurochir Suppl (Wien). 1991;52:137-139.
Rogers CL, Shetter AG, Fiedler JA, Smith KA, Han PP, Speiser BL. Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of the Barrow Neurological Institute. Int J Radiat Oncol Biol Phys. 2000;47(4):1013-1019. https://doi.org/10.1016/s0360-3016(00)00513-7
Ibanez FAL, Hem S, Ajler P, Vecchi E, Ciraolo C, Baccanelli M, Tramontano R, Knezevich F, Carrizo A. A new classification of complications in neurosurgery. World Neurosurg. 2011;75(5-6):709-715.
McLaughlin MR, Jannetta PJ, Clyde BL, Subach BR, Comey CH, Resnick DK. Microvascular decompression of cranial nerves: lessons learned after 4400 operations. J Neurosurg. 1999;90:1-8.
Peyron R, Garcia-Larrea L, Deiber MP, Cinotti L, Convers P, Sindou M, Mauguière F, Laurent B. Electrical-stimulation of precentral cortical area in the treatment of central pain — electrophysiological and pet study. Pain. 1995;62(3):275-286. https://doi.org/10.1016/0304-3959(94)00211-v
Lefaucheur J. Cortical neurostimulation for neuropathic pain: state of the art and perspectives. Pain. 2016;157 Suppl(2):S81-S89.
Peyron R, Faillenot I, Mertens P, Laurent B, Garcia-Larrea L. Motor cortex stimulation in neuropathic pain. Correlations between analgesic effect and hemodynamic changes in the brain. A PET study. Neuroimage. 2007;34(1):310-321. https://doi.org/10.1016/j.neuroimage.2006.08.037
Maarrawi J, Peyron R, Mertens P, Costes N, Magnin M, Sindou M, Laurent B, Garcia-Larrea L. Motor cortex stimulation for pain control induces changes in the endogenous opioid system. Neurology. 2007;67:827-834.
Pagano R, Fonoff ET, Dale CS, Ballester G, Teixeira MJ, Britto LRG. Motor cortex stimulation inhibits thalamic sensory neurons and enhances activity of PAG neurons: Possible pathways for antinociception. Pain. 2012;153(12):2359-2369.
Chiou RJ, Chang CW, Kuo CC. Involvement of the periaqueductal gray in the effect of motor cortex stimulation. Brain Res. 2013;1500:28-35.
Jasmin L, Rabkin SD, Granato A, Boudah A, Ohara PT. Analgesia and hyperalgesia from GABA-mediated modulation of the cerebral cortex. Nature. 2003;424(6946):316-320.
Senapati AK, Huntington PJ, Peng YB. Spinal dorsal horn neuron response to mechanical stimuli is decreased by electrical stimulation of the primary motor cortex. Brain Res. 2005;1036(1-2):173-179.
Ito M, Kuroda S, Shiga T, Tamaki N, Iwasaki Y. Motor cortex stimulation improves local cerebral glucose metabolism in the ipsilateral thalamus in patients with poststroke pain: case report. Neurosurgery. 2011;69(2):E462-E469.
Siebner HR, Hartwigsen G, Kassuba T, Rothwell J. How does transcranial magnetic stimulation modify neuronal activity in the brain ? Implications for studies of cognition. Cortex. 2010;45(9):1035-1042.
Colloca L, Miller FG. Role of expectations in health. Curr Opin Psychiatry. 2011;24(2):149-155.
Honey CM, Tronnier VM, Honey CR. 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.
Zhang X, Hu Y, Tao W, Zhu H, Xiao D, Li Y. 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 Technol Neural Interface. 2017;2016. https://doi.org/10.1111/ner.12547
Hosomi K, Seymour B, Saitoh Y. Modulating the pain network — neurostimulation for central poststroke pain. Nat Rev Neurol. 2015;11(5):290-299. https://doi.org/10.1038/nrneurol.2015.58
Velasco F, Argüelles C, Carrillo-Ruiz JD, Castro G, Velasco AL, Jiménez F, Velasco M. Efficacy of motor cortex stimulation in the treatment of neuropathic pain: a randomized double-blind trial. J Neurosurg. 2008;108(4):698-706. https://doi.org/10.3171/jns/2008/108/4/0698
Colloca L, Ludman T, Bouhassira D, Baron R, Dickenson AH, Yarnitsky D, Freeman R, Truini A, Attal N, Finnerup NB, Eccleston C, Kalso E, Bennett DL, Dworkin RH, Raja SN. Neuropathic pain. Nat Rev Dis Prim. 2017;3:17002. https://doi.org/10.1038/nrdp.2017.2
O’Brien AT, Amorim R, Rushmore RJ, Eden U, Afifi L, Dipietro L, Wagner T, Valero-Cabré A. Motor cortex neurostimulation technologies for hronic post-stroke pain: implications of tissue damage on stimulation currents. Front Hum Neurosci. 2016;10 November:1-8.
O’Connell NE, Wand BM, Marston L, Spencer S, DeSouza LH. Non-invasive brain stimulation techniques for chronic pain. In: Cochrane database of systematic reviews. O’Connell NE, ed. Chichester, UK: John Wiley & Sons, Ltd; 2010. https://doi.org/10.1002/14651858.cd008208.pub2
Cruccu G, Aziz TZ, Garcia-Larrea L, Hansson P, Jensen TS, Lefaucheur JP, Simpson BA, Taylor RS. EFNS guidelines on neurostimulation therapy for neuropathic pain. Eur J Neurol. 2007;14(9):952-970.
Fontaine D, Hamani C, Lozano A. Efficacy and safety of motor cortex stimulation for chronic neuropathic pain: critical review of the literature. J Neurosurg. 2009;110(2):251-256. https://doi.org/10.3171/2008.6.17602
Delavallée M, Finet P, de Tourtchaninoff M, Raftopoulos C. 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(12):2289-2294. https://doi.org/10.1007/s00701-014-2240-4
Raslan AM, Nasseri M, Bahgat D, Abdu E, Burchiel KJ. Motor cortex stimulation for trigeminal neuropathic or deafferentation pain: an institutional case series experience. Stereotact Funct Neurosurg. 2011;89(2):83-88.
Kolodziej MA, Hellwig D, Nimsky C, Benes L. Treatment of central deafferentation and trigeminal neuropathic pain by motor cortex stimulation: report of a series of 20 patients. J Neurol Surgery Part A Cent Eur Neurosurg. 2015;77(1):52-58. https://doi.org/10.1055/s-0035-1558419
Ebel H, Rust D, Tronnier V, Böker D, Kunze S. Chronic precentral stimulation in trigeminal neuropathic pain. Acta Neurochir (Wien). 1996;138(11):1300-1306. https://doi.org/10.1007/bf01411059
Buchanan RJ, Darrow D, Monsivais D, Nadasdy Z, Gjini K. Motor cortex stimulation for neuropathic pain syndromes: a case series experience. Neuroreport. 2014;25(9):715-717.
Nuti C, Peyron R, Garcia-Larrea L, Brunon J, Laurent B, Sindou M, Mertens P. Motor cortex stimulation for refractory neuropathic pain: four year outcome and predictors of efficacy. Pain. 2005;118:43-52.
Nguyen JP, Nizard J, Keravel Y, Lefaucheur J-P. Invasive brain stimulation for the treatment of neuropathic pain. Nat Rev Neurol. 2011;7(12):699-709.
Isagulyan EhD, Tomskij AA, Dekopov AV, Salova EM, Troshina EM, Dorohov EV, Shabalov VA. Results of motor cortex stimulation in the treatment of chronic pain syndromes. Voprosy Neirokhirurgii. N.N. Burdenko. 2015;6:46-60. (In Russ) https://doi.org/10.17116/neiro201579646-60
Brown JA, Pilitsis JG. Motor cortex stimulation for central and neuropathic facial pain: A prospective study of 10 patients and observations of enhanced sensory and motor function during stimulation. Neurosurgery. 2005;56(2):290-296. https://doi.org/10.1227/01.neu.0000148905.75845.98
Velasco F, Carrillo-Ruiz JD, Castro G, Argüelles C., Velasco A.L., Kassian A., Guevara U. Motor cortex electrical stimulation applied to patients with complex regional pain syndrome. Pain. 2009;147(1-3):91-98.
Rainov NG, Heidecke V. Motor cortex stimulation for neuropathic facial pain. Neurol Res. 2003;25(2):157-161.
Anderson WS, Kiyofuji S, Conway JE, Busch C, North RB, Garonzik IM. Dysphagia and neuropathic facial pain treated with motor cortex stimulation: case report. Neurosurgery. 2009;65(3);E626.
Slotty PJ, Eisner W, Honey CR, Wille C, Vesper J. Long-term follow-up of motor cortex stimulation for neuropathic pain in 23 patients. Stereotact Funct Neurosurg. 2015;93(3):199-205. https://doi.org/10.1159/000375177
Slotty PJ, Chang S, Honey CR. Motor threshold: a possible guide to optimizing stimulation parameters for motor cortex stimulation. Neuromodulation. 2015;(18(7)):566-571. https://doi.org/10.1111/ner.12336
Monsalve GA. Motor cortex stimulation for facial chronic neuropathic pain: A review of the literature. Surg Neurol Int. 2012;3(Suppl 4):S290-S311.
Pagano RL, Assis DV, Clara JA, Alves AS, Dale CS, Teixeira MJ, Fonoff ET, Britto LR. Transdural motor cortex stimulation reverses neuropathic pain in rats: A profile of neuronal activation. Eur J Pain. 2011;15(3):268.e1-268.e14.
Lefaucheur J-P, Antal A, Ayache SS, Benninger DH, Brunelin J, Cogiamanian F, Cotelli M, De Ridder D, Ferrucci R, Langguth B, Marangolo P, Mylius V, Nitsche MA, Padberg F, Palm U, Poulet E, Priori A, Rossi S, Schecklmann M, Vanneste S, Ziemann U, Garcia-Larrea L, Paulus W. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clin Neurophysiol. 2016;128(1):56-92.
Henssen DJ, Kurt E, Kozicz T, van Dongen R, Bartels RH, van Cappellen van Walsum A-M. New insights in trigeminal anatomy: a double orofacial tract for nociceptive input. Front Neuroanat. 2016 May 10:53.
Jantsch HH, Kemppainen P, Ringler R, Handwerker HO, Forster C. Cortical representation of experimental tooth pain in humans. Pain. 2005;118(3):390-399. https://doi.org/10.1016/j.pain.2005.09.017