Service de Physiologie–Explorations Fonctionnelles, EA 4391, Excitabilité Nerveuse et Thérapeutique, Hôpital Henri Mondor, Assistance Publique–Hôpitaux de Paris, Université Paris Est, Créteil, France.
Neurosurgery. 2011 Mar;68(1 Suppl Operative):180-7; discussion 187. doi: 10.1227/NEU.0b013e318207f896.
Chronic, drug-resistant neuropathic pain can be treated by surgically implanted motor cortex stimulation (MCS). The leads used for MCS have not been specifically designed for this application.
To study the value of a new 8-contact lead for MCS therapy in a series of 6 patients with refractory central poststroke pain.
The study comprised a 1-month randomized phase, starting 1 month after implantation, during which the neurostimulator was switched on in one-half of the patients or remained off in the other half, followed by an open phase of 10 months, during which the stimulator was switched on in all patients. Clinical assessment was performed at baseline and 1, 2, 3, 6, and 12 months after implantation with the following scales: Visual Analog Scale, Verbal Rating Scale, Brief Pain Inventory, McGill Pain Questionnaire, Sickness Impact Profile, and Medication Quantification Scale.
In the randomized phase, clinical scores were found to be globally reduced in the on- vs off-stimulation condition. In the open follow-up phase, all clinical scores improved significantly over time. The ratio between affective and sensory McGill Pain Questionnaire subscores decreased, suggesting a preferential effect of MCS on the affective component of pain. Compared with preoperative baseline, 2 patients were totally relieved of central poststroke pain, 3 patients were very much relieved, and 1 patient remained unchanged at the final examination.
A good clinical outcome was observed in all patients except 1, suggesting that this new octopolar lead could be used for MCS therapy to treat refractory central poststroke pain.
慢性、耐药性神经性疼痛可以通过植入式运动皮层刺激（MCS）进行手术治疗。用于 MCS 的导联并未专门为此应用而设计。
研究在 6 例难治性脑卒中后中枢性疼痛患者中使用新型 8 触点导联进行 MCS 治疗的价值。
该研究包括 1 个月的随机阶段，从植入后 1 个月开始，在此期间，将神经刺激器开启一半患者或另一半患者保持关闭，然后进行 10 个月的开放阶段，在此期间所有患者均开启刺激器。在基线和植入后 1、2、3、6 和 12 个月时，采用以下量表进行临床评估：视觉模拟量表、言语评定量表、简明疼痛量表、麦吉尔疼痛问卷、疾病影响量表和药物量化量表。
在随机阶段，发现开启刺激器与关闭刺激器相比，临床评分总体降低。在开放随访阶段，所有临床评分随时间显著改善。感觉和情感 McGill 疼痛问卷子评分之间的比值降低，表明 MCS 对疼痛的情感成分有优先作用。与术前基线相比，2 例患者的脑卒中后中枢性疼痛完全缓解，3 例患者非常缓解，1 例患者在最终检查时保持不变。
除 1 例患者外，所有患者均观察到良好的临床结果，这表明这种新型 8 触点导联可用于 MCS 治疗以治疗难治性脑卒中后中枢性疼痛。
