Im Sang-Hyuk, Ha Sang-Woo, Kim Deok-Ryeong, Son Byung-Chul
Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea.
Stereotact Funct Neurosurg. 2015;93(3):212-8. doi: 10.1159/000381557. Epub 2015 Apr 21.
BACKGROUND/OBJECTIVES: Although motor cortex stimulation (MCS) has been used for more than 20 years in the treatment of chronic neuropathic pain, there is still a debate about the efficacy of MCS.
To investigate the long-term results and the factors associated with the long-term success of chronic MCS, 21 patients who underwent MCS trial were classified as having central poststroke pain, central pain after spinal cord injury (SCI) and peripheral neuropathic pain, and we investigated the clinical factors associated with long-term success and degree of pain relief.
Of the 21 patients, 16 (76.2%) had a successful trial and underwent chronic MCS. In the long-term follow-up (53 ± 39 months), only the diagnosis (central poststroke pain and peripheral neuropathic pain) was associated with long-term success defined as >30% pain relief compared with baseline (p < 0.05, χ(2) test). The difference in pain relief was not significant in patients having SCI pain (p > 0.05, 1-way ANOVA). The other variables did not show any significant influence in the long-term success and degree of pain relief (p > 0.05, 1-way ANOVA).
MCS was more effective in the treatment of chronic neuropathic pain of central poststroke pain and peripheral neuropathic pain types than in the treatment of SCI pain in the long-term follow-up.
背景/目的：尽管运动皮层刺激（MCS）已用于治疗慢性神经性疼痛20多年，但关于MCS的疗效仍存在争议。
为了研究慢性MCS的长期结果以及与长期成功相关的因素，将21例行MCS试验的患者分为中风后中枢性疼痛、脊髓损伤（SCI）后中枢性疼痛和周围神经性疼痛患者，我们调查了与长期成功和疼痛缓解程度相关的临床因素。
21例患者中，16例（76.2%）试验成功并接受了慢性MCS。在长期随访（53±39个月）中，只有诊断（中风后中枢性疼痛和周围神经性疼痛）与长期成功相关，长期成功定义为与基线相比疼痛缓解>30%（p<0.05，χ²检验）。SCI疼痛患者的疼痛缓解差异无统计学意义（p>0.05，单因素方差分析）。其他变量对长期成功和疼痛缓解程度无显著影响（p>0.05，单因素方差分析）。
在长期随访中，MCS治疗中风后中枢性疼痛和周围神经性疼痛类型的慢性神经性疼痛比治疗SCI疼痛更有效。
