Isagulyan E D, Tomsky A A, Dekopov A V, Salova E M, Troshina E M, Dorokhov E V, Shabalov V A
Burdenko Neurosurgical Institute, Moscow, Russia.
Burdenko Neurosurgical Institute, Moscow, Russia, Sechenov First Moscow State Medical University, Moscow, Russia.
Zh Vopr Neirokhir Im N N Burdenko. 2015;79(6):46-60. doi: 10.17116/neiro201579646-60.
The article is aimed to demonstrate our experience in motor cortex stimulation (MCS) in patients with chronic neuropathic pain syndromes, assess the clinical efficacy of the technique in short-term and long-term follow-up, and analyze potential predictors of the MCS efficacy.
Twenty patients were implanted with MCS electrodes at the Burdenko Neurosurgical Institute in the period between 2004 and 2014. The mean age of patients was 52 years (26 to 74 years). The patients suffered from neuropathic pain syndromes of different genesis (post-stroke, multiple sclerosis, atypical facial pain, phantom limb pain, brachial plexus injury, spinal cord injury, complex regional pain syndrome I). All patients underwent neurological examination with verification of neuropathic pain (DN4, Pain Detect, LANSS). The pain intensity and its effect on quality of life were assessed before operation and during follow-up according to 10-point visual-analog scales (modified Brief Pain Inventory). Before surgery, all patients underwent several repetitive transcranial magnetic stimulation (rTMS) sessions. After implantation of epidural electrodes, test MCS was performed.
Test stimulation was positive in 19 (95%) patients. All these patients were implanted with a chronic MCS system. The mean follow-up was 49.3 months (from 3 to 96 months). In short-term follow-up (fist 6 months), a positive result of MCS was observed in 17 patients, and a reduction in the pain intensity ranged from 37.5% to 90%. In long-term follow up (from 12 to 96 months), 14 patients had positive MCS RESULTS: and a reduction in the pain intensity amounted to 25% to 60%. All patients with positive MCS results received significantly decreased doses of opioids and tramadol. Two patients developed infectious complications, but there was no neurological deficit. Analysis of the factors affecting the efficacy of motor cortex stimulation did not reveal a statistically significant effect of rTMS and the presence and intensity of motor deficit.
Chronic epidural MCS is an effective and safety method for the treatment of some chronic neurogenic medically-refractory pain syndromes. Further research is necessary to specify the patient selection criteria and the MCS efficacy predictors.
本文旨在展示我们在慢性神经性疼痛综合征患者中进行运动皮层刺激（MCS）的经验，评估该技术在短期和长期随访中的临床疗效，并分析MCS疗效的潜在预测因素。
2004年至2014年期间，20例患者在布尔坚科神经外科研究所植入了MCS电极。患者的平均年龄为52岁（26至74岁）。这些患者患有不同病因的神经性疼痛综合征（中风后、多发性硬化症、非典型面部疼痛、幻肢痛、臂丛神经损伤、脊髓损伤、复杂性区域疼痛综合征I）。所有患者均接受了神经病学检查以验证神经性疼痛（DN4、疼痛检测、LANSS）。根据10分视觉模拟量表（改良简短疼痛量表）在术前和随访期间评估疼痛强度及其对生活质量的影响。术前，所有患者均接受了多次重复经颅磁刺激（rTMS）治疗。硬膜外电极植入后，进行了试验性MCS。
19例（95%）患者的试验性刺激为阳性。所有这些患者均植入了慢性MCS系统。平均随访时间为49.3个月（3至96个月）。在短期随访（前6个月）中，17例患者的MCS结果为阳性，疼痛强度降低范围为37.5%至90%。在长期随访（12至96个月）中，14例患者的MCS结果为阳性，疼痛强度降低至25%至60%。所有MCS结果为阳性的患者的阿片类药物和曲马多剂量均显著减少。2例患者出现感染并发症，但未出现神经功能缺损。对影响运动皮层刺激疗效的因素进行分析，未发现rTMS以及运动功能缺损的存在和严重程度具有统计学意义。
慢性硬膜外MCS是治疗某些慢性神经源性药物难治性疼痛综合征的一种有效且安全的方法。需要进一步研究以明确患者选择标准和MCS疗效预测因素。
