Boccard Sandra G J, Prangnell Simon J, Pycroft Laurie, Cheeran Binith, Moir Liz, Pereira Erlick A C, Fitzgerald James J, Green Alexander L, Aziz Tipu Z
Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Department of Clinical Neurosciences and Surgery, University of Oxford, Oxford, United Kingdom.
Clinical Neuropsychology Service, Russell Cairns Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
World Neurosurg. 2017 Oct;106:625-637. doi: 10.1016/j.wneu.2017.06.173. Epub 2017 Jul 11.
Deep brain stimulation (DBS) of the anterior cingulate cortex (ACC) is a recent technique that has shown some promising short-term results in patients with chronic refractory neuropathic pain. Three years after the first case series, we assessed its efficacy on a larger cohort, with longer follow-up.
Twenty-four patients (19 males; average age, 49.1 years) with neuropathic pain underwent bilateral ACC DBS. Patient-reported outcome measures were collected before and after surgery, using the Numerical Rating Scale (NRS), Short-Form 36 quality of life (SF-36), McGill Pain Questionnaire (MPQ), and EuroQol 5-domain quality of life (EQ-5D) questionnaire.
Twenty-two patients after a trial week were fully internalized and 12 had a mean follow-up of 38.9 months. Six months after surgery the mean NRS score decreased from 8.0 to 4.27 (P = 0.004). There was a significant improvement in the MPQ (mean, -36%; P = 0.021) and EQ-5D score significantly decreased (mean, -21%; P = 0.036). The physical functioning domain of SF-36 was significantly improved (mean, +54.2%; P = 0.01). Furthermore, in 83% of these patients, at 6 months, NRS score was improved by 60% (P < 0.001) and MPQ decreased by 47% (P < 0.01). After 1 year, NRS score decreased by 43% (P < 0.01), EQ-5D was significantly reduced (mean, -30.8; P = 0.05) and significant improvements were also observed for different domains of the SF-36. At longer follow-ups, efficacy was sustained up to 42 months in some patients, with an NRS score as low as 3.
Follow-up results confirm that ACC DBS alleviates chronic neuropathic pain refractory to pharmacotherapy and improves quality of life in many patients.
前扣带回皮质（ACC）的深部脑刺激（DBS）是一项新技术，在慢性难治性神经性疼痛患者中已显示出一些有前景的短期结果。在首个病例系列报道三年后，我们对更大的队列进行了评估，并进行了更长时间的随访。
24例（19例男性；平均年龄49.1岁）神经性疼痛患者接受了双侧ACC DBS。术前和术后采用数字评分量表（NRS）、36项简明健康状况调查量表（SF-36）、麦吉尔疼痛问卷（MPQ）和欧洲五维健康量表（EQ-5D）问卷收集患者报告的结局指标。
22例患者经过一周的试验期后完全植入电极，其中12例平均随访38.9个月。术后6个月，NRS评分均值从8.0降至4.27（P = 0.004）。MPQ有显著改善（均值，-36%；P = 0.021），EQ-5D评分显著降低（均值，-21%；P = 0.036）。SF-36的身体功能领域有显著改善（均值，+54.2%；P = 0.01）。此外，在这些患者中，83%在6个月时NRS评分改善了60%（P < 0.001），MPQ降低了47%（P < 0.01）。1年后，NRS评分降低了43%（P < 0.01），EQ-5D显著降低（均值，-30.8；P = 0.05），SF-36的不同领域也观察到显著改善。在更长时间的随访中，部分患者的疗效持续至42个月，NRS评分低至3分。
随访结果证实，ACC DBS可缓解药物治疗难治的慢性神经性疼痛，并改善许多患者的生活质量。
