Moysak G I, Rzaev D A, Dzhafarov V M, Slavin K V
Federal Center of Neurosurgery, Novosibirsk, Russia; Institute of Medicine and Psychology, Novosibirsk State University, Novosibirsk, Russia.
Federal Center of Neurosurgery, Novosibirsk, Russia.
Zh Vopr Neirokhir Im N N Burdenko. 2018;82(4):70-80. doi: 10.17116/neiro201882470.
To demonstrate the results of treatment of poorly controlled deafferentation facial pain using motor cortex stimulation and to review the relevant literature.
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.
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.
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.
展示使用运动皮层刺激治疗控制不佳的去传入性面部疼痛的结果，并回顾相关文献。
该研究纳入了8例去传入性面部疼痛患者（3例男性，5例女性），他们于2004年至2016年在芝加哥伊利诺伊大学以及2017年在新西伯利亚联邦神经外科中心植入了持续运动皮层刺激系统。患者年龄在37岁至81岁之间（平均年龄57.5岁）。在入院时、出院时及随访期间基于量表对疼痛严重程度进行评估。使用了视觉模拟疼痛量表、巴罗神经学研究所疼痛量表（BNIPS）和麦克劳克林量表。
术后立即有4例患者疼痛显著减轻80%至100%。出院时疼痛强度平均降低了55%。在随访期间，8例患者中3例根据麦克劳克林量表评估运动皮层刺激效果非常好，4例评估为好，1例评估为不满意。
我们的研究结果及近期研究表明，运动皮层刺激是去传入性面部疼痛的治疗选择之一。即使是剧痛和使人衰弱的疼痛强度稍有降低（患者评估为良好效果）也为应用该治疗方法提供了依据。需要进一步研究以确定更精确的患者选择标准并提高刺激效果。
