Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Eur Neurol. 2021;84(3):151-156. doi: 10.1159/000514827. Epub 2021 Apr 14.
Facial pain (FP) is a type of neuropathic pain which recognizes both central and peripheral causes. It can be difficult to treat because it can often become resistant to pharmacological treatments. Motor Cortex Stimulation (MCS) has been used in selected cases, but the correct indications of MCS in FP have not been fully established. Here we systematically reviewed the literature regarding MCS in FP analysing the results of this technique and studying the possible role of different factors in the prognosis of these patients.
A literature search was performed through different databases (PubMed, Scopus, and Embase) according to PRISMA guidelines using the following terms in any possible combination: "facial pain" or "trigeminal" or "anaesthesia dolorosa" and "motor cortex stimulation."
111 articles were reviewed, and 12 studies were included in the present analysis for a total of 108 patients. Overall, at latest follow-up (FU), 70.83% of patients responded to MCS. The preoperative VAS significantly decreased at the latest FU (8.83 ± 1.17 and 4.31 ± 2.05, respectively; p < 0.0001). Younger age (p = 0.0478) and a peripheral FP syndrome (p = 0.0006) positively affected the definitive implantation rate on univariate analysis. Younger age emerged as a factor strongly associated to a higher probability to go to a definitive MCS implant on multivariate analysis (p = 0.0415).
Our results evidenced the effectiveness of MCS in treating FP. Moreover, the younger age emerged as a positive prognostic factor for definitive implantation. Further studies with longer FU are needed to better evaluate the long-term results of MCS.
面部疼痛（FP）是一种神经性疼痛，既有中枢原因也有外周原因。由于其经常对药物治疗产生抗药性，因此治疗起来可能很困难。运动皮层刺激（MCS）已在一些选定的病例中使用，但 MCS 在 FP 中的正确适应证尚未完全确定。在此，我们系统地回顾了关于 FP 中 MCS 的文献，分析了该技术的结果，并研究了不同因素在这些患者预后中的可能作用。
根据 PRISMA 指南，通过不同的数据库（PubMed、Scopus 和 Embase）进行文献检索，使用以下任何可能的组合词进行搜索：“面部疼痛”或“三叉神经”或“感觉异常性疼痛”和“运动皮层刺激”。
共回顾了 111 篇文章，其中 12 项研究被纳入本分析，共纳入 108 例患者。总体而言，在最新随访（FU）时，70.83%的患者对 MCS 有反应。最新 FU 时的术前 VAS 显著降低（分别为 8.83 ± 1.17 和 4.31 ± 2.05，p < 0.0001）。单因素分析显示，年龄较小（p = 0.0478）和周围性 FP 综合征（p = 0.0006）对最终植入率有积极影响。多因素分析显示，年龄较小是与更高概率进行最终 MCS 植入相关的一个重要因素（p = 0.0415）。
我们的结果证明了 MCS 在治疗 FP 方面的有效性。此外，年龄较小是最终植入的一个积极预后因素。需要进行具有更长 FU 的进一步研究，以更好地评估 MCS 的长期结果。
