scholarly journals Is Life Better After Motor Cortex Stimulation for Pain Control? Results at Long-Term and their Prediction by Preoperative rTMS

2014 ◽  
Vol 17;1 (1;17) ◽  
pp. 53-62 ◽  
Author(s):  
Nathalie André-Obadia
Keyword(s):  
Quality Of Life ◽  
Neuropathic Pain ◽  
Pain Relief ◽  
Motor Cortex ◽  
Predictive Value ◽  
Drug Intake ◽  
Motor Cortex Stimulation ◽  
Pain Scores

Background: A positive effect of motor cortex stimulation (MCS) (defined as subjective estimations of pain relief ≥ 30%) has been reported in 55 – 64% of patients. Repetitive magnetic cortical stimulation (rTMS) is considered a predictor of MCS effect. These figures are, however, mostly based on subjective reports of pain intensity, and have not been confirmed in the long-term. Objectives: This study assessed long-term pain relief (2 – 9 years) after epidural motor cortex stimulation and its pre-operative prediction by rTMS, using both intensity and Quality of Life (QoL) scales. Study Design: Analysis of the long-term evolution of pain patients treated by epidural motor cortex stimulation, and predictive value of preoperative response to rTMS. Setting: University Neurological Hospital Pain Center. Methods: Patients: Twenty patients suffering chronic pharmaco-resistant neuropathic pain. Intervention: All patients received first randomized sham vs. active 20Hz-rTMS, before being submitted to MCS surgery. Measurement: Postoperative pain relief was evaluated at 6 months and then up to 9 years post-MCS (average 6.1 ± 2.6 y) using (i) pain numerical rating scores (NRS); (ii) a combined assessment (CPA) including NRS, drug intake, and subjective quality of life; and (iii) a short questionnaire (HowRu) exploring discomfort, distress, disability, and dependence. Results: Pain scores were significantly reduced by active (but not sham) rTMS and by subsequent MCS. Ten out of 20 patients kept a long-term benefit from MCS, both on raw pain scores and on CPA. The CPA results were strictly comparable when obtained by the surgeon or by a third-party on telephonic survey (r = 0.9). CPA scores following rTMS and long-term MCS were significantly associated (Fisher P = 0.02), with 90% positive predictive value and 67% negative predictive value of preoperative rTMS over long-term MCS results. On the HowRu questionnaire, long-term MCSrelated improvement concerned “discomfort” (physical pain) and “dependence” (autonomy for daily activities), whereas “disability” (work, home, and leisure activities) and “distress” (anxiety, stress, depression) did not significantly improve. Limitations: Limited cohort of patients with inhomogeneous pain etiology. Subjectivity of the reported items by the patient after a variable and long delay after surgery. Predictive evaluation based on a single rTMS session compared to chronic MCS. Conclusions: Half of the patients still retain a significant benefit after 2 – 9 years of continuous MCS, and this can be reasonably predicted by preoperative rTMS. Adding drug intake and QoL estimates to raw pain scores allows a more realistic assessment of long-term benefits and enhance the rTMS predictive value. The aims of this study and its design were approved by the local ethics committee (University Hospitals St Etienne and Lyon, France). Key words: Neuropathic pain, chronic refractory pain, repetitive transcranial magnetic stimulation, rTMS, epidural motor cortex stimulation, MCS, quality of life, predictive value

scholarly journals Extradural Motor Cortex Stimulation in Parkinson’s Disease: Long-Term Clinical Outcome

2021 ◽  
Vol 11 (4) ◽  
pp. 416
Author(s):  
Carla Piano ◽  
Francesco Bove ◽  
Delia Mulas ◽  
Enrico Di Stasio ◽  
Alfonso Fasano ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Motor Cortex ◽  
Clinical Outcome ◽  
Motor Cortex Stimulation ◽  
Dopaminergic Therapy

Previous investigations have reported on the motor benefits and safety of chronic extradural motor cortex stimulation (EMCS) for patients with Parkinson’s disease (PD), but studies addressing the long-term clinical outcome are still lacking. In this study, nine consecutive PD patients who underwent EMCS were prospectively recruited, with a mean follow-up time of 5.1 ± 2.5 years. As compared to the preoperatory baseline, the Unified Parkinson’s Disease Rating Scale (UPDRS)-III in the off-medication condition significantly decreased by 13.8% at 12 months, 16.1% at 18 months, 18.4% at 24 months, 21% at 36 months, 15.6% at 60 months, and 8.6% at 72 months. The UPDRS-IV decreased by 30.8% at 12 months, 22.1% at 24 months, 25% at 60 months, and 36.5% at 72 months. Dopaminergic therapy showed a progressive reduction, significant at 60 months (11.8%). Quality of life improved by 18.0% at 12 months, and 22.4% at 60 months. No surgical complication, cognitive or behavioral change occurred. The only adverse event reported was an infection of the implantable pulse generator pocket. Even in the long-term follow-up, EMCS was shown to be a safe and effective treatment option in PD patients, resulting in improvements in motor symptoms and quality of life, and reductions in motor complications and dopaminergic therapy.

scholarly journals Long-Term Results of a Simultaneous Trial of Deep Brain and Motor Cortex Stimulation in Refractory Neuropathic Pain

2017 ◽  
Vol 3 (1) ◽  
pp. 4-15
Author(s):  
Byung-chul Son ◽  
Jin-gyu Choi ◽  
Sang-woo Ha ◽  
Deog-ryeong Kim
Keyword(s):  
Neuropathic Pain ◽  
Pain Relief ◽  
Motor Cortex ◽  
Success Rate ◽  
Rating Scale ◽  
Long Term Results ◽  
Motor Cortex Stimulation ◽  
Significant Difference ◽  
Deep Brain

Objective Although deep brain stimulation (DBS) and motor cortex stimulation (MCS) are effective in patients with refractory neuropathic pain, their application is still empirical; there is no consensus on which technique is better. Methods To enhance the success rate of trial stimulation of invasive neuromodulation techniques and identify approapriate stimulation targets in individual patients, we performed a simultaneous trial of thalamic ventralis caudalis (Vc) DBS and MCS in 11 patients with chronic neuropathic pain and assessed the results of the trial stimulation and long-term analgesia. Results Of the 11 patients implanted with both DBS and MCS electrodes, nine (81.8%) had successful trials. Seven of these nine patients (77.8%) responded to MCS, and two (18.2%) responded to Vc DBS. With long-term follow-up (56 ± 27.5 months), the mean numerical rating scale decreased significantly (P < 0.05). The degree of percentage pain relief in the chronic MCS (n = 7) and chronic DBS (n = 2) groups were 34.1% ± 18.2% and 37.5%, respectively, and there was no significant difference (P = 0.807). Five out of the seven MCS patients (71%) and both DBS patients had long-term success with the treatments, defined as >30% pain relief compared with baseline. Conclusions With simultaneous trial of DBS and MCS, we could enhance the success rate of invasive trials. Considering the initial success rate and the less invasive nature of epidural MCS over DBS, we suggest that MCS may be a better, initial means of treatment in chronic intractable neuropathic pain. Further investigations including other subcortical target-associated medial pain pathways are warranted.

rTMS prediction of quality of life after long-term motor cortex stimulation

2013 ◽  
Vol 43 (5-6) ◽  
pp. 315 ◽  
Author(s):  
N. Andre-Obadia ◽  
P. Mertens ◽  
T. Lelekov-Boissard ◽  
A. Afif ◽  
M. Magnin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Motor Cortex ◽  
Motor Cortex Stimulation

scholarly journals Pre-motor versus motor cerebral cortex neuromodulation for chronic neuropathic pain

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Igor Lavrov ◽  
Timur Latypov ◽  
Elvira Mukhametova ◽  
Brian Lundstrom ◽  
Paola Sandroni ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Cerebral Cortex ◽  
Motor Cortex ◽  
Initial Assessment ◽  
Motor Cortex Stimulation ◽  
Chronic Neuropathic Pain ◽  
Long Term Effect ◽  
Stimulation Of

AbstractElectrical stimulation of the cerebral cortex (ESCC) has been used to treat intractable neuropathic pain for nearly two decades, however, no standardized approach for this technique has been developed. In order to optimize targeting and validate the effect of ESCC before placing the permanent grid, we introduced initial assessment with trial stimulation, using a temporary grid of subdural electrodes. In this retrospective study we evaluate the role of electrode location on cerebral cortex in control of neuropathic pain and the role of trial stimulation in target-optimization for ESCC. Location of the temporary grid electrodes and location of permanent electrodes were evaluated in correlation with the long-term efficacy of ESCC. The results of this study demonstrate that the long-term effect of subdural pre-motor cortex stimulation is at least the same or higher compare to effect of subdural motor or combined pre-motor and motor cortex stimulation. These results also demonstrate that the initial trial stimulation helps to optimize permanent electrode positions in relation to the optimal functional target that is critical in cases when brain shift is expected. Proposed methodology and novel results open a new direction for development of neuromodulation techniques to control chronic neuropathic pain.

Spinal Cord Stimulation in Treatment of Chronic Benign Pain: Challenges in Treatment Planning and Present Status, a 22-Year Experience

Neurosurgery ◽  
2006 ◽  
Vol 58 (3) ◽  
pp. 481-496 ◽  
Author(s):  
Krishna Kumar ◽  
Gary Hunter ◽  
Denny Demeria
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Pain Relief ◽  
Success Rate ◽  
Spinal Cord Stimulation ◽  
Pain Clinic ◽  
Axial Component

Abstract OBJECTIVE: To present an in-depth analysis of clinical predictors of outcome including age, sex, etiology of pain, type of electrodes used, duration of pain, duration of treatment, development of tolerance, employment status, activities of daily living, psychological status, and quality of life. Suggestions for treatment of low back pain with a predominant axial component are addressed. We analyzed the complications and proposed remedial measures to improve the effectiveness of this modality. METHODS: Study group consists of 410 patients (252 men, 58 women) with a mean age of 54 years and a mean follow-up period of 97.6 months. All patients were gated through a multidisciplinary pain clinic. The study was conducted over 22 years. RESULTS: The early success rate was 80% (328 patients), whereas the long-term success rate of internalized patients was 74.1% (243 patients) after the mean follow-up period of 97.6 months. Hardware-related complications included displaced or fractured electrodes, infection, and hardware malfunction. Etiologies demonstrating efficacy included failed back syndrome, peripheral vascular disease, angina pain, complex regional pain syndrome I and II, peripheral neuropathy, lower limb pain caused by multiple sclerosis. Age, sex, laterality of pain or number of surgeries before implant did not play a role in predicting outcome. The percentage of pain relief was inversely related to the time interval between pain onset and time of implantation. Radicular pain with axial component responded better to dual Pisces electrode or Specify-Lead implantation. CONCLUSION: Spinal cord stimulation can provide significant long-term pain relief with improved quality of life and employment. Results of this study will be effective in better defining prognostic factors and reducing complications leading to higher success rates with spinal cord stimulation.

EVALUATION OF SHORT AND LONG TERM BENEFITS/SIDE EFFECTS OF CEMENT AUGMENTATION IN PATIENTS WITH NON INFECTIVE PATHOLOGICAL OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURES

2020 ◽  
pp. 44-48
Author(s):  
Abhay Singh ◽  
Rahul Gupta ◽  
Shachi Shachi
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Pain Relief ◽  
Vertebral Compression Fracture ◽  
Compression Fracture ◽  
Cement Augmentation ◽  
Vertebral Compression Fractures ◽  
Hybrid Technique

BACKGROUND: Vertebral compression fracture usually occurs in old age population with osteoporosis. Due to severity of pain, quality of life becomes very poor. During the study period 67 patients fullling the eligibility cri METHODS: teria underwent vertebroplasty/ kyphoplasty/ cement augmented screw xation/ hybrid procedures were included. Short term and long term benets /side effects were evaluated in all patients. Patients were evaluated on visual analogue score and modied ranking scale. RESULTS: Vertebroplasty was performed in 26(38.8%) whereas kyphoplasty, cement augmented screw xation and hybrid procedure were performed in 18(26.8%), 17(25.4%) and 6(9.0%) respectively. Signicant pain relief occurred in all patients which were evaluated by Visual Analogue Scale. Quality of life also improved which was evaluated with Modied Rankin Scale. In our study, complications which occurred were local cement leak, hematoma formation, infection in 8 (11.9%), 3(4.5%) and 2(3.0%) patients respectively. Use of biological cement has revolutionized CONCLUSION: the management of vertebral compression fracture. Both vertebroplasty and kyphoplasty procedures which are minimal invasive, almost cure the non infective pathological fractures with instant pain relief and very low procedure related morbidity. In cases requiring xation, cement augmentation signicantly improves the purchase of the screw and makes the construct more reliable. Hybrid technique helps to prevent extensive long level xation.

Neurosurgical Choice for Glossopharyngeal Neuralgia: A Benefit–Harm Assessment of Long-Term Quality of Life

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. 131-139 ◽  
Author(s):  
Tao Du ◽  
Bing Ni ◽  
Wei Shu ◽  
Yongsheng Hu ◽  
Hongwei Zhu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pain Relief ◽  
Brief Pain Inventory ◽  
Glossopharyngeal Neuralgia ◽  
Significant Difference ◽  
Patient Database ◽  
Global Impression Of Change ◽  
Satisfaction Rates

Abstract BACKGROUND Microvascular decompression (MVD) and vagoglossopharyngeal rhizotomy (VGR) are effective treatment for glossopharyngeal neuralgia (GN). However, surgical choice is controversial due to the need to maximize pain relief and reduce complications. OBJECTIVE To retrospectively compare safety, efficacy, long-term quality of life (QOL), and global impression of change following MVD and VGR for treatment of GN. METHODS Patient database reviews and telephone surveys were conducted to assess baseline characteristics and long-term outcomes. The effects of pain and complications on QOL were assessed using Brief Pain Inventory-Facial (BPI-Facial) questionnaire. Complication tolerance and surgery satisfaction were sorted using the global impression of change survey. RESULTS Of 87 patients with GN, 63 underwent MVD alone, 20 underwent VGR alone, and 4 underwent VGR following a failed MVD. The long-term rate of pain relief was slightly, but not significantly, lower following MVD than VGR (83.6% vs 91.7%, P = .528). However, long-term complications occurred much more frequently following VGR (3.0% vs 50.0%, P &lt; .001). The BPI-Facial, which evaluates pain and complications, showed that MVD had better postoperative QOL than VGR (P &lt; .001). However, 91.7% of patients who underwent VGR experienced no or mild complications. There was no significant difference in the overall satisfaction rates between the groups (83.3% vs 83.6%, P &gt; .99). CONCLUSION Although VGR resulted in lower postoperative QOL due to a high complication rate, most of these complications were mild. The overall satisfaction rates for the 2 surgeries were similar.

Longitudinal trajectory of cancer survivorship in patients with recurrent rectal cancer: Anatomy of recurrence in relation to quality of life and pain.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 679-679
Author(s):  
Tarik Sammour ◽  
Songphol Malakorn ◽  
George J. Chang ◽  
Miguel A. Rodriguez-Bigas ◽  
Brian Bednarski ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Rectal Cancer ◽  
Cancer Survivorship ◽  
Recurrent Rectal Cancer ◽  
Pain Scores ◽  
Patient Reported ◽  
Eortc Qlq ◽  
Surgical Salvage

679 Background: Multiple treatment modalities are utilized for patients with recurrent rectal cancer (RRC). While recurrent pelvic tumor can be highly symptomatic, treatments often carry significant morbidity risks. Patient reported outcomes such as quality of life (QoL) and pain can supplement traditional clinical endpoints in assessing the effectiveness of salvage treatments, and thus aid in treatment decision making. We aimed to examine the longitudinal trajectory of cancer survivorship in RRC. Methods: A prospective protocol enrolled patients diagnosed with RRC between 2008 and 2015. Participants prospectively self-reported QoL (measured by the validated EORTC QLQ-C30 and EORTC QLQ-CR29) and pain (measured by the Brief Pain Inventory, BPI), at presentation, and then every 6 months for 5 years. After accounting for repeated measures, trajectory of mean scores over time was assessed for patients amenable to surgical salvage vs those who were not, using linear mixed-effects modeling. Results: A total of 104 patients were enrolled of which 73 (70.2%) were amenable to salvage surgery with curative intent. Surgical salvage was associated with 30 day morbidity of 68.5% (13.7% and 5.5%, Grade 3 and 4 respectively). Three year overall survival was 56.7% (68.5% in surgical and 29.0% in non-surgical patients). Mean baseline QoL scores did not differ between surgical vs nonsurgical patients but were significantly impacted by the anatomical site of recurrent disease (lowest scores in posterior pelvic recurrence; P=0.012). On longitudinal analysis with a median followup of 33 months, surgically salvaged patients showed gradual sustained improvement in QoL but not pain scores. Anatomy of initial recurrence had an ongoing impact on QoL long term with posterior recurrences having the worst scores. Both QoL and pain scores worsened in patients not amendable to surgical salvage. Conclusions: Disease anatomy determines QoL at baseline and long term in patients with RRC. Surgery improves QoL but not pain in selected resectable cases.

Long-term Outcomes of Deep Brain Stimulation for Neuropathic Pain

Neurosurgery ◽  
2012 ◽  
Vol 72 (2) ◽  
pp. 221-231 ◽  
Author(s):  
Sandra G.J. Boccard ◽  
Erlick A.C. Pereira ◽  
Liz Moir ◽  
Tipu Z. Aziz ◽  
Alexander L. Green
Keyword(s):  
Quality Of Life ◽  
Neuropathic Pain ◽  
Short Form ◽  
Case Series ◽  
Mcgill Pain Questionnaire ◽  
Euroqol 5D ◽  
Deep Brain

Abstract BACKGROUND: Deep brain stimulation (DBS) to treat neuropathic pain refractory to pharmacotherapy has reported variable outcomes and has gained United Kingdom but not USA regulatory approval. OBJECTIVE: To prospectively assess long-term efficacy of DBS for chronic neuropathic pain in a single-center case series. METHODS: Patient reported outcome measures were collated before and after surgery, using a visual analog score, short-form 36-question quality-of-life survey, McGill pain questionnaire, and EuroQol-5D questionnaires (EQ-5D and health state). RESULTS: One hundred ninety-seven patients were referred over 12 years, of whom 85 received DBS for various etiologies: 9 amputees, 7 brachial plexus injuries, 31 after stroke, 13 with spinal pathology, 15 with head and face pain, and 10 miscellaneous. Mean age at surgery was 52 years, and mean follow-up was 19.6 months. Contralateral DBS targeted the periventricular gray area (n = 33), the ventral posterior nuclei of the thalamus (n = 15), or both targets (n = 37). Almost 70% (69.4%) of patients retained implants 6 months after surgery. Thirty-nine of 59 (66%) of those implanted gained benefit and efficacy varied by etiology, improving outcomes in 89% after amputation and 70% after stroke. In this cohort, &gt;30% improvements sustained in visual analog score, McGill pain questionnaire, short-form 36-question quality-of-life survey, and EuroQol-5D questionnaire were observed in 15 patients with &gt;42 months of follow-up, with several outcome measures improving from those assessed at 1 year. CONCLUSION: DBS for pain has long-term efficacy for select etiologies. Clinical trials retaining patients in long-term follow-up are desirable to confirm findings from prospectively assessed case series.

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