Effectiveness of tonic and burst motor cortex stimulation in chronic neuropathic pain

Paweł Sokal,1 Marek Harat,2 Agnieszka Malukiewicz,1 Michał Kiec,3 Milena Świtońska,1 Renata Jabłońska11Department of Neurosurgery and Neurology, Jan Biziel University Hospital nr 2, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland; 2Division of Preventive Medicine...

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Main Authors: Sokal P, Harat M, Malukiewicz A, Kiec M, Świtońska M, Jabłońska R
Format: Article
Language:English
Published: Dove Medical Press 2019-06-01
Series:Journal of Pain Research
Subjects:
Online Access:https://www.dovepress.com/effectiveness-of-tonic-and-burst-motor-cortex-stimulation-in-chronic-n-peer-reviewed-article-JPR
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spelling doaj-14d7b58051ea4914badec0629fb9f2d82020-11-25T02:44:10ZengDove Medical PressJournal of Pain Research1178-70902019-06-01Volume 121863186946390Effectiveness of tonic and burst motor cortex stimulation in chronic neuropathic painSokal PHarat MMalukiewicz AKiec MŚwitońska MJabłońska RPaweł Sokal,1 Marek Harat,2 Agnieszka Malukiewicz,1 Michał Kiec,3 Milena Świtońska,1 Renata Jabłońska11Department of Neurosurgery and Neurology, Jan Biziel University Hospital nr 2, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland; 2Division of Preventive Medicine and Healthy Policy, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland; 3Department of Neurosurgery, The 10th Military Clinical Hospital, Bydgoszcz, PolandBackground: Motor cortex stimulation (MCS) is an intracranial, invasive method for treatment of chronic pain. Main indications for MCS are central post stroke pain, neuropathic facial pain, phantom limb pain and brachial plexus or spinal cord injury pain. Spinal cord stimulation (SCS) with burst waveform has been proved to be more effective than tonic mode in chronic pain. Necessity to replace depleted batteries of motor cortex tonic stimulators gave us an opportunity of applying burst stimulation. The objective of the pilot study was to evaluate the effects of burst stimulation applied on motor cortex in patients with chronic pain syndromes as well as comparison to tonic mode.Materials and methods: We have evaluated 6 patients (females N=3, males N=3) belonging to the group of 14 cases (females N=5, males N=9) who had undergone surgical procedure of MCS in years 2005–2017. Selected for the study were 6 patients with thalamic pain N=3, with facial pain N=3 (anaesthesia dolorosa and neuropathic trigeminal neuralgia). The patients were subjected to both modes of stimulation then they chose which one was better in relieving pain: tonic or burst. Pain intensity was assessed with the visual analogue scale (VAS) before the replacement of implanted pulse generator (IPG) and after the stimulation with tonic and burst modes.Results: In the study, 5 out of 6 patients with MCS found burst mode more effective than tonic mode. Baseline VAS score in patients that had at least 3 months depleted battery of tonic IPG was 95 mm. After implantation of a new IPG mean VAS score on tonic stimulation was 72 mm, on burst 53 mm.Conclusions: The most preferred option of MCS in selected group of patients was burst stimulation. This study has shown, that the burst stimulation of cerebral cortex is a promising modality when tonic stimulation is not sufficient in refractory, neuropathic pain.Keywords: motor cortex stimulation, burst stimulation, neuropathic painhttps://www.dovepress.com/effectiveness-of-tonic-and-burst-motor-cortex-stimulation-in-chronic-n-peer-reviewed-article-JPRmotor cortex stimulationburst stimulationneuropathic pain
collection DOAJ
language English
format Article
sources DOAJ
author Sokal P
Harat M
Malukiewicz A
Kiec M
Świtońska M
Jabłońska R
spellingShingle Sokal P
Harat M
Malukiewicz A
Kiec M
Świtońska M
Jabłońska R
Effectiveness of tonic and burst motor cortex stimulation in chronic neuropathic pain
Journal of Pain Research
motor cortex stimulation
burst stimulation
neuropathic pain
author_facet Sokal P
Harat M
Malukiewicz A
Kiec M
Świtońska M
Jabłońska R
author_sort Sokal P
title Effectiveness of tonic and burst motor cortex stimulation in chronic neuropathic pain
title_short Effectiveness of tonic and burst motor cortex stimulation in chronic neuropathic pain
title_full Effectiveness of tonic and burst motor cortex stimulation in chronic neuropathic pain
title_fullStr Effectiveness of tonic and burst motor cortex stimulation in chronic neuropathic pain
title_full_unstemmed Effectiveness of tonic and burst motor cortex stimulation in chronic neuropathic pain
title_sort effectiveness of tonic and burst motor cortex stimulation in chronic neuropathic pain
publisher Dove Medical Press
series Journal of Pain Research
issn 1178-7090
publishDate 2019-06-01
description Paweł Sokal,1 Marek Harat,2 Agnieszka Malukiewicz,1 Michał Kiec,3 Milena Świtońska,1 Renata Jabłońska11Department of Neurosurgery and Neurology, Jan Biziel University Hospital nr 2, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland; 2Division of Preventive Medicine and Healthy Policy, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland; 3Department of Neurosurgery, The 10th Military Clinical Hospital, Bydgoszcz, PolandBackground: Motor cortex stimulation (MCS) is an intracranial, invasive method for treatment of chronic pain. Main indications for MCS are central post stroke pain, neuropathic facial pain, phantom limb pain and brachial plexus or spinal cord injury pain. Spinal cord stimulation (SCS) with burst waveform has been proved to be more effective than tonic mode in chronic pain. Necessity to replace depleted batteries of motor cortex tonic stimulators gave us an opportunity of applying burst stimulation. The objective of the pilot study was to evaluate the effects of burst stimulation applied on motor cortex in patients with chronic pain syndromes as well as comparison to tonic mode.Materials and methods: We have evaluated 6 patients (females N=3, males N=3) belonging to the group of 14 cases (females N=5, males N=9) who had undergone surgical procedure of MCS in years 2005–2017. Selected for the study were 6 patients with thalamic pain N=3, with facial pain N=3 (anaesthesia dolorosa and neuropathic trigeminal neuralgia). The patients were subjected to both modes of stimulation then they chose which one was better in relieving pain: tonic or burst. Pain intensity was assessed with the visual analogue scale (VAS) before the replacement of implanted pulse generator (IPG) and after the stimulation with tonic and burst modes.Results: In the study, 5 out of 6 patients with MCS found burst mode more effective than tonic mode. Baseline VAS score in patients that had at least 3 months depleted battery of tonic IPG was 95 mm. After implantation of a new IPG mean VAS score on tonic stimulation was 72 mm, on burst 53 mm.Conclusions: The most preferred option of MCS in selected group of patients was burst stimulation. This study has shown, that the burst stimulation of cerebral cortex is a promising modality when tonic stimulation is not sufficient in refractory, neuropathic pain.Keywords: motor cortex stimulation, burst stimulation, neuropathic pain
topic motor cortex stimulation
burst stimulation
neuropathic pain
url https://www.dovepress.com/effectiveness-of-tonic-and-burst-motor-cortex-stimulation-in-chronic-n-peer-reviewed-article-JPR
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