Article
The impact of burst motor cortex stimulation on poststroke pain – a literature overview and single-centre experience
Burst Motorkortexstimulation zur Behandlung von Schlaganfall-assozierten Schmerzsyndromen
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Authors
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Martin Nüssel
- Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Neurosurgery, Erlangen, Deutschland
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Andreas Stadlbauer
- Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Neurosurgery, Erlangen, Deutschland
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Michael Buchfelder
- Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Neurosurgery, Erlangen, Deutschland
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Thomas Kinfe
- Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Neurosurgery, Division Functional Neurosurgery and Stereotaxy, Erlangen, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: A considerable percentage of patients with poststroke develop refractory pain with unfavorable responses to established conservative therapy. Brain stimulation, both non-invasive (transcranial magnetic stimulation, transcranial direct current stimulation, transcranial alternating stimulation, transcutaneous vagus nerve stimulation, minimally invasive motor cortex stimulation and invasive deep brain stimulation, has been reported to yield response rates ranging from 25% to 45%. Epidural MCS appears to be superior to DBS of the thalamus or brainstem, and it is used more frequently because of its easier and less invasive application and its wider range of indications.
Methods: We performed a review of human studies applying burst and conventional motor cortex stimulation (burstMCS and cMCS, respectively) on the basis of data sources identified through searches of PubMed, MEDLINE/OVID, and SCOPUS. Our aim was to review and discuss clinical data on the indications of burst MCS for various chronic pain states originating from central stroke (excluding trigeminal facial pain). In addition, we evaluated the efficacy and safety of burst versus cMCS for central poststroke pain with an extended follow-up of 5 years in a 60-year old male.
Results: Observational human cohort studies and one RCT using cMCS waveforms have revealed a meaningful clinical response; however, these studies lacked placebo groups and extended observation periods. In our case report, we found that 3 months of adjunctive cMCS reduced pain levels (visual analog scale (VAS) pre: 9/10 versus VAS post 7/10), whereas the pain decreased further under burst MCS (VAS pre: 7/10 versus VAS post: 2/10); the study involved a follow-up of 5 years and the following parameters: burst rate 40 Hz (500 Hz), 1–1,75 mA, 1 msec, bipolar configuration.
Conclusion: BurstMCS resulted in significantly decreased post-stroke pain observed after 5 years of cMCS. The available literature suggests similar efficacy to that of conventional (tonic) motor cortex stimulation, although the results are preliminary. Mechanistically, the precise mechanism of action is not fully understood. However, burstMCS may interact with the nociceptive thalamic-cingulate and descending spinal pain networks. To determine the potential utility of this treatment, large-scale sham-controlled trials comparing cMCS and burstMCS are recommended.
