Burst Motor Cortex Stimulation Evokes Sustained Suppression of Thalamic Stroke Pain: A Narrative Review and Single-Case
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REVIEW
Burst Motor Cortex Stimulation Evokes Sustained Suppression of Thalamic Stroke Pain: A Narrative Review and Single-Case Overview ¨ ssel . Melanie Hamperl . Anna Maslarova . Shafqat R. Chaudhry . Martin Nu ¨ hn . Andreas Stadlbauer . Michael Buchfelder . Julia Ko Thomas Kinfe
Received: October 16, 2020 / Accepted: November 16, 2020 Ó The Author(s) 2020
ABSTRACT Chronic refractory central post-stroke pain (CPSP), one of the most disabling consequences of cerebral stroke, occurs in up to 10% of patients with CPSP. Because a considerable proportion of these patients with chronic pain Supplementary Information The online version of this article (https://doi.org/10.1007/s40122-020-002210) contains supplementary material, which is available to authorized users. ¨ ssel M. Hamperl A. Maslarova M. Nu M. Buchfelder Department of Neurosurgery, Friedrich-Alexander ¨ rnberg, Erlangen, University (FAU) Erlangen-Nu Germany S. R. Chaudhry College of Pharmaceutical Sciences, Shifa Tameer-EMillat University, Islamabad, Pakistan ¨ hn J. Ko Department of Neurology, Friedrich-Alexander ¨ rnberg, Erlangen, University (FAU) Erlangen-Nu Germany A. Stadlbauer Institute of Medical Radiology, University Clinic St. ¨ lten, Karl Landsteiner University of Health Po ¨ lten, Austria Sciences, St. Po T. Kinfe (&) Division of Functional Neurosurgery and Stereotaxy, Friedrich-Alexander University (FAU) ¨ rnberg, Erlangen, Germany Erlangen-Nu e-mail: [email protected]; [email protected]
remain resistant to pharmacological and behavioral therapies, adjunctive invasive and non-invasive brain stimulation therapies are needed. We performed a review of human studies applying burst and conventional motor cortex stimulation (burstMCS and cMCS, respectively) for chronic pain states, on the basis of data sources identified through searches of PubMed, MEDLINE/OVID, and SCOPUS, as well as manual searches of the bibliographies of known primary and review articles. Our aim was to review and discuss clinical data on the indications of burstMCS for various chronic pain states originating from central stroke (excluding trigeminal facial pain). In addition, we assessed the efficacy and safety of burst versus cMCS for central post-stroke pain with an extended follow-up of 5 years in a 60-year-old man. According to our review, uncontrolled 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 burstMCS (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 ms, bipolar configuration. To date, only limited evidence exists for the efficacy and safety of burst motor cortex stimulation for the
Pain Ther
treatment of refra
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