Differential Efficacy of Electric Motor Cortex Stimulation and Lesioning of the Dorsal Root Entry Zone for Continuous vs Paroxysmal Pain After Brachial Plexus Avulsion
Differential Efficacy of Electric Motor Cortex Stimulation and Lesioning of the Dorsal Root Entry Zone for Continuous vs Paroxysmal Pain After Brachial Plexus Avulsion
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DOI：
10.1227/neu.0b013e31820c04a9
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发表时间：
2011-05-01
期刊：
影响因子：
4.8
通讯作者：
Yoshimine, Toshiki
中科院分区：
文献类型：
--
作者：
Ali, Mohamed;Saitoh, Youichi;Yoshimine, Toshiki
背景：创伤性臂丛神经撕脱伤 (BPA) 后的疼痛有两种不同的模式：持续烧灼痛和阵发性射击痛。背根进入区损伤（DREZotomy）对于阵发性疼痛比持续性疼痛更有效。然而，目前尚不清楚电动运动皮层刺激 (EMCS) 对持续性与阵发性 BPA 疼痛是否具有不同作用。 目的：分析 EMCS 和 DREZotomy 对 15 名患者的连续性与阵发性 BPA 疼痛的不同作用。 方法：15 名顽固性 BPA 疼痛患者单独接受 DREZotomy（n = 7）、单独 EMCS (n = 4)，或两个过程 (n = 4)。使用视觉模拟量表评估疼痛强度，并记录阵发性疼痛和持续性疼痛的单独评级。疼痛缓解分为极好（> 75% 疼痛缓解）、良好（50%-75%）或差（< 50%）。良好的结果被定义为良好或更好的疼痛缓解。 结果：8 名患者患有 EMCS； 7 例平均随访 47 个月。在这 7 名患者中，与没有阵发性疼痛的患者相比，3 名（42%）持续疼痛的患者具有良好的结果。 11 名患者接受了 DREZotomy； 10 名患者接受平均 31 个月的随访。在这 10 名患者中，7 名阵发性疼痛患者 (70%) 取得了良好的治疗效果，而 2 名患者 (20%) 患有持续性疼痛。 结论：EMCS 对阵发性疼痛无效，但对持续性疼痛有一定效果。 DREZotomy 对阵发性疼痛非常有效，但对持续性疼痛效果中等。对于 DREZotomy 术后残留的持续疼痛，使用 EMCS 可能是谨慎的做法。
BACKGROUND: Pain after traumatic brachial plexus avulsion (BPA) has 2 distinct patterns: continuous burning pain and paroxysmal shooting pain. Lesioning of the dorsal root entry zone (DREZotomy) is more effective for paroxysmal than continuous pain. It is unknown, however, whether electric motor cortex stimulation (EMCS) has a differential effect on continuous vs paroxysmal BPA pain.OBJECTIVE: To analyze the differential effect of EMCS and DREZotomy on continuous vs paroxysmal BPA pain in a series of 15 patients.METHODS: Fifteen patients with intractable BPA pain underwent DREZotomy alone (n = 7), EMCS alone (n = 4), or both procedures (n = 4). Pain intensity was evaluated with the Visual Analog Scale, and separate ratings were recorded for paroxysmal and continuous pain. Pain relief was categorized as excellent (> 75% pain relief), good (50%-75%), or poor (< 50%). Favorable outcome was defined as good or better pain relief.RESULTS: Eight patients had EMCS; 7 were followed up for an average of 47 months. Of those 7 patients, 3 (42%) with continuous pain had favorable outcomes compared with no patients with paroxysmal pain. Eleven patients had DREZotomy; 10 were followed up for an average of 31 months. Of those 10 patients, 7 (70%) with paroxysmal pain had favorable outcomes compared with 2 (20%) with continuous pain.CONCLUSION: EMCS was ineffective for paroxysmal pain but moderately effective for continuous pain. DREZotomy was highly effective for paroxysmal pain but moderately effective for continuous pain. It may be prudent to use EMCS for residual continuous pain after DREZotomy.