Efficacy and safety of motor cortex stimulation for chronic neuropathic pain: critical review of the literature
Efficacy and safety of motor cortex stimulation for chronic neuropathic pain: critical review of the literature
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DOI：
10.3171/2008.6.17602
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发表时间：
2009-02-01
影响因子：
4.1
通讯作者：
Lozano, Andres
中科院分区：
文献类型：
--
作者：
Fontaine, Denys;Hamani, Clement;Lozano, Andres
目的。作者系统地回顾了已发表的文献，以评估运动皮层刺激（MCS）治疗慢性神经病理性疼痛的疗效和不良反应。使用关键词“运动皮层”、“刺激”和“疼痛”对 PubMed 数据库（1991-2006）进行搜索，得到了 244 篇文章。仅选择原创、不重复的文章进行进一步分析；确定了 14 项研究进行严格审查。所有病例都是系列病例，没有一个得到控制。对 210 名患者的结果进行了评估，并表示为通过手术得到改善的患者百分比。结果。在接受手术的 55% 的患者中观察到对 MCS 的良好反应（疼痛缓解 >= 40-50%），在 152 名术后随访 >= 1 年的患者中，有 45% 的患者观察到这种反应良好。对 76 名患者提供了视觉模拟量表评分，显示 41 名有反应者的平均改善为 57%。 117 名中枢性疼痛患者中 54% 获得良好缓解，44 名三叉神经性疼痛患者中 68% 获得良好缓解。包括 157 名患者在内的 10 项研究报告了不良反应。感染（5.7%）和硬件相关问题（5.1%）是相对常见的并发症。术后早期有 19 名患者（12%）发生癫痫发作，但没有报道慢性癫痫。结论。作者查阅文献的结果表明，MCS 治疗慢性神经病理性疼痛是安全有效的。然而，必须谨慎考虑结果，因为没有一项试验是盲法或对照的。必须进行更好设计的研究来确认 MCS 对慢性神经性疼痛的疗效。 （DOI：10.3171/2008.6.17602）
Object. The authors systematically reviewed the published literature to evaluate the efficacy of and adverse effects after motor cortex stimulation (MCS) for chronic neuropathic pain.Methods. A search of the PubMed database (1991-2006) using the key words "motor cortex," "stimulation," and "pain" yielded 244 articles. Only original nonduplicated articles were selected for further analysis; 14 studies were identified for critical review. All were series of cases and none was controlled. The outcomes in 210 patients were assessed and expressed as the percentage of patients that improved with the procedure.Results. A good response to MCS (pain relief >= 40-50%) was observed in similar to 55% of patients who underwent surgery and in 45% of the 152 patients with a postoperative follow-up >= 1 year. Visual analog scale scores were provided in 76 patients, revealing an average 57% improvement in the 41 responders. A good response was achieved in 54% of the 117 patients with central pain and 68% of the 44 patients with trigeminal neuropathic pain. Adverse effects were reported in 10 studies, including 157 patients. Infections (5.7%) and hardware-related problems (5.1%) were relatively common complications. Seizures occurred in 19 patients (12%) in the early postoperative period, but no chronic epilepsy was reported.Conclusions. The results of the authors' review of the literature suggest that MCS is safe and effective in the treatment of chronic neuropathic pain. Results must be considered with caution, however, as none of the trials were blinded or controlled. Studies with a better design are mandatory to confirm the efficacy of MCS for chronic neuropathic pain. (DOI: 10.3171/2008.6.17602)