Efficacy of motor cortex stimulation in the treatment of neuropathic pain: a randomized double-blind trial.
Efficacy of motor cortex stimulation in the treatment of neuropathic pain: a randomized double-blind trial.
复制标题
运动皮层刺激治疗神经性疼痛的功效：一项随机双盲试验。
作者：
F. Velasco;C. Argüelles;J. Carrillo;G. Castro;A. Velasco;Fiacro Jiménez;M. Velasco
对象
在这项研究中，作者使用双盲方案来评估运动皮质刺激(MCS)治疗神经病理性疼痛的疗效。
方法
选择11例单侧神经病理性疼痛患者(视觉模拟评分(VAS)评分8~10分)，进行MCS检查。通过以痛区对侧运动皮质为中心的开颅手术植入20触点网格。使用神经图像、体感诱发电位、急性电刺激和皮质诱发电位来识别运动皮质条。亚急性治疗刺激试验使作者能够确定用于长期MCS的最有效的一对接触。网格被一个连接到内化刺激器的4触点电极所取代。采用双极刺激，频率40-赫兹，脉冲宽度90微秒，幅度2-7V，“开”模式1小时，“关”模式4小时。疼痛评估采用VAS、Bourhim和McGill疼痛评分，每个月应用一年。在第60天或第90天，刺激器以随机、双盲的方式关闭30天。使用的统计工具是威尔科克森检验。
结果
3名患者在亚急性试验中没有报告改善，并被排除在长期MCS之外；其余患者接受了长期刺激。MCS可显著改善疼痛(p<；0.01)；这种情况在随访期内持续。将刺激切换到关闭模式会显著增加疼痛(p<；0.05)。在所有病例中，1年后的改善为>；或=40%(40-86%)。
结论
根据一项由双盲操作促成的评估，运动皮质刺激是治疗神经病理性疼痛的有效方法。建议进行亚急性刺激试验，以确定要刺激的最佳运动皮质区域，并确定无反应者。
OBJECT
In this study the authors used a double-blind protocol to assess the efficacy of motor cortex stimulation (MCS) for treating neuropathic pain.
METHODS
Eleven patients with unilateral neuropathic pain (visual analog scale [VAS] score 8-10) of different origins and topography were selected for MCS. A 20-contact grid was implanted through a craniotomy centered over the motor cortex contralateral to the painful area. The motor cortex strip was identified using neuroimages, somatosensory evoked potentials, acute electrical stimulation, and corticocortical evoked potentials. Subacute therapeutic stimulation trials allowed the authors to determine the most efficient pair of contacts to use for long-term MCS. The grid was replaced with a 4-contact electrode connected to an internalized stimulator. Bipolar stimulation at a 40-Hz frequency, 90-micro sec pulse width, amplitude 2-7 V, and 1 hour in "ON" and 4 hours in "OFF" mode was used. Pain was evaluated using the VAS, Bourhis, and McGill pain scales applied each month for 1 year. At Day 60 or 90, the stimulators were turned to OFF mode for 30 days in a randomized, double-blind fashion. The statistical tool used was the Wilcoxon test.
RESULTS
Three patients did not report improvement in the subacute trial and were excluded from long-term MCS; the remaining patients underwent long-term stimulation. Significant improvement of pain was induced by MCS (p < 0.01); this persisted during the follow-up period. Turning stimulation to OFF mode increased pain significantly (p < 0.05). Improvement at 1 year was >or= 40% (40-86%) in all cases.
CONCLUSIONS
Motor cortex stimulation is an efficient treatment for neuropathic pain, according to an evaluation facilitated by a double-blind maneuver. Subacute stimulation trials are recommended to determine the optimum motor cortex area to be stimulated and to identify nonresponders.