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Stimulation of primary motor cortex for intractable deafferentation pain

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Advances in Functional and Reparative Neurosurgery

Part of the book series: Acta Neurochirurgica Supplementum ((NEUROCHIRURGICA,volume 99))

Summary

To treat intractable deafferentation pains, we prefer stimulation of the primary motor cortex (M1). The methods of stimulation we utilize are electrical stimulation and repetitive transcranial magnetic stimulation (rTMS). In our department, we first attempt rTMS, and if this rTMS is effective, we recommend the patient to undergo procedures for motor cortex stimulation (MCS). A 90% intensity of resting motor threshold setting is used for rTMS treatment. In this study ten trains of 5Hz rTMS for 10 seconds (50 seconds resting interval) were applied to the M1, S1, pre-motor and supplementary motor areas. Only M1 stimulation was effective for pain reduction in 10 of 20 patients (50%). Twenty-nine MCS procedures were performed by subdural implantation of electrodes, and in the case of hand or face pain, electrodes were implanted within the central sulcus (11 cases), because the main part of M1 is located in the central sulcus in humans. The success rate of MCS was around 63%, and seemed to be higher in cases of pain with spinal cord and peripheral origins, while it was lower in cases of post-stroke pain.

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References

  1. Boroojerdi B, Foltys H, Krings T, Spetzger U, Thron A, Topper R (1999) Localization of the motor hand area using transcranial magnetic stimulation and functional magnetic resonance imaging. Clin Neurophysiol 110: 699–704

    Article  PubMed  CAS  Google Scholar 

  2. Coghill RC, Sang CN, Maisog JM, Iadarola MJ (1999) Pain intensity processing within the human brain: a bilateral distributed mechanism. J Neurophysiol 82: 1934–1943

    PubMed  CAS  Google Scholar 

  3. Garcia-Larrea L, Peyron R, Mertens P, Gregoire MC, Lavenne F, Le Bars D, Convers P, Mauguiere F, Sindou M, Laurent B (1999) Electrical stimulation of motor cortex for pain control: a combined PET-scan and electrophysiological study. Pain 83: 259–273

    Article  PubMed  CAS  Google Scholar 

  4. Herwig U, Schonfeldt-Lecuona C, Wunderlich AP, von Tiesenhausen C, Thielscher A, Walter H, Spitzer M (2001) The navigation of transcranial magnetic stimulation. Psychiatry Res 108: 123–131

    PubMed  CAS  Google Scholar 

  5. Katayama Y, Yamamoto T, Kobayashi K, Kasai M, Oshima H, Fukaya C (2001) Motor cortex stimulation for post-stroke pain: comparison of spinal cord and thalamic stimulation. Stereotact Funct Neurosurg 77: 183–186

    Article  PubMed  CAS  Google Scholar 

  6. Katayama Y, Yamamoto T, Kobayashi K, Oshima H, Fukaya C (2003) Deep brain and motor cortex stimulation for post-stroke movement disorders and post-stroke pain. Acta Neurochir [Suppl] 87: 121–123

    CAS  Google Scholar 

  7. Kimbrell TA, Little JT, Dunn RT, Frye MA, Greenberg BD, Wassermann EM, Repella JD, Danielson AL, Willis MW, Benson BE, Speer AM, Osuch E, George MS, Post RM (1999) Frequency dependence of antidepressant response to left prefrontal repetitive transcranial magnetic stimulation (rTMS) as a function of baseline cerebral glucose metabolism. Biol Psychiatry 46: 1603–1613

    Article  PubMed  CAS  Google Scholar 

  8. Lefaucheur JP, Drouot X, Menard-Lefaucheur I, Zerah F, Bendib B, Cesaro P, Keravel Y, Nguyen JP (2004) Neurogenic pain relief by repetitive transcranial magnetic cortical stimulation depends on the origin and the site of pain. J Neurol Neurosurg Psychiatry 75: 612–616

    Article  PubMed  Google Scholar 

  9. Meyerson BA, Lindblom U, Linderoth B, Lind G, Herregodts P (1993) Motor cortex stimulation as treatment of trigeminal neuropathic pain. Acta Neurochir [Suppl] 58: 150–153

    CAS  Google Scholar 

  10. Neggers SF, Langerak TR, Schutter DJ, Mandl RC, Ramsey NF, Lemmens PJ, Postma A (2004) A stereotactic method for imageguided transcranial magnetic stimulation validated with fMRI and motor-evoked potentials. Neuroimage 21: 1805–1817

    Article  PubMed  CAS  Google Scholar 

  11. Nguyen JP, Keravel Y, Feve A, Uchiyama T, Cesaro P, Le Guerinel C, Pollin B (1997) Treatment of deafferentation pain by chronic stimulation of the motor cortex: report of a series of 20 cases. Acta Neurochir [Suppl] 68: 54–60

    CAS  Google Scholar 

  12. Peyron R, Laurent B, Garcia-Larrea (2000) Functional imaging of brain responses to pain. A review and meta-analysis. Neurophysiol Clin 30: 263–288

    Article  PubMed  CAS  Google Scholar 

  13. Pleger B, Janssen F, Schwenkreis P, Volker B, Maier C, Tegenthoff M (2004) Repetitive transcranial magnetic stimulation of the motor cortex attenuates pain perception in complex regional pain syndrome type I. Neurosci Lett 356: 87–90

    Article  PubMed  CAS  Google Scholar 

  14. Rainov NG, Heidecke V (2003) Motor cortex stimulation for neuropathic facial pain. Neurol Res 25: 157–161

    Article  PubMed  Google Scholar 

  15. Saitoh Y, Shibata M, Hirano S, Hirata M, Mashimo T, Kato A, Yoshimine T (2000) Motor cortex stimulation for central and peripheral deafferentation pain. J Neurosurg 92: 150–155

    PubMed  CAS  Google Scholar 

  16. Saitoh Y, Kato A, Ninomiya H, Baba T, Shibata M, Mashimo T, Yoshimine T (2003) Primary motor cortex stimulation within the central sulcus for treating deafferentation pain. Acta Neurochir [Suppl] 87: 149–152

    CAS  Google Scholar 

  17. Saitoh Y, Osaki Y, Nishimura H, Hirano S, Kato A, Hashikawa K, Hatazawa J, Yoshimine T (2004) Increased regional cerebral blood flow in the contralateral thalamus after successful motor cortex stimulation in a patient with poststroke pain. J Neurosurg 100: 935–939

    Article  PubMed  Google Scholar 

  18. Siebner HR, Filipovic SR, Rowe JB, Cordivari C, Gerschlager W, Rothwell JC, Frackowiak RS, Bhatia KP (2003) Patients with focal arm dystonia have increased sensitivity to slow-frequency repetitive TMS of the dorsal premotor cortex. Brain 126: 2710–2725

    Article  PubMed  Google Scholar 

  19. Tamura Y, Okabe S, Ohnishi T, N Saito D, Arai N, Mochio S, Inoue K, Ugawa Y (2004) Effects of 1-Hz repetitive transcranial magnetic stimulation on acute pain induced by capsaicin. Pain 107(1–2): 107–115

    Article  PubMed  Google Scholar 

  20. Wassermann EM (1998) Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5–7, 1996. Electroenceph Clin Neurophysiol 108: 1–16

    Article  PubMed  CAS  Google Scholar 

  21. Wassermann EM, Lisanby SH (2001) Therapeutic application of repetitive transcranial magnetic stimulation: a review. Clin Neurophysiol 112: 1367–1377

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Osaka University Graduate School, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan

    Y. Saitoh, A. Hirayama, H. Kishima, S. Oshino, M. Hirata, A. Kato & T. Yoshimine

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  1. Y. Saitoh
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  2. A. Hirayama
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  3. H. Kishima
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  4. S. Oshino
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  5. M. Hirata
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  6. A. Kato
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  7. T. Yoshimine
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Corresponding author

Correspondence to Y. Saitoh .

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Editors and Affiliations

  1. Yonsei University College of Medicine, Seoul, Korea

    Jin Woo Chang

  2. Nihon University, Tokyo, Japan

    Yoichi Katayama  & Takamitsu Yamamoto  & 

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© 2006 Springer-Verlag

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Saitoh, Y. et al. (2006). Stimulation of primary motor cortex for intractable deafferentation pain. In: Chang, J.W., Katayama, Y., Yamamoto, T. (eds) Advances in Functional and Reparative Neurosurgery. Acta Neurochirurgica Supplementum, vol 99. Springer, Vienna. https://doi.org/10.1007/978-3-211-35205-2_11

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  • DOI: https://doi.org/10.1007/978-3-211-35205-2_11

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-35204-5

  • Online ISBN: 978-3-211-35205-2

  • eBook Packages: MedicineMedicine (R0)

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