17. Motor Cortex Stimulation in Refractory Pain

  1. Sam Eljamel3 and
  2. Konstantin V. Slavin4
  1. Giovanni Broggi,
  2. Giuseppe Messina,
  3. Roberto Cordella and
  4. Angelo Franzini

Published Online: 19 JUL 2013

DOI: 10.1002/9781118346396.ch17

Neurostimulation: Principles and Practice

Neurostimulation: Principles and Practice

How to Cite

Broggi, G., Messina, G., Cordella, R. and Franzini, A. (2013) Motor Cortex Stimulation in Refractory Pain, in Neurostimulation: Principles and Practice (eds S. Eljamel and K. V. Slavin), John Wiley & Sons, Ltd, Oxford, UK. doi: 10.1002/9781118346396.ch17

Editor Information

  1. 3

    Centre for Neurosciences, Ninewells Hospital & Medical School, Dundee, Scotland, UK

  2. 4

    Department of Neurosurgery, University of Illinois at Chicago. Chicago, Illinois, USA

Author Information

  1. Fondazione Instituto Neurologico “Carlo Besta”, Milan, Italy

Publication History

  1. Published Online: 19 JUL 2013
  2. Published Print: 19 AUG 2013

ISBN Information

Print ISBN: 9781118346358

Online ISBN: 9781118346396

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Keywords:

  • epilepsy;
  • functional magnetic resonance imaging (fMRI);
  • motor cortex stimulation;
  • neurostimulation;
  • refractory pain;
  • surgical procedure

Summary

The connection between the motor cortex and pain circuits was suggested for the first time by Penfield, who observed some sensitive responses after stimulation of the motor cortex in a patient who had previously been submitted to removal of the postcentral cortex for treatment of epilepsy. The indications for motor cortex stimulation (MCS) have expanded recently, and include drug refractory pain due to cerebral stroke, peripheral nerve injury pain, neuropathic facial pain, phantom limb pain, pain related to spinal cord injuries, and postherpetic neuralgia; several series report positive results in patients affected by these conditions. The surgical procedure can be performed after localization of the precentral cortex based on neuroradiological anatomy, intraoperative somatosensory evoked potentials (SSEP), intraoperative stimulation, and, as stated previously, with the implementation of functional magnetic resonance imaging (fMRI) in the neuronavigation system.