Bilateral cortical stimulation for deafferentation pain after spinal cord injury

Case report

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✓ The relief of intractable pain after spinal cord injury (SCI) is very difficult to obtain, even with dorsal root entry zone lesioning, spinal cord stimulation, and thalamic stimulation. Using bilateral motor cortex stimulation (MCS) the authors successfully treated a woman who experienced deafferentation pain 4 years after sustaining an SCI. To the authors' knowledge, this is the first report of bilateral MCS for pain relief after SCI. The success they achieved using this method indicates that MCS could be a new treatment option for deafferentation pain following SCI.

Article Information

Address reprint requests to: Youichi Saitoh, M.D., Ph.D., Department of Neurosurgery, Osaka University Graduate School of Medicine, 2–2 Yamadaoka, Suita, Osaka 565–0871, Japan. email: neurosaitoh@mbk.nifty.com.

© AANS, except where prohibited by US copyright law.

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Figures

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    A T2-weighted magnetic resonance image demonstrating a high-intensity area in the cervical spinal cord at the C5–6 level.

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    Drawing of a 20-electrode grid (4 × 5 array with a 0.3-cm electrode diameter and a 0.7-cm separation), which was placed on the cerebral surface of the motor and sensory areas corresponding to the left hand. A Resume stimulating electrode was placed on the right primary motor cortex within the central sulcus. After a period of stimulation testing, we found an optimal stimulation site to reduce the left upper-limb pain in the central sulcus. The large arrow indicates the optimal site at which pain was reduced more than 60%; the other arrows indicate slightly less effective sites of stimulation.

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    Plain x-ray films revealing quadripolar electrodes in the right central sulcus and left interhemispheric fissure.

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