Chronic motor cortex stimulation in patients with thalamic pain

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✓ Analysis of the authors' experience over the last 10 years has indicated that excellent pain control has rarely been obtained by thalamic relay nucleus stimulation in patients with thalamic pain. In the present study, 11 patients with thalamic pain were treated by chronic stimulation of the precentral gyrus. In eight patients (73%), the stimulation system was internalized since excellent pain control was achieved during a 1-week test period of precentral gyrus stimulation. In contrast, no clear effect was noted or the original pain was even exacerbated by postcentral gyrus stimulation. The effect of precentral stimulation was unchanged in five patients (45%) for follow-up periods of more than 2 years. In the remaining three patients, the effect decreased gradually over several months. This outcome was significantly better than that obtained in an earlier series tested by the authors with thalamic relay nucleus stimulation (p < 0.05). The pain inhibition usually occurred at intensities below the threshold for production of muscle contraction (pulse duration 0.1 to 0.5 msec, intensity 3 to 8 V). When good pain inhibition was achieved, the patients reported a slight tingling or mild vibration sensation during stimulation projected in the same area of distribution as their pain.

The authors discuss the possibility that, in deafferentation pain, sensory neurons below the level of deafferentation cannot exert their normal inhibitory influences toward deafferented nociceptive neurons because of the development of aberrant connections. Thus, while stimulation of the first- to third-order sensory neurons at the level of the thalamic relay nucleus or below cannot bring about good pain inhibition in patients with thalamic pain, activation of hypothetical fourth-order sensory neurons through precentral stimulation may be able to inhibit deafferented nociceptive neurons within the cortex. None of the patients developed either observable or electroencephalographic seizure activity.

Article Information

Address reprint requests to: Takashi Tsubokawa, M.D., D.Sc, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo 173, Japan.

© AANS, except where prohibited by US copyright law.

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Figures

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    Radiographs showing placement of the electrode array for precentral stimulation. A: Contractions of the lower-extremity muscles were induced by precentral stimulation at the medial edge of the hemisphere with relatively higher intensity. B: Stimulation of the cortical convexity induced contractions of the upper-extremity muscles.

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    Schematic representations of the hypothesis for changes in pain inhibitory mechanisms in patients with deafferentation pain. Left to Right: Normal physiology; lesions within the peripheral nerves; lesions within the spinal cord; and lesions at the level of the thalamus. Normally, inhibitory mechanisms driven by non-noxious information exist within the spinal cord, thalamus, and cortex. Stimulation of the peripheral nerves and dorsal column (DC) is effective for relieving pain. In deafferentation pain, the inhibitory mechanism (black arrows) is lost at the level of deafferentation and it is probable that non-noxious information even facilitates the activity of nociceptive neurons (white arrows). Effective stimulation sites (horizontal arrows) are therefore located only above the level of deafferentation. According to this hypothesis, thalamic relay nucleus stimulation is not appropriate for thalamic pain (right). DRG = dorsal root ganglion; ML = medial lemniscus; IC = internal capsule.

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    Schematic representations of the hypothesis for the pain-inhibitory mechanisms of precentral stimulation in patients with thalamic pain (right) compared with the normal physiology (left). Normally, an inhibitory mechanism (black arrow) driven by non-noxious information exists at the cortical level. In patients with thalamic pain, the inhibitory mechanism is lost at the cortical level and it is probable that non-noxious information even facilitates the activity of nociceptive neurons (white arrows). Thalamic relay nucleus stimulation is therefore inappropriate. Postcentral gyrus stimulation is also not appropriate because the sensory cortex (SCX) is the level of deafferentation. Precentral stimulation activates non-nociceptive neurons within the sensory cortex orthodromically or antidromically, which may inhibit (black arrow) hyperactive nociceptive neurons in the sensory cortex. This schema represents only antidromic activation of neurons within the sensory cortex. MCX = motor cortex.

References

  • 1.

    Adams JEHosobuchi YFields HL: Stimulation of internal capsule for relief of chronic pain. J Neurosurg 41:7407441974Adams JE Hosobuchi Y Fields HL: Stimulation of internal capsule for relief of chronic pain. J Neurosurg 41:740–744 1974

    • Search Google Scholar
    • Export Citation
  • 2.

    Amassian VECracco RQ: Human cerebral cortical responses to contralateral transcranial stimulation. Neurosurgery 20:1481551987Amassian VE Cracco RQ: Human cerebral cortical responses to contralateral transcranial stimulation. Neurosurgery 20:148–155 1987

    • Search Google Scholar
    • Export Citation
  • 3.

    Amassian VESomasudaram MRothwell JCet al: Paraesthesias are elicited by single pulse, magnetic coil stimulation of motor cortex in susceptible humans. Brain 114:250525201991Amassian VE Somasudaram M Rothwell JC et al: Paraesthesias are elicited by single pulse magnetic coil stimulation of motor cortex in susceptible humans. Brain 114:2505–2520 1991

    • Search Google Scholar
    • Export Citation
  • 4.

    Asanuma H: Functional role of sensory inputs to the motor cortex. Prog Neurobiol 16:2412621981Asanuma H: Functional role of sensory inputs to the motor cortex. Prog Neurobiol 16:241–262 1981

    • Search Google Scholar
    • Export Citation
  • 5.

    de Gutiérrez-Mahoney CG: The treatment of painful phantom limb by removal of post-central cortex. J Neurosurg 1:1561621944de Gutiérrez-Mahoney CG: The treatment of painful phantom limb by removal of post-central cortex. J Neurosurg 1:156–162 1944

    • Search Google Scholar
    • Export Citation
  • 6.

    Dejerine JRoussy G: Le syndrome thalamique. Rev Neurol 14:5215321906Dejerine J Roussy G: Le syndrome thalamique. Rev Neurol 14:521–532 1906

    • Search Google Scholar
    • Export Citation
  • 7.

    Erickson TCBleckwenn WJWoolsey CN: Observations on the post central gyrus in relation to pain. Trans Am Neurol Assoc 77:57591952Erickson TC Bleckwenn WJ Woolsey CN: Observations on the post central gyrus in relation to pain. Trans Am Neurol Assoc 77:57–59 1952

    • Search Google Scholar
    • Export Citation
  • 8.

    Fields HLAdams JE: Pain after cortical injury relieved by electrical stimulation of the internal capsule. Brain 97:1691781974Fields HL Adams JE: Pain after cortical injury relieved by electrical stimulation of the internal capsule. Brain 97:169–178 1974

    • Search Google Scholar
    • Export Citation
  • 9.

    Foerster O: The motor cortex in man in the light of Hughlings Jackson's doctrines. Brain 59:1351591936Foerster O: The motor cortex in man in the light of Hughlings Jackson's doctrines. Brain 59:135–159 1936

    • Search Google Scholar
    • Export Citation
  • 10.

    Gerhart KDYezierski RPFang ZRet al: Inhibition of primate spinothalamic tract neurons by stimulation in ventral posterior lateral (VPL,) thalamic nucleus: possible mechanisms. J Neurophysiol 49:4064231983Gerhart KD Yezierski RP Fang ZR et al: Inhibition of primate spinothalamic tract neurons by stimulation in ventral posterior lateral (VPL) thalamic nucleus: possible mechanisms. J Neurophysiol 49:406–423 1983

    • Search Google Scholar
    • Export Citation
  • 11.

    Gybels JM: Indications for the use of neurosurgical techniques in pain control in Bond MRCharlton JEWoolf CJ (eds): Proceedings of the VIth World Congress on Pain. Amsterdam: Elsevier1991 pp 475482Gybels JM: Indications for the use of neurosurgical techniques in pain control in Bond MR Charlton JE Woolf CJ (eds): Proceedings of the VIth World Congress on Pain. Amsterdam: Elsevier 1991 pp 475–482

    • Search Google Scholar
    • Export Citation
  • 12.

    Hillman PWall PD: Inhibitory and excitatory factors influencing the receptive fields of lamina 5 spinal cord cells. Exp Brain Res 9:2843061969Hillman P Wall PD: Inhibitory and excitatory factors influencing the receptive fields of lamina 5 spinal cord cells. Exp Brain Res 9:284–306 1969

    • Search Google Scholar
    • Export Citation
  • 13.

    Holmgren HLeijon GBoivie Jet al: Central post-stroke pain — somatosensory evoked potentials in relation to location of the lesion and sensory signs. Pain 40:43521990Holmgren H Leijon G Boivie J et al: Central post-stroke pain — somatosensory evoked potentials in relation to location of the lesion and sensory signs. Pain 40:43–52 1990

    • Search Google Scholar
    • Export Citation
  • 14.

    Horrax G: Experiences with cortical excisions for the relief of intractable pain. Surgery 20:5936021946Horrax G: Experiences with cortical excisions for the relief of intractable pain. Surgery 20:593–602 1946

    • Search Google Scholar
    • Export Citation
  • 15.

    Hosobuchi Y: Subcortical electrical stimulation for control of intractable pain in humans. Report of 122 cases (1970–1984). J Neurosurg 64:5435531986Hosobuchi Y: Subcortical electrical stimulation for control of intractable pain in humans. Report of 122 cases (1970–1984). J Neurosurg 64:543–553 1986

    • Search Google Scholar
    • Export Citation
  • 16.

    Hosobuchi YAdams JERutkin B: Chronic thalamic stimulation for the control of facial anesthesia dolorosa. Arch Neurol 29:1581611973Hosobuchi Y Adams JE Rutkin B: Chronic thalamic stimulation for the control of facial anesthesia dolorosa. Arch Neurol 29:158–161 1973

    • Search Google Scholar
    • Export Citation
  • 17.

    Iwata KTsuboi YMuramatsu Het al: Distribution and response properties of cat SI neurons responsive to changes in tooth temperature. J Neurophysiol 64:8228341990Iwata K Tsuboi Y Muramatsu H et al: Distribution and response properties of cat SI neurons responsive to changes in tooth temperature. J Neurophysiol 64:822–834 1990

    • Search Google Scholar
    • Export Citation
  • 18.

    Jones EGCoulter JDHendry SHC: Intracortical connectivity of architectonic fields in the somatic sensory, motor and parietal cortex of monkeys. J Comp Neurol 181:2913481978Jones EG Coulter JD Hendry SHC: Intracortical connectivity of architectonic fields in the somatic sensory motor and parietal cortex of monkeys. J Comp Neurol 181:291–348 1978

    • Search Google Scholar
    • Export Citation
  • 19.

    Katayama YTsubokawa T: Somatosensory evoked potentials from the thalamic sensory relay nucleus (VPL) in humans: correlations with short latency somatosensory evoked potentials recorded at the scalp. Electroencephalogr Clin Neurophysiol 68:1872011987Katayama Y Tsubokawa T: Somatosensory evoked potentials from the thalamic sensory relay nucleus (VPL) in humans: correlations with short latency somatosensory evoked potentials recorded at the scalp. Electroencephalogr Clin Neurophysiol 68:187–201 1987

    • Search Google Scholar
    • Export Citation
  • 20.

    Katayama YTsubokawa TMaejima Set al: Corticospinal direct responses in humans: identification of the motor cortex during intracranial surgery under general anesthesia. J Neurol Neurosurg Psychiatry 51:50591988Katayama Y Tsubokawa T Maejima S et al: Corticospinal direct responses in humans: identification of the motor cortex during intracranial surgery under general anesthesia. J Neurol Neurosurg Psychiatry 51:50–59 1988

    • Search Google Scholar
    • Export Citation
  • 21.

    Katayama YTsubokawa TSugitani Met al: Inhibition of hyperactive trigeminal subnucleus caudalis neurons after experimental trigeminal rhizotomy in response to thalamic sensory relay nucleus stimulation. Neurol Res 8:971011986Katayama Y Tsubokawa T Sugitani M et al: Inhibition of hyperactive trigeminal subnucleus caudalis neurons after experimental trigeminal rhizotomy in response to thalamic sensory relay nucleus stimulation. Neurol Res 8:97–101 1986

    • Search Google Scholar
    • Export Citation
  • 22.

    Leijon GBoivie JJohansson I: Central post-stroke pain — neurological symptoms and pain characteristics. Pain 36:13251989Leijon G Boivie J Johansson I: Central post-stroke pain — neurological symptoms and pain characteristics. Pain 36:13–25 1989

    • Search Google Scholar
    • Export Citation
  • 23.

    Lewin WPhillips CG: Observations on partial removal of the post-central gyrus for pain. J Neurol Neurosurg Psychiatry 15:1431471952Lewin W Phillips CG: Observations on partial removal of the post-central gyrus for pain. J Neurol Neurosurg Psychiatry 15:143–147 1952

    • Search Google Scholar
    • Export Citation
  • 24.

    Libet B: Electrical stimulation of cortex in human subjects, and conscious sensory aspects in Iggo A (ed): Handbook of Sensory Physiology Vol 2. Somatosensory Systems. Berlin: Springer-Verlag1973 pp 743790Libet B: Electrical stimulation of cortex in human subjects and conscious sensory aspects in Iggo A (ed): Handbook of Sensory Physiology Vol 2. Somatosensory Systems. Berlin: Springer-Verlag 1973 pp 743–790

    • Search Google Scholar
    • Export Citation
  • 25.

    Libet BAlberts WWWright EW Jret al: Production of threshold levels of conscious sensation by electrical stimulation of human somatosensory cortex. J Neurophysiol 27:5465781964Libet B Alberts WW Wright EW Jr et al: Production of threshold levels of conscious sensation by electrical stimulation of human somatosensory cortex. J Neurophysiol 27:546–578 1964

    • Search Google Scholar
    • Export Citation
  • 26.

    Loeser JDWard AA JrWhite LE Jr: Chronic deafferentation of human spinal cord neurons. J Neurosurg 29:48501968Loeser JD Ward AA Jr White LE Jr: Chronic deafferentation of human spinal cord neurons. J Neurosurg 29:48–50 1968

    • Search Google Scholar
    • Export Citation
  • 27.

    Mazars GJ: Intermittent stimulation of nucleus ventralis posterolateralis for intractable pain. Surg Neurol 4:93951975Mazars GJ: Intermittent stimulation of nucleus ventralis posterolateralis for intractable pain. Surg Neurol 4:93–95 1975

    • Search Google Scholar
    • Export Citation
  • 28.

    Melzack RWall PD: Pain mechanisms: a new theory. Science 150:9719791965Melzack R Wall PD: Pain mechanisms: a new theory. Science 150:971–979 1965

    • Search Google Scholar
    • Export Citation
  • 29.

    Mountcastle VBPowell TP: Neural mechanisms subserving cutaneous sensibility, with special reference to the role of afferent inhibition in sensory perception and discrimination. Bull Johns Hopkins Hosp 105:2012321959Mountcastle VB Powell TP: Neural mechanisms subserving cutaneous sensibility with special reference to the role of afferent inhibition in sensory perception and discrimination. Bull Johns Hopkins Hosp 105:201–232 1959

    • Search Google Scholar
    • Export Citation
  • 30.

    Murphy JTWong YCKwan HC: Afferent-efferent linkages in motor cortex for single forelimb muscles. J Neurophysiol 38:99010141975Murphy JT Wong YC Kwan HC: Afferent-efferent linkages in motor cortex for single forelimb muscles. J Neurophysiol 38:990–1014 1975

    • Search Google Scholar
    • Export Citation
  • 31.

    Nashold BS Jr: Central pain: its origins and treatment. Clin Neurosurg 21:3113221974Nashold BS Jr: Central pain: its origins and treatment. Clin Neurosurg 21:311–322 1974

    • Search Google Scholar
    • Export Citation
  • 32.

    Nashold BS JrFriedman H: Dorsal column stimulation for control of pain. Preliminary report on 30 patients. J Neurosurg 36:5905971972Nashold BS Jr Friedman H: Dorsal column stimulation for control of pain. Preliminary report on 30 patients. J Neurosurg 36:590–597 1972

    • Search Google Scholar
    • Export Citation
  • 33.

    Pagni CA: Central pain due to spinal cord and brain stem damage in Wall PDMelzack R (eds): Textbook of Pain. Edinburgh: Churchill Livingstone1984 pp 481495Pagni CA: Central pain due to spinal cord and brain stem damage in Wall PD Melzack R (eds): Textbook of Pain. Edinburgh: Churchill Livingstone 1984 pp 481–495

    • Search Google Scholar
    • Export Citation
  • 34.

    Penfield W: Some observations on the cerebral cortex of man. Proc R Soc Lond (Biol) 134:3293311947Penfield W: Some observations on the cerebral cortex of man. Proc R Soc Lond (Biol) 134:329–331 1947

    • Search Google Scholar
    • Export Citation
  • 35.

    Penfield WBoldrey E: Somatic motor and sensory representation in the cerebral cortex of man as studied by electrical stimulation. Brain 60:3894431937Penfield W Boldrey E: Somatic motor and sensory representation in the cerebral cortex of man as studied by electrical stimulation. Brain 60:389–443 1937

    • Search Google Scholar
    • Export Citation
  • 36.

    Penfield WJasper H: Epilepsy and the Functional Anatomy of the Human Brain. Boston: Little, Brown & Co1954 pp 41106Penfield W Jasper H: Epilepsy and the Functional Anatomy of the Human Brain. Boston: Little Brown & Co 1954 pp 41–106

    • Search Google Scholar
    • Export Citation
  • 37.

    Plotkin R: Results in 60 cases of deep brain stimulation for chronic intractable pain. Appl Neurophysiol 45:1731781982Plotkin R: Results in 60 cases of deep brain stimulation for chronic intractable pain. Appl Neurophysiol 45:173–178 1982

    • Search Google Scholar
    • Export Citation
  • 38.

    Purpura DPSchofer RJMusgrave FS: Cortical intracellular potentials during augmenting and recruiting responses. II. Patterns of synaptic activities in pyramidal and nonpyramidal tract neurons. J Neurophysiol 27:1331511964Purpura DP Schofer RJ Musgrave FS: Cortical intracellular potentials during augmenting and recruiting responses. II. Patterns of synaptic activities in pyramidal and nonpyramidal tract neurons. J Neurophysiol 27:133–151 1964

    • Search Google Scholar
    • Export Citation
  • 39.

    Riddoch G: The clinical features of central pain (Lumleian lecture). Lancet 1:109310981150–1159 1205–12091938Riddoch G: The clinical features of central pain (Lumleian lecture). Lancet 1:1093–1098 1150–1159 1205–1209 1938

    • Search Google Scholar
    • Export Citation
  • 40.

    Rinaldi PCYoung RFAlbe-Fessard Det al: Spontaneous neuronal hyperactivity in the medial and intralaminar thalamic nuclei of patients with deafferentation pain. J Neurosurg 74:4154211991Rinaldi PC Young RF Albe-Fessard D et al: Spontaneous neuronal hyperactivity in the medial and intralaminar thalamic nuclei of patients with deafferentation pain. J Neurosurg 74:415–421 1991

    • Search Google Scholar
    • Export Citation
  • 41.

    Rosen IAsanuma H: Peripheral afferent inputs to the forelimb area of the monkey motor cortex: input-output relations. Exp Brain Res 14:2572731972Rosen I Asanuma H: Peripheral afferent inputs to the forelimb area of the monkey motor cortex: input-output relations. Exp Brain Res 14:257–273 1972

    • Search Google Scholar
    • Export Citation
  • 42.

    Schmid UDEbeling UReulen HJ: Electrophysiological localization of the human sensorimotor cortex. J Neurosurg 70:8178181989Schmid UD Ebeling U Reulen HJ: Electrophysiological localization of the human sensorimotor cortex. J Neurosurg 70:817–818 1989

    • Search Google Scholar
    • Export Citation
  • 43.

    Shealy CNMortimer JTHagfors NR: Dorsal column electroanalgesia. J Neurosurg 32:5605641961Shealy CN Mortimer JT Hagfors NR: Dorsal column electroanalgesia. J Neurosurg 32:560–564 1961

    • Search Google Scholar
    • Export Citation
  • 44.

    Siegfried J: Monopolar electrical stimulation of nucleus ventroposteromedialis thalami for postherpetic facial pain. Appl Neurophysiol 45:1791841982Siegfried J: Monopolar electrical stimulation of nucleus ventroposteromedialis thalami for postherpetic facial pain. Appl Neurophysiol 45:179–184 1982

    • Search Google Scholar
    • Export Citation
  • 45.

    Sweet WHWepsic JG: Treatment of chronic pain by stimulation of fibers of primary afferent neurons. Trans Am Neurol Assoc 93:1031071968Sweet WH Wepsic JG: Treatment of chronic pain by stimulation of fibers of primary afferent neurons. Trans Am Neurol Assoc 93:103–107 1968

    • Search Google Scholar
    • Export Citation
  • 46.

    Tasker RR: Deafferentation in Wall PDMelzack R (eds): Textbook of Pain. Edinburgh: Churchill Livingstone1984 pp 119132Tasker RR: Deafferentation in Wall PD Melzack R (eds): Textbook of Pain. Edinburgh: Churchill Livingstone 1984 pp 119–132

    • Search Google Scholar
    • Export Citation
  • 47.

    Tsubokawa TKatayama YYamamoto Tet al: Chronic motor cortex stimulation for the treatment of central pain. Acta Neurochir Suppl 52:1371391991Tsubokawa T Katayama Y Yamamoto T et al: Chronic motor cortex stimulation for the treatment of central pain. Acta Neurochir Suppl 52:137–139 1991

    • Search Google Scholar
    • Export Citation
  • 48.

    Tsubokawa TKatayama YYamamoto Tet al: Deafferentation pain and stimulation of thalamic sensory relay nucleus: clinical and experimental study. Appl Neurophysiol 48:1661711985Tsubokawa T Katayama Y Yamamoto T et al: Deafferentation pain and stimulation of thalamic sensory relay nucleus: clinical and experimental study. Appl Neurophysiol 48:166–171 1985

    • Search Google Scholar
    • Export Citation
  • 49.

    Tsubokawa TMoriyasu M: Follow-up results of centre median thalamotomy for relief of intractable pain. A method of evaluating the effectiveness during operation. Confin Neurol 37:2802841975Tsubokawa T Moriyasu M: Follow-up results of centre median thalamotomy for relief of intractable pain. A method of evaluating the effectiveness during operation. Confin Neurol 37:280–284 1975

    • Search Google Scholar
    • Export Citation
  • 50.

    Tsubokawa TYamamoto TKatayama Y: Thalamic relay nucleus stimulation for relief of intractable pain. Clinical results and β-endorphin immunoreactivity in the cerebrospinal fluid. Pain 18:1151261984Tsubokawa T Yamamoto T Katayama Y: Thalamic relay nucleus stimulation for relief of intractable pain. Clinical results and β-endorphin immunoreactivity in the cerebrospinal fluid. Pain 18:115–126 1984

    • Search Google Scholar
    • Export Citation
  • 51.

    Turnbull IMShulman RWoodhurst WB: Thalamic stimulation for neuropathic pain. J Neurosurg 52:4864931980Turnbull IM Shulman R Woodhurst WB: Thalamic stimulation for neuropathic pain. J Neurosurg 52:486–493 1980

    • Search Google Scholar
    • Export Citation
  • 52.

    Wall PDSweet WH: Temporary abolition of pain in man. Science 155:1081091967Wall PD Sweet WH: Temporary abolition of pain in man. Science 155:108–109 1967

    • Search Google Scholar
    • Export Citation
  • 53.

    White JCSweet WH: Pain and the Neurosurgeon: A Forty-Year Experience. Springfield, Ill: Charles C Thomas1969 p 401White JC Sweet WH: Pain and the Neurosurgeon: A Forty-Year Experience. Springfield Ill: Charles C Thomas 1969 p 401

    • Search Google Scholar
    • Export Citation
  • 54.

    Wood CCSpencer DDAllison Tet al: Localization of human sensorimotor cortex during surgery by cortical surface recording of somatosensory evoked potentials. J Neurosurg 68:991111988Wood CC Spencer DD Allison T et al: Localization of human sensorimotor cortex during surgery by cortical surface recording of somatosensory evoked potentials. J Neurosurg 68:99–111 1988

    • Search Google Scholar
    • Export Citation
  • 55.

    Woolsey CNErickson TCGilson WE: Localization in somatic sensory and motor areas of human cerebral cortex as determined by direct recording of evoked potentials and electrical stimulation. J Neurosurg 51:4765061979Woolsey CN Erickson TC Gilson WE: Localization in somatic sensory and motor areas of human cerebral cortex as determined by direct recording of evoked potentials and electrical stimulation. J Neurosurg 51:476–506 1979

    • Search Google Scholar
    • Export Citation
  • 56.

    Yamamoto TKatayama YTsubokawa Tet al: Usefulness of the morphine/thiamylal test for the treatment of deafferentation pain. Pain Res 6:1431461991Yamamoto T Katayama Y Tsubokawa T et al: Usefulness of the morphine/thiamylal test for the treatment of deafferentation pain. Pain Res 6:143–146 1991

    • Search Google Scholar
    • Export Citation
  • 57.

    Young RFKroening RFulton Wet al: Electrical stimulation of the brain in treatment of chronic pain. Experience over 5 years. J Neurosurg 62:3893961985Young RF Kroening R Fulton W et al: Electrical stimulation of the brain in treatment of chronic pain. Experience over 5 years. J Neurosurg 62:389–396 1985

    • Search Google Scholar
    • Export Citation

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