Poststroke pain control by chronic motor cortex stimulation: neurological characteristics predicting a favorable response

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Object. The goal of this study was to identify the neurological characteristics of patients with poststroke pain who show a favorable response to motor cortex (MC) stimulation used to control their pain.

Methods. The neurological characteristics of 31 patients treated by MC stimulation were analyzed. In 15 patients (48%), excellent or good pain control (pain reduction > 60%) was achieved for follow-up periods of more than 2 years by using MC stimulation at intensities below the threshold for muscle contraction. Satisfactory pain control was achieved in 13 (73%) of 18 patients in whom motor weakness in the painful area was virtually absent or mild, but in only two (15%) of the 13 patients who demonstrated moderate or severe weakness in the painful area (p < 0.01). Muscle contraction was inducible in the painful area in 20 patients when stimulated at a higher intensity. No such muscle response was inducible in the remaining 11 patients, no matter how extensively the authors attempted to determine appropriate stimulation sites. Satisfactory pain control was achieved in 14 (70%) of the 20 patients in whom muscle contraction was inducible, but in only one (9%) of the 11 patients in whom muscle contraction was not inducible (p < 0.01). No significant relationship was observed between pain control and various sensory symptoms, including the presence of hypesthesia, spontaneous dysesthesia, hyperpathia, and allodynia, or the disappearance of the N20 component of the median nerve—evoked somatosensory scalp potential. No significant relationship existed between the effect of MC stimulation on the pain and stimulation-induced phenomena, including paresthesia, improvement in motor performance, and attenuation of involuntary movements.

Conclusions. These findings suggest that the pain control afforded by MC stimulation requires neuronal circuits that are maintained by the presence of intact corticospinal tract neurons originating from the MC. Preoperative evaluation of motor weakness of the painful area appears to be useful for predicting a favorable response to MC stimulation in the control of poststroke pain.

Article Information

Address reprint requests to: Yoichi Katayama, M.D., Ph.D., Department of Neurological Surgery, Nihon University School of Medicine, Tokyo 173, Japan.

© AANS, except where prohibited by US copyright law.

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References

  • 1.

    Abdelmoumène MBesson JMAléonard P: Cortical areas exerting presynaptic inhibitory action on the spinal cord in cat and monkey. Brain Res 20:3273291970Abdelmoumène M Besson JM Aléonard P: Cortical areas exerting presynaptic inhibitory action on the spinal cord in cat and monkey. Brain Res 20:327–329 1970

    • Search Google Scholar
    • Export Citation
  • 2.

    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
  • 3.

    Amassian VESomasundaram MRothwell JCet al: Paraesthesias are elicited by single pulse, magnetic coil stimulation of motor cortex in susceptible humans. Brain 114: 250525201991Amassian VE Somasundaram 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.

    Andersen PEccles JCSears TA: Presynaptic inhibitory action of cerebral cortex on the spinal cord. Nature 194:7407411962Andersen P Eccles JC Sears TA: Presynaptic inhibitory action of cerebral cortex on the spinal cord. Nature 194:740–741 1962

    • Search Google Scholar
    • Export Citation
  • 5.

    Angel A: A possible mechanism for the central action of anesthetic agents in Holden AVWinlow W (eds): The Neurobiology of Pain. Manchester: Manchester University Press1984 pp 359396Angel A: A possible mechanism for the central action of anesthetic agents in Holden AV Winlow W (eds): The Neurobiology of Pain. Manchester: Manchester University Press 1984 pp 359–396

    • Search Google Scholar
    • Export Citation
  • 6.

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

    • Search Google Scholar
    • Export Citation
  • 7.

    Bowsher D: The management of central post-stroke pain. Postgrad Med J 71:5986041998Bowsher D: The management of central post-stroke pain. Postgrad Med J 71:598–604 1998

    • Search Google Scholar
    • Export Citation
  • 8.

    Brinkman JBush BMPorter R: Deficient influences of peripheral stimuli on precentral neurones in monkeys with dorsal column lesions. J Physiol (Lond) 276:27481978Brinkman J Bush BM Porter R: Deficient influences of peripheral stimuli on precentral neurones in monkeys with dorsal column lesions. J Physiol (Lond) 276:27–48 1978

    • Search Google Scholar
    • Export Citation
  • 9.

    Canavero SBonicalzi V: Cortical stimulation for central pain. J Neurosurg 83:111711181995 (Letter)Canavero S Bonicalzi V: Cortical stimulation for central pain. J Neurosurg 83:1117–1118 1995 (Letter)

    • Search Google Scholar
    • Export Citation
  • 10.

    Carpenter DLundberg ANorrsell U: Primary afferent depolarization evoked from sensorimotor cortex. Acta Physiol Scand 59:1261421963Carpenter D Lundberg A Norrsell U: Primary afferent depolarization evoked from sensorimotor cortex. Acta Physiol Scand 59:126–142 1963

    • Search Google Scholar
    • Export Citation
  • 11.

    Chapman CEBushnell MCMiron Det al: Sensory perception during movement in man. Exp Brain Res 68:5165241987Chapman CE Bushnell MC Miron D et al: Sensory perception during movement in man. Exp Brain Res 68:516–524 1987

    • Search Google Scholar
    • Export Citation
  • 12.

    Coulter JDMaunz RAWillis WD: Effects of stimulation of sensorimotor cortex on primate spinothalamic neurons. Brain Res 65:3513561974Coulter JD Maunz RA Willis WD: Effects of stimulation of sensorimotor cortex on primate spinothalamic neurons. Brain Res 65:351–356 1974

    • Search Google Scholar
    • Export Citation
  • 13.

    DeJong RN: Case taking and the neurological examination in Baker AB (ed): Clinical Neurology. New York: Hoebar-Harper1955 Vol 1 pp 1100DeJong RN: Case taking and the neurological examination in Baker AB (ed): Clinical Neurology. New York: Hoebar-Harper 1955 Vol 1 pp 1–100

    • Search Google Scholar
    • Export Citation
  • 14.

    Ebel HRust DTronnier Vet al: Chronic precentral stimulation in trigeminal neuropathic pain. Acta Neurochir 138:130013061996Ebel H Rust D Tronnier V et al: Chronic precentral stimulation in trigeminal neuropathic pain. Acta Neurochir 138:1300–1306 1996

    • Search Google Scholar
    • Export Citation
  • 15.

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

    • Search Google Scholar
    • Export Citation
  • 16.

    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
  • 17.

    Garcia-Larrea LPeyron RMertens Pet al: Positron emission tomography during motor cortex stimulation for pain control. Stereotact Funct Neurosurg 68:1411481998Garcia-Larrea L Peyron R Mertens P et al: Positron emission tomography during motor cortex stimulation for pain control. Stereotact Funct Neurosurg 68:141–148 1998

    • Search Google Scholar
    • Export Citation
  • 18.

    Gorecki JHirayama TDostrovsky JOet al: Thalamic stimulation and recording in patients with deafferentation and central pain. Stereotact Funct Neurosurg 52:2192261989Gorecki J Hirayama T Dostrovsky JO et al: Thalamic stimulation and recording in patients with deafferentation and central pain. Stereotact Funct Neurosurg 52:219–226 1989

    • Search Google Scholar
    • Export Citation
  • 19.

    Gybels JM: Indications for neurosurgical treatment of chronic pain. Acta Neurochir Suppl 68:54601997Gybels JM: Indications for neurosurgical treatment of chronic pain. Acta Neurochir Suppl 68:54–60 1997

    • Search Google Scholar
    • Export Citation
  • 20.

    Herregodts PStadnik TDe Ridder Fet al: Cortical stimulation for central neuropathic pain: 3-D surface MRI for easy determination of the motor cortex. Acta Neurochir Suppl 64:1321351995Herregodts P Stadnik T De Ridder F et al: Cortical stimulation for central neuropathic pain: 3-D surface MRI for easy determination of the motor cortex. Acta Neurochir Suppl 64:132–135 1995

    • Search Google Scholar
    • Export Citation
  • 21.

    Hirai TJones EG: Segregation of lemniscal inputs and motor cortex outputs in cat ventral thalamic nuclei: application of a novel technique. Exp Brain Res 71:3293441988Hirai T Jones EG: Segregation of lemniscal inputs and motor cortex outputs in cat ventral thalamic nuclei: application of a novel technique. Exp Brain Res 71:329–344 1988

    • Search Google Scholar
    • Export Citation
  • 22.

    Hirato MKawashima YShibazaki Tet al: Pathophysiology of central (thalamic) pain: a possible role of the intralaminar nuclei in superficial pain. Acta Neurochir Suppl 52:1331361991Hirato M Kawashima Y Shibazaki T et al: Pathophysiology of central (thalamic) pain: a possible role of the intralaminar nuclei in superficial pain. Acta Neurochir Suppl 52:133–136 1991

    • Search Google Scholar
    • Export Citation
  • 23.

    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
  • 24.

    Hosobuchi Y: Motor cortical stimulation for control of central deafferentation pain. Adv Neurol 63:2152171993Hosobuchi Y: Motor cortical stimulation for control of central deafferentation pain. Adv Neurol 63:215–217 1993

    • Search Google Scholar
    • Export Citation
  • 25.

    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
  • 26.

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

    • Search Google Scholar
    • Export Citation
  • 27.

    Katayama YFukaya CYamamoto Tet al: Control of post-stroke involuntary and voluntary movement disorders with deep brain or epidural cortical stimulation. Stereotact Funct Neurosurg 69:73791998Katayama Y Fukaya C Yamamoto T et al: Control of post-stroke involuntary and voluntary movement disorders with deep brain or epidural cortical stimulation. Stereotact Funct Neurosurg 69:73–79 1998

    • Search Google Scholar
    • Export Citation
  • 28.

    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
  • 29.

    Katayama YTsubokawa TMaejima Set al: Corticospinal direct responses in humans: identification of the motor cortex during intracranial surgery under general anaesthesia. 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 anaesthesia. J Neurol Neurosurg Psychiatry 51:50–59 1988

    • Search Google Scholar
    • Export Citation
  • 30.

    Katayama YTsubokawa TYamamoto T: Chronic motor cortex stimulation for central deafferentation pain: experience with bulbar pain secondary to Wallenberg syndrome. Stereotact Funct Neurosurg 62:2952991994Katayama Y Tsubokawa T Yamamoto T: Chronic motor cortex stimulation for central deafferentation pain: experience with bulbar pain secondary to Wallenberg syndrome. Stereotact Funct Neurosurg 62:295–299 1994

    • Search Google Scholar
    • Export Citation
  • 31.

    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
  • 32.

    Lenz FAKwan HCDostrovsky JOet al: Characteristics of the bursting pattern of action potentials that occurs in the thalamus of patients with central pain. Brain Res 496:3573601989Lenz FA Kwan HC Dostrovsky JO et al: Characteristics of the bursting pattern of action potentials that occurs in the thalamus of patients with central pain. Brain Res 496:357–360 1989

    • Search Google Scholar
    • Export Citation
  • 33.

    Lenz FATasker RRDostrovsky JOet al: Abnormal single-unit activity recorded in the somatosensory thalamus of a quadriplegic patient with central pain. Pain 31:2252361987Lenz FA Tasker RR Dostrovsky JO et al: Abnormal single-unit activity recorded in the somatosensory thalamus of a quadriplegic patient with central pain. Pain 31:225–236 1987

    • Search Google Scholar
    • Export Citation
  • 34.

    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
  • 35.

    Lindblom UFOttosson JO: Influence of pyramidal stimulation upon the relay of coarse cutaneous afferents in the dorsal horn. Acta Physiol Scand 38:3093181957Lindblom UF Ottosson JO: Influence of pyramidal stimulation upon the relay of coarse cutaneous afferents in the dorsal horn. Acta Physiol Scand 38:309–318 1957

    • Search Google Scholar
    • Export Citation
  • 36.

    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
  • 37.

    Lucier GERüegg DCWiesendanger M: Responses of neurones in motor cortex and in area 3A to controlled stretches of forelimb muscles in cebus monkeys. J Physiol (Lond) 251:8338531975Lucier GE Rüegg DC Wiesendanger M: Responses of neurones in motor cortex and in area 3A to controlled stretches of forelimb muscles in cebus monkeys. J Physiol (Lond) 251:833–853 1975

    • Search Google Scholar
    • Export Citation
  • 38.

    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
  • 39.

    Melzack R: Phantoms and the concept of a neuromatrix. Trends Neurosci 13:88921990Melzack R: Phantoms and the concept of a neuromatrix. Trends Neurosci 13:88–92 1990

    • Search Google Scholar
    • Export Citation
  • 40.

    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
  • 41.

    Meyerson BALindblom ULinderoth Bet al: Motor cortex stimulation as treatment of trigeminal neuropathic pain. Acta Neurochir Suppl 58:1501531993Meyerson BA Lindblom U Linderoth B et al: Motor cortex stimulation as treatment of trigeminal neuropathic pain. Acta Neurochir Suppl 58:150–153 1993

    • Search Google Scholar
    • Export Citation
  • 42.

    Migita KUozumi TArita Ket al: Transcranial magnetic coil stimulation of motor cortex in patients with central pain. Neurosurgery 36:103710401995Migita K Uozumi T Arita K et al: Transcranial magnetic coil stimulation of motor cortex in patients with central pain. Neurosurgery 36:1037–1040 1995

    • Search Google Scholar
    • Export Citation
  • 43.

    Milne RJAniss AMKay NEet al: Reduction in perceived intensity of cutaneous stimuli during movement: a quantitative study. Exp Brain Res 70:5695761988Milne RJ Aniss AM Kay NE et al: Reduction in perceived intensity of cutaneous stimuli during movement: a quantitative study. Exp Brain Res 70:569–576 1988

    • Search Google Scholar
    • Export Citation
  • 44.

    Mountcastle VBPowell TPS: 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 TPS: 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
  • 45.

    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
  • 46.

    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
  • 47.

    N'Guyen JPUchiyama TLefaucheur JPet al: Precentral cortex stimulation: Implantation strategy and personal experience. Workshop of XIIth Meeting of the World Society for Stereotactic and Functional NeurosurgeryLyonJuly 1–4, 1997 pp 45N'Guyen JP Uchiyama T Lefaucheur JP et al: Precentral cortex stimulation: Implantation strategy and personal experience. Workshop of XIIth Meeting of the World Society for Stereotactic and Functional Neurosurgery Lyon July 1–4 1997 pp 4–5

    • Search Google Scholar
    • Export Citation
  • 48.

    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
  • 49.

    Parrent AGTasker RR: Can the ipsilateral hemisphere mediate pain in man? Acta Neurochir 117:891992 (Abstract)Parrent AG Tasker RR: Can the ipsilateral hemisphere mediate pain in man? Acta Neurochir 117:89 1992 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 50.

    Penfield WJasper H: Epilepsy and Functional Anatomy of the Human Brain. Boston: Little Brown1954 pp 41106Penfield W Jasper H: Epilepsy and Functional Anatomy of the Human Brain. Boston: Little Brown 1954 pp 41–106

    • Search Google Scholar
    • Export Citation
  • 51.

    Peyron RGarcia-Larrea LDeiber MPet al: Electrical stimulation of precentral cortical area in the treatment of central pain: electrophysiological and PET study. Pain 62:2752861995Peyron R Garcia-Larrea L Deiber MP et al: Electrical stimulation of precentral cortical area in the treatment of central pain: electrophysiological and PET study. Pain 62:275–286 1995

    • Search Google Scholar
    • Export Citation
  • 52.

    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
  • 53.

    Shealy CNMortimer JTHagfors NR: Dorsal column electroanalgesia. J Neurosurg 32:5605641970Shealy CN Mortimer JT Hagfors NR: Dorsal column electroanalgesia. J Neurosurg 32:560–564 1970

    • Search Google Scholar
    • Export Citation
  • 54.

    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
  • 55.

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

    • Search Google Scholar
    • Export Citation
  • 56.

    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
  • 57.

    Tasker RRDeCarvalho GTCDolan EJ: Intractable pain of spinal cord origin: clinical features and implications for surgery. J Neurosurg 77:3733781992Tasker RR DeCarvalho GTC Dolan EJ: Intractable pain of spinal cord origin: clinical features and implications for surgery. J Neurosurg 77:373–378 1992

    • Search Google Scholar
    • Export Citation
  • 58.

    Tracey DJAsanuma CJones EGet al: Thalamic relay to motor cortex: afferent pathways from brainstem, cerebellum, and spinal cord in monkeys. J Neurophysiol 44:5325541980Tracey DJ Asanuma C Jones EG et al: Thalamic relay to motor cortex: afferent pathways from brainstem cerebellum and spinal cord in monkeys. J Neurophysiol 44:532–554 1980

    • Search Google Scholar
    • Export Citation
  • 59.

    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
  • 60.

    Tsubokawa TKatayama YYamamoto Tet al: Chronic motor cortex stimulation in patients with thalamic pain. J Neurosurg 78:3934011993Tsubokawa T Katayama Y Yamamoto T et al: Chronic motor cortex stimulation in patients with thalamic pain. J Neurosurg 78:393–401 1993

    • Search Google Scholar
    • Export Citation
  • 61.

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

    • Search Google Scholar
    • Export Citation
  • 62.

    Tsumoto TNakamura SIwama K: Pyramidal tract control over cutaneous and kinesthetic sensory transmission in the cat thalamus. Exp Brain Res 22:2812941975Tsumoto T Nakamura S Iwama K: Pyramidal tract control over cutaneous and kinesthetic sensory transmission in the cat thalamus. Exp Brain Res 22:281–294 1975

    • Search Google Scholar
    • Export Citation
  • 63.

    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
  • 64.

    Willis WD Jr: Central neurogenic pain: possible mechanisms. Adv Pain Res Ther 19:811021991Willis WD Jr: Central neurogenic pain: possible mechanisms. Adv Pain Res Ther 19:81–102 1991

    • Search Google Scholar
    • Export Citation
  • 65.

    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
  • 66.

    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
  • 67.

    Yamamoto TKatayama YHirayama Tet al: Pharmacological classification of central post-stroke pain: comparison with the results of chronic motor cortex stimulation therapy. Pain 72:5121997Yamamoto T Katayama Y Hirayama T et al: Pharmacological classification of central post-stroke pain: comparison with the results of chronic motor cortex stimulation therapy. Pain 72:5–12 1997

    • Search Google Scholar
    • Export Citation
  • 68.

    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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