Motor Cortex Stimulation for Chronic Central and Peripheral Neuropathic Pain: State of Art

Motor cortex stimulation (MCS) was proposed by Tsubokawa in 1991 for the treatment of post-stroke thalamic pain. Since that time, the indications enlarged including trigeminal neuropathic pain and other types of central and peripheral deafferentation pain. Clinical knowledge of MCS derives mainly from published individual cases and case series. Mechanisms underlying the effects of MCS are not yet clearly known. Empirical approach is generally used to select the optimal parameters by adjusting the combination of contacts, polarity, frequency, pulse width and amplitude, according to the patient's pain relief. Complications are relatively rare but long-term loss of efficacy is reported.