Bilateral cortical stimulation for bilateral refractory atypical trigeminal neuropathic pain: Case report.

IF 0.6 4区医学 Q4 ENDOCRINOLOGY & METABOLISM

Neuro endocrinology letters Pub Date : 2021-05-04

Petr Skalický, Vaclav Masopust

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引用次数: 0

Abstract

Background: Atypical trigeminal neuropathic pain (aTNP) is a disabling clinical entity. If conservative treatment fails neuromodulation could be indicated. Motor cortex stimulation (MCS) has emerged as an alternative advanced management of such cases.

Case report: We report a case of a patient with bilateral aTNP effectively treated with bilateral MCS. We describe case history, preoperative planning, surgical technique, follow-up and stimulation settings. The surgical technique and the settings used were both gradually adjusted according to current knowledge.

Conclusions: The bilateral MCS led to substantial pain relief in a patient for whom previous pharmacological management had failed. Initial VAS 10/10 with attacks of acute pain was reduced to median VAS 2/10 (maximum VAS 5/10) without acute attacks since the second electrode parameters were set. The reported results for MCS treatment of TNP in the literature demonstrate good long-term efficacy with low complication rates. Although MCS remains to be an off-label procedure, our case demonstrates that in a well-chosen candidate this option could provide impressive results. Although no clear evidence is currently given, we believe that future studies will elucidate indication criteria, surgical technique and stimulation parameters for MCS so it could be offered in a regular basis to patients with refractory pain.

本刊更多论文

双侧皮层刺激治疗双侧难治性非典型三叉神经痛：病例报告。

背景：非典型三叉神经痛（aTNP）是一种致残性临床症状。如果保守治疗无效，可采用神经调节疗法。运动皮层刺激（MCS）已成为此类病例的另一种先进治疗方法：我们报告了一例使用双侧 MCS 有效治疗双侧 aTNP 患者的病例。我们描述了病史、术前计划、手术技术、随访和刺激设置。手术技术和刺激设置都是根据现有知识逐步调整的：结论：对一名之前药物治疗无效的患者进行双侧多脉冲刺激治疗后，疼痛得到了明显缓解。自第二个电极参数设置以来，最初伴有急性疼痛发作的 VAS 10/10 已降至中位 VAS 2/10（最大 VAS 5/10），且未出现急性发作。文献报道的MCS治疗TNP的结果表明，长期疗效好，并发症发生率低。尽管MCS仍然是一种标签外的治疗方法，但我们的病例表明，如果患者选择得当，这种方法可以取得令人印象深刻的疗效。虽然目前还没有明确的证据，但我们相信，未来的研究将阐明 MCS 的适应症标准、手术技术和刺激参数，从而为难治性疼痛患者提供常规治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neuro endocrinology letters 医学-内分泌学与代谢

CiteScore

1.00

自引率

14.30%

发文量

审稿时长

6 months

期刊介绍： Neuroendocrinology Letters is an international, peer-reviewed interdisciplinary journal covering the fields of Neuroendocrinology, Neuroscience, Neurophysiology, Neuropsychopharmacology, Psychoneuroimmunology, Reproductive Medicine, Chronobiology, Human Ethology and related fields for RAPID publication of Original Papers, Review Articles, State-of-the-art, Clinical Reports and other contributions from all the fields covered by Neuroendocrinology Letters. Papers from both basic research (methodology, molecular and cellular biology, anatomy, histology, biology, embryology, teratology, normal and pathological physiology, biophysics, pharmacology, pathology and experimental pathology, biochemistry, neurochemistry, enzymology, chronobiology, receptor studies, endocrinology, immunology and neuroimmunology, animal physiology, animal breeding and ethology, human ethology, psychology and others) and from clinical research (neurology, psychiatry and child psychiatry, obstetrics and gynecology, pediatrics, endocrinology, immunology, cardiovascular studies, internal medicine, oncology and others) will be considered. The Journal publishes Original papers and Review Articles. Brief reports, Special Communications, proved they are based on adequate experimental evidence, Clinical Studies, Case Reports, Commentaries, Discussions, Letters to the Editor (correspondence column), Book Reviews, Congress Reports and other categories of articles (philosophy, art, social issues, medical and health policies, biomedical history, etc.) will be taken under consideration.