Cyclization of Motor Cortex Stimulation for Neuropathic Pain: A Prospective, Randomized, Blinded Trial

Neuromodulation : Journal of the International Neuromodulation Society
Zurab IvanishviliChristopher R Honey

Abstract

Programming guidelines for motor cortex stimulation (MCS) in neuropathic pain requires further investigation. After optimizing voltage as a percentage of motor threshold, we evaluated the effect of cyclizing time of stimulation on pain relief for chronic neuropathic pain. Six patients were enrolled into this trial. In a prospective, randomized, double-blinded manner, patients were programmed to receive stimulation 100, 83.3, 66.7, or 50% of the time in 30-min intervals. Outcomes were assessed after 14 days on each setting with a visual analogue scale (VAS) for pain and the SF36 quality of life questionnaire. There was no significant difference (p > 0.05) between the different cyclized settings as measured by the VAS, MGPQ, or SF36 in our cohort. There were two distinct subgroups: responders (n = 4) and nonresponders (n = 2) to cyclization. Responders continued to have pain relief when stimulation was reduced to only 50% of the time (15 min ON/15 min off). Interestingly, this group subjectively preferred the 50% stimulation timing compared to 100%. Nonresponders could not tolerate cyclizing because of increased pain. In this small cohort, cyclization of MCS settings revealed two distinct subgroups: responders and nonresponders. ...Continue Reading

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Citations

Jul 5, 2017·Neuromodulation : Journal of the International Neuromodulation Society·Jean-Paul NguyenJean-Pascal Lefaucheur

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