Intraoperative neurophysiologic mapping of the central cortical region for epidural electrode placement in the treatment of neuropathic pain by motor cortex stimulation

Brain Stimulation
Jean-Pascal Lefaucheur, Daniel Ciampi de Andrade

Abstract

Neuropathic pain results from injury to the central or peripheral nervous system and can prove itself refractory to classical medical treatment by anticonvulsants and antidepressants. In such cases, motor cortex stimulation is among the neurostimulation techniques available for its symptomatic control. This technique is based on surgical implantation of electrodes over the motor cortical representation of the painful area. Image-guided navigation is used for precise identification of the motor cortex intraoperatively, but proper placement of the electrodes is usually ensured by electrophysiologic mapping. This article details the intraoperative electrophysiologic procedure that we currently use for refining electrode placement in the epidural space, including the recording of somatosensory and motor-evoked potentials (MEPs). Various procedures have been reported and some groups are using direct cortical mapping and subdural electrode placement rather than epidural. Our method is one of several proposed techniques and is mostly based on intraoperative MEP mapping in response to monopolar (anodal) epidural stimulation of the cortex. The limit of this approach is that MEPs cannot be recorded in patients with total or severe motor ...Continue Reading

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