Table 2.
Studies involving comparison of Motor Cortex Stimulation and Deep Brain Stimulation.
| Paper | Article Type | Patient N | Aetiology of Pain | Target | Outcome Measures | f/u Times | Results | Conclusion |
|---|---|---|---|---|---|---|---|---|
| Nandi et al. (2002) [57] | case-series | 10 | All post-stroke pain. aMCS patients: post-stroke hemi-body pain (4); post-stroke facial pain (4); bDBS patients: post-stroke hemi body (3), post-stroke face and leg (1) | cPVG | dVAS | 2–3 weeks; some up to 4 years | MCS: 1/6 success rate. DBS:3/4 had at least 40% reduction in VAS scores during stimulation, 2/2 internalised with success. |
MCS is not effective relieving post-stroke neuropathic pain. DBS is the preferred option. |
| Katayama et al (2001 a.) [55] | case-series | 45 | phantom limb (trauma- ert leg), brachial plexus avulsion (rt arm). | thalamus | VAS | unspecified- results reported to be ‘long term’ | All 19 patients were given fSCS and if failed were split into either DBS or MCS. For DBS 60% (6/10) gave pain relief, and for MCS 1/5 (20%) required pain relief. 4 patients were given both DBS and MCS- one patient reported better pain control by MCS than DBS. 2 patients reported the opposite. |
DBS preferable to MCS, especially lower limb. |
| Katayama et al (2001 b.) [56] | case-series | 45 | post-stroke pain | thalamus | VAS | unspecified- results reported to be ‘long term’ | Success rates (defined as >60% reduction in VAS scores) of 7% for SCS (3/45), 25% for DBS (3/12), 48% for MCS (15/31) | Success rate increases as stimulation moves higher. MCS more successful than DBS. |
| Son, Kim et al. (2014) [105] | open label | 9* | Central post-stroke pain (4), gSCI (4), amputation stump pain in arm (1) | ventralis caudalis (Vc) thalamus DBS | hNRS, medication use. | 39 months mean, (8–72) | 6/8 (75%) responded to MCS. 2/8 had successful DBS (one patient with amputation stump pain and the other with SCI pain caused by cervical syrinx). NRS score decreased significantly (p < 0.05) MCS: 37.9 ± 16.5 and DBS 37.5%. | Considering the initial success rate and the less invasive nature of epidural MCS compared with DBS, MCS would be a more reasonable initial means of treatment for chronic intractable neuropathic pain. |
aMCS = Motor Cortex Stimulation. bDBS = Deep Brain Stimulation. cPVG = Periventricular Grey. dVAS = Visual Analogue Scale. ert=right. fSCS = Spinal Cord Stimulation. gSCI = Spinal Cord Injury. hNRS = Numeric Rating Scale. * = 8 successfully implanted and used in the comparison.