Abstract
Invasive motor Cortex Stimulation (iMCS) was introduced in the 1990’s for the treatment of chronic neuropathic orofacial pain (CNOP), although its effectiveness remains doubtful. However, CNOP is known to be a heterogeneous group of orofacial pain disorders, which can lead to different responses to iMCS. Therefore, this paper investigated (1) whether the effectiveness of iMCS is significantly different among different CNOP disorders and (2) whether other confounding factors can be impacting iMCS results in CNOP. A systematic review and meta-analysis using a linear mixed-model was performed. Twenty-three papers were included, totaling 140 CNOP patients. Heterogeneity of the studies showed to be 55.8%. A visual analogue scale (VAS) measured median pain relief of 66.5% (ranging from 0–100%) was found. Linear mixed-model analysis showed that patients suffering from trigeminal neuralgia responded significantly more favorable to iMCS than patients suffering from dysfunctional pain syndromes (p = 0.030). Also, patients suffering from CNOP caused by (supra)nuclear lesions responded marginally significantly better to iMCS than patients suffering from CNOP due to trigeminal nerve lesions (p = 0.049). No other confounding factors were elucidated. This meta-analysis showed that patients suffering from trigeminal neuralgia and patients suffering from (supra)nuclear lesions causing CNOP responded significantly more favorable than others on iMCS. No other confounding factors were found relevant.
Highlights
Invasive motor Cortex Stimulation was introduced in the 1990’s for the treatment of chronic neuropathic orofacial pain (CNOP), its effectiveness remains doubtful
This paper showed that various predictive variables existed in Invasive motor Cortex Stimulation (iMCS) for neuropathic pain, including the sex of the patient and the location of the lesion within the nervous system[50]
This study shows that a broad variety of diagnoses, which all can cause CNOP, have been described in the iMCS literature
Summary
Invasive motor Cortex Stimulation (iMCS) was introduced in the 1990’s for the treatment of chronic neuropathic orofacial pain (CNOP), its effectiveness remains doubtful. This meta-analysis showed that patients suffering from trigeminal neuralgia and patients suffering from (supra)nuclear lesions causing CNOP responded significantly more favorable than others on iMCS. A neuroanatomical paper from our group showed that a more extensive trigeminothalamic network is present in the brainstem of humans and could play an important role in pain processing[51,52] Based on these two papers, we hypothesized that CNOP caused by lesions within the root of the trigeminal nerve and/or within the brain(stem) will respond more favorable to iMCS than lesions of the trigeminal branches. In line with our previous paper, other confounding factors are believed to play an important role in the effectivity of iMCS in CNOP This meta-analysis assessed whether the effectiveness of iMCS is significantly impacted by localization of a lesion within the somatosensory system (i.e., different CNOP disorders respond differently to iMCS). We assessed whether other confounding factors impacted the outcomes of iMCS in treating CNOP
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