Motor Cortex Stimulation

Motor Cortex Stimulation (MCS) is a surgical procedure involving stimulation of the brain using an electrode implanted under the skull for treatment of certain pain syndromes or for rehabilitation after stroke. The procedure consists of placing an electrode on the surface of the brain that stimulates the underlying brain surface. Neurosurgeons have found that this treatment can be effective for some patients with facial pain, phantom limb pain, post-stroke pain, complex regional pain syndrome, and pain resulting from other conditions such as multiple sclerosis, spinal cord injury, and traumatic brain injury. The treatment has also been studied as a tool to improve recovery of strength after stroke. In general, good results have been found when the strategy is used to treat neuropathic facial pain syndromes such as anesthesia dolorosa (painful numbness due to injury to facial sensory nerves) that have few other treatment options.

A comprehensive preoperative evaluation will determine if a patient is a good candidate for MCS. Preoperative scans, such as computed tomography (CT) and magnetic resonance imaging (MRI), are obtained. These are used by the surgeon in the operating room to help identify the areas of the brain that are ideal for stimulator placement. The procedure is performed with the patient under anesthesia in the operating room. An electrode is placed on the surface of the brain over the pre-selected area. A wire from the electrode is then tunneled under the skin to either an external stimulator or to an implantable pulse generator (IPG). Some surgeons perform a trial with an external stimulator to see if a patient has pain relief before implanting the IPG. The IPG is usually placed under the skin just beneath the clavicle and looks very similar to a cardiac pacemaker.

Patients usually stay in the hospital for 1-2 days after surgery. Follow-up visits are then needed to adjust the stimulation parameters to optimize a patient’s pain relief. Depending on a patient’s stimulation settings, the IPG needs to be replaced every few years. Motor cortex stimulation is a relatively new treatment option that is still under investigation.

Submitted Oct.. 3, 2016
Thomas Ostergard, MD
Department of Neurological Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA
Jonathan P. Miller, MD
Member, International Neuromodulation Society Public Education Committee
Department of Neurological Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA

Last Updated on Monday, November 22, 2021 11:01 AM