DYSPHAGIA AND NEUROPATHIC FACIAL PAIN TREATED WITH MOTOR CORTEX STIMULATION: CASE REPORT

被引：10

作者：

Anderson, William S. ^{[1
]}

Kiyofuji, Satoshi ^{[2
]}

Conway, James E. ^{[4
]}

Busch, Chris ^{[4
]}

North, Richard B. ^{[3
]}

Garonzik, Ira M. ^{[4
]}

机构：

[1] Harvard Univ, Brigham & Womens Hosp, Dept Neurosurg, Sch Med, Boston, MA 02115 USA

[2] Univ Tokyo, Dept Med, Tokyo, Japan

[3] Sinai Hosp, Baltimore, MD 21215 USA

[4] Baltimore Neurosurg & Spine Ctr, Johns Hopkins Green Spring Stn, Lutherville Timonium, MD USA

来源：

NEUROSURGERY | 2009年 / 65卷 / 03期

关键词：

Dysphagia; Glossopharyngeal neuralgia; Motor cortex stimulation; Neuropathic facial pain;

D O I：

10.1227/01.NEU.0000349211.01111.8A

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

OBJECTIVE: We report on a patient with a neuropathic facial pain syndrome, including elements of trigeminal neuralgia, glossopharyngeal neuralgia, and dysphagia. After failing medical and surgical decompressive treatments, the patient underwent implantation of a motor cortex stimulation (MCS) system. CLINICAL PRESENTATION: A 54-year-old woman presented with a 14-year history of left-sided facial pain, throat pain, and associated nausea and vomiting. The patient failed several open surgical and percutaneous procedures for her facial pain syndrome. Additionally, several medication trial attempts were unsuccessful. Imaging studies were normal. INTERVENTION: The patient underwent placement of a right-sided MCS system for treatment of her neuropathic facial pain syndrome. The procedure was tolerated well, and the trial stimulator provided promising results. The permanent MCS generator needed to be reprogrammed at the time of the 5-week follow-up visit to optimize symptom relief. The patient demonstrated dramatic improvements in her neuropathic facial and oral pain, including improvements in swallowing toleration, after the 5-week follow-up examination with subthreshold MCS. A decline in treatment efficacy also occurred 2 years after implantation due to generator depletion. Symptom improvement returned with stimulation after the generator was replaced. CONCLUSION: A novel implantable MCS system was used to treat this patient's neuropathic facial pain. Durable improvements were noted not only in her facial pain, but also in swallowing toleration. The ultimate role of MCS in the treatment of pain conditions is still not well-defined but might play a part in refractory cases and, as in this case, might improve other functional issues, including dysphagia.

引用

页码：626 / 626

页数：1

共 30 条

[1] Bohm E., Strang R.R., Glossopharyngeal neuralgia, Brain, 85, pp. 371-388, (1962)
[2] Brown J.A., Pilitsis J.G., Motor cortex stimulation for central and neuropathic facial pain: A prospective study of 10 patients and observations of enhanced sensory and motor function during stimulation, Neurosurgery, 56, pp. 290-297, (2005)
[3] Bullard D.E., Nashold Jr. B.S., The caudalis DREZ for facial pain, Stereotact Funct Neurosurg, 68, pp. 168-174, (1997)
[4] Burchiel K.J., A new classification for facial pain, Neurosurgery, 53, pp. 1164-1167, (2003)
[5] Ebel H., Rust D., Tronnier V., Boker D., Kunze S., Chronic precentral stimulation in trigeminal neuropathic pain, Acta Neurochirurgica, 138, 11, pp. 1300-1306, (1996)
[6] Evans R.W., Torelli P., Manzoni G.C., Glossopharyngeal neuralgia, Headache, 46, pp. 1200-1202, (2006)
[7] Henderson J.M., Lad S.P., Motor cortex stimulation and neuropathic facial pain, Neurosurg Focus, 21, (2006)
[8] Henderson J.M., Boongird A., Rosenow J.M., Lapresto E., Rezai A.R., Recovery of pain control by intensive reprogramming after loss of benefit from motor cortex stimulation for neuropathic pain, Stereotactic and Functional Neurosurgery, 82, 5-6, pp. 207-213, (2004)
[9] Kanpolat Y., Kahilogullari G., Ugur H.C., Elhan A.H., Computed tomographyguided percutaneous trigeminal tractotomy-nucleotomy, Neurosurg, 63, SUPPL. 1, (2008)
[10] Kanpolat Y., Tuna H., Bozkurt M., Elhan A.H., Spinal and nucleus caudalis dorsal root entry zone operations for chronic pain, Neurosurgery, 62, 3 SUPPL. 1, (2008)

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