Brain Disorders and Therapeutics

Biography

Biography: Wilhelm Eisner

Abstract

Introduction: In the last 30 years neuromodulation by deep brain stimulation gained widely acceptance starting in the field of movement disorders. In pain syndromes deep brain stimulation is far less effective. The results in nociceptive pain syndromes are around 50% and in neuropathic pain syndromes less than 50%. For the last 25 years the author has focused on neurosurgical pain therapy by neuromodulation.

Material & Methods: We will provide a historical overview on neurosurgical pain therapy of the head and on the pain matrix evolved by imaging studies. Further we will demonstrate our development of deep brain stimulation consisting of two electrodes per cerebral hemisphere and our achievement of pain free patient including normalization of sensory function. Out of 46 treated patients with neuropathic pain syndromes we had a group of 12 patients with neuropathic pain of the face. 50% showed a severe sensory deficit for touch-, pain-, warmth- and cold sensation. All patients had pre- and postoperative neurophysiological-, neuropsychological examination beside of pain questionnaires. Further quantitative sensory testing (QST) in neuropathic areas and normal area in the contralateral face side were performed before and after surgery. We examined six women from 29 to 65 years of age with pure trigeminal neuropathia. All patients were treated with two electrodes in the same side of the pain. One electrode was reaching from a precoronal approach the ventral posteromedial nucleus (VPM) thalamic area and one electrode was inserted from a parietal approach into the posterior limp of the capsula interna by stereotaxy. 3T MRT and stereotactic computed tomography angiography were fused to gain maximum information and safety. Operation was performed under intubation anesthesia. Tractography was showing motor and sensory fiber tracts. All patients got neuropsychological testing of memory and cognition pre- and one year postoperatively to detect stimulation induced changes.

Results: All six patients lost allodynia, hyperpathia and dysesthesia. Pain did not exist anymore. Touch and repeated touch was not provoking pain anymore. All patients gained a relief of the permanent burning pain followed by normalization of sensory function in the face as it has been before the neural trauma. Neuropsychological testing showed no change in memory and cognition before and one year after surgery. We will give examples of the treatment on peripheral neuropathic pain syndromes and central neuropathic pain syndromes such as thalamic pain syndromes.

Conclusion: Our method against neuropathic facial pain is high effective and safe as it is in other neuropathic pain syndromes. More than five years of stable and successful treatment urge to perform prospective randomized and blinded trails.