E.D. Isagulyan, V.A. Shabalov, A.A. Tomskiy, E.M. Salova
Burdenko Research Institute of Neurosurgery, Moscow, Russia
Inefficacy of drug therapy, lasting six months, causes necessity of surgical treatment.
The study goal has been to assess results of chronic neurostimulation of spinal and cerebral structures in severe neurogenic pain syndromes.
Material and Methods. There were 70 cases with severe neurogenic pain syndromes, aged 19-62 (mean age – 41.2 years). The median period of pain was 5 years. Neurostimulators for chronic electrostimulation (ES) of the posterior column were implanted in 55 cases. Chronic ES of deep cerebral structures was carried out in 7 patients. Chronic ES of the central cerebral cortex was used in 8 cases with deafferentation pain syndromes.
A follow-up period was about 3 years in all three groups. Positive results were watched in 49 (89%) out of 55 cases with chronic ES of the spinal cord (excellent - 21, good – 22 and satisfactory – 6). Chronic SCS led to considerable reduction of analgesic doses (by 75% on the average) in all cases or complete refusal of them. Everyday activity improved (by 70% on the average). Positive results were also obtained in 6 patients with chronic ES of deep-lying cerebral structures (excellent - 2, good – 2, satisfactory - 2). The MSC group was characterized by 4 excellent, 1 good and 3 satisfactory results.
Conclusion. If drug therapy of 3-6 month is ineffective one should regard possibility of electrode implantation. When results of a test period are positive, chronic neurostimulation can considerably improve further treatment of cases with neurogenic pain syndromes.