Neuromodulation for central post-stroke pain: mechanism, safety andoutcome.

Central post-stroke pain (CPSP) has been treated with three distinct types of neuromodulation (deep brain stimulation of the sensory thalamus (Vc-DBS), motor cortex repetitive transcranial magnetic stimulation (M1-rTMS), and motor cortex stimulation (MCS)), but the level of evidence for these procedures is very low. Moreover, data on the changes in pain brain circuitry in CPSP, and the effect of neuromodulation on this circuitry is very limited.We propose a prospective, double-blind, randomised cross-over on/off study in CPSP patients, who will undergo M1-rTMS and either MCS or Vc-DBS. They will be assessed using clinical scales for pain, functioning, quality of life, mood and sensation. Adverse events will be monitored. In addition, we will use functional imaging and electrophysiological recordings to study the outcome, safety, pathophysiology and mechanism of action of neuromodulation in CPSP.

Keywords:neurosurgery, neuromodulation, central post-stroke pain, deep brain stimulation, motor cortex stimulation

Disciplines:Neurosurgery