Motor Cortex Stimulation for Intractable Pain

Richard K. Osenbach, M.D.

Disclosures

Neurosurg Focus. 2006;21(6) 

In This Article

Complications

Relatively few serious complications have been reported to arise from MCS, but the most troubling of these is the development of seizures. So far, there is no evidence that long-term MCS leads to the development of chronic seizures. Although some patients may experience brief seizures, especially during testing to identify the threshold for motor contraction, there have been no reports of any patient developing a long-term seizure disorder.[6,32] To minimize the risk of seizures, it is recommended that patients receive anticonvulsant drugs during the perioperative period and for a while postoperatively, although the optimal duration of therapy is not known. Some authors have recommended as little as 2 weeks of anticonvulsant therapy,[6] but our preference has been to continue anticonvulsants for a period of 6 months.

Other procedure-related morbidity includes infection, epidural hematoma, and subdural effusion. Infection is obviously a concern with any implanted device, especially when temporary extension wires are used during the testing period. However, relatively few infectious complications with MCS have been reported. Most stimulator-related infections, at least with implanted spinal cord stimulators, involve the IPG pocket. Although there are rare cases in which the IPG and extension wires can be removed while preserving the electrode, in our experience this has been the exception, not the rule. Erosion of the connector through the skin has been reported in a number of patients who have undergone DBS procedures and in a few patients with MCS. Placement of the connector in the soft tissues of the neck should be avoided. In this location, there is considerable stress related to cervical motion and the connectors have a tendency to erode through the skin or break.

Some patients report stimulation-induced headache or pain at the electrode site. This is related to stimulation of pain fibers within the dura mater. In our experience, these symptoms are generally self-limited and eventually resolve, although an occasional patient may require repeated operation for denervation of the dura adjacent to the electrode.[15] Other complications include epidural hematoma, subdural effusion, and cerebrospinal fluid leakage, all of which are relatively uncommon.

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