HAL will be down for maintenance from Friday, June 10 at 4pm through Monday, June 13 at 9am. More information
Skip to Main content Skip to Navigation
Master Thesis

Étude des facteurs prédictifs de l'efficacité de la stimulation corticale dans le traitement des douleurs neuropathiques chroniques

Abstract : Background: stimulation of the motor cortex (MCS) is an alternative treatment for chronic neuropathic pain, which often do not respond to usual treatments. Little data are available on the factors that predict the effectiveness of cortical stimulation for pain relief. A better targeting of responder patients would allow to avoid therapeutic failures. We conducted a study to investigate the predictive factors of the effectiveness of cortical stimulation in the treatment of chronic neuropathic pain. Methods : prospective study of all patients (n=38) who had motor cortex stimulation for analgesic purposes, implanted in the Neurosurgery Department of the Brest University Hospital from 2005 to 2014: 23 men, 15 women, aged between 33 and 76 years (mean age 52 years). The evaluation criteria were NRS (Numerical Rating Scales) and WBPQ score (Wisconsin Brief Pain Questionnaire), preoperatively, and then at 3 months, 6 months, 1 year after implantation. The patients were classified into three groups according to the origin of their pain: cerebral (vascular), medullary and brainstem (traumatic, post radiation), peripheral (brachial plexus avulsion, algohallucinosis, facial neuralgia ....). The following possible predictive factors were studied: age, sex, etiology of pain, duration of pain, state of the motor cortex, response to transcranial magnetic stimulation (rTMS), and presence of somatosensory evoked potentials (SEP). The efficacy criteria were a reduction in NRS>50% and WBPQ score >50%. Results : the criterion "at least 50% reduction in NRS" was obtained by 21 of 38 patients (55.26%). The criterion "at least 50% reduction in WBQ" was obtained by 18 of 29 patients (62.07%). We found as significant predictive factors:Age, a person over 60 years old having 3.39 times more chance (RR= 3.39, CI((0.96-12.03)) to improve his NRS than a person under 60 years old.We found that a person without cerebral pathology had 3 times more chance (RR=1/0.30,CI(0.08-1.04)) to note an improvement of his NRS than a person with cerebral pathology. Motor cortex integrity was a positive predictive factor with 5 .33 times greater chance (RR=5.33, CI(0.84-33.4)) of improving NRS compared with patients with injured motor cortex. Patients without peripheral pathology were 1.92 times more likely (RR=1.92, CI(0.28-0.94)), to improve their WBPQ score, compared with patients with peripheral pathology. Conclusion : stimulation of the motor cortex is effective in the treatment of chronic neuropathic pain. In our study, we found that age over 60 years, absence of cerebral pathology, and intactness of the motor cortex were effective predictive factors.
Document type :
Master Thesis
Complete list of metadata

https://dumas.ccsd.cnrs.fr/dumas-03563388
Contributor : Ubo Santé Connect in order to contact the contributor
Submitted on : Wednesday, February 9, 2022 - 4:25:19 PM
Last modification on : Thursday, February 10, 2022 - 3:12:40 AM
Long-term archiving on: : Tuesday, May 10, 2022 - 7:07:50 PM

File

These-Medecine_Generale-2015-C...
Files produced by the author(s)

Licence


Distributed under a Creative Commons Attribution - NonCommercial - NoDerivatives 4.0 International License

Identifiers

  • HAL Id : dumas-03563388, version 1

Collections

Citation

Marie-Gabrielle Courtès. Étude des facteurs prédictifs de l'efficacité de la stimulation corticale dans le traitement des douleurs neuropathiques chroniques. Sciences du Vivant [q-bio]. 2015. ⟨dumas-03563388⟩

Share

Metrics

Record views

41

Files downloads

20