Motor Cortex Stimulation

Motor cortex stimulation is a procedure for treating patients with severe facial pain who have not found relief with medications and other treatments. The technique is versatile; it can be used for a variety of facial pain disorders that are otherwise difficult to treat, including post-stroke facial pain, post-herpetic neuralgia (i.e. facial pain after a shingles attack), anesthesia dolorosa, pain after dental or sinus procedures, and other forms of trigeminal neuropathic pain. Motor cortex stimulation can also be an excellent salvage therapy for patients with with persistent pain after previous surgical treatments for trigeminal neuralgia.

Motor cortex stimulation involves inserting a small electrode array beneath the skull over the part of the brain that controls movement of the affected part of the face (the motor cortex). The procedure is performed in two stages. The first stage is referred to as a stimulator trial. I perform a small craniotomy to insert an an array of electrodes. A set of temporary wires exits through the skin and is connected to an external battery pack. The battery pack delivers targeted electrical impulses to the motor cortex, and the patient monitors his or her facial pain symptoms for the next week.

One week later, the patient returns for a second procedure. If the patient had benefit from the trial stimulator (usually defined as a reduction in chronic pain by at least 50%), I implant a small pacemaker under the collarbone and connect it to the electrode array inside the skull. The permanent system is entirely under the skin and is not visible from the outside. If the trial was ineffective, I remove the electrode array from under the skull.

Motor cortex stimulation can provide dramatic pain relief for patients with difficult-to-treat facial pain disorders who have exhausted other treatment options. Unfortunately, many patients (and doctors!) are not aware that that the procedure exists. Of note, motor cortex stimulation is an off-label use of a spinal cord stimulator. In other words, the stimulator implanted in this procedure is approved by the FDA for treating back or limb pain and is intended to be placed on the spinal cord. Since the spinal cord does not supply sensation to the face, I instead use the device to target pain processing in the brain.

I choose patients very carefully for motor cortex stimulation, and part of the evaluation includes a meeting with a pain psychologist.

If you live near Denver and have a facial pain disorder, please consider meeting me in consultation to learn about your options.