Seminars in Neurosurgery 2004; 15(2/03): 177-182
DOI: 10.1055/s-2004-835706
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Motor Cortex Stimulation

Jeffrey A. Brown1
  • 1Department of Neurological Surgery, Wayne State University, School of Medicine, Detroit, Michigan
Further Information

Publication History

Publication Date:
25 October 2004 (online)

In 1991 Tsubokawa first published his early results in the treatment of medically intractable central pain by epidural motor cortex stimulation. Since then a number of reviews have elaborated on the optimal indications, surgical technique, degree of pain relief achievable, and mechanism of effectiveness. Pain syndromes that have been treated by motor cortex stimulation in published series include central pain secondary to stroke, trigeminal deafferentation pain including postherpetic neuralgia and anesthesia dolorosa, peripheral deafferentation pain syndromes such as brachial plexus or sciatic nerve injury, complex regional pain syndrome, pain associated with spinal cord injury, and phantom limb and stump pain. Good to excellent pain relief has been achieved in 75 to 77% of patients after 2-year follow-up. However, when motor weakness is associated with the painful region, pain relief is achievable in only 15% of patients. Positron emission tomography studies show that cortical stimulation increases blood flow in the ipsilateral ventral lateral thalamus, cingulate gyrus, insula, and brainstem. The presence of increased blood flow in the cingulate1 gyrus suggests that motor cortex stimulation improves the suffering component of chronic pain. Observations of increased blood flow in the motor thalamus add to the hypothesis that thalamic hyperactivity secondary to deafferentation is inhibited. Motor cortex stimulation is clinically effective at thresholds below that of motor activation. Tolerance has not been seen. The best results have been achieved in patients with facial neuropathic pain. Further prospective studies are needed to more fully determine indications, optimal surgical technique, and long-term benefit from treatment.


  • 1 Penfield W, Jasper H. Epilepsy and the Functional Anatomy of the Human Brain. Boston; Little, Brown 1954
  • 2 Lende R, Kirsch W, Druckman R. Relief of facial pain after combined removal of precentral and postcentral cortex.  J Neurosurg. 1971;  34 537-543
  • 3 White J, Sweet W H. Pain: Its Mechanisms and Neurosurgical Control. Springfield; IL: Charles C Thomas 1955
  • 4 Hosobuchi Y. Chronic brain stimulation for the treatment of intractable pain.  Res Clin Stud Headache. 1978;  5 122-126
  • 5 Hosobuchi Y. Subcortical electrical stimulation for control of intractable pain in humans: report of 122 cases (1970-1984).  J Neurosurg. 1986;  64 543-553
  • 6 Andy O J. Parafasicular-centromedian nuclei stimulation for intractable pain and dyskinesia (painful-dyskinesia).  Appl Neurophysiol. 1980;  43 133-144
  • 7 Namba S, Shimizu Y, Wani T, Nakano N. Deafferentation hyperactivity: an experimental model for deafferented pain in cats; considerations based on neurochemical and electrophysiological findings.  Neurol Med Chir (Tokyo). 1985;  25 715-722
  • 8 Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T. Deafferentation pain and stimulation of the thalamic sensory relay nucleus.  Appl Neurophysiol. 1985;  48 166-171
  • 9 Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S. Chronic motor cortex stimulation for the treatment of central pain.  Acta Neurochir Suppl (Wien). 1991;  52 137-139
  • 10 Hardy S G, Haigler H J. Prefrontal influences upon the midbrain: a possible route for pain modulation.  Brain Res. 1985;  339 285-293
  • 11 Hardy S G. Analgesia elicited by prefrontal stimulation.  Brain Res. 1985;  339 281-284
  • 12 Lenz F, Kwan H, Dostrovsky J O. Characteristics of the bursting pattern of action potentials that occurs in the thalamus of patients with central pain.  Brain Res. 1989;  496 357-360
  • 13 Gorecki J, Hirayama T, Dostrovsky J, Tasker R, Lenz F. Thalamic stimulation and recording in patients with deafferentation and central pain.  Stereotact Funct Neurosurg. 1989;  52 219-226
  • 14 Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S. Treatment of thalamic pain by chronic motor cortex stimulation.  Pacing Clin Electrophysiol. 1991;  14 131-134
  • 15 Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S. Chronic motor cortex stimulation in patients with thalamic pain.  J Neurosurg. 1993;  78 393-401
  • 16 Ebel H, Rust D, Tronnier V, Boker D, Kunze S. Chronic precentral stimulation in trigeminal neuropathic pain.  Acta Neurochir (Wien). 1996;  138 1300-1306
  • 17 Katayama Y, Tsubokawa T, Yamamoto T. Chronic motor cortex stimulation for central deafferentation pain: experience with bulbar pain secondary to Wallenberg syndrome.  Stereotact Funct Neurosurg. 1994;  62 295-299
  • 18 Meyerson B A, Lindblom U, Linderoth B, Lind G, Herregodts P. Motor cortex stimulation as treatment of trigeminal neuropathic pain.  Acta Neurochir Suppl (Wien). 1993;  58 150-153
  • 19 Rainov N G, Fels C, Heidecke V, Burkert W. Epidural electrical stimulation of the motor cortex in patients with facial neuralgia.  Clin Neurol Neurosurg. 1997;  99 205-209
  • 20 Nguyen J P, Keravel Y, Feve A et al.. Treatment of deafferentation pain by chronic stimulation of the motor cortex: report of a series of 20 cases.  Acta Neurochir Suppl (Wien). 1997;  68 54-60
  • 21 Katayama Y, Fukaya C, Yamamoto T. Poststroke pain control by chronic motor cortex stimulation: neurological characteristics predicting a favorable response.  J Neurosurg. 1998;  89 585-591
  • 22 Peyron R, Garcia-Larrea L, Deiber M P et al.. Electrical stimulation of precentral cortical area in the treatment of central pain: electrophysiological and PET study.  Pain. 1995;  62 275-286
  • 23 Garcia-Larrea L, Peyron R, Mertens P et al.. Positron emission tomography during motor cortex stimulation for pain control.  Stereotact Funct Neurosurg. 1997;  68 141-148
  • 24 Garcia-Larrea L, Peyron R, Mertens P et al.. Electrical stimulation of motor cortex for pain control: a combined PET-scan and electrophysiological study.  Pain. 1999;  83 259-273
  • 25 Yamamoto T, Katayama Y, Hirayama T, Tsubokawa T. Pharmacological classification of central post-stroke pain: comparison with the results of chronic motor cortex stimulation therapy.  Pain. 1997;  72 5-12
  • 26 Melzack R. The McGill Pain Questionnaire: major properties and scoring methods.  Pain. 1975;  1 277-299
  • 27 Nguyen J P, Lefaucheur J P, Decq P et al.. Chronic motor cortex stimulation in the treatment of central and neuropathic pain. Correlations between clinical, electrophysiological and anatomical data.  Pain. 1999;  82 245-251
  • 28 Bezard E, Boraud T, Nguyen J P, Velasco F, Keravel Y, Gross C. Cortical stimulation and epileptic seizure: a study of the potential risk in primates.  Neurosurgery. 1999;  45 346-350

Jeffrey A BrownM.D. 

Department of Neurological Surgery, Wayne State University, School of Medicine

4160 John R, Ste. 930

Detroit, MI 48201