Deep brain stimulation and motor cortex stimulation for central post-stroke pain: a systematic review and meta-analysis

TL;DR

This study compares deep brain stimulation and motor cortex stimulation for treating post-stroke pain, finding slight advantages for motor cortex stimulation.

Contribution

The paper provides the first meta-analysis comparing DBS and MCS for central post-stroke pain using objective pain scores.

Findings

MCS showed a 53.1% improvement in pain scores compared to 48.6% for DBS.

Pooled improvement rates were 0.62 for DBS and 0.64 for MCS.

MCS had higher heterogeneity (I2 = 40%) compared to DBS (I2 = 16%).

Abstract

Deep brain stimulation (DBS) and motor cortex stimulation (MCS) are invasive interventions in order to treat various neuropathic pain syndromes such as central post-stroke pain (CPSP). While each treatment has varying degree of success, comparative analysis has not yet been performed, and the success rates of these techniques using validated, objective pain scores have not been synthesized.

A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Three databases were searched, and articles published from January 2000 to October 2024 were included (last search date October 25, 2024). Meta-Analysis was performed using random effects models. We evaluated the performance of DBS or MCS by assessing studies that reported pain relief using visual analogue scale (VAS) or numerical rating scale (NRS) scores.

Of the 478 articles identified, 32 were included in the analysis (330 patients—139 DBS and 191 MCS). The improvement in mean VAS score for patients that underwent DBS post-surgery was 48.6% compared to a score of 53.1% for patients that had MCS. The pooled number of patients who improved after DBS was 0.62 (95% CI, 0.51–0.71, I2 = 16%). The pooled number of patients who improved after MCS was 0.64 (95% CI, 0.53–0.74, I2 = 40%).

The use of neurosurgical interventions such as DBS and MCS are last-resort treatments for CPSP, with limited studies exploring and comparing these two techniques. While our study shows that MCS might be a slightly better treatment option, further research would need to be done to determine the appropriate surgical intervention in the treatment of CPSP.

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