Treatment of Central Pain Syndromes

Central pain syndromes are caused by changes or damage within the brain, for example after a stroke or in connection with multiple sclerosis. These types of pain are often severe and can be difficult to treat with medication alone. One possible treatment option is epidural motor cortex stimulation.

Epidural motor cortex stimulation

In this procedure, a thin electrode is placed over the area of the brain responsible for movement (the motor cortex). Gentle electrical impulses are then used to influence how pain signals are processed in the brain.

With this treatment, about 60% of patients experience a pain reduction of approximately 50%.

In close cooperation with the Interdisciplinary Pain Center, patients with therapy-resistant central pain undergo a thorough evaluation. This takes place during a two-day outpatient stay and helps determine whether motor cortex stimulation is a suitable option for pain relief.

The procedure itself is performed under local anesthesia. Using precise stereotactic techniques, the electrode is placed on the motor cortex through a small opening in the skull (approximately 12 mm in diameter). The electrode is initially connected to an external stimulator, allowing different stimulation settings to be tested over several days.

If the test stimulation leads to a noticeable improvement in pain, a second procedure is performed to implant a permanent pacemaker under the skin below the collarbone. This device then provides long-term stimulation of the motor cortex to help reduce pain.

Trigeminal Neuralgia

Trigeminal neuralgia is a condition that causes sudden, extremely severe facial pain. These pain attacks occur in short episodes and are often followed by pain-free intervals that can last for minutes, hours, or even longer.

If medication no longer provides sufficient relief, we offer a minimally invasive procedure called percutaneous thermocoagulation of the Gasserian ganglion. This treatment is performed under local anesthesia and is an alternative to open microsurgical decompression surgery. It is particularly well suited for older patients or those with additional medical conditions.

During the procedure, the pain-transmitting fibers of the trigeminal nerve are selectively treated at the Gasserian ganglion, an important relay point of the nerve. Using precise temperature control, the affected nerve fibers are gently deactivated by heating them to approximately 60–70 °C, while preserving surrounding structures.

A thin probe is inserted under local anesthesia and continuous X-ray guidance to ensure accurate positioning. A brief test stimulation is used to confirm correct placement before the nerve fibers are treated for about 90 seconds. The probe is then removed. Patients are usually able to return home after 1–2 days of hospital observation.

Treatment outcomes

Large clinical studies show excellent results:

• Complete pain relief in over 90,9% of patients
• Significant improvement in the remaining 9,1% of the patients
• Serious complications, such as chronic anesthesia-related pain (anesthesia dolorosa), are very rare (approximately 0.6%)