La neuromodulazione elettrica cerebrale per il dolore centrale farmacoresistente - Brain elecrtical neuromodulation for pharmacological resistant central pain

Central pain is a very difficult condition to treat. Sometimes it is resistant to pharmacological therapy. Mininvasive brain electrical neuromodulation is indicated in cases of failed treatments. Deep Brain Stimulation (DBS) of Ventro-Caudalis and Ventro-Postero-Lateral -somatosensorial thalamic nuclei (VC/VPL) and of Periventricular and Periacqueduttal Gray matter (PVG/PAG) is effective in 46 per cent of patients in long follow-up. Motor Cortex Stimulation (MCS) is less invasive and more safe neurosurgic al technique with good results in 60 per cent of patients with post-stroke pain and spinal cord injury pain, 75 per cent of patients with neuropathic trigeminal pain and 45 per cent of patient with brachial plexus avulsion. Both DBS and MCS are promising and interesting fields of research and functional neurosurgery studies will increase with the functional neuroimaging development, that will allow a better knowledge of chronic pain pathways