NEUROSTIMULATION
Surgical Treatments for Facial Neuralgias

Disclaimer.

Neurostimulation is a medical treatment for people suffering from chronic pain, including Trigeminal Neuralgia and other facial neuralgias. A small device, much like a pacemaker delivers low voltage electrical stimulation to the spinal cord or targeted peripheral nerve to block the sensation of pain. Once experimental, this treatment is being used more often to treat intractable facial pain. 

This is an example of what a neurostimulation device looks like.

According to Dr. Tony  Whitworth from the University of Texas, Southwestern Center in Dallas there are five types of Neurostimulation that can be of help to facial pain patients.  Peripheral Nerve Stimulation, Ganglion Nerve Stimulation, Spinal Chord Stimulation, Deep Brain Stimulation and Motor Cortex Stimulation.

1. Peripheral Nerve Stimulation
   In Peripheral Nerve Stimulation, sometimes referred to as PENS, a thin electrical lead is inserted into the cheek, lip or other area of the face.. The electrical lead is positioned into the face using a CT scanner. Once positioned, the lead is connected to an external neurostimulator which sends low level electrical pulses through the lead to the face which is felt as a slight tingling, burning or itching. A trial period of 1-10 days using the neurostimulator externally typically follows.  Once the neurostimulator is adjusted and found to be effective, a second surgical procedure is done to implant the complete neurostimulator system.

According to Dr. Whitworth, this procedure is most beneficial for patients with "pain in the Trigeminal Nerve branch V1 (eye, forehead, nose) or V2 (upper teeth, gums and lip, the cheek, lower eyelid and the side of the nose) and requires at least some remaining sensation in the pain region."

More information
Trigeminal Stimulation: Department of Neurosurgery Oregon Health and Science

Personal Experience
Kimberly's experience with Peripheral Nerve Stimulation

2. Ganglion Stimulation
   According to Dr. Whitworth, this procedure "Can treat pain in any trigeminal distribution but has a high rate of dislodgement, 50% at one year."
    
3. Spinal Cord Stimulation
   According to Dr. Whitworth, this procedure "Uses a very stable electrode, is good for treating pain in the V3 (lower teeth, gums and lip) and requires some preserved sensation."
    
4. Deep Brain Stimulation
   In this surgical procedure, thin electrodes are inserted through the skull into the thalamus, the area of the brain where pain signals are sensed. After a trial period, if there is significant improvement with the pain level, the device is implanted into the body.  According to "Striking Back, The Trigeminal Neuralgia and Face Pain Handbook, "The average success rate in the past four years is only 25-35%, although those figure have improved with experience in recent years."
   
   According to Dr. Whitworth, this procedure is "Good for pain in any trigeminal distribution, does not require intact sensation, offers at best a 50% success rate.  It is often used to treat anesthesia dolorosa, trigeminal neuropathic pain, and trigeminal deafferentation pain."
    
5. Motor Cortex Stimulation
   Motor cortex stimulation (MCS) is a surgical option reserved for patients with trigeminal neuralgia pain which proves difficult to alleviate. This procedure involves stimulation of the region of the outer portion of the brain (motor cortex).  See Motor Cortex Stimulation

According to Dr. Whitworth, this procedure is "– Good for pain in any trigeminal distribution, doesn’t require intact sensation, and its success rate runs 60-70%. It was developed 10-12 years ago in Japan and has only been used in the US for 5-6 years. It is often used to treat anesthesia dolorosa, trigeminal neuropathic pain, and trigeminal deafferentation pain.."

More Information
Department of Neurosurgery Oregon Health and Science

Neurostimulation for the Treatment of Intractable Facial Pain by Richard Osenbach, MD
 

References

• Medtronic: Introduction to Neurostimulation - Explains what neurostimulation is and how it works.
• TNA North Central Texas Newsletter April 2004
• Opuslinks.com - A website created by a woman with trigeminal neuralgia who underwent Motor Cortex Stimulation.
• Department of Neurosurgery Oregon Health and Science