P049 Chronic post stroke central pain: Increased success rate of chronic epidural motor cortex stimulation using somatotopic, navigated repetitive TMS for patient selection and implant placement

Introduction The outcome at group level of neuromodulation for central pain using stimulation of motor cortices is limited, though for some, there are large effects. Thus, there is a need for selection of patients. Methods 15 patients with refractory central post stroke pain had somatotopically directed, placebo controlled, motor cortex stimulation with navigated rTMS (nrTMS). Symptoms were reported one week before and two weeks after the procedure. The optimal stimulation positions were transferred to an intraoperatively used neuronavigation system and verified by epidural stimulation. Here, an electrode was sewn to the dura mater . Patients reported symptoms, intermittently up to 12 months after the operation. Results Of the 15 patients evaluated, seven were rejected since they did not respond to nrTMS. Of the eight that did respond, four are waiting for- and four have had the procedure. Of the four with implant all report an, on the whole, positive, clinically meaningful effect. Discussion The value of Evidence Based Medicine is beginning to be reconsidered. The kind of procedure described above may considerably improve the outcome of this invasive procedure for severe central pain, making it sound from economical and ethical perspectives.