Motor Cortex Stimulation for Refractory Trigeminal Pain: A Case Series from Atlantic Canada
Bibliographic record
Abstract
INTRODUCTION: Neuromodulation is emerging as a promising intervention for intractable pain syndromes. Despite heterogeneous outcomes in the literature, motor cortex stimulation (MCS) has proven effective in addressing chronic orofacial pain. Painful trigeminal neuropathy (PTN) is characterized by constant facial pain and somatosensory signs. Refractory cases, unresponsive to medical and surgical therapies, significantly impact quality of life and pose socioeconomic challenges. This article presents a retrospective case series of five MCS patients who were treated for refractory PTN in Atlantic Canada. METHODS: Since 2021, eight cases of refractory PTN from Atlantic Canada have been recruited. Demographic and clinical characteristics were collected, with primary and secondary outcomes respectively defined as a 50% Visual Analogue Scale (VAS) reduction and a 60% reduction in morphine equivalent dose per day (MED, mg/day) at 12 months post-operation. Pain intensity was assessed preoperatively and at 6- and 12-month follow-ups, along with eating habits, return to work, and global satisfaction. RESULTS: Five patients with refractory PTN were implanted with MCS, all of whom achieved the primary and secondary outcomes. Preoperatively, mean VAS was 8.4 ± 1.0, reduced to 2.0 ± 1.1 at 12 months post-MCS, corresponding to a 77 ± 13% pain reduction. Average MED/day was reduced by 93 ± 13%, with 60% of participants narcotic-free at 12 months and 80% at 18 months. There were no immediate or delayed complications related to the MCS procedure. CONCLUSION: MCS exhibits significant potential for long-term pain relief and reducing opioid consumption in refractory trigeminal pain, emphasizing the necessity for large national multicenter trials.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".