Motor cortex stimulation

Motor cortex stimulation represents a paradigm shift in our understanding of the options available for treatment of both motor and somatosensory syndromes including central and neuropathic pain, weakness after stroke, Parkinson's disease, and tinnitus. Extensive clinical information over the past 15 years is now available on the beneficial effects on intractable central and neuropathic pain, especially facial pain. More recently, there is preclinical and clinical evidence of its benefit in treating Parkinson's disease. Clinical applications of epidural cortical stimulation in conjunction with rehabilitation to enhance recovery from motor weakness after stroke now exist. There is potential benefit suggested in the treatment of intractable tinnitus with implanted cortical electrodes. Noninvasive transcranial magnetic stimulation may also be useful to screen patients for treatment by electrode implantation in these entities. This article reviews the current status of applications of cortical stimulation in each of these areas.