Deep Brain Stimulation in Mesencephalic Lemniscus Medialis for Chronic Pain

  • F. Mundinger
  • J. F. Salomão
Part of the Acta Neurochirurgica Supplementum book series (NEUROCHIRURGICA, volume 30)


Stereotactic deep brain stimulation (DBS) with chronically implanted special devices intermittently activated by the patient himself has led to a new concept in the treatment of chronic central pain, such as the thalamic pain syndrome, herpes-zoster neuralgia, anaesthesia dolorosa, radicular and plexus lacerations, stump pain with and without causalgia and cancer pain.

Our results in 32 cases (March 31, 1979) with lemniscus medialis stimulation, including the specific and nonspecific somatosensory nuclei or periaqueductal gray matter show in 53% of our cases, a reduction of pain of over 50%. The follow-up period was 47 months. These results are better than those obtained from stimulating only one of the systems.

Mesencephalic lemniscus medialis DBS, introduced by one of the authors (Mundinger), leads to a functional blockade of spinothalamic, lemniscus medialis and spino-reticular systems. In cases where a positive morphine test had been done previously, endorphine secretion also plays a role. It is assumed that the effect of endorphine production lasts longer than the Stimulation itself, especially in periaqueductal mesencephalic gray matter and medial pulvinar stimulation.


Deep Brain Stimulation Herpes Zoster Trigeminal Neuralgia Phantom Limb Pain Lemniscus Medialis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Adams, J., Hosobuchi, Y., Fields, H. L., Stimulation of internal capsule for relief of chronic pain. J. Neurosurg.41 (1974), 740–744.PubMedCrossRefGoogle Scholar
  2. 2.
    Birg, W., Mundinger, F., Computer calculations of target parameter for a stereotactic apparatus. Acta Neurochir. (Wien) 29 (1973), 123–129.CrossRefGoogle Scholar
  3. 3.
    Birg, W., Mundinger, F., Computer programmes for stereotactic neurosurgery. 6th Symposium of the International Society for Research in Stereoencephalo- tomy. Tokyo 1973. Confin. neurol. (Basel) 36 (1974), 326–366.CrossRefGoogle Scholar
  4. 4.
    Birg, W., Mundinger, F., Calculation of the position of a sideprotruding electrode tip in stereotactic brain Operations using a stereotactic apparatus with polar coordinates. Acta Neurochir. (Wien) 32 (1975), 83–87.CrossRefGoogle Scholar
  5. 5.
    Hassler, R., Central interactions of the system of the rapidly and slowly con- ducted pain. Advanc. Neurosurg. 3 (1975), 143–149.Google Scholar
  6. 6.
    Hoefer, T., Mundinger, F., Birg, W., Reinke, M., Computer calculation to localize subcortical targets in plane X-rays for stereotactic neurosurgery. 6th Symposium of the International Society for Research in Stereoencephalotomy, Tokyo, 1973. Confin. neurol. (Basel) 36 (1974), 334–340.CrossRefGoogle Scholar
  7. 7.
    Melzak, R., Wall, P. D., Pain mechanism. A new theory. Science 150 (1965), 975–979.Google Scholar
  8. 8.
    Müke, R., Correia, A., Potentials and limits of percutaneous cervical cordo- tomy. Advanc. Neurosurg. 3 (1975), 195–198.Google Scholar
  9. 9.
    Mundinger, F., Stereotaktische Operationen am Gehirn. Grundlagen-Indika- tionen-Resultate. Stuttgart: Hippokrates. 1975.Google Scholar
  10. 10.
    Mundinger, F., Die Behandlung chronischer Schmerzen mit Hirnstimulatoren. Dtsch. med. Wschr. 102 (1977), 1724–1729.PubMedCrossRefGoogle Scholar
  11. 11.
    Mundinger, F., Die stereotaktisch-funktionelle Behandlung des Schmerzes durch intracerebrale Ausschaltung und Stimulation. Jahrestagung des Berufsverbandes Westfälischer Nervenärzte e.V., Bad Salzuflen, 1976. In: Aktuelle Probleme der Neuropsychiatrie, pp. 88–103 (Gottschaidt, M., Grass, H., Brock, M., eds.). Berlin-Heidelberg-New York: Springer. 1978.Google Scholar
  12. 12.
    Mundinger, F., Becker, P., Long term results of central stereotactic interventions for pain. Advanc. Neurosurg. 3 (1975), 237–241.Google Scholar
  13. 13.
    Mundinger, F., Becker, P., Late results of central stereotactic interventions for pain. Und Meeting of the European Society for Stereotactic and Functional Neurosurgery, Madrid 1975. Acta Neurochir. Suppl. 24 (1977), 229.Google Scholar
  14. 14.
    Mundinger, F., Reinke, M.-A., Hoefer, Th., Birg, W., Determination of intracerebral structures using osseous reference points for Computer aided stereotactic Operations. Appl. Neurophysiol. 38 (1975), 3–22.PubMedGoogle Scholar
  15. 15.
    Penzholz, H., Menzel, J., Hagenlocher, H. U., Results of surgical treatment of idiopathic trigeminal neuralgia using different operative techniques. Advanc. Neurosurg. 3 (1975), 320–327.Google Scholar
  16. 16.
    Piotrowski, W., Panitz, C., Results after open cordotomy. Advanc. Neurosurg. 3 (1975), 174–177.Google Scholar
  17. 17.
    Ray, Ch. D., Control of pain by electrical Stimulation. A clinical value of dorsal column Stimulation (DCS). Advanc. Neurosurg. 3 (1975), 216– 224.Google Scholar
  18. 18.
    Shealy, C. N., Mortimer, J. R., Reswick, J. B., Electrical inhibition of pain Stimulation of the dorsal columns. Preliminary clinical report. Anesth. Anaig. Curr. Res. 46 (1967), 489.Google Scholar
  19. 19.
    Siegfried, J., Results of percutaneous controlled thermocoagulation of the Gasserian ganglion in 300 cases of trigeminal pain. Advanc. Neurosurg. 3 (1975), 287–295.Google Scholar
  20. 20.
    Winkelmüller, W., Dietz, H., Stolke, D., The clinical value of dorsal column Stimulation (DCS). Advanc. Neurosurg. 3 (1975), 225–228.Google Scholar
  21. 21.
    Wüllenweber, R., Distelmaier, P., Results of treatment of trigeminal neuralgia by the Operations of Dandy. Advanc. Neurosurg. 3 (1975), 316–319.Google Scholar
  22. 22.
    Zimmermann, M., Neurophysiological models for nociception, pain and pain therapy. Advanc. Neurosurg. 3 (1975), 199–205.Google Scholar

Copyright information

© Springer-Verlag 1980

Authors and Affiliations

  • F. Mundinger
    • 1
  • J. F. Salomão
  1. 1.Abteilung Stereotaxie und Neuronuklearmedizin, Neurochirurgische UniversitätsklinikFreiburg i. Br.Federal Republic of Germany

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