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Motor Cortex Stimulation

Indication: Neuropathic Pain

Motor cortex stimulation has been used for the treatment of central and neuropathic pain syndromes since 1991. It is best indicated for medically unresponsive central and neuropathic pain including that due to thalamic, putaminal, and lateral medullary infarction, traumatic trigeminal neuropathy (not idiopathic trigeminal neuralgia), postherpetic facial neuralgia, brachial plexopathy, and neuropathic pain after a spinal cord injury, and phantom limb pain. There have only been scattered case reports regarding motor cortex stimulation for complex regional pain syndromes. Cortical stimulation is not indicated for patients with a history of seizures. Personality disorders such as severe depression or psychotic disorders need to be screened out prior to using this procedure.

The motor cortex stimulation leads are placed on the dura surgically with the target selected on the primary motor cortex based on somatotopic anatomic landmarks. The optimal stimulation level is that which provides the best pain relief yet does not cause a seizure, pain from dural stimulation, or electromyographic activity. With improved mapping techniques for the epidural stimulation sites in 12 patients with medically intractable neuropathic facial pain, Nguyen reported good to excellent pain relief in 75% of the patients.

The precise mechanism for the motor cortex stimulation in relieving pain remains unknown. Studies have demonstrated that motor cortex stimulation leads to an increase in cerebral blood flow in the ipsilateral thalamus, cingulate gyrus, orbitofrontal cortex, and midbrain. The extent of pain relief correlates best, however, with anterior cingulate gyrus blood flow. Two other hypothesized mechanisms for pain relief after motor cortex stimulation include direct activation of inhibitory interneurons in the spinal cord or indirect inhibition during stimulation.

Meet the FLPNR Team

  • Richard Adkins, MD
  • Hoang (Wayne) T. Vu, D.O.
  • Lourdes Varela–Batista, M.D.
  • Vinh-Loc Nguyen, P.A.
  • Irene Aponte Moreno, N.P.
  • Sunny Park, N.P.
Anesthesiology Specialist in Ocala, FL Doctor of Osteopathic Medicine in Ocala, FL Physician in Ocala, FL Physician in Ocala, FL Nurse Practitioner in Ocala, FL Nurse Practitioner in Ocala, FL
Anesthesiology Specialist in Ocala, FL

Richard Adkins, MD

Anesthesiology Specialist

Dr. Richard Adkins has been in practice for more than 30 years. His specialty is in anesthesiology and pain medicine.

Doctor of Osteopathic Medicine in Ocala, FL

Hoang (Wayne) T. Vu, D.O.

Dr. Hoang (Wayne) T. Vu is board certified by both the American Board of Pain Medicine and the American Board of Physical Medicine and Rehabilitation. Dr. Vu earned his degree of Doctor of Osteopathic Medicine from Touro University College of Osteopathic Medicine in California in 2003.

Physician in Ocala, FL

Lourdes Varela–Batista, M.D.

Dr. Varela is a fellowship trained pain specialist and board certified PMR expert. Her specialities include physical medicine and rehabilitation and interventional pain medicine. She received her undergraduate degree from University of Puerto Rico and completed her medical degree from New York Medica College. Dr. Varela completed her physical medicine and rehabilitation residency at University of Texas Health Science Center San Antonio.

Physician in Ocala, FL

Vinh-Loc Nguyen, P.A.

Vinh-Loc Nguyen is a NCCPA certified physician assistant and is licensed by the State of Florida Department of Health. He received his Bachelor of Science degree in microbiology and Bachelor of Arts Degree in economics from University of Florida in 1994. He had a successful career in the financial industry before returning to his true passion for medicine.

Nurse Practitioner in Ocala, FL

Irene Aponte Moreno, N.P.

Ms. Irene Aponte Moreno is an Adult-Gerontology certified Nurse Practitioner and licensed by the State of Florida Department of Health. In 2014, she received her Master of Science degree in Nursing from the University of South Alabama. She completed her Bachelor of Science degree in Nursing from Jacksonville State University in December of 2006. In 2003, she received an Associates of Arts degree from Southwestern Michigan College. She also completed an Associate degree in Informatics from the University Institute Antonio Jose de Sucre located in Lara State, Venezuela.

Nurse Practitioner in Ocala, FL

Sunny Park, N.P.

Ms. Sunny Park is an AANP and ANCC certified Advanced Registered Nurse Practitioner, licensed by the State of Florida Department of Health. She graduated with Summa Cum Laude with Bachelor of Arts in Drawing from Southern Illinois University in 1999. She pursued nursing career and graduated with Associate of Science in Nursing in 2007 and started working as a registered nurse in Cardiovascular ICU in St.Luke’s Medical Center. She continued with her education and graduated with Magna Cum Laude obtaining Bachelor of Science in Nursing in 2010 from Cardinal Stritch University. During her nursing education, she was awarded multiple scholarships including the Lamplight scholarship by Milwaukee Nurses Association.


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