Jeffrey A. Brown, MD, recognized for expertise in treating patients with complex pain syndromes
Jeffrey A. Brown, MD, a well-known neurosurgeon recognized for his skill and success in treating patients with intractable, complex and chronic pain syndromes, has become a member of Winthrop-University Hospital's renowned neurosurgical staff.
MRI brain image from computer workstation in operating room shows target for facial pain treatment.
A pioneer in the development and use of Motor Cortex Stimulation (MCS) to relieve intense, unremitting facial and neck pain, Dr. Brown is among a few neurosurgeons in the country -- and the only one on Long Island -- performing this procedure.
MCS involves easing pain via electrical stimulation of the motor cortex, the portion of the brain that controls movement. Through a small opening, Dr. Brown places an array of tiny electrodes between the skull and the thin membrane that covers the brain. Without invading the brain, he uses highly sophisticated computer technology to pinpoint the part of thh the organ that controls movement of the painful area and then transmits a controlled electrical pulse to stimulate that region.
"It's as if the brain is an engine missing a spark plug," Dr. Brown said. "Stimulating the motor cortex can be compared to installing a new plug. The engine, or brain, begins to run smoothly and the pain is relieved."
No one really knows how the electrical pulses provide relief; some believe the increased blood flow to the targeted areas generated by the pulses decreases the pain; others link the pulses to a quieting of the thalamus, which becomes hyperactive during pain.
But exactly how MCS works didn't matter to Kevin Gill, who experienced "nightmarish" facial pain for 20 years following a serious stroke. After Dr. Brown performed his procedure, Mr. Gill remembered crying with relief. "It was so unbelievable," he reported. "The pain was gone. I hadn't slept through the night for 20 years. Now I could sleep and even dream again."
According to Dr. Brown, MCS is not experimental. "The idea of using an electrical jolt to treat a neurological condition is hardly new," he said. "The use of MCS has increased lately because today's extraordinary computers enable us to navigate the brain non-invasively, target a very specific area and accurately. position the electrodes. With the precisely configured electrical pulses, we can perform 'virtual brain surgery' through the brain's protective membrane without cutting or burning the problem nerve pathway and disturbing the brain itself."
After the electrodes are in place and the patient has awakened from the two-hour procedure, brain stimulation begins. The pulses go through the motor cortex, easing pain by triggering effects deep in the brain.
The electrodes are tested over a number of days to customize the pulse intensity and timing that works best for each patient. Once that is established, the electrode wires are connected to an implanted "pulse generator," a programmable, pacemaker-type device for the brain that drives the electrodes.
The pulse generator is battery-operated and programmed to release timed electrical pulses at safe levels set by the neurosurgeon; patients can control the stimulation through hand-held programmers within those parameters.
Candidates for MCS:
- Have burning facial pain that can no longer be relieved with medication.
- May or may not have had surgery to alleviate their pain.
- Must be able to communicate clearly.
- Should have realistic expectations and not regard the procedure as the "miracle cure."
Dr. Brown, who has been researching the treatment of difficult chronic pain syndromes for more than a decade, has published more than 40 articles in peer-reviewed neurosurgery journals on the treatment of chronic pain -- especially facial pain and trigeminal neuralgia. Before joining Winthrop, he was a professor of neurosurgery and chief of neurosurgical pain and functional surgery at Wayne State University and the Detroit Medical Center. He has performed dozens of MCS procedures, relieving most patients of 50 percent of their pain without damaging the brain or injuring nerves.
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