Abstract : 
Dejerine-Roussy syndrome, or thalamic pain syndrome, is one of the most intractable chronic pain conditions, developing as a consequence of thalamic stroke, with a reported incidence in up to 8%-12% of patients. A key challenge in the management of this disorder is its high refractoriness to standard pharmacotherapy. We present a case series evaluating the preliminary efficacy and safety of incobotulinumtoxinA (incoBoNT-A) injected locally to reduce the intensity of pain in this patient population. This case series included patients with a confirmed diagnosis of Dejerine-Roussy syndrome that developed after an ischemic stroke. The primary outcome measures were change in pain intensity as assessed on the Visual Analogue Scale (VAS), the severity of neuropathic pain according to the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale, and the Clinical Global Impression (CGI) assessment administered at 4 and 12 weeks post-injection. The follow-up period lasted 24 months, during which patients received intradermal and/or intramuscular injections of incoBoNT-A at a total dose of 350 ± 50 units every 3 to 4 months. All injections were administered on the affected side of the body. Each patient had an individualized injection protocol that included different body areas, such as intradermal papular injections in the facial allodynia zone and intramuscular injections into trigger points of target muscles in the head, neck, limbs, and trunk using electromyographic and ultrasound guidance. All patients, prior to botulinum neurotoxin (BoNT) therapy, had experienced chronic pain lasting over 2 years, with high intensity (VAS score 8.0 ± 1.2). The LANSS score was 18.2±1.8, and the CGI score of 5.7±0.6. All patients were resistant to ≥ 2 lines of adequate pharmacotherapy and had no post-stroke spasticity. Four weeks after the first injection, all patients exhibited a clinically significant reduction in pain intensity to 3.8 ± 0.52 on the VAS; the CGI score was 2.0. Four out of five patients showed a substantial reduction in neuropathic pain by 6 to 7 points on the LANSS scale. The effect persisted for up to 10 to 12 weeks, with two patients reducing their analgesic dosage. Repeated injections every 3 to 4 months maintained the achieved level of analgesia in all patients throughout the 24-month period. Injections of incoBoNT-A demonstrated preliminary efficacy and safety in the treatment of refractory Dejerine-Roussy syndrome, significantly improving patients’ quality of life.

Biography:

Irina Matveeva received her PhD in medicine in 2007 from the Irkutsk Medical Academy of Postgraduate Education. She is an associate professor in the Department of Neurology and Neurosurgery at the Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, the leading institution for postgraduate medical