Author's experience of lateral medullary infarction – thermal perception and muscle allodynia

Kamano, Shuji

doi:10.1016/s0304-3959(02)00462-1

Cited by 9 publications

(6 citation statements)

References 22 publications

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“…Nevertheless, a subgroup remains either tolerant long term or demonstrates progressive reductions in efficacy. Hypotheses for these results include that patients genuinely become tolerant to the treatment, that a particular pain characteristic is reduced but others unmasked become worse over time, 29 and that chronic pain exhibits disease progression concomitant with increasing severity despite DBS, as has been demonstrated in tremor. 12 Advances in stimulator technology such as the development of demand-driven stimulators may enable patient-controlled analgesia and potentially overcome aspects of tolerance.…”

Section: Discussionmentioning

confidence: 99%

Thalamic deep brain stimulation for neuropathic pain after amputation or brachial plexus avulsion

Pereira

Boccard

Linhares

et al. 2013

FOC

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Object Fifteen hundred patients have received deep brain stimulation (DBS) to treat neuropathic pain refractory to pharmacotherapy over the last half-century, but few during the last decade. Deep brain stimulation for neuropathic pain has shown variable outcomes and gained consensus approval in Europe but not the US. This study prospectively evaluated the efficacy at 1 year of DBS for phantom limb pain after amputation, and deafferentation pain after brachial plexus avulsion (BPA), in a single-center case series. Methods Patient-reported outcome measures were collated before and after surgery, using a visual analog scale (VAS) score, 36-Item Short-Form Health Survey (SF-36), Brief Pain Inventory (BPI), and University of Washington Neuropathic Pain Score (UWNPS). Results Twelve patients were treated over 29 months, receiving contralateral, ventroposterolateral sensory thalamic DBS. Five patients were amputees and 7 had BPAs, all from traumas. A postoperative trial of externalized DBS failed in 1 patient with BPA. Eleven patients proceeded to implantation and gained improvement in pain scores at 12 months. No surgical complications or stimulation side effects were noted. In the amputation group, after 12 months the mean VAS score improved by 90.0% ± 10.0% (p = 0.001), SF-36 by 57.5% ± 97.9% (p = 0.127), UWNPS by 80.4% ± 12.7% (p < 0.001), and BPI by 79.9% ± 14.7% (p < 0.001). In the BPA group, after 12 months the mean VAS score improved by 52.7% ± 30.2% (p < 0.001), SF-36 by 15.6% ± 30.5% (p = 1.000), UWNPS by 26.2% ± 40.8% (p = 0.399), and BPI by 38.4% ± 41.7% (p = 0.018). Mean DBS parameters were 2.5 V, 213 microseconds, and 25 Hz. Conclusions Deep brain stimulation demonstrated efficacy at 1 year for chronic neuropathic pain after traumatic amputation and BPA. Clinical trials that retain patients in long-term follow-up are desirable to confirm findings from prospectively assessed case series.

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Section: Discussionmentioning

confidence: 99%

Thalamic deep brain stimulation for neuropathic pain after amputation or brachial plexus avulsion

Pereira

Boccard

Linhares

et al. 2013

FOC

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“…A good outcome may be the removal of a particular component of pain, for example burning hyperaesthesia, without quantitative reduction in pain scores. Such pain relief may serve to unmask other types or components of pain elsewhere, such as muscular allodynia, as has been described after stroke [194]. Conversely, complete pain eradication by DBS may even accompany unease, motor complications, or other sequelae precipitating intolerance of stimulation.…”

Section: Discussionmentioning

confidence: 99%

Neuropathic Pain and Deep Brain Stimulation

Pereira

Aziz

2014

Neurotherapeutics

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Deep brain stimulation (DBS) is a neurosurgical intervention the efficacy, safety, and utility of which are established in the treatment of Parkinson's disease. For the treatment of chronic, neuropathic pain refractory to medical therapies, many prospective case series have been reported, but few have published findings from patients treated with current standards of neuroimaging and stimulator technology over the last decade . We summarize the history, science, selection, assessment, surgery, programming, and personal clinical experience of DBS of the ventral posterior thalamus, periventricular/periaqueductal gray matter, and latterly rostral anterior cingulate cortex (Cg24) in 113 patients treated at 2 centers (John Radcliffe, Oxford, UK, and Hospital de São João, Porto, Portugal) over 13 years. Several experienced centers continue DBS for chronic pain, with success in selected patients, in particular those with pain after amputation, brachial plexus injury, stroke, and cephalalgias including anesthesia dolorosa. Other successes include pain after multiple sclerosis and spine injury. Somatotopic coverage during awake surgery is important in our technique, with cingulate DBS under general anesthesia considered for whole or hemibody pain, or after unsuccessful DBS of other targets. Findings discussed from neuroimaging modalities, invasive neurophysiological insights from local field potential recording, and autonomic assessments may translate into improved patient selection and enhanced efficacy, encouraging larger clinical trials.

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“…Evidence from LFP recording shows chronic pain patients with DBS ‘off’ have characteristically enhanced low frequency (8–14 Hz) power spectra of both PAG and VP (thalamus) local field potentials when in pain [141]. Further research could explore non-invasive functional neuroimaging, including single-photo emission computed tomography, PET, and MEG to find correlates of this [109,142,143,144]. Perhaps rTMS may be an aid to selection as it can be with SCS and MCS.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, in this study, 5/9 patients said they would have the surgery all over again if they knew the result they would get—suggesting over 50% success rate according to patient satisfaction. There are further issues with the outcome measures used to detect successful results; the removal of a particular component of pain, for example, burning hyperesthesia, may unmask another type, such as muscular allodynia, as has been described after stroke [109]. In the future, a score capturing a more objective measure of the changes in analgesia may be useful.…”

Section: Management Of Chronic Painmentioning

confidence: 99%

The Current State of Deep Brain Stimulation for Chronic Pain and Its Context in Other Forms of Neuromodulation

2018

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Chronic intractable pain is debilitating for those touched, affecting 5% of the population. Deep brain stimulation (DBS) has fallen out of favour as the centrally implantable neurostimulation of choice for chronic pain since the 1970–1980s, with some neurosurgeons favouring motor cortex stimulation as the ‘last chance saloon’. This article reviews the available data and professional opinion of the current state of DBS as a treatment for chronic pain, placing it in the context of other neuromodulation therapies. We suggest DBS, with its newer target, namely anterior cingulate cortex (ACC), should not be blacklisted on the basis of a lack of good quality study data, which often fails to capture the merits of the treatment.

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Author's experience of lateral medullary infarction – thermal perception and muscle allodynia

Cited by 9 publications

References 22 publications

Thalamic deep brain stimulation for neuropathic pain after amputation or brachial plexus avulsion

Thalamic deep brain stimulation for neuropathic pain after amputation or brachial plexus avulsion

Neuropathic Pain and Deep Brain Stimulation

The Current State of Deep Brain Stimulation for Chronic Pain and Its Context in Other Forms of Neuromodulation

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