Case Series: Deep Brain Stimulation for Facial Pain

Kashanian, Alon; DiCesare, Jasmine A T; Rohatgi, Pratik; Albano, Luigi; Krahl, Scott E.; Bari, Ausaf; Salles, Antônio De; Pouratian, Nader

doi:10.1093/ons/opaa170

Cited by 17 publications

(13 citation statements)

References 17 publications

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“…5,26 Small, retrospective case series have since been published that suggest the efficacy of this treatment paradigm, both in FNPS and in TDPS. 5,6,27,28 DBS of the PAG reduces nociceptive pain, likely by stimulating endogenous opioid production, although the exact mechanism is not clear. 3,26,29 DBS of the VPM has been used for the treatment of neuropathic facial pain and is believed to work by inhibiting aberrant neuronal firing within the thalamic somatosensory relay centers that allow for discrimination of location and intensity of pain.…”

Section: Discussionmentioning

confidence: 99%

Functional MRI–Guided Motor Cortex and Deep Brain Stimulation for Intractable Facial Pain: A Novel, Personalized Approach in 1 Patient

Saway

Webb

Weber

et al. 2022

Operative Neurosurgery

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BACKGROUND:Facial neuropathic pain syndromes such as trigeminal neuralgia are debilitating disorders commonly managed by medications, vascular decompression, and/or ablative procedures. In trigeminal neuralgia cases unresponsive to these interventions, trigeminal deafferentation pain syndrome (TDPS) can emerge and remain refractory to any further attempts at these conventional therapies. Deep brain stimulation (DBS) and motor cortex stimulation are 2 neuromodulatory treatments that have demonstrated efficacy in small case series of TDPS yet remain largely underutilized. In addition, functional MRI (fMRI) is a tool that can help localize central processing of evoked stimuli such as mechanically triggered facial pain. In this study, we present a case report and operative technique in a patient with TDPS who underwent fMRI to guide the operative management and placement of dual targets in the sensory thalamus and motor cortex.OBJECTIVE:To evaluate the safety, efficacy, and outcome of a novel surgical approach for TDPS in a single patient.METHODS:The fMRI and operative technique of unilateral DBS targeting the ventroposteromedial nucleus of the thalamus and facial motor cortex stimulator placement through a single burr hole is illustrated as well as the patient's clinical outcome.RESULTS:In less than 1 year, the patient had near complete resolution of his facial pain with no postoperative complications.CONCLUSION:We present the first published case of successful treatment of TDPS using simultaneous DBS of the ventroposteromedial and motor cortex stimulation. fMRI can be used as an effective imaging modality to guide neuromodulation in this complex disorder.

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Section: Discussionmentioning

confidence: 99%

Functional MRI–Guided Motor Cortex and Deep Brain Stimulation for Intractable Facial Pain: A Novel, Personalized Approach in 1 Patient

Saway

Webb

Weber

et al. 2022

Operative Neurosurgery

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Section: Discussionmentioning

confidence: 99%

“…In patients with chronic facial pain, refractory to medical and standard surgical treatments, central neuromodulation therapies, including stimulating (e.g., deep brain stimulation) and ablating techniques (e.g., CNS radiosurgery, high-intensity focused ultrasonography) might be considered. 40 To date, the thalamic nuclei, periventricular or periaqueductal gray and the anterior cingulate cortex are the most frequently used targets. 40 Our findings pave the way to a potential therapeutic role of direct or indirect stimulation of hippocampal-parahippocampal circuitry for chronic and intractable TN, as already studied in patients with Alzheimer's disease and epilepsy.…”

Section: Ta B L E 2 (Continued)mentioning

confidence: 99%

“…40 To date, the thalamic nuclei, periventricular or periaqueductal gray and the anterior cingulate cortex are the most frequently used targets. 40 Our findings pave the way to a potential therapeutic role of direct or indirect stimulation of hippocampal-parahippocampal circuitry for chronic and intractable TN, as already studied in patients with Alzheimer's disease and epilepsy. 41 The present study has some limitations.…”

Section: Ta B L E 2 (Continued)mentioning

confidence: 99%

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Alterations of brain structural MRI are associated with outcome of surgical treatment in trigeminal neuralgia

Albano

Basaia

Castellano

et al. 2021

Euro J of Neurology

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Background and purpose To assess magnetic resonance imaging (MRI) alterations occurring in patients with trigeminal neuralgia (TN) and to explore the predictive ability of MRI for initial surgical outcome and long‐term pain relief/recurrence after Gamma Knife radiosurgery (GKS). Methods Thirty patients with idiopathic or classic TN, who underwent GKS and were followed for at least 24 months, were retrospectively included. Pre‐treatment structural MRI and pre‐ and serial, postoperative clinical features were investigated. Fifteen age‐ and sex‐matched healthy controls were also enrolled. Cortical thickness and gray matter (GM) volumes were assessed in TN patients relative to controls, as well as between patient subgroups according to treatment outcomes (initial responders/non‐responders, patients with pain recurrence/long‐lasting pain relief at the last follow‐up). Clinical and MRI predictors of treatment outcomes were explored. Results Cortical thinning of temporal, prefrontal, cingulate, somatosensory and occipital areas bilaterally was found in TN patients relative to controls. No cortical thickness and GM volume differences were observed when TN initial responders and non‐responders were compared. Patients who experienced TN recurrence after initial pain relief were characterized by thicker parahippocampal and temporal cortices bilaterally and greater volume of right amygdala and hippocampus compared to patients with long‐lasting pain relief. In TN patients, disease duration and baseline cortical thinning of right parahippocampal, left fusiform and middle temporal cortices were associated with poor outcome after GKS at the last follow‐up (R2=0.57, p<0.001). Conclusion The study provides novel insights into structural brain alterations of TN patients, which might contribute to disease development and pain maintenance.

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“…The popularity of thalamic DBS for the treatment of chronic pain declined when approval of the Federal and Drug Administration (FDA) could not be accomplished after two large trials were considered failures for a variety of reasons [28,29]. Nevertheless, single centers worldwide continued to perform thalamic DBS in patients with various pain syndromes, and a few case series with variable outcomes were published over the past two decades [30][31][32][33][34][35][36][37][38][39][40][41]. Many of these studies, however, were hampered by limited numbers of patients and relatively short follow-up periods.…”

Section: Introductionmentioning

confidence: 99%

Centromedian–Parafascicular and Somatosensory Thalamic Deep Brain Stimulation for Treatment of Chronic Neuropathic Pain: A Contemporary Series of 40 Patients

et al. 2021

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Introduction: The treatment of neuropathic and central pain still remains a major challenge. Thalamic deep brain stimulation (DBS) involving various target structures is a therapeutic option which has received increased re-interest. Beneficial results have been reported in several more recent smaller studies, however, there is a lack of prospective studies on larger series providing long term outcomes. Methods: Forty patients with refractory neuropathic and central pain syndromes underwent stereotactic bifocal implantation of DBS electrodes in the centromedian–parafascicular (CM–Pf) and the ventroposterolateral (VPL) or ventroposteromedial (VPM) nucleus contralateral to the side of pain. Electrodes were externalized for test stimulation for several days. Outcome was assessed with five specific VAS pain scores (maximum, minimum, average pain, pain at presentation, allodynia). Results: The mean age at surgery was 53.5 years, and the mean duration of pain was 8.2 years. During test stimulation significant reductions of all five pain scores was achieved with either CM–Pf or VPL/VPM stimulation. Pacemakers were implanted in 33/40 patients for chronic stimulation for whom a mean follow-up of 62.8 months (range 3–180 months) was available. Of these, 18 patients had a follow-up beyond four years. Hardware related complications requiring secondary surgeries occurred in 11/33 patients. The VAS maximum pain score was improved by ≥50% in 8/18, and by ≥30% in 11/18 on long term follow-up beyond four years, and the VAS average pain score by ≥50% in 10/18, and by ≥30% in 16/18. On a group level, changes in pain scores remained statistically significant over time, however, there was no difference when comparing the efficacy of CM–Pf versus VPL/VPM stimulation. The best results were achieved in patients with facial pain, poststroke/central pain (except thalamic pain), or brachial plexus injury, while patients with thalamic lesions had the least benefit. Conclusion: Thalamic DBS is a useful treatment option in selected patients with severe and medically refractory pain.

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Case Series: Deep Brain Stimulation for Facial Pain

Cited by 17 publications

References 17 publications

Functional MRI–Guided Motor Cortex and Deep Brain Stimulation for Intractable Facial Pain: A Novel, Personalized Approach in 1 Patient

Functional MRI–Guided Motor Cortex and Deep Brain Stimulation for Intractable Facial Pain: A Novel, Personalized Approach in 1 Patient

Alterations of brain structural MRI are associated with outcome of surgical treatment in trigeminal neuralgia

Centromedian–Parafascicular and Somatosensory Thalamic Deep Brain Stimulation for Treatment of Chronic Neuropathic Pain: A Contemporary Series of 40 Patients

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