Deep Brain Stimulation and Motor Cortical Stimulation for Neuropathic Pain

Stadler, James A.; Ellens, Damien J.; Rosenow, Joshua M.

doi:10.1007/s11916-010-0161-3

Cited by 33 publications

(27 citation statements)

References 36 publications

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“…Note that both montages present stimulation near the sensorimotor area lying inside the longitudinal fissure, but stronger for the feet motor area stimulation. This is a desired behaviour for feet motor area stimulation, since feet motor cortex is placed deep in the fissure, which makes it difficult to be targeted [64]. For both versions of the montage it should be considered that other nearby motor areas are affected, but not necessarily with significant effects.…”

Section: Resultsmentioning

confidence: 99%

Effect of tDCS stimulation of motor cortex and cerebellum on EEG classification of motor imagery and sensorimotor band power

Angulo-Sherman

Rodríguez-Ugarte

Sciacca

et al. 2017

J NeuroEngineering Rehabil

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BackgroundTranscranial direct current stimulation (tDCS) is a technique for brain modulation that has potential to be used in motor neurorehabilitation. Considering that the cerebellum and motor cortex exert influence on the motor network, their stimulation could enhance motor functions, such as motor imagery, and be utilized for brain-computer interfaces (BCIs) during motor neurorehabilitation.MethodsA new tDCS montage that influences cerebellum and either right-hand or feet motor area is proposed and validated with a simulation of electric field. The effect of current density (0, 0.02, 0.04 or 0.06 mA/cm2) on electroencephalographic (EEG) classification into rest or right-hand/feet motor imagery was evaluated on 5 healthy volunteers for different stimulation modalities: 1) 10-minutes anodal tDCS before EEG acquisition over right-hand or 2) feet motor cortical area, and 3) 4-seconds anodal tDCS during EEG acquisition either on right-hand or feet cortical areas before each time right-hand or feet motor imagery is performed. For each subject and tDCS modality, analysis of variance and Tukey-Kramer multiple comparisons tests (p <0.001) are used to detect significant differences between classification accuracies that are obtained with different current densities. For tDCS modalities that improved accuracy, t-tests (p <0.05) are used to compare μ and β band power when a specific current density is provided against the case of supplying no stimulation.ResultsThe proposed montage improved the classification of right-hand motor imagery for 4 out of 5 subjects when the highest current was applied for 10 minutes over the right-hand motor area. Although EEG band power changes could not be related directly to classification improvement, tDCS appears to affect variably different motor areas on μ and/or β band.ConclusionsThe proposed montage seems capable of enhancing right-hand motor imagery detection when the right-hand motor area is stimulated. Future research should be focused on applying higher currents over the feet motor cortex, which is deeper in the brain compared to the hand motor cortex, since it may allow observation of effects due to tDCS. Also, strategies for improving analysis of EEG respect to accuracy changes should be implemented.

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Section: Resultsmentioning

confidence: 99%

Effect of tDCS stimulation of motor cortex and cerebellum on EEG classification of motor imagery and sensorimotor band power

Angulo-Sherman

Rodríguez-Ugarte

Sciacca

et al. 2017

J NeuroEngineering Rehabil

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“…ECS techniques have been reported in neuropathic pain [38], visual restoration, and tinnitus therapy [39]. Most interpretations suggest that enhanced neuroplasticity with more robust long-term learning and reorganization of neural circuits, possibly mediated by Gamma amino butyric acid (GABA)-ergic intracortical networks, may contribute to the improved neuronal functions associated with ECS [13].…”

Section: Discussionmentioning

confidence: 99%

“…Most interpretations suggest that enhanced neuroplasticity with more robust long-term learning and reorganization of neural circuits, possibly mediated by Gamma amino butyric acid (GABA)-ergic intracortical networks, may contribute to the improved neuronal functions associated with ECS [13]. It is believed that excitation of the motor cortex also results in inhibition of nociceptive neurons in somatosensory areas [38]. An implanted system should enhance efficacy and perhaps result in longer-term functional improvement [32].…”

Section: Discussionmentioning

confidence: 99%

Developing and Evaluating a Flexible Wireless Microcoil Array Based Integrated Interface for Epidural Cortical Stimulation

Wang

Chaudhry

Hou

et al. 2017

IJMS

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Stroke leads to serious long-term disability. Electrical epidural cortical stimulation has made significant improvements in stroke rehabilitation therapy. We developed a preliminary wireless implantable passive interface, which consists of a stimulating surface electrode, receiving coil, and single flexible passive demodulated circuit printed by flexible printed circuit (FPC) technique and output pulse voltage stimulus by inductively coupling an external circuit. The wireless implantable board was implanted in cats’ unilateral epidural space for electrical stimulation of the primary visual cortex (V1) while the evoked responses were recorded on the contralateral V1 using a needle electrode. The wireless implantable board output stable monophasic voltage stimuli. The amplitude of the monophasic voltage output could be adjusted by controlling the voltage of the transmitter circuit within a range of 5–20 V. In acute experiment, cortico-cortical evoked potential (CCEP) response was recorded on the contralateral V1. The amplitude of N2 in CCEP was modulated by adjusting the stimulation intensity of the wireless interface. These results demonstrated that a wireless interface based on a microcoil array can offer a valuable tool for researchers to explore electrical stimulation in research and the dura mater-electrode interface can effectively transmit electrical stimulation.

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“…A total of 73% (8/11) reported excellent pain control, which persisted unchanged in five patients (45%) for more than 2 years. Since then, various types of NP have been successfully treated with dural motor cortex stimulation (MCS), including post-stroke pain, spinal cord injury pain, thalamic pain, trigeminal neuralgia, trigeminal neuropathic pain, and trigeminal deafferentation pain (anesthesia dolorosa) syndromes 13. A recent meta-analysis of the various MCS trials found that 64% of patients with NP reported significant pain relief 14.…”

Section: The Development Of Brain Stimulation To Treat Chronic Painmentioning

confidence: 99%

Non-invasive Transcranial Magnetic Stimulation (TMS) of the Motor Cortex for Neuropathic Pain—At the Tipping Point?

Treister¹,

Lang²,

Klein³

et al. 2013

Rambam Maimonides Med J

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The term “neuropathic pain” (NP) refers to chronic pain caused by illnesses or injuries that damage peripheral or central pain-sensing neural pathways to cause them to fire inappropriately and signal pain without cause. Neuropathic pain is common, complicating diabetes, shingles, HIV, and cancer. Medications are often ineffective or cause various adverse effects, so better approaches are needed. Half a century ago, electrical stimulation of specific brain regions (neuromodulation) was demonstrated to relieve refractory NP without distant effects, but the need for surgical electrode implantation limited use of deep brain stimulation. Next, electrodes applied to the dura outside the brain’s surface to stimulate the motor cortex were shown to relieve NP less invasively. Now, electromagnetic induction permits cortical neurons to be stimulated entirely non-invasively using transcranial magnetic stimulation (TMS). Repeated sessions of many TMS pulses (rTMS) can trigger neuronal plasticity to produce long-lasting therapeutic benefit. Repeated TMS already has US and European regulatory approval for treating refractory depression, and multiple small studies report efficacy for neuropathic pain. Recent improvements include “frameless stereotactic” neuronavigation systems, in which patients’ head MRIs allow TMS to be applied to precise underlying cortical targets, minimizing variability between sessions and patients, which may enhance efficacy. Transcranial magnetic stimulation appears poised for the larger trials necessary for regulatory approval of a NP indication. Since few clinicians are familiar with TMS, we review its theoretical basis and historical development, summarize the neuropathic pain trial results, and identify issues to resolve before large-scale clinical trials.

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Deep Brain Stimulation and Motor Cortical Stimulation for Neuropathic Pain

Cited by 33 publications

References 36 publications

Effect of tDCS stimulation of motor cortex and cerebellum on EEG classification of motor imagery and sensorimotor band power

Effect of tDCS stimulation of motor cortex and cerebellum on EEG classification of motor imagery and sensorimotor band power

Developing and Evaluating a Flexible Wireless Microcoil Array Based Integrated Interface for Epidural Cortical Stimulation

Non-invasive Transcranial Magnetic Stimulation (TMS) of the Motor Cortex for Neuropathic Pain—At the Tipping Point?

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