Deep brain stimulation for pain relief: A meta-analysis

Bittar, Richard G.; Kar-Purkayastha, Ishani; Owen, Sarah; Bear, Renee E.; Green, Alexander L.; Wang, ShouYan; Aziz, Tipu Z.

doi:10.1016/j.jocn.2004.10.005

Cited by 344 publications

(230 citation statements)

References 30 publications

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“…Attempts to alleviate medically intractable pain through continuous stimulation of deep brain structures have been reported for nearly half a century (Mazars et al, 1960;Raskin et al, 1987;Bittar et al, 2005). Over the years, several brain regions have been targeted with varying degrees of success.…”

Section: Discussionmentioning

confidence: 99%

Hypothalamic Deep Brain Stimulation in Positron Emission Tomography

May¹,

Leone²,

Boecker³

et al. 2006

J. Neurosci.

163

101

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Recently, functional imaging data have underscored the crucial role the hypothalamus plays in cluster headache, one of the most severe forms of primary headache. This prompted the application of hypothalamic deep brain stimulation. Yet, it is not apparent how stimulation of an area that is thought to act as a pace-maker for acute headache attacks is able to prevent these attacks from occurring. We addressed this issue by examining 10 operated chronic cluster headache patients, using H 2 15 O-positron emission tomography and alternately switching the hypothalamic stimulator on and off. The stimulation induced activation in the ipsilateral hypothalamic gray (the site of the stimulator tip), the ipsilateral thalamus, somatosensory cortex and praecuneus, the anterior cingulate cortex, and the ipsilateral trigeminal nucleus and ganglion. We additionally observed deactivation in the middle temporal gyrus, posterior cingulate cortex, and contralateral anterior insula. Both activation and deactivation are situated in cerebral structures belonging to neuronal circuits usually activated in pain transmission and notably in acute cluster headache attacks. Our data argue against an unspecific antinociceptive effect or pure inhibition of hypothalamic activity. Instead, the data suggest a hitherto unrecognized functional modulation of the pain processing network as the mode of action of hypothalamic deep brain stimulation in cluster headache.

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Section: Discussionmentioning

confidence: 99%

Hypothalamic Deep Brain Stimulation in Positron Emission Tomography

May¹,

Leone²,

Boecker³

et al. 2006

J. Neurosci.

163

101

View full text Add to dashboard Cite

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“…Several different targets have been used, among them periventricular/periaqueductal gray matter, the internal capsule, and the sensory thalamus. 33,34 Miscellaneous. Other applications of DBS have been presented in case reports or small series.…”

Section: Imaging Of Patients Before Electrode Implantationmentioning

confidence: 99%

Neuroimaging and Deep Brain Stimulation

Dormont¹,

Seidenwurm²,

Galanaud³

et al. 2009

AJNR Am J Neuroradiol

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SUMMARY: Deep brain stimulation (DBS) is a new neurosurgical method principally used for the treatment of Parkinson disease (PD).Many new applications of DBS are under development, including the treatment of intractable psychiatric diseases. Brain imaging is used for the selection of patients for DBS, to localize the target nucleus, to detect complications, and to evaluate the final electrode contact position. In patients with implanted DBS systems, there is a risk of electrode heating when MR imaging is performed. This contraindicates MR imaging unless specific precautions are taken. Involvement of neuroradiologists in DBS procedures is essential to optimize presurgical evaluation, targeting, and postoperative anatomic results. The precision of the neuroradiologic correlation with anatomic data and clinical outcomes in DBS promises to yield significant basic science and clinical advances in the future. Chronic high-frequency stimulation of the ventral intermediate nucleus (VIM) of the thalamus was first described in the early 1990s by Benabid et al.1 These authors implanted chronic stimulating electrodes in the VIM connected to a subcutaneous pulse generator positioned in the thoracic region to treat disabling tremor in 26 patients with Parkinson disease (PD) and in 6 with essential tremor.1 They demonstrated the effectiveness of this technique and its ability to produce complete relief from tremor. Improvement was maintained for up to 29 months. This was the first clinical demonstration that chronic high-frequency stimulation of nuclei (deep brain stimulation [DBS]) could replace destructive lesion-producing functional neurosurgery such as thalamotomy. This new technique was reversible and led to a renaissance in functional neurosurgery.Next, the same team introduced bilateral DBS of the subthalamic nucleus (STN) in patients with disabling akineticrigid PD and severe motor fluctuations.2 This work extended data obtained in a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine monkey model of PD showing that lesions and electric stimulation of the subthalamic nucleus reduced all of the major motor disturbances in this animal model. The results in patients with advanced PD were striking and were reproduced in many centers internationally. The US Food and Drug Administration approved the use of DBS for treatment of advanced PD with bilateral STN stimulation in 2002 and internal globus pallidus (GPi) stimulation in 2003. The main indication for DBS remains advanced PD, but numerous additional applications have been developed, ranging from dystonia to cluster headache, Tourette syndrome, and even psychiatric indications like obsessive-compulsive disorders (OCD) and major depression.DBS is a neurosurgical method, but the role of neuroimaging in successful DBS intervention is critical. Neuroimaging is used for the preoperative selection of patients who will have DBS and to localize the intended target nuclei. In the postoperative period, imaging detects complications that uncommonly accompany the procedure, confirms the pos...

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“…New emerging non-invasive techniques of neuromodulation have been reported with promising results such as dTMS [65], double or triple pulse TMS, RINCE stimulation and tDSC. Even though their capacity to influence has been reported, many properties of its effects on the cortical and deep circuitry are unknown.…”

Section: Future Prospectsmentioning

confidence: 99%

Neuromodulation in Treating Complex Regional Pain Syndrome: A Critical Review of the Evidence

Picarelli¹,

Sterman-Neto²,

De-Oliveira³

et al. 2017

J Neurol Neurosci

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Background and objectives: The management of complex regional pain syndrome (CRPS) remains a challenging task therefore a large number of interventions have been investigated.Lately, invasive and non-invasive neuromodulation have been coming up as an alternative for some patients even as an add-on treatment to medicines or physical therapy. The objective of this review is to evaluate the evidence of its effectiveness in CRPS chronic pain management.

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Deep brain stimulation for pain relief: A meta-analysis

Cited by 344 publications

References 30 publications

Hypothalamic Deep Brain Stimulation in Positron Emission Tomography

Hypothalamic Deep Brain Stimulation in Positron Emission Tomography

Neuroimaging and Deep Brain Stimulation

Neuromodulation in Treating Complex Regional Pain Syndrome: A Critical Review of the Evidence

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