Dissecting neuropathic from poststroke pain: the white matter within

Lemos, Marcelo Delboni; Faillenot, Isabelle; Lucato, Leandro Tavares; Teixeira, Manoel Jacobsen; Barbosa, Luciana Mendonça; Alho, Eduardo Joaquim Lopes; Conforto, Adriana Bastos; Rodrigues, Antônia Lilian de Lima; Galhardoni, Ricardo; Silva, Valquíria Aparecida da; Listik, Clarice; Rosí, Jefferson; Peyron, R.; Garcia-Larrea, Luis; Andrade, Daniel Ciampi de

doi:10.1097/j.pain.0000000000002427

Cited by 14 publications

(11 citation statements)

References 87 publications

(126 reference statements)

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“…A very recent study confirmed that damage of the white matter surrounding the posterior insular point plays a crucial role in the occurrence of poststroke central pain. 13 These authors interpreted their findings in the framework of the EPIC model. 3 According to this model, the anterior insula (and possibly other agranular cortical regions within the so-called pain matrix) continuously sends predictions to the granular cortex of the PIMO.…”

Section: Discussionmentioning

confidence: 99%

“…Stimulation of the white matter underlying this area could provide a means to disentangle the different contributions. Prediction and prediction-error neurons, believed to project to the anterior insula 13 and located in the most superficial white matter layer of the U fibers, should be less activated than thalamic inputs when stimulating the white matter in the depth of the cortex. In this article, we report, for the first time, the results of electrical white matter stimulation in a series of patients operated on for a glial tumor in the PIMO region.…”

Section: Introductionmentioning

confidence: 99%

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Electrostimulation of the white matter of the posterior insula and medial operculum: perception of vibrations, heat, and pain

Mandonnet,

Obaid,

Descoteaux

et al. 2023

Pain

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This study aimed to characterize the sensory responses observed when electrically stimulating the white matter surrounding the posterior insula and medial operculum (PIMO). We reviewed patients operated on under awake conditions for a glioma located in the temporoparietal junction. Patients' perceptions were retrieved from operative reports. Stimulation points were registered in the Montreal Neurological Institute template. A total of 12 stimulation points in 8 patients were analyzed. Painful sensations in the contralateral leg were reported (5 sites in 5 patients) when stimulating the white matter close to the parcel OP2/3 of the Glasser atlas. Pain had diverse qualities: burning, tingling, crushing, or electric shock. More laterally, in the white matter of OP1, pain and heat sensations in the upper part of the body were described (5 sites in 2 patients). Intermingled with these sites, vibration sensations were also reported (3 sites in 2 patients). Based on the tractograms of 44 subjects from the Human Connectome Project data set, we built a template of the pathways linking the thalamus to OP2/3 and OP1. Pain sites were located in the thalamo-OP2/3 and thalamo-OP1 tracts. Heat sites were located in the thalamo-OP1 tract. In the 227 awake surgeries performed for a tumor located outside of the PIMO region, no patients ever reported pain or heat sensations when stimulating the white matter. Thus, we propose that the thalamo-PIMO connections constitute the main cortical inputs for nociception and thermoception and emphasize that preserving these fibers is of utmost importance to prevent the postoperative onset of a debilitating insulo-opercular pain syndrome.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Electrostimulation of the white matter of the posterior insula and medial operculum: perception of vibrations, heat, and pain

Mandonnet,

Obaid,

Descoteaux

et al. 2023

Pain

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show abstract

“…In these cases, the pain is chronic and debilitating, with all characteristics of central pain caused by a spinothalamic tract deafferentation. A very recent study con rmed that damage of the white matter surrounding the posterior insular point plays a crucial role in the occurrence of central pain 39 . In the present series, none of the patients experienced chronic central pain.…”

Section: Surgical Interestmentioning

confidence: 98%

Electrostimulation of the white matter of the posterior insula and medial operculum: perception of vibrations, heat, and pain

Mandonnet

Rheault

Descoteaux

et al. 2022

Preprint

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Objectives The aim of this study was to characterize the sensory responses observed when stimulating electrically the white matter surrounding the posterior insular point. Methods We reviewed patients operated on under awake conditions for a glioma located in the vicinity of the posterior insular point. Patients’ reports of perceived sensations under electrical stimulation were retrospectively collected. Stimulation points were manually located in the postoperative MRI and further registered to the MNI template. Results Twelve stimulation points in eight patients were analyzed. Painful sensations in the leg were reported in 6 cases, at the level of the posterior part of the superior insular sulcus. Pain had diverse qualities: burning, tingling, crushing, or electric shock. More laterally, in the white matter of the parietal operculum, heat sensations were described, with a mesio-lateral somatotopy, with from mesial to lateral, lower limb – trunk and/or superior limb – face. Finally, vibration sensations were also reported, intermingled with pain and heat areas. In relation to Glasser atlas, pain sites abutted OP2/3 parcel, while heat sites were located within OP1. Conclusion The white matter surrounding the posterior insula and medial operculum constitutes a sensory hub, at the cross-road of triangular connections, linking two at a time the primary somatosensory area, the secondary somatosensory area, and the thalamus. Its surgical preservation is of utmost importance to prevent the postoperative onset of a debilitating insulo-opercular pain syndrome.

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“…3 Although focus is generally put on spinal, brainstem, thalamic, or parietoinsular lesions, the role of the thalamocortical white matter is commonly ignored. 5 Reports of lesions involving specifically white matter paths connecting the thalamus with the PIMO rarely address the development of central pain (see one exception in Ref. 1).…”

mentioning

confidence: 99%

“…However, a recent study in 89 patients who had a stroke with or without central poststroke pain (CPSP) showed that interruption of thalamo-PIMO white matter connections was a critical determinant of central pain, which could identify patients with CPSP and differentiate this group not only from strokes without pain but also from patients with pain of nonneuropathic origin. 5 Modern techniques of tractography such as those used in the study by Mandonnet et al should allow for early selection of patients at risk to develop central pain after brain lesions and therefore optimize pre-emptive or therapeutic interventions.…”

mentioning

confidence: 99%

Under the insula: a commentary on “electrostimulation of the white matter of the posterior insula and medial operculum: perception of vibrations, heat, and pain”

Dissecting neuropathic from poststroke pain: the white matter within

Cited by 14 publications

References 87 publications

Electrostimulation of the white matter of the posterior insula and medial operculum: perception of vibrations, heat, and pain

Electrostimulation of the white matter of the posterior insula and medial operculum: perception of vibrations, heat, and pain

Electrostimulation of the white matter of the posterior insula and medial operculum: perception of vibrations, heat, and pain

Under the insula: a commentary on “electrostimulation of the white matter of the posterior insula and medial operculum: perception of vibrations, heat, and pain”

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