Medial thalamic permanent electrodes for pain control in man: An electrophysiological and clinical study

Thoden, U.; Doerr, M.; Dieckmann, G; Krainick, J.-U.

doi:10.1016/0013-4694(79)90259-1

Cited by 69 publications

(26 citation statements)

References 25 publications

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“…lb, e, f). These data were sim ilar to other authors' results but there are some controversial points [1][2][3][5][6][7][8]. We conclude that the thalamic first positive deflection must have been of medial lemniscal origin and the first negative wave was attributable to synaptic potentials of thalamic relay neurons [7].…”

Section: Results and Conclusionsupporting

confidence: 57%

See 1 more Smart Citation

The Spread of Somatosensory-Evoked Potentials Within the Nervous System

Sólyom¹,

Tóth²,

Holczinger³

et al. 1985

Stereotact Funct Neurosurg

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Four thalamic and cortical recordings were carried out in 5 patients. The thalamic-evoked potentials were typical and revealed a triphasic complex, but their latencies showed a relatively high Standard deviation. They could be divided into two groups according to their latencies, both of which had low SD. These data suggested that there could be two types of latency of thalamic SEP, because the 4 patients’ body sizes were very similar. More detailed surface, cortical and depth recordings are needed to resolve these questions.

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Section: Results and Conclusionsupporting

confidence: 57%

“…Very few direct recordings have been carried out from the human cortex and subcortical structures on pa tients with chronic deep electrodes. Direct recordings from the thala mus [1][2][3][5][6][7][8] and the cortex [2,4] have been discussed but failed to provide definite results and conclusions.…”

mentioning

confidence: 99%

The Spread of Somatosensory-Evoked Potentials Within the Nervous System

Sólyom¹,

Tóth²,

Holczinger³

et al. 1985

Stereotact Funct Neurosurg

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show abstract

“…Three out of 5 patients reported good to excellent reduction of chronic pain. Thoden et al [76] stated to target the medial thalamus, but also intended to stimulate both the CM-Pf complex and MD. Gybels et al [114] thought the best position for the electrode was the junction of CM and Pf.…”

Section: Experience With Functional Neurosurgerymentioning

confidence: 99%

“…Microstimulation of the CM-Pf complex was occasionally described to exacerbate the patient's spontaneous pain. Thoden et al [76] performed 277 stimulation trials at the lateral border of MD, CM and Pf and gave detailed descriptions of sensations observed, ranging from simple headache to paresthesia. Ray and Burton [77] described a feeling of warmth focused on the contralateral hemibody while stimulating the CM-Pf complex.…”

Section: Electrophysiological Datamentioning

confidence: 99%

Center Median-Parafascicular Complex and Pain Control

Weigel

Krauss²

2004

Stereotact Funct Neurosurg

107

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The center median-parafascicular (CM-Pf) complex, which constitutes the major portion of the intralaminar thalamus in man, has long been known to be involved in the processing of pain under normal and pathological conditions. Yet, these ‘forgotten’ nuclei with their rich connectivity to other thalamic nuclei, the basal ganglia and cortical areas have received only relatively little attention over the past two decades. With regard to the recent reinterest in functional stereotactic neurosurgery as a treatment option for chronic refractory pain, the CM-Pf complex has been reconsidered as a target. This review provides a systematic overview on the current knowledge about the anatomy and connectivity of the CM-Pf complex, neurophysiological studies, and on concepts of its role in pain processing under various conditions. We also review the previous experience with ablative surgery and deep brain stimulation of the CM-Pf complex. Studies in men and experimental animals indicate that the CM-Pf complex is part of a medial pain system, which appears to be involved primarily in affective and motivational dimensions of pain. Single-unit recordings from the CM-Pf complex have shown that the activity of CM-Pf cells is modified by painful stimuli. Under pathological conditions, bursting firing patterns and altered discharge rates were found. Thalamotomies targeting at the CM-Pf complex yielded beneficial results for chronic pain, but interpretation of the results is limited. With bifocal deep brain stimulation, short-term effects of CM-Pf stimulation were superior to those of somatosensory thalamic stimulation in neuropathic pain. There is evidence, that the CM-Pf complex might also be involved in the mediation of the beneficial effects of somatosensory thalamic stimulation and periventricular grey stimulation.

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“…Several others pioneered thalamic DBS, including Mazars [24][25][26][27] and Adams who, along with Hosobuchi, also targeted the internal capsule [28][29][30]. Observations from inadvertent localization errors and investigations into current spread from the PAG led others to target more medial thalamic nuclei, including the centromedian-parafascicular complex (Cm-Pf) [31][32][33][34]. The rostral anterior cingulate cortex (Cg24) was recently targeted for DBS on the basis of functional neuroimaging demonstrating its activation and half a century of its lesioning by cingulotomy in cancer pain [35][36][37][38].…”

Section: Introductionmentioning

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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Medial thalamic permanent electrodes for pain control in man: An electrophysiological and clinical study

Cited by 69 publications

References 25 publications

The Spread of Somatosensory-Evoked Potentials Within the Nervous System

The Spread of Somatosensory-Evoked Potentials Within the Nervous System

Center Median-Parafascicular Complex and Pain Control

Neuropathic Pain and Deep Brain Stimulation

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