Successful deep brain stimulation for central post-stroke pain and dystonia in a single operation

Holland, Marshall T.; Zanaty, Mario; Li, Luyuan; Thomsen, Teri; Beeghly, James; Greenlee, Jeremy D.W.; Reddy, Chandan G.

doi:10.1016/j.jocn.2018.01.036

Cited by 9 publications

(9 citation statements)

References 22 publications

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“…More recently, cortex stimulation and deep brain stimulation have been used to treat CPSP. 8 A case report published 3 years earlier claimed that stellate ganglion block is effective for CPSP. 12 Ultrasound guidance could improve the accuracy of local anesthetic injection into target site.…”

Section: Discussionmentioning

confidence: 99%

“…More recent treatment options included stereotaxic irradiation of the pituitary with γ-irradiation, trans-cranial cortex stimulation and deep brain stimulation. [8][9][10] Stellate ganglion block is a method to treat reflex sympathetic dystrophy, 11 and was reported to be effective for thalamic pain in a case report in 2007. 12 We now report a case of successful treatment of cramp-like pain after thalamic hemorrhage using ultrasound-guided stellate ganglion block.…”

Section: Introductionmentioning

confidence: 99%

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<p>Ultrasound-Guided Stellate Ganglion Block for Central Post-Stroke Pain: A Case Report and Review</p>

Liu¹,

Qing²,

Tang³

et al. 2020

JPR

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Background: Central post-stroke pain (CPSP) is refractory to pharmacotherapy (eg, NSAIDs, opioids, antidepressants, and anticonvulsants), and may require transcranial or deep brain stimulation. Case Presentation: A 67-year-old woman presented with severe paroxysmal cramp-like pain on the right side, including the head and both upper and lower extremities. The pain started 5 years earlier, was initially mild and occasional, but gradually intensified to an unbearable degree with an average of 10-15 daily episodes, each lasting for 5-10 mins. The patient disclosed "hemorrhagic stroke" 10 years ago that resulted in hemiplegia on the right side. CT examination verified the lesion. The patient received daily injection of 2-mL 2% lidocaine under ultrasound guidance to block the stellate ganglion. Pain subsided rapidly in both intensity and frequency. On the seventh day, the patient no longer had pain episodes. At the last follow-up, 9 months later, the patient was free from pain. Conclusion: Ultrasound-guided stellate ganglion block is a viable alternative for CPSP that is refractory to pharmacotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

<p>Ultrasound-Guided Stellate Ganglion Block for Central Post-Stroke Pain: A Case Report and Review</p>

Liu¹,

Qing²,

Tang³

et al. 2020

JPR

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“…A case study of a 60-year-old female who suffered a right posterior cerebral artery stroke demonstrated the efficacy of a single deep brain stimulation (DBS) operation in eliminating CPSP associated with dystonia [26]. The presenting symptoms of CPSP, experienced by this patient, were refractory to conservative management and manifested as delayed left face and hemibody allodynia and hyperesthesia as well as significant left-sided dystonia [26]. Upon evaluation, it was ascertained that the dystonia was contributing significantly to her pain.…”

Section: Deep Brain Stimulationmentioning

confidence: 99%

“…The patient underwent DBS with implantation of a lead in the right-sided ventral capsule (VC)/ventral striatum (VS) to target her pain and another lead in the right-sided globus pallidus interna (GPi) to target her dystonia [26]. These targets were chosen by a multi-disciplinary team that recognized that the allodynia was associated with a major affective/depressive component likely stemming from the VC/VS, a common target for treatment of refractory depression and CPSP [26]. Likewise, the GPi is a common target for DBS treatment of primary dystonia that is refractory to pharmaceuticals [26].…”

Section: Deep Brain Stimulationmentioning

confidence: 99%

“…These targets were chosen by a multi-disciplinary team that recognized that the allodynia was associated with a major affective/depressive component likely stemming from the VC/VS, a common target for treatment of refractory depression and CPSP [26]. Likewise, the GPi is a common target for DBS treatment of primary dystonia that is refractory to pharmaceuticals [26]. In the case of this patient, the dystonia resolved almost immediately following surgery and the pain became significantly reduced following several sessions of lead programming [26].…”

Section: Deep Brain Stimulationmentioning

confidence: 99%

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Diagnosis, Treatment, and Management of Dejerine–Roussy Syndrome: a Comprehensive Review

Urits

Gress

Charipova

et al. 2020

Curr Pain Headache Rep

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Purpose of Review Post-stroke pain represents a complex condition with few standardized diagnostic criteria. As such, the array of symptoms is often difficult to categorize and diagnose. Central post-stroke pain (CPSP), also known as Dejerine-Roussy syndrome, presents as painful paresthesia in any part of the body that is usually coupled with sensory abnormalities. Recent Findings In patients who had experienced a cerebrovascular accident, CPSP typically affects the same areas of the body that are also impacted by the general motor and sensory deficits that result from stroke. Though it is generally debated, CPSP is thought to result from a lesion in any part of the central nervous system. Pain usually presents in the range of 3-6 months after the occurrence of stroke, manifesting contralaterally to the lesion, and most commonly involving the upper extremities. For the most accurate diagnosis of CPSP, a thorough history and clinical examination should be supplemented with imaging. Infarcted areas of the brain can be visualized using either CT or MRI. First-line treatment of CPSP is pharmacologic and consists of a three-drug regimen. Despite this, CPSP is often refractory to medical management producing only modest pain reduction in a limited subset of patients. Adverse effects associated with pharmacologic management of CPSP and frequent recalcitrance to treatment have driven alternative minimally invasive methods of pain control which include transcranial stimulation, deep brain stimulation, and neuromodulation. Summary The aim of this review is to provide a comprehensive update to recent advances in the understanding of the treatment and management of CPSP. KeywordsCentral post-stroke pain . Dejerine-Roussy . Central nervous system . Cerebrovascular accident This article is part of the Topical Collection on Other Pain

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Successful deep brain stimulation for central post-stroke pain and dystonia in a single operation

Cited by 9 publications

References 22 publications

<p>Ultrasound-Guided Stellate Ganglion Block for Central Post-Stroke Pain: A Case Report and Review</p>

<p>Ultrasound-Guided Stellate Ganglion Block for Central Post-Stroke Pain: A Case Report and Review</p>

Diagnosis, Treatment, and Management of Dejerine–Roussy Syndrome: a Comprehensive Review

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