scholarly journals A Deep Brain Stimulation Trial Period for Treating Chronic Pain

2020 ◽  
Vol 9 (10) ◽  
pp. 3155
Author(s):  
Prasad Shirvalkar ◽  
Kristin K. Sellers ◽  
Ashlyn Schmitgen ◽  
Jordan Prosky ◽  
Isabella Joseph ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Electrical Contacts ◽  
Trial Period ◽  
External Stimulation ◽  
Stimulation Trial ◽  
Implanted Electrodes ◽  
Brain Target ◽  
Deep Brain

Early studies of deep brain stimulation (DBS) for various neurological disorders involved a temporary trial period where implanted electrodes were externalized, in which the electrical contacts exiting the patient’s brain are connected to external stimulation equipment, so that stimulation efficacy could be determined before permanent implant. As the optimal brain target sites for various diseases (i.e., Parkinson’s disease, essential tremor) became better established, such trial periods have fallen out of favor. However, deep brain stimulation trial periods are experiencing a modern resurgence for at least two reasons: (1) studies of newer indications such as depression or chronic pain aim to identify new targets and (2) a growing interest in adaptive DBS tools necessitates neurophysiological recordings, which are often done in the peri-surgical period. In this review, we consider the possible approaches, benefits, and risks of such inpatient trial periods with a specific focus on developing new DBS therapies for chronic pain.

scholarly journals Deep Brain Stimulation of the Posterior Insula in Chronic Pain: A Theoretical Framework

2021 ◽  
Vol 11 (5) ◽  
pp. 639
Author(s):  
David Bergeron ◽  
Sami Obaid ◽  
Marie-Pierre Fournier-Gosselin ◽  
Alain Bouthillier ◽  
Dang Khoa Nguyen
Keyword(s):  
Chronic Pain ◽  
Electrical Stimulation ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
High Frequency ◽  
Brain Lesion ◽  
Low Frequency ◽  
Posterior Insula ◽  
Deep Brain ◽  
Stimulation Of

Introduction: To date, clinical trials of deep brain stimulation (DBS) for refractory chronic pain have yielded unsatisfying results. Recent evidence suggests that the posterior insula may represent a promising DBS target for this indication. Methods: We present a narrative review highlighting the theoretical basis of posterior insula DBS in patients with chronic pain. Results: Neuroanatomical studies identified the posterior insula as an important cortical relay center for pain and interoception. Intracranial neuronal recordings showed that the earliest response to painful laser stimulation occurs in the posterior insula. The posterior insula is one of the only regions in the brain whose low-frequency electrical stimulation can elicit painful sensations. Most chronic pain syndromes, such as fibromyalgia, had abnormal functional connectivity of the posterior insula on functional imaging. Finally, preliminary results indicated that high-frequency electrical stimulation of the posterior insula can acutely increase pain thresholds. Conclusion: In light of the converging evidence from neuroanatomical, brain lesion, neuroimaging, and intracranial recording and stimulation as well as non-invasive stimulation studies, it appears that the insula is a critical hub for central integration and processing of painful stimuli, whose high-frequency electrical stimulation has the potential to relieve patients from the sensory and affective burden of chronic pain.

Brain shift: an error factor during implantation of deep brain stimulation electrodes

2007 ◽  
Vol 107 (5) ◽  
pp. 989-997 ◽  
Author(s):  
Yasushi Miyagi ◽  
Fumio Shima ◽  
Tomio Sasaki
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Brain Shift ◽  
Mr Images ◽  
Implanted Electrodes ◽  
Error Factor ◽  
Bilateral Surgery ◽  
Second Procedure ◽  
The Brain ◽  
Deep Brain

Object The goal of this study was to focus on the tendency of brain shift during stereotactic neurosurgery and the shift's impact on the unilateral and bilateral implantation of electrodes for deep brain stimulation (DBS). Methods Eight unilateral and 10 bilateral DBS electrodes at 10 nuclei ventrales intermedii and 18 subthalamic nuclei were implanted in patients at Kaizuka Hospital with the aid of magnetic resonance (MR) imaging–guided and microelectrode-guided methods. Brain shift was assessed as changes in the 3D coordinates of the anterior and posterior commissures (AC and PC) with MR images before and immediately after the implantation surgery. The positions of the implanted electrodes, based on the midcommissural point and AC–PC line, were measured both on x-ray films (virtual position) during surgery and the postoperative MR images (actual position) obtained on the 7th day postoperatively. Results Contralateral and posterior shift of the AC and PC were the characteristics of unilateral and bilateral procedures, respectively. The authors suggest the following. 1) The first unilateral procedure elicits a unilateral air invasion, resulting in a contralateral brain shift. 2) During the second procedure in the bilateral surgery, the contralateral shift is reset to the midline and, at the same time, the anteroposterior support by the contralateral hemisphere against gravity is lost due to a bilateral air invasion, resulting in a significant posterior (caudal) shift. Conclusions To note the tendency of the brain to shift is very important for accurate implantation of a DBS electrode or high frequency thermocoagulation, as well as for the prediction of therapeutic and adverse effects of stereotactic surgery.

Subthalamic Nucleus Deep Brain Stimulation May Improve Pain in the Setting of Parkinson Disease

2020 ◽  
pp. 85-88
Author(s):  
Anjali Gera ◽  
Gian Pal
Keyword(s):  
Chronic Pain ◽  
Deep Brain Stimulation ◽  
Parkinson Disease ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Foot Deformities ◽  
Common Source ◽  
Constant Pain ◽  
Deep Brain

More than 50% of patients with Parkinson disease (PD) can have chronic pain. PD pain has been associated with reduced quality of life scores on validated measures. The most common source of PD pain is musculoskeletal in origin. This pain may manifest as rigidity, cramps, shoulder discomfort, spinal or hand and foot deformities, dystonic pain, or nonradicular back pain. Our case illustrates improvement in chronic pain following bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) surgery in a 45-year-old patient with PD. Approximately 1 year after PD onset, he developed constant pain and tremor in his left upper extremity, which gradually worsened over time. Initially, carbidopa/levodopa completely alleviated both his arm tremor and pain. Over the next several years, he developed off periods that were associated with bothersome tremor and pain, and on periods that were associated with prominent neck and left arm dyskinesia, both of which were associated with significant pain. At age 60 years, after 15 years of PD, he underwent bilateral STN DBS implantation. Following DBS, he had significant improvement in his left arm tremor, rigidity, motor fluctuations, and pain. He also had a 70% reduction in his dopaminergic medication and complete resolution of dyskinesia and neck pain.

Deep Brain Stimulation and Motor Cortex Stimulation for Chronic Pain

2020 ◽  
Vol 68 (8) ◽  
pp. 235
Author(s):  
Patrick Senatus ◽  
Sarah Zurek ◽  
Milind Deogaonkar
Keyword(s):  
Chronic Pain ◽  
Deep Brain Stimulation ◽  
Motor Cortex ◽  
Brain Stimulation ◽  
Motor Cortex Stimulation ◽  
Deep Brain

Somatosensory functional MRI tractography for individualized targeting of deep brain stimulation in patients with chronic pain after brachial plexus injury

2019 ◽  
Vol 161 (12) ◽  
pp. 2485-2490
Author(s):  
Witold H. Polanski ◽  
Amir Zolal ◽  
Johann Klein ◽  
Hagen H. Kitzler ◽  
Gabriele Schackert ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Deep Brain Stimulation ◽  
Brachial Plexus ◽  
Functional Mri ◽  
Brain Stimulation ◽  
Brachial Plexus Injury ◽  
Deep Brain

scholarly journals The Active Electrode in the Living Brain: The Response of the Brain Parenchyma to Chronically Implanted Deep Brain Stimulation Electrodes

2020 ◽  
Author(s):  
Judith Evers ◽  
Madeleine Lowery
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Foreign Body Response ◽  
Surrounding Tissue ◽  
Active Electrode ◽  
Fibrous Sheath ◽  
Tissue Impedance ◽  
Implanted Electrodes ◽  
Postmortem Studies ◽  
Deep Brain

Abstract BACKGROUND Deep brain stimulation is an established symptomatic surgical therapy for Parkinson disease, essential tremor, and a number of other movement and neuropsychiatric disorders. The well-established foreign body response around implanted electrodes is marked by gliosis, neuroinflammation, and neurodegeneration. However, how this response changes with the application of chronic stimulation is less well-understood. OBJECTIVE To integrate the most recent evidence from basic science, patient, and postmortem studies on the effect of such an “active” electrode on the parenchyma of the living brain. METHODS A thorough and in-part systematic literature review identified 49 papers. RESULTS Increased electrode-tissue impedance is consistently observed in the weeks following electrode implantation, stabilizing at approximately 3 to 6 mo. Lower impedance values are observed around stimulated implanted electrodes when compared with unstimulated electrodes. A temporary reduction in impedance has also been observed in response to stimulation in nonhuman primates. Postmortem studies from patients confirm the presence of a fibrous sheath, astrocytosis, neuronal loss, and neuroinflammation in the immediate vicinity of the electrode. When comparing stimulated and unstimulated electrodes directly, there is some evidence across animal and patient studies of altered neurodegeneration and neuroinflammation around stimulated electrodes. CONCLUSION Establishing how stimulation influences the electrical and histological properties of the surrounding tissue is critical in understanding how these factors contribute to DBS efficacy, and in controlling symptoms and side effects. Understanding these complex issues will aid in the development of future neuromodulation systems that are optimized for the tissue environment and required stimulation protocols.

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