A Deep Brain Stimulation Trial Period for Treating Chronic Pain

Abstract

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.

Analysis-rcs-data: Open-Source Toolbox for the Ingestion, Time-Alignment, and Visualization of Sense and Stimulation Data From the Medtronic Summit RC+S System

“…Deep-brain stimulation is an established or experimental therapy for a number of neurological and psychiatric diseases ( Mayberg et al, 2005 ; Lozano et al, 2008 ; Mallet et al, 2009 ; Schlaepfer et al, 2013 ; Pereira and Aziz, 2014 ; Fontaine et al, 2015 ; Moro et al, 2017 ; Limousin and Foltynie, 2019 ; Harmsen et al, 2020 ; Shirvalkar et al, 2020 ; Krauss et al, 2021 ). Originally applied in an open-loop paradigm, there has been a surge of interest in delivering closed-loop or adaptive stimulation in response to disease and symptom biomarkers ( Neumann et al, 2014 ; Arlotti et al, 2018 ; Hoang and Turner, 2019 ; Provenza et al, 2019 ).…”

Analysis-rcs-data: Open-source toolbox for the ingestion, time-alignment, and visualization of sense and stimulation data from the Medtronic Summit RC+S system

“…DBS is an established or experimental therapy for a number of neurological and psychiatric diseases (Krauss et al 2021;Mayberg et al 2005;Lozano et al 2008;Schlaepfer et al 2013;Fontaine et al 2015;Moro et al 2017;Limousin and Foltynie 2019;Pereira and Aziz 2014;Harmsen et al 2020;Mallet et al 2009;Shirvalkar et al 2020). Originally applied in an open-loop paradigm, there has been a surge of interest in delivering closed-loop or adaptive stimulation in response to disease and symptom biomarkers (Arlotti et al 2018;Neumann et al 2014;Hoang and Turner 2019;Provenza et al 2019).…”

The continued relevance of Deep Brain Stimulation for chronic pain

“…Shirvalkar, et al champion the more invasive option of SteroEEG (SEEG) trials with the aim to identify optimal brain regions in candidates likely to respond. This method has been used in refractory epilepsy, and can be placed through burr holes targeting both cortical and deep structures of the brain [55]. Of course, with the added invasive nature comes with risks; SEEG has potential for haemorrhage, neurological de icit, death, and infection rates will be higher than noninvasive approaches, so will require added bene its to justify this pre-DBS.…”