Case Series: Deep Brain Stimulation for Facial Pain

Abstract

BACKGROUND Deep brain stimulation (DBS) has been used for chronic pain for decades, but its use is limited due to a lack of reliable data about its efficacy for specific indications. OBJECTIVE To report on 9 patients who underwent DBS for facial pain, with a focus on differences in outcomes between distinct etiologies. METHODS We retrospectively reviewed 9 patients with facial pain who were treated with DBS of the ventral posteromedial nucleus of the thalamus and periventricular gray. We report on characteristics including facial pain etiology, complications, changes in pain scores using the visual analog scale (VAS), and willingness to undergo DBS again. RESULTS Nine patients underwent DBS for either poststroke, post-traumatic, postherpetic, or atypical facial pain. Eight patients (89%) were permanently implanted. Seven patients had sufficient follow-up (mean 40.3 mo). Of these 7 patients, average VAS scores decreased from 9.4 to 6.1 after DBS. The average decrease in VAS was 55% for post-traumatic facial pain (2 patients), 45% for poststroke (2 patients), 15% for postherpetic neuralgia (2 patients), and 0% for atypical facial pain (1 patient). Three of the 8 implanted patients (38%) had complications which required removal of hardware. Only 2 of 7 (29%) patients met classical criteria for responders (50% decrease in pain scores). However, among 4 patients who were asked about willingness to undergo DBS again, all expressed that they would repeat the procedure. CONCLUSION There is a trend towards improvement in pain scores following DBS for facial pain, most prominently with post-traumatic pain.

Functional MRI–Guided Motor Cortex and Deep Brain Stimulation for Intractable Facial Pain: A Novel, Personalized Approach in 1 Patient

“…5,26 Small, retrospective case series have since been published that suggest the efficacy of this treatment paradigm, both in FNPS and in TDPS. 5,6,27,28 DBS of the PAG reduces nociceptive pain, likely by stimulating endogenous opioid production, although the exact mechanism is not clear. 3,26,29 DBS of the VPM has been used for the treatment of neuropathic facial pain and is believed to work by inhibiting aberrant neuronal firing within the thalamic somatosensory relay centers that allow for discrimination of location and intensity of pain.…”

Alterations of brain structural MRI are associated with outcome of surgical treatment in trigeminal neuralgia

“…In patients with chronic facial pain, refractory to medical and standard surgical treatments, central neuromodulation therapies, including stimulating (e.g., deep brain stimulation) and ablating techniques (e.g., CNS radiosurgery, high‐intensity focused ultrasonography) might be considered 40 40 .…”

“…In patients with chronic facial pain, refractory to medical and standard surgical treatments, central neuromodulation therapies, including stimulating (e.g., deep brain stimulation) and ablating techniques (e.g., CNS radiosurgery, high-intensity focused ultrasonography) might be considered. 40 To date, the thalamic nuclei, periventricular or periaqueductal gray and the anterior cingulate cortex are the most frequently used targets. 40 Our findings pave the way to a potential therapeutic role of direct or indirect stimulation of hippocampal-parahippocampal circuitry for chronic and intractable TN, as already studied in patients with Alzheimer's disease and epilepsy.…”

“…40 To date, the thalamic nuclei, periventricular or periaqueductal gray and the anterior cingulate cortex are the most frequently used targets. 40 Our findings pave the way to a potential therapeutic role of direct or indirect stimulation of hippocampal-parahippocampal circuitry for chronic and intractable TN, as already studied in patients with Alzheimer's disease and epilepsy. 41 The present study has some limitations.…”

Centromedian–Parafascicular and Somatosensory Thalamic Deep Brain Stimulation for Treatment of Chronic Neuropathic Pain: A Contemporary Series of 40 Patients

“…The popularity of thalamic DBS for the treatment of chronic pain declined when approval of the Federal and Drug Administration (FDA) could not be accomplished after two large trials were considered failures for a variety of reasons [28,29]. Nevertheless, single centers worldwide continued to perform thalamic DBS in patients with various pain syndromes, and a few case series with variable outcomes were published over the past two decades [30][31][32][33][34][35][36][37][38][39][40][41]. Many of these studies, however, were hampered by limited numbers of patients and relatively short follow-up periods.…”