Deep brain stimulation can regulate arterial blood pressure in awake humans

Green, Alexander L.; Wang, Shouyan; Owen, Sarah; Xie, Kangning; Liu, Xuguang; Paterson, David J.; Stein, John; Bain, Peter G.; Aziz, Tipu Z.

doi:10.1097/01.wnr.0000183904.15773.47

Cited by 97 publications

(95 citation statements)

References 25 publications

(29 reference statements)

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“…Human DBS and animal studies have identified that dlPAG activation triggers active coping strategies, involving sympathoexcitation, hyperventilation and short‐duration, non‐opioid‐mediated analgesia [Bandler et al, 2000; Green et al, 2005; Keay and Bandler, 2001; Pereira et al, 2010]. Our results are consistent with these observations.…”

Section: Discussionsupporting

confidence: 91%

Connectivity‐based segmentation of the periaqueductal gray matter in human with brainstem optimized diffusion MRI

Ezra

Faull

Jbabdi

et al. 2015

Human Brain Mapping

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The periaqueductal gray matter (PAG) is a midbrain structure, involved in key homeostatic neurobiological functions, such as pain modulation and cardiorespiratory control. Animal research has identified four subdivisional columns that differ in both connectivity and function. Until now these findings have not been replicated in humans. This study used high‐resolution brainstem optimized diffusion magnetic resonance imaging and probabilistic tractography to segment the human PAG into four subdivisions, based on voxel connectivity profiles. We identified four distinct subdivisions demonstrating high spatial concordance with the columns of the animal model. The resolution of these subdivisions for individual subjects permitted detailed examination of their structural connectivity without the requirement of an a priori starting location. Interestingly patterns of forebrain connectivity appear to be different to those found in nonhuman studies, whereas midbrain and hindbrain connectivity appears to be maintained. Although there are similarities in the columnar structure of the PAG subdivisions between humans and nonhuman animals, there appears to be different patterns of cortical connectivity. This suggests that the functional organization of the PAG may be different between species, and as a consequence, functional studies in nonhumans may not be directly translatable to humans. This highlights the need for focused functional studies in humans. Hum Brain Mapp 36:3459–3471, 2015. © 2015 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.

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Section: Discussionsupporting

confidence: 91%

Connectivity‐based segmentation of the periaqueductal gray matter in human with brainstem optimized diffusion MRI

Ezra

Faull

Jbabdi

et al. 2015

Human Brain Mapping

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“…Its autonomic effects have been well studied in animals [92,[114][115][116][117] and changes noted with DBS [101]. We have demonstrated a positive correlation between the degree of analgesia in patients receiving PAG DBS and the magnitude of blood pressure reduction [118], and have shown that whereas dorsal PAG stimulation can acutely elevate blood pressure, ventral stimulation reduces it [119,120]. Such findings advance investigations for objective markers of chronic pain and also the potential selection of patients who may respond best to PAG DBS.…”

Section: Physiologysupporting

confidence: 53%

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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“…The advancement of neuroimaging techniques has provided an opportunity for translation of these findings to humans and the insular and anterior cingulate cortices have been suggested as human brain regions that are activated by central command during exercise (45,168,234,235,339,379,380). More recently, direct electrical stimulation of midbrain areas during neurosurgery (e.g., deep brain stimulation) in awake humans has been used to enhance our understanding of potential central command areas (16,117,118,338) (Fig. 7).…”

Section: Neural Cardiovascular Control Mechanisms Central Commandmentioning

confidence: 97%

Autonomic Adjustments to Exercise in Humans

Fisher

Young

Fadel

2015

Comprehensive Physiology

223

253

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Autonomic nervous system adjustments to the heart and blood vessels are necessary for mediating the cardiovascular responses required to meet the metabolic demands of working skeletal muscle during exercise. These demands are met by precise exercise intensity-dependent alterations in sympathetic and parasympathetic nerve activity. The purpose of this review is to examine the contributions of the sympathetic and parasympathetic nervous systems in mediating specific cardiovascular and hemodynamic responses to exercise. These changes in autonomic outflow are regulated by several neural mechanisms working in concert, including central command (a feed forward mechanism originating from higher brain centers), the exercise pressor reflex (a feed-back mechanism originating from skeletal muscle), the arterial baroreflex (a negative feed-back mechanism originating from the carotid sinus and aortic arch), and cardiopulmonary baroreceptors (a feed-back mechanism from stretch receptors located in the heart and lungs). In addition, arterial chemoreceptors and phrenic afferents from respiratory muscles (i.e., respiratory metaboreflex) are also capable of modulating the autonomic responses to exercise. Our goal is to provide a detailed review of the parasympathetic and sympathetic changes that occur with exercise distinguishing between the onset of exercise and steady-state conditions, when appropriate. In addition, studies demonstrating the contributions of each of the aforementioned neural mechanisms to the autonomic changes and ensuing cardiac and/or vascular responses will be covered.

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Deep brain stimulation can regulate arterial blood pressure in awake humans

Cited by 97 publications

References 25 publications

Connectivity‐based segmentation of the periaqueductal gray matter in human with brainstem optimized diffusion MRI

Connectivity‐based segmentation of the periaqueductal gray matter in human with brainstem optimized diffusion MRI

Neuropathic Pain and Deep Brain Stimulation

Autonomic Adjustments to Exercise in Humans

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