Deep brain stimulation for movement disorders and pain

Bittar, Richard G.; Burn, Sasha; Bain, Peter G.; Owen, Sarah; Joint, Carole; Shlugman, D.; Aziz, Tipu Z.

doi:10.1016/j.jocn.2004.09.001

Cited by 89 publications

(36 citation statements)

References 10 publications

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“…Its pertinent anatomical boundaries in the midbrain include the medial lemniscus laterally, superior colliculus inferoposteriorly and the red nucleus inferoanteriorly. Further explanations of our neurosurgical procedure and target localisation techniques are published elsewhere [8,27,28,29]. …”

Section: Methodsmentioning

confidence: 99%

Human Periventricular Grey Somatosensory Evoked Potentials Suggest Rostrocaudally Inverted Somatotopy

Pereira

Wang

Owen

et al. 2013

Stereotact Funct Neurosurg

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Background: Somatosensory homunculi have been demonstrated in primary somatosensory cortex and ventral posterior thalamus but not periaqueductal and periventricular grey matter (PAVG), a therapeutic target for deep brain stimulation (DBS) in chronic pain. Aims: The study is an investigation of somatotopic representation in PAVG and assessment for a somatosensory homunculus. Methods: Five human subjects were investigated using electrical somatosensory stimulation and deep brain macroelectrode recording. DBS were implanted in the contralateral PAVG. Cutaneous arm, leg and face regions were stimulated while event-related potentials were recorded from deep brain electrodes. Electrode contact positions were mapped using MRI and brain atlas information. Results: Monopolar P1 somatosensory evoked potential amplitudes were highest and onset latencies shortest in contralateral caudal PAVG with facial stimulation and rostral with leg stimulation, in agreement with reported subjective sensation during intra-operative electrode advancement. Conclusions: A rostrocaudally inverted somatosensory homunculus exists in the human PAVG region. Objective human evidence of PAVG somatotopy increases understanding of a brainstem region important to pain and autonomic control that is a clinical target for both pharmacological and neurosurgical therapies. Such knowledge may assist DBS target localisation for neuropathic pain syndromes related to particular body regions like brachial plexopathies, anaesthesia dolorosa and phantom limb pain.

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Section: Methodsmentioning

confidence: 99%

Human Periventricular Grey Somatosensory Evoked Potentials Suggest Rostrocaudally Inverted Somatotopy

Pereira

Wang

Owen

et al. 2013

Stereotact Funct Neurosurg

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“…Recent developments in deep brain stimulation (DBS) of specific targets in the human brain have been successful in alleviating the symptoms of otherwise treatment-resistant disorders; mainly chronic pain [1][2][3], phantom pain [4], cluster headache [5], and motor disorders including Parkinson's disease [6], multiple sclerosis or essential tremor, dystonia and spasmodic torticollis [7] with some success also reported for unipolar depression [8]. The data so far suggest that lowfrequency stimulation works particularly well for the treatment of pain, whereas high-frequency stimulation works best for movement disorders.…”

Section: Introductionmentioning

confidence: 99%

Deep brain stimulation for chronic pain investigated with magnetoencephalography

Kringelbach

Jenkinson²,

Green³

et al. 2007

NeuroReport

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“…From insights revealed by basal ganglia microelectrode recordings and DBS for movement disorders reviewed elsewhere [102][103][104], we postulate that altered rhythmic activity in VP and PAG neurons is likely to play an important role in the pathophysiology of central pain. At either target, our clinical experience is that, in general, DBS at lower frequencies (≤50 Hz) is analgesic and at higher frequencies (>70 Hz) hyperalgesic [79,105,106], supporting a dynamic model whereby synchronous oscillations in discrete neuronal populations centrally modulate chronic pain perception. Analgesic DBS may therefore either disrupt pathological high-frequency synchronous oscillations or, more likely, augment pathologically diminished low-frequency synchronous oscillations in the thalamic and reticular components of a reticulo-thalamo-corticofugal pain neuromatrix.…”

Section: Physiologymentioning

confidence: 93%

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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Deep brain stimulation for movement disorders and pain

Cited by 89 publications

References 10 publications

Human Periventricular Grey Somatosensory Evoked Potentials Suggest Rostrocaudally Inverted Somatotopy

Human Periventricular Grey Somatosensory Evoked Potentials Suggest Rostrocaudally Inverted Somatotopy

Deep brain stimulation for chronic pain investigated with magnetoencephalography

Neuropathic Pain and Deep Brain Stimulation

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