Functional and Metabolic Changes in the Brain in Neuropathic Pain Syndrome against the Background of Chronic Epidural Electrostimulation of the Spinal Cord

Abstract

Changes in functional and metabolic activities of the brain were evaluated by EEG and positron-emission/computer tomography with 18F-fluorodeoxyglucose in patients with neuropathic pain syndrome previous to and 3 months after implantation of a system for chronic epidural spinal cord stimulation. In most cases, the use of a nerve stimulator was followed by alleviation of neuropathic pain and partial normalization of functional and metabolic activities of brain structures responsible for pain perception, emotiogenic, behavioral, and autonomic responses.

Objective Measures to Characterize the Physiological Effects of Spinal Cord Stimulation in Neuropathic Pain: A Literature Review

“…Fourteen studies included in this review used functional neuroimaging techniques to assess the mechanistic effects of SCS (Table ). Three studies used electromagnetic techniques, such as EEG and magnetoencephalography (MEG), to investigate the effects of SCS on cortical processing .…”

“…Among the 67 studies included in this review, 24 used neurophysiological measures (27)(28)(29)(30)(31)(32)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59), 14 used functional neuroimaging techniques (12,(33)(34)(35)(36)(60)(61)(62)(63)(64)(65)(66)(67)(68), 3 used a combination of neurophysiological and functional neuroimaging techniques (69-71), 14 used quantitative sensory testing (37)(38)(39)(72)(73)(74)(75)(76)(77)(78)(79)(80)…”

Brain activity modifications following spinal cord stimulation for chronic neuropathic pain: A systematic review

“…Twenty‐four studies were included in the systematic review: thirteen used neuroelectrical imaging techniques (Blair et al., ; Doerr et al., ; Augustinsson et al., ; Gildenberg and Murthy, ; Theuvenet et al., ; Schulman et al., ; Poláček et al., ; Schlaier et al., ; De Andrade et al., ; Buonocore et al., ; Wolter et al., ; Pahapill and Zhang, ; Pluijms et al., ); eight used haemodynamic imaging techniques (Hosobuchi, ; Meglio et al., ; Kiriakopoulos et al., ; Kunitake et al., ; Nagamachi et al., ; Stančák et al., ; Kishima et al., ; Moens et al., ); two used both neuroelectrical and haemodynamic techniques, which are discussed respectively in the following two sections (Mazzone et al., ; Sufianov et al., ); and one investigated cerebral neurobiology, which is discussed within the section on haemodynamic studies (Moens et al., ). The results of the study selection process are displayed in Fig.…”

Spinal Cord Stimulation: Clinical Efficacy and Potential Mechanisms

“…SCS can increase regional cerebral blood flow (CBF), especially when administered at the cervical level, suggesting a direct effect on CBF regulatory centers . Studies using PET and SPECT imaging of CBF had similar findings, with normalization of activity in multiple brain regions, including the thalamus, postcentral gyrus, orbitofrontal cortex, and anterior cingulate cortex in one study . Others found regional CBF changes in the thalamus, anterior cingulate cortex, prefrontal cortex, and bilateral parietal association areas .…”

“…In addition to its segmental effects, SCS modulates cortical processing of somatosensory information, as reviewed recently . SCS has been shown to decrease cortical excitability, as measured via sensory evoked potentials (SEPs), and can normalize pathologic cortical activity . These measures may be useful to predict pain relief .…”