Functional MRI Signature of Chronic Pain Relief From Deep Brain Stimulation in Parkinson Disease Patients

Abstract

BACKGROUND Chronic pain occurs in 83% of Parkinson disease (PD) patients and deep brain stimulation (DBS) has shown to result in pain relief in a subset of patients, though the mechanism is unclear. OBJECTIVE To compare functional magnetic resonance imaging (MRI) data in PD patients with chronic pain without DBS, those whose pain was relieved (PR) with DBS and those whose pain was not relieved (PNR) with DBS. METHODS Functional MRI (fMRI) with blood oxygen level-dependent activation data was obtained in 15 patients in control, PR, and PNR patients. fMRI was obtained in the presence and absence of a mechanical stimuli with DBS ON and DBS OFF. Voxel-wise analysis using pain OFF data was used to determine which regions were altered during pain ON periods. RESULTS At the time of MRI, pain was scored a 5.4 ± 1.2 out of 10 in the control, 4.25 ± 1.18 in PNR, and 0.8 ± 0.67 in PR cohorts. Group analysis of control and PNR groups showed primary somatosensory (SI) deactivation, whereas PR patients showed thalamic deactivation and SI activation. DBS resulted in more decreased activity in PR than PNR (P < .05) and more activity in anterior cingulate cortex (ACC) in PNR patients (P < .05). CONCLUSION Patients in the control and PNR groups showed SI deactivation at baseline in contrast to the PR patients who showed SI activation. With DBS ON, the PR cohort had less activity in SI, whereas the PNR had more anterior cingulate cortex activity. We provide pilot data that patients whose pain responds to DBS may have a different fMRI signature than those who do not, and PR and PNR cohorts produced different brain responses when DBS is employed.

A Meta-Analysis of the Effect of Subthalamic Nucleus-Deep Brain Stimulation in Parkinson's Disease-Related Pain

“…In addition, rat studies on STN-DBS in the treatment of PD-related pain also found that STN exhibited complex tonic and phasic responses to noxious stimuli (Pautrat et al, 2018 ). Some functional magnetic resonance imaging studies also show that the pain network (such as primary somatosensory and anterior cingulate cortex) is decreased by STN-DBS in patients whose pain was relieved by DBS compared with patients whose pain were not relieved by DBS (DiMarzio et al, 2019 ). In addition, the pathology of PD may influence pain in several ways.…”

Vertical open‐bore MRI scanners generate significantly less radiofrequency heating around implanted leads: A study of deep brain stimulation implants in 1.2T OASIS scanners versus 1.5T horizontal systems

“…It is estimated that 50%‐75% of patients with cardiovascular implants will need to undergo MRI during their lifetime, 38 with many patients requiring repeated examinations 39 . Similarly, MRI is increasingly indicated in patients with neuro‐modulation devices, such as those with DBS implants, 40 as it can directly visualize implanted electrodes, 41,42 and allow the stimulation to be tailored on a patient‐specific basis to maximize the therapy and minimize side effects 41‐44 . Indeed, lessons learned from failed clinical trials have brought the consensus that meticulous application of neuroimaging is indispensable to guide neuro‐modulation therapies, both for target verification and ruling out complications, and for quantifying the functional effects of stimulation on sparse brain networks across participants and etiologies 45,46 …”

Stimulation of zona incerta selectively modulates pain in humans

“…Other human studies describing the sensory effects of nearby subthalamic stimulation differ on whether mechanical pain thresholds are modified by stimulation 17 , 18 . However, the mechanistic pathway of these effects may also be distinct from that of DBS at zona incerta 22 .…”