Systematic Review and Neural Network Analysis to Define Predictive Variables in Implantable Motor Cortex Stimulation to Treat Chronic Intractable Pain

Henssen, Dylan; Witkam, Richard L.; Dao, Johan C.M.L.; Comes, D.; Walsum, A.M. van Cappellen van; Kozicz, Tamás; Dongen, Robert van; Vissers, Kris; Bartels, Ronald H. M. A.; Jong, Guido de; Kurt, Erkan

doi:10.1016/j.jpain.2019.02.004

Cited by 7 publications

(7 citation statements)

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“…Although this meta‐analysis suggests that various brain regions experience increased or decreased rCBF, the differences between responders and non‐responders could not be taken into account at a meta‐level. The present meta‐analysis found that within the included neuroimaging studies, 51% of the patients respond to iMCS, which is in agreement with larger, more epidemiological meta‐analyses on this topic . However, how the neuroimaging data was impacted by outcome, has only been investigated by Maarraawi et al They showed by using PET‐CT that significant decreases of [ 11 C]diprenorphine (a non‐selective opioid antagonist) binding capacity were found in the anterior middle cingulate cortex (MCC) and periaqueductal gray (PAG) after iMCS, which correlated with pain relief .…”

Section: Discussionsupporting

confidence: 86%

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Invasive Motor Cortex Stimulation Influences Intracerebral Structures in Patients With Neuropathic Pain: An Activation Likelihood Estimation Meta-Analysis of Imaging Data

Volkers

Giesen

Heiden

et al. 2020

Neuromodulation: Technology at the Neural Interface

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Objective Invasive motor cortex stimulation (iMCS) has been proposed as a treatment for intractable neuropathic pain syndromes. Although the mechanisms underlying the analgesic effect of iMCS remain largely elusive, several studies found iMCS‐related changes in regional cerebral blood flow (rCBF) in neuropathic pain patients. The aim of this study was to meta‐analyze the findings of neuroimaging studies on rCBF changes to iMCS. Methods PubMed, Embase, MEDLINE, Google Scholar, and the Cochrane Library were systematically searched for retrieval of relevant scientific papers. After initial assessment of relevancy by screening title and abstract by two investigators, independently, predefined inclusion and exclusion criteria were used for final inclusion of papers. Descriptive results were statistically assessed, whereas coordinates were pooled and meta‐analyzed in accordance with the activation likelihood estimation (ALE) methodology. Results Six studies were included in the systematic narrative analysis, suggesting rCBF increases in the cingulate gyrus, thalamus, insula, and putamen after switching the MCS device “ON” as compared to the “OFF” situation. Decreases in rCBF were found in for example the precentral gyrus and different occipital regions. Two studies did not report stereotactic coordinates and were excluded from further analysis. ALE meta‐analysis showed that, after switching the iMCS electrode “ON,” increased rCBF occurred in the (1) anterior cingulate gyrus; (2) putamen; (3) cerebral peduncle; (4) precentral gyrus; (5) superior frontal gyrus; (6) red nucleus; (7) internal part of the globus pallidus; (8) ventral lateral nucleus of the thalamus; (9) medial frontal gyrus; (10) inferior frontal gyrus; and (11) claustrum, as compared to the “OFF” situation. Reductions in rCBF were found in the posterior cingulate gyrus when the iMCS electrode was turned “OFF.” Conclusions These findings suggested that iMCS induces changes in principal components of the default mode‐, the salience‐, and sensorimotor network.

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Section: Discussionsupporting

confidence: 86%

“…Because the first reports, numerous studies provided evidence for the effectiveness of iMCS in experimental, double‐blinded randomized controlled trials and in clinical settings (for a review, see ref. ). The underlying mechanisms of action of iMCS remains elusive, but is proposed to involve a distributed network of brain regions .…”

Section: Introductionmentioning

confidence: 97%

Invasive Motor Cortex Stimulation Influences Intracerebral Structures in Patients With Neuropathic Pain: An Activation Likelihood Estimation Meta-Analysis of Imaging Data

Volkers

Giesen

Heiden

et al. 2020

Neuromodulation: Technology at the Neural Interface

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“…A previous paper of our group also investigated outcome prediction factors involved in iMCS outcome. These factors included the sex of the patient, the origin of the lesion within the somatosensory nervous system, the preoperative VAS score, the preoperative use of rTMS, the preoperative intake of opioids and the duration of the follow-up period 50 .However, with the exception of the possible effect of the localization of the lesion, these factors were not reproduced in the present research. www.nature.com/scientificreports www.nature.com/scientificreports/ Mechanisms of action of iMCS.…”

Section: Discussionmentioning

confidence: 76%

Motor cortex stimulation in chronic neuropathic orofacial pain syndromes: a systematic review and meta-analysis

Henssen

Kurt

Walsum

et al. 2020

Sci Rep

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Invasive motor Cortex Stimulation (iMCS) was introduced in the 1990's for the treatment of chronic neuropathic orofacial pain (CNOP), although its effectiveness remains doubtful. However, CNOP is known to be a heterogeneous group of orofacial pain disorders, which can lead to different responses to iMCS. Therefore, this paper investigated (1) whether the effectiveness of iMCS is significantly different among different CNOP disorders and (2) whether other confounding factors can be impacting iMCS results in CNOP. A systematic review and meta-analysis using a linear mixed-model was performed. Twenty-three papers were included, totaling 140 CNOP patients. Heterogeneity of the studies showed to be 55.8%. A visual analogue scale (VAS) measured median pain relief of 66.5% (ranging from 0-100%) was found. Linear mixed-model analysis showed that patients suffering from trigeminal neuralgia responded significantly more favorable to iMCS than patients suffering from dysfunctional pain syndromes (p = 0.030). Also, patients suffering from CNOP caused by (supra)nuclear lesions responded marginally significantly better to iMCS than patients suffering from CNOP due to trigeminal nerve lesions (p = 0.049). No other confounding factors were elucidated. This meta-analysis showed that patients suffering from trigeminal neuralgia and patients suffering from (supra)nuclear lesions causing CNOP responded significantly more favorable than others on iMCS. No other confounding factors were found relevant.In the early 1990's, Tsubokawa and his colleagues searched for a new therapy to treat intractable neuropathic pain as other forms of therapies, including continuous deep brain stimulation of thalamic nuclei, only provided satisfactory pain relief in approximately 30% of the cases. For that reason, they started to empirically stimulate various brain regions in animal models for intractable neuropathic pain. During their experiments, they recognized the primary motor cortex as a target that could provide excellent pain relief. Within their experiments, Tsubokawa transected the spinothalamic tract in cats, which led to thalamic hyperactivity and pain-related behavior. By stimulating the primary motor cortex in these cats, it was found that both the hyperactivity was inhibited and the pain-related behavior diminished, indicating an analgesic effect of iMCS in the treated cats. These experimental findings were in line with their subsequent clinical investigations in individuals suffering from intractable neuropathic pain as a consequence of thalamic syndrome 1-5 . Since then, iMCS has been carried out in approximately 700 cases world-wide, yielding highly variable outcomes 1,6-40 . Nevertheless, iMCS has become a last resort neurosurgical therapy for different intractable neuropathic pain syndromes 3-5,14,17,21,26,35,41-44 . In 1993, Meyerson et al. reported for the first time on the use of iMCS in chronic neuropathic orofacial pain (CNOP) as a last resort treatment. They reported that, in a case series of 10 individuals suffering from CNOP...

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“…Considering that the motor cortex is an important region for pain processing and control (Volz et al, 2015;Lopes et al, 2019) we argue that by modulating the bilateral motor cortex's HbO responses, acupuncture manipulation could produce analgesic effects. Firstly, it has been well known that the motor cortex has the role of pain control (Ostergard et al, 2014), and electrical stimulation in the motor cortex could treat intractable pain syndromes effectively (Arle and Shils, 2008;Henssen et al, 2019). Secondly, previous fNIRS studies also proved that analgesic effects could be delivered during acupuncture manipulation, in which the decreased hemodynamic responses of the motor cortex were observed (Takamoto et al, 2010;Rojas et al, 2019).…”

Section: Modulation Of the Motor Cortex And The Analgesic Effect Of Acupuncturementioning

confidence: 98%

Acupuncture With deqi Modulates the Hemodynamic Response and Functional Connectivity of the Prefrontal-Motor Cortical Network

Xiang

Zhang

et al. 2021

Front. Neurosci.

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As a world intangible cultural heritage, acupuncture is considered an essential modality of complementary and alternative therapy to Western medicine. Despite acupuncture’s long history and public acceptance, how the cortical network is modulated by acupuncture remains largely unclear. Moreover, as the basic acupuncture unit for regulating the central nervous system, how the cortical network is modulated during acupuncture at the Hegu acupoint is mostly unclear. Here, multi-channel functional near-infrared spectroscopy (fNIRS) data were recorded from twenty healthy subjects for acupuncture manipulation, pre- and post-manipulation tactile controls, and pre- and post-acupuncture rest controls. Results showed that: (1) acupuncture manipulation caused significantly increased acupuncture behavioral deqi performance compared with tactile controls. (2) The bilateral prefrontal cortex (PFC) and motor cortex were significantly inhibited during acupuncture manipulation than controls, which was evidenced by the decreased power of oxygenated hemoglobin (HbO) concentration. (3) The bilateral PFC’s hemodynamic responses showed a positive correlation trend with acupuncture behavioral performance. (4) The network connections with bilateral PFC as nodes showed significantly increased functional connectivity during acupuncture manipulation compared with controls. (5) Meanwhile, the network’s efficiency was improved by acupuncture manipulation, evidenced by the increased global efficiency and decreased shortest path length. Taken together, these results reveal that a cooperative PFC-Motor functional network could be modulated by acupuncture manipulation at the Hegu acupoint. This study provides neuroimaging evidence that explains acupuncture’s neuromodulation effects on the cortical network.

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Systematic Review and Neural Network Analysis to Define Predictive Variables in Implantable Motor Cortex Stimulation to Treat Chronic Intractable Pain

Cited by 7 publications

References 64 publications

Invasive Motor Cortex Stimulation Influences Intracerebral Structures in Patients With Neuropathic Pain: An Activation Likelihood Estimation Meta-Analysis of Imaging Data

Invasive Motor Cortex Stimulation Influences Intracerebral Structures in Patients With Neuropathic Pain: An Activation Likelihood Estimation Meta-Analysis of Imaging Data

Motor cortex stimulation in chronic neuropathic orofacial pain syndromes: a systematic review and meta-analysis

Acupuncture With deqi Modulates the Hemodynamic Response and Functional Connectivity of the Prefrontal-Motor Cortical Network

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