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Somatosensory functional MRI tractography for individualized targeting of deep brain stimulation in patients with chronic pain after brachial plexus injury

  • Original Article - Functional Neurosurgery - Pain
  • Published:
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Abstract

Background

The optimal targets for deep brain stimulation (DBS) in patients with refractory chronic pain are not clearly defined. We applied sensory functional MRI (fMRI)- and diffusion tensor imaging (DTI)-based DBS in chronic pain patients into 3 different targets to ascertain the most beneficial individual stimulation site.

Methods

Three patients with incapacitating chronic pain underwent DBS into 3 targets (periventricular gray (PVG), ventroposterolateral thalamus (VPL), and posterior limb of the internal capsule according to fMRI and DTI (PLIC). The electrodes were externalized and double-blinded tested for several days. Finally, the two electrodes with the best pain reduction were kept for permanent stimulation. The patients were then followed up for 12 months. Outcome measures comprised the numerical rating scale (NRS), short-form McGill’s score (SF-MPQ), and health-related quality of life (SF-36).

Results

Continuous pain (mean NRS 6.6) was reduced to NRS 3.6 after 12 months. Only with stimulation of the PLIC pain attacks, that occurred at least 3 times a week (mean NRS 9.6) resolved in 2 patients and improved in one patient concerning both intensity (NRS 5) and frequency (twice a month). The mean SF-MPQ decreased from 92.7 to 50. The health-related quality of life improved considerably.

Conclusion

fMRI- and DTI-based DBS to the PLIC was the only target with a significant effect on pain attacks and seems to be the most promising target in chronic pain patients after brachial plexus injury. The combination with PVG or VPL can further improve patients’ outcome especially in terms of reducing the continuous pain.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital CarlGustavCarus, Technical University of Dresden, Fetscherstr. 74, 01307, Dresden, Germany

    Witold H. Polanski, Amir Zolal, Johann Klein, Gabriele Schackert & Stephan B. Sobottka

  2. Institute of Diagnostic and Interventional Neuroloradiology, University Hospital CarlGustavCarus, Technical University of Dresden, Fetscherstr. 74, 01307, Dresden, Germany

    Hagen H. Kitzler

  3. Department of Neurosurgery, University Hospital of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria

    Wilhelm Eisner

Authors
  1. Witold H. Polanski
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  2. Amir Zolal
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  3. Johann Klein
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  4. Hagen H. Kitzler
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  5. Gabriele Schackert
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  6. Wilhelm Eisner
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  7. Stephan B. Sobottka
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Corresponding author

Correspondence to Witold H. Polanski.

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The authors declare that they have no conflict of interest.

Ethical approval

The surgery of the three patients was done as an expanded access in off-label use.

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Informed consent was obtained from all individual participants included in the surgery and for publication of the results.

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This article is part of the Topical Collection on Functional Neurosurgery - Pain

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Polanski, W.H., Zolal, A., Klein, J. et al. Somatosensory functional MRI tractography for individualized targeting of deep brain stimulation in patients with chronic pain after brachial plexus injury. Acta Neurochir 161, 2485–2490 (2019). https://doi.org/10.1007/s00701-019-04065-2

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  • DOI: https://doi.org/10.1007/s00701-019-04065-2

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