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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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fMRI- and DT-MRI-based deep brain stimulation in patients with chronic pain

fMRT- und DTI-basierte tiefe Hirnstimulation bei Patienten mit chronischem Schmerzsyndrom

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  • presenting/speaker Witold Polanski - Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
  • Amir Zolal - SRH Wald-Klinikum Gera GmbH, Wirbelsäulenchirurgie und Neurotraumatologie, Gera, Deutschland
  • Johann Klein - Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
  • Hagen Kitzler - Universitätsklinikum Carl Gustav Carus, Neuroradiologie, Dresden, Deutschland
  • Gabriele Schackert - Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
  • Wilhelm Eisner - Landeskrankenhaus Innsbruck, Klinik und Poliklinik für Neurochirurgie, Innsbruck, Austria
  • Stephan B. Sobottka - Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocP106

doi: 10.3205/19dgnc442, urn:nbn:de:0183-19dgnc4428

Published: May 8, 2019

© 2019 Polanski et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Deep brain stimulation (DBS) for patients with chronic pain is commonly performed since the early 1970s with inconsistent results and within variable targets. We applied sensoric functional MRI (fMRI)- and diffusion tensor imaging (DT-MRI)-based DBS in chronic pain patients into 4 different targets to ascertain the most beneficial, individual stimulation site.

Methods: Three patients with chronic arm pain after brachial plexus injury underwent sensoric fMRI and DTI-based DBS into 4 targets (periventricular gray (PVG), ventroposterolateral thalamus (VPL), internal capsule (ICs) according to standard coordinates and according to fMRI (ICm)) with external extension. After lead placement pain reduction was evaluated in a double-blinded test-stimulation. The two most effective electrodes were selected and connected to a stimulator for permanent treatment. The follow-up period was 1, 3, 6 and 9 months after surgery recording the numerical rating scale (NRS) and short-form McGill’s score (SF-MPQ) as well as health-related quality of life (SF-36 and EuroCol EQ-5D-3L).

Results: Stimulation of ICs revealed no pain reducing effect, whereas stimulation of PVG, VPL and ICm reduced the pain with low-frequency stimulation. The best effect was observed for ICm. Before surgery, all three patients suffered from permanent pain (mean NRS 6.6) and pain attacks (mean NRS 9.6) at least 3 times a week. These pain attacks were persisting for several hours. Up to 9 months after DBS, the permanent pain was reduced to mean NRS 3.6. The pain attacks resolved in 2 patients and improved in one patient with weaker attacks (NRS 5) only twice a month. SF-MPQ decreased from median 92.7 to 50. Likewise, the health-related quality of life considerably improved.

Conclusion: fMRI and DT-MRI-based DBS into the internal capsule combined with PVG or VPL stimulation for patients with chronic pain after arm-plexus injury shows promising results, which should be re-evaluated in a multicenter trial.