Single Electrode Deep Brain Stimulation with Dual Targeting at Dual Frequency for the Treatment of Chronic Pain: A Case Series and Review of the Literature
Deep Brain Stimulation (DBS) has been used to target many deep brain structures for the treatment of chronic pain. The periaqueductal grey and periventricular grey (PAG/PVG) is an effective target but results are variable, sometimes short-lived or subject to tolerance. The centromedian intra-laminar...
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| Published in | Brain sciences Vol. 7; no. 1; p. 9 |
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| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
| Published |
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13.01.2017
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| Online Access | Get full text |
| ISSN | 2076-3425 2076-3425 |
| DOI | 10.3390/brainsci7010009 |
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| Abstract | Deep Brain Stimulation (DBS) has been used to target many deep brain structures for the treatment of chronic pain. The periaqueductal grey and periventricular grey (PAG/PVG) is an effective target but results are variable, sometimes short-lived or subject to tolerance. The centromedian intra-laminar parafascicular complex (CMPf) modulates medial pain pathways and CMPf DBS may address the affective aspects of pain perception. Stimulation of multiple deep brain targets may offer a strategy to optimize management of patients with complex pain symptomatology. However, previous attempts to stimulate multiple targets requires multiple trajectories and considerable expense. Using a single electrode to stimulate multiple targets would help overcome these challenges. A pre-requisite of such a technique is the ability to use different stimulation parameters at different contacts simultaneously on the same electrode. We describe a novel technique in 3 patients with chronic pain syndromes for whom conventional medical and/or neuromodulation therapy had failed using a single electrode technique to stimulate PVG/PAG and CMPf at dual frequencies. |
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| AbstractList | Deep Brain Stimulation (DBS) has been used to target many deep brain structures for the treatment of chronic pain. The periaqueductal grey and periventricular grey (PAG/PVG) is an effective target but results are variable, sometimes short-lived or subject to tolerance. The centromedian intra-laminar parafascicular complex (CMPf) modulates medial pain pathways and CMPf DBS may address the affective aspects of pain perception. Stimulation of multiple deep brain targets may offer a strategy to optimize management of patients with complex pain symptomatology. However, previous attempts to stimulate multiple targets requires multiple trajectories and considerable expense. Using a single electrode to stimulate multiple targets would help overcome these challenges. A pre-requisite of such a technique is the ability to use different stimulation parameters at different contacts simultaneously on the same electrode. We describe a novel technique in 3 patients with chronic pain syndromes for whom conventional medical and/or neuromodulation therapy had failed using a single electrode technique to stimulate PVG/PAG and CMPf at dual frequencies. Deep Brain Stimulation (DBS) has been used to target many deep brain structures for the treatment of chronic pain. The periaqueductal grey and periventricular grey (PAG/PVG) is an effective target but results are variable, sometimes short-lived or subject to tolerance. The centromedian intra-laminar parafascicular complex (CMPf) modulates medial pain pathways and CMPf DBS may address the affective aspects of pain perception. Stimulation of multiple deep brain targets may offer a strategy to optimize management of patients with complex pain symptomatology. However, previous attempts to stimulate multiple targets requires multiple trajectories and considerable expense. Using a single electrode to stimulate multiple targets would help overcome these challenges. A pre-requisite of such a technique is the ability to use different stimulation parameters at different contacts simultaneously on the same electrode. We describe a novel technique in 3 patients with chronic pain syndromes for whom conventional medical and/or neuromodulation therapy had failed using a single electrode technique to stimulate PVG/PAG and CMPf at dual frequencies.Deep Brain Stimulation (DBS) has been used to target many deep brain structures for the treatment of chronic pain. The periaqueductal grey and periventricular grey (PAG/PVG) is an effective target but results are variable, sometimes short-lived or subject to tolerance. The centromedian intra-laminar parafascicular complex (CMPf) modulates medial pain pathways and CMPf DBS may address the affective aspects of pain perception. Stimulation of multiple deep brain targets may offer a strategy to optimize management of patients with complex pain symptomatology. However, previous attempts to stimulate multiple targets requires multiple trajectories and considerable expense. Using a single electrode to stimulate multiple targets would help overcome these challenges. A pre-requisite of such a technique is the ability to use different stimulation parameters at different contacts simultaneously on the same electrode. We describe a novel technique in 3 patients with chronic pain syndromes for whom conventional medical and/or neuromodulation therapy had failed using a single electrode technique to stimulate PVG/PAG and CMPf at dual frequencies. |
| Author | Hollingworth, Milo Barua, Neil Patel, Nikunj Sims-Williams, Hugh Pickering, Anthony |
| AuthorAffiliation | 1 Department of Neurosurgery, North Bristol Trust, Bristol BS10 5NB, UK; milo.hollingworth@gmail.com (M.H.), neil.barua@nbt.nhs.uk (N.B.) 2 Department of Neurosurgery, Sheffield Teaching Hospital, Sheffield S10 2JF, UK; simswilliams@doctors.org.uk 3 School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol BS8 1TD, UK; tony.pickering@bristol.ac.uk |
| AuthorAffiliation_xml | – name: 1 Department of Neurosurgery, North Bristol Trust, Bristol BS10 5NB, UK; milo.hollingworth@gmail.com (M.H.), neil.barua@nbt.nhs.uk (N.B.) – name: 2 Department of Neurosurgery, Sheffield Teaching Hospital, Sheffield S10 2JF, UK; simswilliams@doctors.org.uk – name: 3 School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol BS8 1TD, UK; tony.pickering@bristol.ac.uk |
| Author_xml | – sequence: 1 givenname: Milo surname: Hollingworth fullname: Hollingworth, Milo – sequence: 2 givenname: Hugh surname: Sims-Williams fullname: Sims-Williams, Hugh – sequence: 3 givenname: Anthony surname: Pickering fullname: Pickering, Anthony – sequence: 4 givenname: Neil surname: Barua fullname: Barua, Neil – sequence: 5 givenname: Nikunj surname: Patel fullname: Patel, Nikunj |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/28098766$$D View this record in MEDLINE/PubMed |
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| Keywords | pain PAG/PVG pain pathways deep brain stimulation CMPf |
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| SubjectTerms | Chronic pain CMPf deep brain stimulation Electrodes Neuromodulation PAG/PVG Pain pain pathways Review |
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| Title | Single Electrode Deep Brain Stimulation with Dual Targeting at Dual Frequency for the Treatment of Chronic Pain: A Case Series and Review of the Literature |
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