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

• Published in: Brain sciences Vol. 7; no. 1; p. 9
• Main Authors: Hollingworth, Milo, Sims-Williams, Hugh P, Pickering, Anthony E, Barua, Neil, Patel, Nikunj K
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 13.01.2017; MDPI
• Subjects: Chronic pain; CMPf; deep brain stimulation; Electrodes; Neuromodulation; PAG/PVG; Pain; pain pathways; Review; pain; PAG/PVG; pain pathways; deep brain stimulation; CMPf
• ISSN: 2076-3425; 2076-3425
• DOI: 10.3390/brainsci7010009

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.