Thalamic deep brain stimulation for post-traumatic neuropathic limb pain: Efficacy at five years' follow-up and effective volume of activated brain tissue

Autores da FMUP

• Ricardo Manuel De Pinto Vaz

  Autor

• Celso Albuquerque Reis

  Autor

Participantes de fora da FMUP

• Abreu, V
• Chamadoira, C.
• Rebelo, V
• Costa, F.
• Martins, J.
• Gillies, M. J.
• Aziz, T. Z.
• Pereira, E. A. C.

Unidades de investigação

• Biomedicina

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

Chronic neuropathic pain affects 7%-10% of the population. Deep brain stimulation (DBS) has shown variable but promising results in its treatment. This study prospectively assessed the long-term effectiveness of DBS in a series of patients with chronic neuropathic pain, correlating clinical results with neuroimaging. Sixteen patients received 5 years' post-surgical follow-up in a single center. Six had phantom limb pain after amputation and 10 had deafferentation pain after traumatic brachial plexus injury. Patientreported outcome measures were completed before and after surgery, using VAS, UWNPS, BPI and SF-36 scores. Neuroimaging evaluated electrode location and effective volumes of activated tissue (VAT). Two subgroups were created based on the percentage of VAT superimposed upon the ventroposterolateral thalamic nucleus (eVAT), and clinical outcomes were compared. Analgesic effect was assessed at 5 years and compared to preoperative pain, with an improvement on VAS of 76.4% (p = 0.0001), on UW-NPS of 35.2% (p = 0.3582), on BPI of 65.1% (p = 0.0505) and on SF-36 of 5% (p = 0.7406). Eight patients with higher eVAT showed improvement on VAS of 67.5% (p = 0.0017) while the remaining patients, with lower eVAT, improved by 50.6% (p = 0.03607). DBS remained effective in improving chronic neuropathic pain after 5 years. While VPL-targeting contributes to success, analgesia is also obtained by stimulating surrounding posterior ventrobasal thalamic structures and related spinothalamocortical tracts. (C) 2021 Elsevier Masson SAS. All rights reserved.

Keywords

• GENERAL-POPULATION; NEUROSTIMULATION; EPIDEMIOLOGY