Characterising the Analgesic Effect of Different Targets for Deep Brain Stimulation in Trigeminal Anaesthesia Dolorosa

Hugh P Sims-Williams*, Shazia Javed, Anthony E Pickering, Nikunj K Patel

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

5 Citations (Scopus)
225 Downloads (Pure)

Abstract

BACKGROUND: Several deep brain stimulation (DBS) targets have been explored for the alleviation of trigeminal anaesthesia dolorosa. We aimed to characterise the analgesia produced from the periaqueductal grey (PAG) and centromedian-parafascicular (CmPf) nucleus using a within-subject design.

METHOD: We report a case series of 3 subjects implanted with PAG and CmPf DBS systems for the treatment of anaesthesia dolorosa. At follow-up, testing of onset and offset times, magnitude, and thermal and mechanical sensitivity was performed.

RESULTS: The mean pain score of the cohort was acutely reduced by 56% (p < 0.05) with PAG and 67% (p < 0.01) with CmPf stimulation at mean time intervals of 38 and 16 min, respectively. The onset time was 12.5 min (p < 0.05) for PAG stimulation and 2.5 min (p < 0.01) for CmPf. The offset time was 2.5 min (p < 0.05) for PAG and 12.5 min (p < 0.01) for CmPf. The two targets were effective at different stimulation frequencies and were not antagonistic in effect.

CONCLUSION: The mechanisms by which stimulation at these two targets produces analgesia are likely to be different. Certain pain qualities may respond more favourably to specific targets. Knowledge of onset and offset times for the targets can guide optimisation of stimulation settings. The use of more than one stimulation target may be beneficial and should be considered in anaesthesia dolorosa patients.

Original languageEnglish
Pages (from-to)174-181
Number of pages8
JournalStereotactic and Functional Neurosurgery
Volume94
Issue number3
Early online date21 Jun 2016
DOIs
Publication statusPublished - Aug 2016

Structured keywords

  • Anaesthesia Pain and Critical Care

Keywords

  • Centromedian-parafascicular nucleus
  • De-afferentation pain
  • Depth electrode
  • Periaqueductal grey
  • Quantitative sensory testing

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