Subcortical electrical stimulation for control of intractable pain in humans

1986 ◽  
Vol 64 (4) ◽  
pp. 543-553 ◽  
Author(s):  
Yoshio Hosobuchi
Keyword(s):  
Electrical Stimulation ◽  
Back Pain ◽  
Pain Control ◽  
Pain Syndrome ◽  
Leg Pain ◽  
Intractable Pain ◽  
Content Type ◽  
Implanted Electrodes ◽  
Severe Chronic Pain ◽  
Stimulation Of

✓ Chronic electrical stimulation of the subcortical area of the brain by implanted electrodes provides satisfactory control of a number of intractable pain syndromes that are refractory to medication. This series of 122 patients who underwent electrode implantation for the control of severe chronic pain was evaluated over a follow-up period of 2 to 14 years. Of the 65 patients with pain of peripheral origin, who were treated with stimulation of the periaqueductal gray region (PAG), 50 obtained successful pain control. Of 76 patients with a deafferentation pain syndrome, 44 obtained control of the dysesthesia with stimulation of the subcortical somatosensory region. Nineteen patients with both leg and back pain received electrodes in the PAG and the somatosensory regions; whereas back pain was relieved by PAG stimulation, dysesthetic leg pain was controlled more effectively by somatosensory region stimulation. The electrical stimulation technique appears to provide long-term pain control safely, with few side effects or complications.

Post-Stroke Intractable Pain

2019 ◽  
pp. 173-178
Author(s):  
Innocent Njoku ◽  
Julie G. Pilitsis
Keyword(s):  
Electrical Stimulation ◽  
Motor Cortex ◽  
Primary Motor Cortex ◽  
Pain Syndrome ◽  
Underlying Mechanism ◽  
Anterior Cingulate ◽  
Intractable Pain ◽  
Analgesic Effects ◽  
Diagnostic Work ◽  
Stimulation Of

Deep brain stimulation (DBS) has been used as a mode to treat chronic intractable pain by targeting the ventroposterior (VP) thalamus, the periaqueductal gray (PAG), or the anterior cingulate cortex (ACC). The exact underlying mechanism by which these targets produce an analgesic effect remains unclear, but stimulation of the thalamocortical pathways, alteration of thalamic activity, and interference of the pain relay pathway have been postulated as plausible mechanisms. Motor cortex stimulation (MCS) has also been used for the treatment of intractable pain through stimulation of the primary motor cortex. Intermittent electrical stimulation is delivered at thresholds lower than evoking a motor response but adequate enough to provide variable analgesic effects. We present a case to illustrate the diagnostic work-up, surgical technique, complications, and outcomes of (sub)cortical electrical stimulation for central pain syndrome.

The mechanism and effect of chronic electrical stimulation of the globus pallidus for treatment of Parkinson disease

2004 ◽  
Vol 100 (6) ◽  
pp. 997-1001 ◽  
Author(s):  
Mitsuhiro Ogura ◽  
Naoyuki Nakao ◽  
Ekini Nakai ◽  
Yuji Uematsu ◽  
Toru Itakura
Keyword(s):  
Electrical Stimulation ◽  
Parkinson Disease ◽  
Globus Pallidus ◽  
Rating Scale ◽  
Underlying Mechanism ◽  
Clinical Effects ◽  
Content Type ◽  
Chronic Electrical Stimulation ◽  
Fine Print ◽  
Stimulation Of

Object. Although chronic electrical stimulation of the globus pallidus (GP) has been shown to ameliorate motor disabilities in Parkinson disease (PD), the underlying mechanism remains to be clarified. In this study the authors explored the mechanism for the effects of deep brain stimulation of the GP by investigating the changes in neurotransmitter levels in the cerebrospinal fluid (CSF) during the stimulation. Methods. Thirty patients received chronic electrical stimulation of the GP internus (GPi). Clinical effects were assessed using the Unified PD Rating Scale (UPDRS) and the Hoehn and Yahr Staging Scale at 1 week before surgery and at 6 and 12 months after surgery. One day after surgery, CSF samples were collected through a ventricular tube before and 1 hour after GPi stimulation. The concentration of neurotransmitters such as γ-aminobutyric acid (GABA), noradrenaline, dopamine, and homovanillic acid (HVA) in the CSF was measured using high-performance liquid chromatography. The treatment was effective for tremors, rigidity, and drug-induced dyskinesia. The concentration of GABA in the CSF increased significantly during stimulation, although there were no significant changes in the level of noradrenaline, dopamine, and HVA. A comparison between an increased rate of GABA concentration and a lower UPDRS score 6 months postimplantation revealed that the increase in the GABA level correlated with the stimulation-induced clinical effects. Conclusions. Stimulation of the GPi substantially benefits patients with PD. The underlying mechanism of the treatment may involve activation of GABAergic afferents in the GP.

Electrical Stimulation of the Spinal Cord and Peripheral Nerves for Pain Control

1981 ◽  
Vol 44 (4) ◽  
pp. 207-217 ◽  
Author(s):  
Don M. Long ◽  
Donald Erickson ◽  
James Campbell ◽  
Richard North
Keyword(s):  
Spinal Cord ◽  
Electrical Stimulation ◽  
Peripheral Nerves ◽  
Pain Control ◽  
Stimulation Of

Facilitation of female reproductive behavior from mesensephalic central gray in the rat

1979 ◽  
Vol 237 (5) ◽  
pp. R278-R284 ◽  
Author(s):  
Y. Sakuma ◽  
D. W. Pfaff
Keyword(s):  
Electrical Stimulation ◽  
Mesencephalic Reticular Formation ◽  
Female Rats ◽  
Motor Systems ◽  
Functional Link ◽  
Implanted Electrodes ◽  
Unilateral Stimulation ◽  
Postural Changes ◽  
Central Gray ◽  
Stimulation Of

Electrical stimulation in the mesencephalic central gray (CG) and adjacent subtectum through chronically implanted electrodes in free-moving estrogen-primed ovariectomized female rats elicited a rapid and large facilitation of the lordosis reflex in response to either male mounts or manula cutaneous stimuli. Unilateral stimulation was sufficient for this effect. The facilitation increased in a graded manner to increased stimulus intensity, and was optimally evoked by stimuli delivered at 50--150 Hz. Facilitation disappeared rapidly following the end ot electrical stimulation, and within 15 min, reflex performance returned to the prestimulation level. Lordosis facilitation appeared when no aversive responses occurred; stimulation with comparable parameters at the lateral edge of CG or in the mesencephalic reticular formation often resulted in postural changes or aversive responses but was not able to facilitate lordosis. Lordosis refelx facilitation was probably mediated by projections descending from neurons in and around the CG, and represents stimulation of a functional link between ascending somatosensory and descending motor systems for the control of lordosis behavior.

Plasma 17-hydroxycorticosteroid levels during electrical stimulation of the amygdaloid complex in conscious monkeys

1958 ◽  
Vol 196 (1) ◽  
pp. 44-48 ◽  
Author(s):  
John W. Mason
Keyword(s):  
Electrical Stimulation ◽  
Large Dose ◽  
Rhesus Monkeys ◽  
Hypothalamic Stimulation ◽  
Amygdaloid Complex ◽  
Implanted Electrodes ◽  
Stimulation Of

Substantial plasma 17-OH-CS elevations invariably occurred during electrical stimulation of the amygdaloid complex in unanesthetized rhesus monkeys through chronically implanted electrodes. No evidence of localization of this effect within anatomical subdivisions of the amygdaloid complex was observed. Stimulation of the amygdala elicited plasma 17-OH-CS elevations (20 µg %/hr.) equal to those occurring with hypothalamic stimulation or injection of a large dose of ACTH (16 mg/kg), while no elevations were observed during putamen stimulation or under normal conditions.

Chronic motor cortex stimulation in patients with thalamic pain

1993 ◽  
Vol 78 (3) ◽  
pp. 393-401 ◽  
Author(s):  
Takashi Tsubokawa ◽  
Yoichi Katayama ◽  
Takamitsu Yamamoto ◽  
Teruyasu Hirayama ◽  
Seigou Koyama
Keyword(s):  
Sensory Neurons ◽  
Pain Control ◽  
Precentral Gyrus ◽  
Content Type ◽  
Nociceptive Neurons ◽  
Thalamic Relay ◽  
Relay Nucleus ◽  
Pain Inhibition ◽  
Thalamic Pain ◽  
Stimulation Of

✓ Analysis of the authors' experience over the last 10 years has indicated that excellent pain control has rarely been obtained by thalamic relay nucleus stimulation in patients with thalamic pain. In the present study, 11 patients with thalamic pain were treated by chronic stimulation of the precentral gyrus. In eight patients (73%), the stimulation system was internalized since excellent pain control was achieved during a 1-week test period of precentral gyrus stimulation. In contrast, no clear effect was noted or the original pain was even exacerbated by postcentral gyrus stimulation. The effect of precentral stimulation was unchanged in five patients (45%) for follow-up periods of more than 2 years. In the remaining three patients, the effect decreased gradually over several months. This outcome was significantly better than that obtained in an earlier series tested by the authors with thalamic relay nucleus stimulation (p < 0.05). The pain inhibition usually occurred at intensities below the threshold for production of muscle contraction (pulse duration 0.1 to 0.5 msec, intensity 3 to 8 V). When good pain inhibition was achieved, the patients reported a slight tingling or mild vibration sensation during stimulation projected in the same area of distribution as their pain. The authors discuss the possibility that, in deafferentation pain, sensory neurons below the level of deafferentation cannot exert their normal inhibitory influences toward deafferented nociceptive neurons because of the development of aberrant connections. Thus, while stimulation of the first- to third-order sensory neurons at the level of the thalamic relay nucleus or below cannot bring about good pain inhibition in patients with thalamic pain, activation of hypothetical fourth-order sensory neurons through precentral stimulation may be able to inhibit deafferented nociceptive neurons within the cortex. None of the patients developed either observable or electroencephalographic seizure activity.

Percutaneous epidural stimulation of the spinal cord for relief of pain

1978 ◽  
Vol 48 (3) ◽  
pp. 323-328 ◽  
Author(s):  
Bruno J. Urban ◽  
Blaine S. Nashold
Keyword(s):  
Spinal Cord ◽  
Dorsal Column ◽  
Long Term Results ◽  
Percutaneous Technique ◽  
Intractable Pain ◽  
Epidural Stimulation ◽  
Content Type ◽  
Major Operation ◽  
Stimulation Of

✓ Percutaneous epidural stimulation of the spinal cord was carried out in 20 patients with intractable pain. The procedure proved simple, and no major complications were encountered. The long-term results were comparable to the results obtained after a dorsal column stimulator implant by laminectomy. The percutaneous technique allowed extended trial stimulation without committing the patient to a major operation. Those patients in whom stimulation did not alleviate pain could be identified during a 2-week observation period, and the system could be removed easily. Seven patients were placed on chronic autostimulation and only one of those failed to experience continuing pain relief throughout the follow-up time of up to 2 years. It is concluded that percutaneous epidural stimulation constitutes a valid alternative to dorsal column stimulator implantation.

Functional magnetic resonance imaging of somatosensory cortex activity produced by electrical stimulation of the median nerve or tactile stimulation of the index finger

2000 ◽  
Vol 93 (5) ◽  
pp. 774-783 ◽  
Author(s):  
Maxwell Boakye ◽  
Sean C. Huckins ◽  
Nikolaus M. Szeverenyi ◽  
Bobby I. Taskey ◽  
Charles J. Hodge
Keyword(s):  
Electrical Stimulation ◽  
Median Nerve ◽  
Somatosensory Cortex ◽  
Tactile Stimulation ◽  
Index Finger ◽  
Functional Magnetic Resonance ◽  
Content Type ◽  
The Right ◽  
Fine Print ◽  
Stimulation Of

Object. Functional magnetic resonance (fMR) imaging was used to determine patterns of cerebral blood flow changes in the somatosensory cortex that result from median nerve stimulation (MNS).Methods. Ten healthy volunteers underwent stimulation of the right median nerve at frequencies of 5.1 Hz (five volunteers) and 50 Hz (five volunteers). The left median nerve was stimulated at frequencies of 5.1 Hz (two volunteers) and 50 Hz (five volunteers). Tactile stimulation (with a soft brush) of the right index finger was also applied (three volunteers). Functional MR imaging data were transformed into Talairach space coordinates and averaged by group. Results showed significant activation (p < 0.001) in the following regions: primary sensorimotor cortex (SMI), secondary somatosensory cortex (SII), parietal operculum, insula, frontal cortex, supplementary motor area, and posterior parietal cortices (Brodmann's Areas 7 and 40). Further analysis revealed no statistically significant difference (p > 0.05) between volumes of cortical activation in the SMI or SII resulting from electrical stimuli at 5.1 Hz and 50 Hz. There existed no significant differences (p > 0.05) in cortical activity in either the SMI or SII resulting from either left- or right-sided MNS. With the exception of the frontal cortex, areas of cortical activity in response to tactile stimulation were anatomically identical to those regions activated by electrical stimulation. In the SMI and SII, activation resulting from tactile stimulation was not significantly different (p > 0.05) from that resulting from electrical stimulation.Conclusions. Electrical stimulation of the median nerve is a reproducible and effective means of activating multiple somatosensory cortical areas, and fMR imaging can be used to investigate the complex network that exists between these areas.

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