gms | German Medical Science

63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

13. - 16. Juni 2012, Leipzig

50 years of clinical application of deep brain stimulation for chronic refractory pain syndromes – Past – Present – Future!?

Meeting Abstract

Suche in Medline nach

  • D. Rasche - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
  • V.M. Tronnier - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.10.06

DOI: 10.3205/12dgnc249, URN: urn:nbn:de:0183-12dgnc2492

Veröffentlicht: 4. Juni 2012

© 2012 Rasche et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: The treatment of refractory chronic pain syndromes was always difficult and, in specific cases, frustrating. Therefore, a number of invasive procedures have been tried in order to influence chronic pain. During the last century, a change in therapy occurred and destructive procedures at the peripheral or central nervous systems were replaced by various neurostimulation options in the era of neuromodulation. In 1961, the first deep brain stimulation (DBS) of the thalamus for refractory chronic pain was published and was followed by several case samples by different authors. The current and future perspectives of DBS in chronic pain are presented, including the clinical experience and patient series of the authors.

Methods: In a total of 65 patients with various chronic refractory pain syndromes, a DBS was conducted as a stereotactic procedure with fixed head frame and MRI- or CT-navigation scan for target planning and definition. Two leads were placed in the somatosensory thalamus and the periaquaductal grey matter. After intraoperative testing, extensions of the leads were externalized and a standard protocol for different stimulation parameters including placebo and double-blinded stimulation followed for at least 8 days.

Results: An accurate lead positioning was achieved by neuronavigation, intraoperative neuromonitoring and micro-recording for target definition in all cases. The primary criterion was pain reduction, measured with the visual analogue scale (VAS) and the concomitant withdrawal of analgesics. Placebo or double-blinded stimulation was able to identify 16 patients (25%) as false-positive responders and leads were explanted. Altogether 38/65 (58%) patients experienced pain relief by DBS and a stimulation device was internalized. Best results with pain reduction > 30% were evaluated in phantom limb pain, trigeminal neuropathic pain, CRPS II and failed back surgery syndrome.

Conclusions: Although DBS is commonly used for movement disorders chronic refractory pain patients can be good candidates for this therapy too. Psychological evaluation to rule out psychological contraindications is mandatory, as is the double-blinded testing of subthreshold stimulation. Future perspectives include the individual sensing of specific pain signals and on-demand stimulation, technical progress for improved lead and stimulation devices, adaption of stimulation parameters and patterns and the implementation of brain-computer-interface technology.