Periaqueductal/periventricular gray deep brain stimulation for the treatment of neuropathic facial pain
BackgroundThe Periaqueductal gray (PAG) and the periventricular gray (PVG) are the anatomical targets for deep brain stimulation (DBS) to treat severe, refractory neuropathic pain.MethodsSeven (four female and three male) patients were qualified for PAG/PVG DBS because of neuropathic facial pain. Fr...
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Frontiers Media S.A.
2023-11-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1239092/full |
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| author | Victor Mandat Victor Mandat Pawel R. Zdunek Bartosz Krolicki Krzysztof Szalecki Henryk M. Koziara Konrad Ciecierski Tomasz S. Mandat |
| author_facet | Victor Mandat Victor Mandat Pawel R. Zdunek Bartosz Krolicki Krzysztof Szalecki Henryk M. Koziara Konrad Ciecierski Tomasz S. Mandat |
| author_sort | Victor Mandat |
| collection | DOAJ |
| description | BackgroundThe Periaqueductal gray (PAG) and the periventricular gray (PVG) are the anatomical targets for deep brain stimulation (DBS) to treat severe, refractory neuropathic pain.MethodsSeven (four female and three male) patients were qualified for PAG/PVG DBS because of neuropathic facial pain. Frame-based unilateral implantations of DBS were conducted according to indirect planning of the PAG/PVG, contralateral to reported pain (3389, Activa SC 37603, Medtronic). The efficacy of PAG/PVG DBS on pain was measured with Numeric Pain Rating Scale (NRS) and Neuropathic Pain Symptom Inventory (NPSI) before surgery and 3, 12, and 24 months after surgery.ResultsThe mean age of the group at the implantation was 43.7 years (range: 28–62; SD: 12.13). The mean duration of pain varied from 2 to 12 years (mean: 7.3; SD: 4.11). Five patients suffered from left-sided facial pain and two suffered right-sided facial pain. The etiology of pain among four patients was connected to ischemic brain stroke and in one patient to cerebral hemorrhagic stroke. Patients did not suffer from any other chronic medical condition The beginnings of ailments among two patients were related to craniofacial injury. NRS decreased by 54% at the 3 months follow-up. The efficacy of the treatment measured with mean NRS decreased at one-year follow-up to 48% and to 45% at 24 months follow-up. The efficacy of the treatment measured with NPSI decreased from 0.27 to 0.17 at 2 years follow-up (mean reduction by 38%). The most significant improvement was recorded in the first section of NPSI (Q1: burning- reduced by 53%). The records of the last section (number five) of the NPSI (paresthesia/dysesthesia- Q11/Q12) have shown aggravation of those symptoms by 10% at the two-years follow-up. No surgery- or hardware-related complications were reported in the group. Transient adverse effects related to the stimulation were eliminated during the programming sessions.ConclusionPAG/PVG DBS is an effective and safe method of treatment of medically refractory neuropathic facial pain. The effectiveness of the treatment tends to decrease at 2 years follow-up. The clinical symptoms which tend to respond the best is burning pain. Symptoms like paresthesia and dysesthesia might increase after DBS treatment, even without active stimulation. |
| first_indexed | 2024-03-11T12:12:34Z |
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| id | doaj.art-40d78e9d72df4e9c95c62e6e534921c4 |
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| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-03-11T12:12:34Z |
| publishDate | 2023-11-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Neurology |
| spelling | doaj.art-40d78e9d72df4e9c95c62e6e534921c42023-11-07T10:46:29ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-11-011410.3389/fneur.2023.12390921239092Periaqueductal/periventricular gray deep brain stimulation for the treatment of neuropathic facial painVictor Mandat0Victor Mandat1Pawel R. Zdunek2Bartosz Krolicki3Krzysztof Szalecki4Henryk M. Koziara5Konrad Ciecierski6Tomasz S. Mandat7Department of Neurosurgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, PolandDepartment of Biology, University of Toronto, Toronto, ON, CanadaDepartment of Neurosurgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, PolandDepartment of Neurosurgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, PolandDepartment of Neurosurgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, PolandDepartment of Neurosurgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, PolandResearch and Academic Computer Network Organization (NASK), Warsaw, PolandDepartment of Neurosurgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, PolandBackgroundThe Periaqueductal gray (PAG) and the periventricular gray (PVG) are the anatomical targets for deep brain stimulation (DBS) to treat severe, refractory neuropathic pain.MethodsSeven (four female and three male) patients were qualified for PAG/PVG DBS because of neuropathic facial pain. Frame-based unilateral implantations of DBS were conducted according to indirect planning of the PAG/PVG, contralateral to reported pain (3389, Activa SC 37603, Medtronic). The efficacy of PAG/PVG DBS on pain was measured with Numeric Pain Rating Scale (NRS) and Neuropathic Pain Symptom Inventory (NPSI) before surgery and 3, 12, and 24 months after surgery.ResultsThe mean age of the group at the implantation was 43.7 years (range: 28–62; SD: 12.13). The mean duration of pain varied from 2 to 12 years (mean: 7.3; SD: 4.11). Five patients suffered from left-sided facial pain and two suffered right-sided facial pain. The etiology of pain among four patients was connected to ischemic brain stroke and in one patient to cerebral hemorrhagic stroke. Patients did not suffer from any other chronic medical condition The beginnings of ailments among two patients were related to craniofacial injury. NRS decreased by 54% at the 3 months follow-up. The efficacy of the treatment measured with mean NRS decreased at one-year follow-up to 48% and to 45% at 24 months follow-up. The efficacy of the treatment measured with NPSI decreased from 0.27 to 0.17 at 2 years follow-up (mean reduction by 38%). The most significant improvement was recorded in the first section of NPSI (Q1: burning- reduced by 53%). The records of the last section (number five) of the NPSI (paresthesia/dysesthesia- Q11/Q12) have shown aggravation of those symptoms by 10% at the two-years follow-up. No surgery- or hardware-related complications were reported in the group. Transient adverse effects related to the stimulation were eliminated during the programming sessions.ConclusionPAG/PVG DBS is an effective and safe method of treatment of medically refractory neuropathic facial pain. The effectiveness of the treatment tends to decrease at 2 years follow-up. The clinical symptoms which tend to respond the best is burning pain. Symptoms like paresthesia and dysesthesia might increase after DBS treatment, even without active stimulation.https://www.frontiersin.org/articles/10.3389/fneur.2023.1239092/fullperiaqueductal grayperiventricular graydeep brain stimulationneuropathic painface |
| spellingShingle | Victor Mandat Victor Mandat Pawel R. Zdunek Bartosz Krolicki Krzysztof Szalecki Henryk M. Koziara Konrad Ciecierski Tomasz S. Mandat Periaqueductal/periventricular gray deep brain stimulation for the treatment of neuropathic facial pain Frontiers in Neurology periaqueductal gray periventricular gray deep brain stimulation neuropathic pain face |
| title | Periaqueductal/periventricular gray deep brain stimulation for the treatment of neuropathic facial pain |
| title_full | Periaqueductal/periventricular gray deep brain stimulation for the treatment of neuropathic facial pain |
| title_fullStr | Periaqueductal/periventricular gray deep brain stimulation for the treatment of neuropathic facial pain |
| title_full_unstemmed | Periaqueductal/periventricular gray deep brain stimulation for the treatment of neuropathic facial pain |
| title_short | Periaqueductal/periventricular gray deep brain stimulation for the treatment of neuropathic facial pain |
| title_sort | periaqueductal periventricular gray deep brain stimulation for the treatment of neuropathic facial pain |
| topic | periaqueductal gray periventricular gray deep brain stimulation neuropathic pain face |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1239092/full |
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