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Long-term Outcomes of Deep Brain Stimulation for Neuropathic Pain.
MedLine Citation:
PMID:  23149975     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: Deep brain stimulation (DBS) to treat neuropathic pain refractory to pharmacotherapy has reported variable outcomes, and gained UK but not USA regulatory approval. OBJECTIVE:: To prospectively assess long-term efficacy of DBS for chronic neuropathic pain in a single center case series. METHODS:: Patient reported outcome measures were collated before and after surgery, using a visual analog score (VAS), Short Form 36 quality of life survey (SF-36), McGill pain questionnaire (MPQ), and EuroQol-5D questionnaires (EQ-5D; Health state). RESULTS:: 197 patients were referred over twelve years, of whom 85 received DBS for various etiologies: 9 amputees, 7 brachial plexus injuries, 31 after stroke, 13 with spinal pathology, 15 with head and face pain, and 10 miscellaneous. Mean age at surgery was 52 years and mean follow-up 19.6 months. Contralateral DBS targeted the periventricular gray area (PVG; n=33), the ventral posterior nuclei of the thalamus (VPL/VPM; n=15), or both targets (n=37). Almost seventy percent (69.4%) of patients retained implants 6 months after surgery. 39 of 59 (66%) of those implanted gained benefit and efficacy varied by etiology, improving outcomes in 89% after amputation and 70% after stroke. In this cohort, sustained >30% improvements in VAS, MPQ, SF-36, and EQ-5D were observed in 15 patients with >42 months follow-up, with several outcome measures improving from those assessed at one year. CONCLUSION:: DBS for pain has long-term efficacy for select etiologies. Clinical trials retaining patients in long-term follow-up are desirable to confirm findings from prospectively assessed case series.
Authors:
Sandra Gj Boccard; Erlick Ac Pereira; Liz Moir; Tipu Z Aziz; Alexander L Green
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-10
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1Department of Physiology, Anatomy and Genetics, University of Oxford, UK 2Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Departments of Clinical Neuroscience and Surgery, University of Oxford, UK 3 Nuffield Department of Neurosciences, University of Oxford, UK.
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