Long-term outcomes of deep brain stimulation for neuropathic pain.

Journal article

BACKGROUND: Deep brain stimulation (DBS) to treat neuropathic pain refractory to pharmacotherapy has reported variable outcomes and has gained United Kingdom 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, short-form 36-question quality-of-life survey, McGill pain questionnaire, and EuroQol-5D questionnaires (EQ-5D and health state). RESULTS: One hundred ninety-seven patients were referred over 12 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 was 19.6 months. Contralateral DBS targeted the periventricular gray area (n = 33), the ventral posterior nuclei of the thalamus (n = 15), or both targets (n = 37). Almost 70% (69.4%) of patients retained implants 6 months after surgery. Thirty-nine 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, >30% improvements sustained in visual analog score, McGill pain questionnaire, short-form 36-question quality-of-life survey, and EuroQol-5D questionnaire were observed in 15 patients with >42 months of follow-up, with several outcome measures improving from those assessed at 1 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: Boccard, S; Pereira, E; Moir, L; Aziz, T; Green, A

• Publication status: Published
• Journal: Neurosurgery
• Volume: 72
• Issue: 2
• Pages: 221-231
• Publication date: 2013-02-01
• DOI: 10.1227/neu.0b013e31827b97d6
• EISSN: 1524-4040
• ISSN: 0148-396X
• Language: English
• Keywords: Brain; Pain Measurement; Middle Aged; Treatment Outcome; Adult; Magnetic Resonance Imaging; Male; Neuralgia; Quality of Life; Aged; Deep Brain Stimulation; Longitudinal Studies; Humans; Female