Table 5.
Deep brain stimulation with diffusion tensor imaging for pain disorders.
| First author (ref) | Response | Scale | Preop scores | Postop scores | Mean improvement (%) | Target | Tract |
|---|---|---|---|---|---|---|---|
| Prospective direct tract targeting | |||||||
| Coenen (44) | 1 responder | VAS | 7–9 | 2–5 | 44–78 | PVG, PAG, VCP | MPNS/ATR IC/STP |
| TL/ML | |||||||
| Hunsche (45) | 3 responders | VAS | All 10 | 4.7 ± 2.3 (2–6) | 53.3 ± 23.1 | PLIC | STC |
| 1 non-responder | 9 | 10 | |||||
| Retrospective tract stimulation modeling | |||||||
| Boccard (46) | 6 responders | VAS | 8.4 ± 1.4 (6–10) | Not reported | Analgesic relief in all, with 1 pain free | ACC | – |
| 2a non-responders | 9–10 | Not reported | – | ||||
| Kim (47) | 4 responders | VAS | Not reported | Not reported | Moderate to significant | PAG, VPL, VPM | – |
| 1 non-responder | No relief | ||||||
| Kovanliyaka (48) | 1 responder | – | – | Pain free | 100 | VPL | – |
| Owen (49, 50) | 2 responders | MPQ | 20.0 ± 12.7 (11–29) | Both 0 | 100 | PVG, PAG | – |
| 2b non-responders | 41.5 ± 19.1 (55–28) | 43, explanted | 22 | ||||
| Prospective cohort: | Retrospective cohort: | ||||||
| Overall responder proportion = 4 out of 5 (80%) | Overall responder proportion = 13 out of 18 (72%) | ||||||
| Overall mean improvement in responders = 51.7 ± 23.1% | (Insufficient quantitative data to calculate overall mean improvement) | ||||||
| Overall mean improvement among non-responders = 25.0% | |||||||
Scales. VAS, visual analog scale; MPQ, McGill Pain Questionnaire (62).
Targets. PVG, periventricular gray; PAG, periaqueductal gray; VCP, nucleus ventralis caudalis posterior; PLIC, posterior limp of internal capsule; ACC, anterior cingulate cortex; VPL, ventroposterolateral nucleus; VPM, ventroposteromedial nucleus.
Tracts. MPNS/ATR, median polysynaptic pain system/anterior thalamic radiation; IC/STP, internal capsule/superior thalamic peduncle; TL/ML, trigeminal lemniscus/medial meniscus; STC, spinothalamocortical tract.
aOne patient requested for DBS system removed and one did not have the internal pulse generator implanted.
bSystem was explanted in one patient (non-responder) after trial due to poor efficacy.