Long-term Outcomes of Deep Brain Stimulation for Neuropathic Pain

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.
Neurosurgery (Impact Factor: 3.62). 11/2012; 72(2). DOI: 10.1227/NEU.0b013e31827b97d6
Source: PubMed


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.

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