Tipu Zahed Aziz
University of Oxford
Long-term Outcomes of Deep Brain Stimulation for Neuropathic Pain
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.
Dr. Tipu Z. Aziz is the founder and head of Oxford functional neurosurgery, Fellow of The Academia of Medical Science of UK. His primate work was central to confirming the subthalamic nucleus as a possible surgical target for deep brain stimulation in Parkinson’s disease and more recently the pedunculopontine nucleus. OFN is currently one of the busiest centers for such surgery in the UK and academically very productive. His research interests are the role of the upper brain stem in the control of movement, the clinical neurophysiology of movement disorders and neuropathic pain and autonomic responses to deep brain stimulation, use of MR and MEG imaging in functional neurosurgery.