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.
ABBREVIATIONS: DBS, deep brain stimulation
EQ-5D, EuroQol-5D questionnaire
IPG, implantable pulse generator
MPQ, McGill pain questionnaire
PVG, periventricular gray region
SD, standard deviation
SF-36, short-form 36-question quality-of-life survey
VAS, visual analog score
VPL, ventral posterior lateral thalamic nuclei
VPM, ventral posterior medial thalamic nuclei
‡Department of Physiology, Anatomy and Genetics, University of Oxford, United Kingdom
§Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Departments of Clinical Neuroscience and Surgery, University of Oxford, United Kingdom
Correspondence: Sandra G.J. Boccard, PhD, Department of Neurosurgery, Level 3, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK. E-mail: email@example.com
* These authors contributed to this manuscript equally.
Received April 16, 2012
Accepted October 19, 2012