Hollingworth Milo, Sims-Williams Hugh P, Pickering Anthony E, Barua Neil, Patel Nikunj K
Department of Neurosurgery, North Bristol Trust, Bristol BS10 5NB, UK.
Department of Neurosurgery, Sheffield Teaching Hospital, Sheffield S10 2JF, UK.
Brain Sci. 2017 Jan 13;7(1):9. doi: 10.3390/brainsci7010009.
Deep Brain Stimulation (DBS) has been used to target many deep brain structures for the treatment of chronic pain. The periaqueductal grey and periventricular grey (PAG/PVG) is an effective target but results are variable, sometimes short-lived or subject to tolerance. The centromedian intra-laminar parafascicular complex (CMPf) modulates medial pain pathways and CMPf DBS may address the affective aspects of pain perception. Stimulation of multiple deep brain targets may offer a strategy to optimize management of patients with complex pain symptomatology. However, previous attempts to stimulate multiple targets requires multiple trajectories and considerable expense. Using a single electrode to stimulate multiple targets would help overcome these challenges. A pre-requisite of such a technique is the ability to use different stimulation parameters at different contacts simultaneously on the same electrode. We describe a novel technique in 3 patients with chronic pain syndromes for whom conventional medical and/or neuromodulation therapy had failed using a single electrode technique to stimulate PVG/PAG and CMPf at dual frequencies.
深部脑刺激（DBS）已被用于针对许多深部脑结构来治疗慢性疼痛。导水管周围灰质和室周灰质（PAG/PVG）是一个有效的靶点，但结果存在差异，有时效果短暂或会产生耐受性。中央中核-束旁复合体内侧核（CMPf）调节内侧疼痛通路，CMPf深部脑刺激可能解决疼痛感知的情感方面问题。刺激多个深部脑靶点可能为优化复杂疼痛症状患者的管理提供一种策略。然而，以往刺激多个靶点的尝试需要多条轨迹且费用高昂。使用单个电极刺激多个靶点将有助于克服这些挑战。这种技术的一个先决条件是能够在同一电极上同时在不同触点使用不同的刺激参数。我们描述了一种针对3例慢性疼痛综合征患者的新技术，对于这些患者，传统药物和/或神经调节疗法均已失败，该技术使用单电极技术以双频率刺激PVG/PAG和CMPf。
