Nowacki Andreas, Zhang David Y, Sarica Can, Elias Gavin J B, Bajaj Sweta, Franzini Angelo, Franzini Andrea, Saryyeva Assel, Nguyen Thuy Anh Khoa, Aziz Tipu, Krauss Joachim K, Eisner Wilhelm, Lozano Andres M, Green Alexander L, Pollo Claudio
1Department of Neurosurgery, Inselspital, Bern University Hospital, University Bern, Switzerland.
2Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Ontario, Canada.
J Neurosurg. 2025 Jan 3;142(5):1235-1246. doi: 10.3171/2024.8.JNS24742. Print 2025 May 1.
The effectiveness and optimal stimulation site of deep brain stimulation (DBS) for central poststroke pain (CPSP) remain elusive. The objective of this retrospective international multicenter study was to assess clinical as well as neuroimaging-based predictors of long-term outcomes after DBS for CPSP.
The authors analyzed patient-based clinical and neuroimaging data of previously published and unpublished cohorts from 6 international DBS centers. DBS leads were reconstructed and normalized. A stimulation map was constructed on the basis of individual stimulation settings and associated outcomes. Furthermore, the authors projected the individual segmented stroke lesions and volumes of tissue activated (VTAs) of the stimulating electrode onto a normalized human connectome to obtain the connectivity profiles of the individual lesions and VTAs.
The authors analyzed the data of 54 patients, of whom 15 were excluded from the final analysis due to a lack of imaging data. Among the remaining 39 patients from 6 different cohorts, the authors found 14 (35.9%) responders who were defined by pain relief of at least 50% at 12-month follow-up. Stimulation mapping identified areas in the posterior limb of the internal capsule, the sensorimotor thalamus, and the medial and intralaminar thalamus as effective for pain reduction. Baseline characteristics did not differ between responders and nonresponders. The stimulation sites of the responders showed significantly reduced structural connectivity to the sensory areas of the cerebral cortex compared to nonresponders.
This comprehensive, multicenter analysis corroborates the efficacy of DBS in treating CPSP for a relevant number of patients. The posterior limb of the internal capsule and the sensorimotor thalamus emerged as potential stimulation sweet spots. The difference in structural connectivity between responders and nonresponders may constitute a biomarker of effective stimulation that can help guide surgical planning in future well-designed prospective trials.
脑深部电刺激（DBS）治疗中风后中枢性疼痛（CPSP）的有效性及最佳刺激部位仍不明确。这项回顾性国际多中心研究的目的是评估DBS治疗CPSP后长期疗效的临床及基于神经影像学的预测因素。
作者分析了来自6个国际DBS中心已发表和未发表队列中基于患者的临床及神经影像学数据。对DBS电极进行重建和标准化。根据个体刺激设置及相关结果构建刺激图谱。此外，作者将个体分割的中风病灶及刺激电极的组织激活体积（VTA）投射到标准化人类连接组上，以获得个体病灶及VTA的连接图谱。
作者分析了54例患者的数据，其中15例因缺乏影像学数据被排除在最终分析之外。在来自6个不同队列的其余39例患者中，作者发现14例（35.9%）有反应者，定义为在12个月随访时疼痛缓解至少50%。刺激图谱确定内囊后肢、感觉运动丘脑以及内侧和板内核丘脑区域对减轻疼痛有效。有反应者和无反应者的基线特征无差异。与无反应者相比，有反应者的刺激部位与大脑皮质感觉区域的结构连接显著减少。
这项全面的多中心分析证实了DBS对相当数量的患者治疗CPSP的疗效。内囊后肢和感觉运动丘脑成为潜在的刺激最佳部位。有反应者和无反应者之间结构连接的差异可能构成有效刺激的生物标志物，有助于在未来精心设计的前瞻性试验中指导手术规划。
