Deep Brain Stimulation for Phantom Limb PainKeywords: deep brain stimulation, outcome, pain, electrode, functionalInteractive Manuscript
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What is the background behind your study?
1300 patients have received deep brain stimulation (DBS) for chronic pain over the last half-century, but few during the last decade.
What is the purpose of your study?
Here we evaluate outcomes of DBS of the ventral posterolateral thalamus (VPL) and periaqueductal gray (PVG) for chronic phantom limb pain after amputation.
Describe your patient group.
14 patients (11 male, 3 female, mean age 52 years) were treated. 11 amputations resulted from trauma, 3 after ischemia (1 bilateral) and 1 from infection. All patients proceeded to full implantation, 6 having contralateral VPL DBS, 4 having contralateral PVG DBS, 1 dual target DBS and 1 bilateral PVG DBS.
Describe what you did.
Patients treated from over 9 years from October 2003 to May 2011 by awake surgery in 2 European centers were studied prospectively. Quantitative assessments of pain (Visual Analog Score (VAS)) and quality of life (SF-36) were conducted in both centres alongside additional outcome scores. These were performed before and after surgery at 1-3 months, 6 months and annually.
Describe your main findings.
Mean VAS reductions were 61% at 1-3 months and 57% at 1 year. Mean SF-36 improvements were 22% at 1-3 months and 13% at 1 year. 4 patients had 4 year outcomes of 36% VAS and 11% SF-36 improvements. Mean DBS parameters were 2.8 volts, 238 microseconds and 22 Hertz. There were no operative complications but 3 patients received electrode revisions, 2 due to electrode damage and 1 to overcome tolerance.
Describe the main limitation of this study.
This is a retrospective study.
Describe your main conclusion.
DBS can relieve phantom limb pain.
Describe the importance of your findings and how they can be used by others.
Promising 2 center data encourages progression to randomised, controlled clinical trials.
1300 patients have received deep brain stimulation (DBS) for chronic pain over the last half-century, but few during the last decade.
Here we evaluate outcomes of DBS of the ventral posterolateral thalamus (VPL) and periaqueductal gray (PVG) for chronic phantom limb pain after amputation.
14 patients (11 male, 3 female, mean age 52 years) were treated. 11 amputations resulted from trauma, 3 after ischemia (1 bilateral) and 1 from infection. All patients proceeded to full implantation, 6 having contralateral VPL DBS, 4 having contralateral PVG DBS, 1 dual target DBS and 1 bilateral PVG DBS.
Patients treated from over 9 years from October 2003 to May 2011 by awake surgery in 2 European centers were studied prospectively. Quantitative assessments of pain (Visual Analog Score (VAS)) and quality of life (SF-36) were conducted in both centres alongside additional outcome scores. These were performed before and after surgery at 1-3 months, 6 months and annually.
Mean VAS reductions were 61% at 1-3 months and 57% at 1 year. Mean SF-36 improvements were 22% at 1-3 months and 13% at 1 year. 4 patients had 4 year outcomes of 36% VAS and 11% SF-36 improvements. Mean DBS parameters were 2.8 volts, 238 microseconds and 22 Hertz. There were no operative complications but 3 patients received electrode revisions, 2 due to electrode damage and 1 to overcome tolerance.
This is a retrospective study.
DBS can relieve phantom limb pain.
Promising 2 center data encourages progression to randomised, controlled clinical trials.
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