title: Thalamic sensory relay nucleus stimulation for the treatment of peripheral deafferentation pain.
abstract: We applied chronic deep brain stimulation (DBS) of the thalamic nucleus ventralis caudalis (Vc) for the treatment of peripheral deafferentation pain. The subjects included 11 cases of phantom limb pain and 7 of root or nerve injury pain without phantom sensation. In the phantom limb pain patients, the spike density markedly increased in the same area of the Vc where microstimulation induced paresthesia in the part with phantom sensation. Reorganization of the receptive field representation within the Vc was also demonstrated by microrecording and microstimulation. In the root or nerve injury pain patients with severe allodynia and without phantom sensation, oscillating neural hyperactivity appeared when the allodynia was induced during single-cell recording in the Vc. In both groups stimulation of these areas with the DBS electrode was useful for achieving pain reduction. Inhibition of spinothalamic tract neurons, restoration of the original receptive field representation and modulation of thalamocortical rhythmic oscillations are proposed to play important roles in a possible mechanism of Vc-DBS for the treatment of deafferentation pain.
authors.affiliation: Department of Neurological Surgery and Division of Applied System Neuroscience, Nihon University School of Medicine, Tokyo, Japan. nusmyama@med.nihon-u.ac.jp
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Katayama
authors.forename: Toshiki
authors.initials: T
authors.lastname: Obuchi
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Kano
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Hideki
authors.initials: H
authors.lastname: Oshima
authors.forename: Chikashi
authors.initials: C
authors.lastname: Fukaya
mesh_terms: D002422:Causalgia / Q000503:physiopathology / Q000628:therapy*; D046690:Deep Brain Stimulation / Q000379:methods*; D006801:Humans; D009475:Neurons, Afferent / Q000502:physiology; D010591:Phantom Limb / Q000503:physiopathology / Q000628:therapy*; D013788:Thalamus / Q000503:physiopathology*; D016896:Treatment Outcome