title: Subthalamic deep brain stimulation modulates small fiber-dependent sensory thresholds in Parkinson's disease.
abstract: The effects of deep brain stimulation of the subthalamic nucleus on nonmotor symptoms of Parkinson's disease (PD) rarely have been investigated. Among these, sensory disturbances, including chronic pain (CP), are frequent in these patients. The aim of this study was to evaluate the changes induced by deep brain stimulation in the perception of sensory stimuli, either noxious or innocuous, mediated by small or large nerve fibers. Sensory detection and pain thresholds were assessed in 25 PD patients all in the off-medication condition with the stimulator turned on or off (on- and off-stimulation conditions, respectively). The relationship between the changes induced by surgery on quantitative sensory testing, spontaneous CP, and motor abilities were studied. Quantitative sensory test results obtained in PD patients were compared with those of age-matched healthy subjects. Chronic pain was present in 72% of patients before vs 36% after surgery (P=.019). Compared with healthy subjects, PD patients had an increased sensitivity to innocuous thermal stimuli and mechanical pain, but a reduced sensitivity to innocuous mechanical stimuli. In addition, they had an increased pain rating when painful thermal stimuli were applied, particularly in the off-stimulation condition. In the on-stimulation condition, there was an increased sensitivity to innocuous thermal stimuli but a reduced sensitivity to mechanical or thermal pain. Pain provoked by thermal stimuli was reduced when the stimulator was turned on. Motor improvement positively correlated with changes in warm detection and heat pain thresholds. Subthalamic nucleus deep brain stimulation contributes to relieve pain associated with PD and specifically modulates small fiber-mediated sensations.
authors.affiliation: Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil Pain Center, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil Neurology Division, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil EA 4391, Faculté de Médecine, Université Paris Est Créteil, Créteil, France Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France Transcranial Magnetic Stimulation Laboratories, Psychiatry Institute, University of São Paulo, São Paulo, Brazil.
authors.forename: Daniel Ciampi
authors.initials: DC
authors.lastname: de Andrade
authors.forename: Jean-Pascal
authors.initials: JP
authors.lastname: Lefaucheur
authors.forename: Ricardo
authors.initials: R
authors.lastname: Galhardoni
authors.forename: Karine S L
authors.initials: KSL
authors.lastname: Ferreira
authors.forename: Anderson Rodrigues Brandão
authors.initials: ARB
authors.lastname: Paiva
authors.forename: Edson
authors.initials: E
authors.lastname: Bor-Seng-Shu
authors.forename: Luciana
authors.initials: L
authors.lastname: Alvarenga
authors.forename: Martin L
authors.initials: ML
authors.lastname: Myczkowski
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Marcolin
authors.forename: Silvia R D T
authors.initials: SRDT
authors.lastname: de Siqueira
authors.forename: Erich
authors.initials: E
authors.lastname: Fonoff
authors.forename: Egberto Reis
authors.initials: ER
authors.lastname: Barbosa
authors.forename: Manoel Jacobsen
authors.initials: MJ
authors.lastname: Teixeira
mesh_terms: D000328:Adult; D000368:Aged; D046690:Deep Brain Stimulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000502:physiology*; D010146:Pain / Q000503:physiopathology*; D058748:Pain Perception / Q000502:physiology*; D017288:Pain Threshold / Q000502:physiology*; D010300:Parkinson Disease / Q000503:physiopathology* / Q000628:therapy; D020531:Subthalamic Nucleus / Q000503:physiopathology*