title: The nucleus accumbens as a potential target for central poststroke pain.
abstract: Although deep brain stimulation (DBS) has been found to be efficacious for some chronic pain syndromes, its usefulness in patients with central poststroke pain (CPSP) has been disappointing. The most common DBS targets for pain are the periventricular gray region (PVG) and the ventralis caudalis of the thalamus. Despite the limited success of DBS for CPSP, few alternative targets have been explored. The nucleus accumbens (NAC), a limbic structure within the ventral striatum that is involved in reward and pain processing, has emerged as an effective target for psychiatric disease. There is also evidence that it may be an effective target for pain. We describe a 72-year-old woman with a large right hemisphere infarct who subsequently experienced refractory left hemibody pain. She underwent placement of 3 electrodes in the right PVG, ventralis caudalis of the thalamus, and NAC. Individual stimulation of the NAC and PVG provided substantial improvement in pain rating. The patient underwent implantation of permanent electrodes in both targets, and combined stimulation has provided sustained pain relief at nearly 1 year after the procedure. These results suggest that the NAC may be an effective DBS target for CPSP.
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Rochester, MN 55901, USA.
authors.forename: Grant W
authors.initials: GW
authors.lastname: Mallory
authors.forename: Osama
authors.initials: O
authors.lastname: Abulseoud
authors.forename: Sun-Chul
authors.initials: SC
authors.lastname: Hwang
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Gorman
authors.forename: Squire M
authors.initials: SM
authors.lastname: Stead
authors.forename: Bryan T
authors.initials: BT
authors.lastname: Klassen
authors.forename: Paola
authors.initials: P
authors.lastname: Sandroni
authors.forename: James C
authors.initials: JC
authors.lastname: Watson
authors.forename: Kendall H
authors.initials: KH
authors.lastname: Lee
mesh_terms: D000368:Aged; D002552:Cerebral Ventricles / Q000473:pathology; D046690:Deep Brain Stimulation / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D009434:Neural Pathways / Q000473:pathology; D009714:Nucleus Accumbens; D010146:Pain / Q000209:etiology; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010487:Periaqueductal Gray / Q000473:pathology*; D020521:Stroke / Q000150:complications* / Q000503:physiopathology