title: Single Electrode Deep Brain Stimulation with Dual Targeting at Dual Frequency for the Treatment of Chronic Pain: A Case Series and Review of the Literature.
abstract: Deep Brain Stimulation (DBS) has been used to target many deep brain structures for the treatment of chronic pain. The periaqueductal grey and periventricular grey (PAG/PVG) is an effective target but results are variable, sometimes short-lived or subject to tolerance. The centromedian intra-laminar parafascicular complex (CMPf) modulates medial pain pathways and CMPf DBS may address the affective aspects of pain perception. Stimulation of multiple deep brain targets may offer a strategy to optimize management of patients with complex pain symptomatology. However, previous attempts to stimulate multiple targets requires multiple trajectories and considerable expense. Using a single electrode to stimulate multiple targets would help overcome these challenges. A pre-requisite of such a technique is the ability to use different stimulation parameters at different contacts simultaneously on the same electrode. We describe a novel technique in 3 patients with chronic pain syndromes for whom conventional medical and/or neuromodulation therapy had failed using a single electrode technique to stimulate PVG/PAG and CMPf at dual frequencies.
authors.affiliation: Department of Neurosurgery, North Bristol Trust, Bristol BS10 5NB, UK. milo.hollingworth@gmail.com.
authors.forename: Milo
authors.initials: M
authors.lastname: Hollingworth
authors.affiliation: Department of Neurosurgery, Sheffield Teaching Hospital, Sheffield S10 2JF, UK. simswilliams@doctors.org.uk.
authors.forename: Hugh P
authors.initials: HP
authors.lastname: Sims-Williams
authors.affiliation: School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol BS8 1TD, UK. tony.pickering@bristol.ac.uk.
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Pickering
authors.affiliation: Department of Neurosurgery, North Bristol Trust, Bristol BS10 5NB, UK. neil.barua@nbt.nhs.uk.
authors.forename: Neil
authors.initials: N
authors.lastname: Barua
authors.affiliation: Department of Neurosurgery, North Bristol Trust, Bristol BS10 5NB, UK. nik.patel@nbt.nhs.uk.
authors.forename: Nikunj K
authors.initials: NK
authors.lastname: Patel
keywords: CMPf; PAG/PVG; deep brain stimulation; pain; pain pathways