Sandra G J Boccard1, Henrique M Fernandes2, Saad Jbabdi3, Tim J Van Hartevelt2, Morten L Kringelbach4, Gerardine Quaghebeur5, Liz Moir6, Victor Piqueras Mancebo6, Erlick A C Pereira6, James J Fitzgerald6, Alexander L Green6, John Stein7, Tipu Z Aziz6. 1. Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Departments of Clinical Neuroscience and Surgery, University of Oxford, United Kingdom. Electronic address: sandra.boccard@ndcn.ox.ac.uk. 2. Department of Psychiatry, University of Oxford, United Kingdom; CFIN/MindLab, Aarhus University, Aarhus, Denmark. 3. Centre for Functional MRI of the Brain (FMRIB), University of Oxford, United Kingdom. 4. Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Departments of Clinical Neuroscience and Surgery, University of Oxford, United Kingdom; Department of Psychiatry, University of Oxford, United Kingdom; CFIN/MindLab, Aarhus University, Aarhus, Denmark. 5. Department of Neuroradiology, John Radcliffe Hospital, Oxford, United Kingdom. 6. Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Departments of Clinical Neuroscience and Surgery, University of Oxford, United Kingdom. 7. Department of Physiology, Anatomy, & Genetics, University of Oxford, United Kingdom.
Abstract
BACKGROUND: Deep brain stimulation (DBS) of the anterior cingulate cortex (ACC) is a new treatment for alleviating intractable neuropathic pain. However, it fails to help some patients. The large size of the ACC and the intersubject variability make it difficult to determine the optimal site to position DBS electrodes. The aim of this work was therefore to compare the ACC connectivity of patients with successful versus unsuccessful DBS outcomes to help guide future electrode placement. METHODS: Diffusion magnetic resonance imaging (dMRI) and probabilistic tractography were performed preoperatively in 8 chronic pain patients (age 53.4 ± 6.1 years, 2 females) with ACC DBS, of whom 6 had successful (SO) and 2 unsuccessful outcomes (UOs) during a period of trialing. RESULTS: The number of patients was too small to demonstrate any statistically significant differences. Nevertheless, we observed differences between patients with successful and unsuccessful outcomes in the fiber tract projections emanating from the volume of activated tissue around the electrodes. A strong connectivity to the precuneus area seems to predict unsuccessful outcomes in our patients (UO: 160n/SO: 27n), with (n), the number of streamlines per nonzero voxel. On the other hand, connectivity to the thalamus and brainstem through the medial forebrain bundle (MFB) was only observed in SO patients. CONCLUSIONS: These findings could help improve presurgical planning by optimizing electrode placement, to selectively target the tracts that help to relieve patients' pain and to avoid those leading to unwanted effects.
BACKGROUND: Deep brain stimulation (DBS) of the anterior cingulate cortex (ACC) is a new treatment for alleviating intractable neuropathic pain. However, it fails to help some patients. The large size of the ACC and the intersubject variability make it difficult to determine the optimal site to position DBS electrodes. The aim of this work was therefore to compare the ACC connectivity of patients with successful versus unsuccessful DBS outcomes to help guide future electrode placement. METHODS: Diffusion magnetic resonance imaging (dMRI) and probabilistic tractography were performed preoperatively in 8 chronic pain patients (age 53.4 ± 6.1 years, 2 females) with ACC DBS, of whom 6 had successful (SO) and 2 unsuccessful outcomes (UOs) during a period of trialing. RESULTS: The number of patients was too small to demonstrate any statistically significant differences. Nevertheless, we observed differences between patients with successful and unsuccessful outcomes in the fiber tract projections emanating from the volume of activated tissue around the electrodes. A strong connectivity to the precuneus area seems to predict unsuccessful outcomes in our patients (UO: 160n/SO: 27n), with (n), the number of streamlines per nonzero voxel. On the other hand, connectivity to the thalamus and brainstem through the medial forebrain bundle (MFB) was only observed in SO patients. CONCLUSIONS: These findings could help improve presurgical planning by optimizing electrode placement, to selectively target the tracts that help to relieve patients' pain and to avoid those leading to unwanted effects.
Authors: Md Safwan Samsir; Rahimah Zakaria; Salmi Abdul Razak; Mohamed Saat Ismail; Mohd Zulkifli Abdul Rahim; Chia-Shu Lin; Nik Mohammad Faez Nik Osman; Mohammad Afiq Asri; Nor Haslina Mohd; Asma Hayati Ahmad Journal: Malays J Med Sci Date: 2020-10-27
Authors: Martin Nüssel; Yining Zhao; Constantin Knorr; Martin Regensburger; Andreas Stadlbauer; Michael Buchfelder; Alessandro Del Vecchio; Thomas Kinfe Journal: Pain Ther Date: 2022-04-26
Authors: Safwan Samsir; Rahimah Zakaria; Salmi Abdul Razak; Mohamed Saat Ismail; Mohd Zulkifli Abdul Rahim; Chia-Shu Lin; Nik Mohammad Faez Nik Osman; Mohammad Afiq Asri; Asma Hayati Ahmad Journal: Malays J Med Sci Date: 2018-10-30
Authors: Alexander R Weiss; Martin J Gillies; Marios G Philiastides; Matthew A Apps; Miles A Whittington; James J FitzGerald; Sandra G Boccard; Tipu Z Aziz; Alexander L Green Journal: Front Hum Neurosci Date: 2018-05-22 Impact factor: 3.169