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Case report
Directional sensory thalamus deep brain stimulation in poststroke refractory pain
  1. Timo Rafael ten Brinke1,
  2. Hisse Arnts2,
  3. Rick Schuurman2 and
  4. Pepijn van den Munckhof2
  1. 1Neurology, Amsterdam UMC-Locatie AMC, Amsterdam, The Netherlands
  2. 2Neurosurgery, Amsterdam UMC-Locatie AMC, Amsterdam, The Netherlands
  1. Correspondence to Mr Timo Rafael ten Brinke; t.r.tenbrinke{at}amsterdamumc.nl

Abstract

Thalamic deep brain stimulation (DBS) for chronic pain is performed in selected patients with a variable success rate. We report the use of recently developed directional DBS in a patient with hemibody central poststroke pain (CPSP) and its added value in the induction of pleasant, pain-distracting paresthesia’s throughout the contralateral body side. A 68-year-old man suffered from multiple strokes in the left hemisphere 11 years before presentation, resulting in medically refractory right-sided hemibody CPSP. He was implanted with a directional DBS electrode in the left ventrocaudal nucleus of the thalamus. A directional single-segment contact configuration produced a better improvement throughout the contralateral body side than ring-mode and other directional configurations. Treatment led to a reduction of almost 50% in pain. This case demonstrates the value of directional DBS in the treatment of chronic pain, as steering increases selectivity and reduces side effects in a small target area surrounded by structures with high functional diversity.

  • stroke
  • pain (neurology)
  • neurosurgery
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Footnotes

  • Contributors TRtB and PvdM were involved in the treatment of the patient, data acquisition, interpretation of the data and writing of the manuscript. HA and RS critically revised the paper and participated in discussions about the case.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests TRtB has received non-financial support from Boston Scientific in the form of a travel grant. RS acts as an independent advisor for Medtronic, Elekta, and Boston Scientific.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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