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BACKGROUND: Deep Brain Stimulation of the Anterior Cingulate Cortex is a recent technique that has shown some promising short-term results in patients with chronic refractory neuropathic pain. Three years after the first case-series, we assessed its efficacy on a larger cohort, with longer follow-up. METHODS: 24 patients (19 males; 49.1 years) with neuropathic pain underwent bilateral ACC DBS. Patient reported outcome measures were collected pre- and post-surgery, using the Numerical Rating Scale (NRS), Short-Form 36 quality of life (SF-36), McGill pain (MPQ) and EuroQol-5D questionnaires. RESULTS: 22 patients after a trial week were fully internalized and 12 had a mean follow-up of 38.9 months. Six months post-surgery the mean NRS score dropped from 8.0 to 4.27 (P=.004). There was a significant improvement in the MPQ (mean -36%; P=.021) and EQ-5D score significantly decreased (mean -21%; P=.036). The PF domain of SF-36 was significantly improved (mean +54.2%; P=.01). Furthermore, in 83% of these patients: at 6 months NRS was improved by 60% (P<.001) and MPQ decreased by 47% (P<.01). After 1 year, NRS decreased by 43% (P< .01), EQ-5D was significantly reduced (mean -30.8; P=.05) and significant improvements were also observed for different domains of the SF-36. At longer follow-ups, efficacy was sustained up to 42 months in some patients, with a NRS as low as 3. CONCLUSIONS: Follow-up results confirm that ACC DBS alleviates chronic neuropathic pain refractory to pharmacotherapy and improves quality of life in a significant number of patients.

Original publication

DOI

10.1016/j.wneu.2017.06.173

Type

Journal article

Journal

World Neurosurg

Publication Date

11/07/2017

Keywords

Anterior Cingulate Cortex, Deep Brain Stimulation, Neuropathic pain