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Published on: July 18, 2016
The nucleus accumbens as a potential target for central poststroke pain
Grant W Mallory1, Osama Abulseoud, Sun-Chul Hwang
1Department of Neurosurgery, Mayo Clinic, Rochester, MN 55901, USA.
Mayo Clinic Proceedings
|September 18, 2012
Summary
Deep brain stimulation (DBS) shows limited success for central poststroke pain (CPSP). Targeting the nucleus accumbens (NAC) alongside the periventricular gray region (PVG) provided significant pain relief in a patient with refractory CPSP.
Area of Science:
- Neurology
- Neurosurgery
- Pain Medicine
Background:
- Deep brain stimulation (DBS) is used for chronic pain but has shown limited efficacy in central poststroke pain (CPSP).
- Established DBS targets for pain, such as the periventricular gray region (PVG) and thalamus, have yielded disappointing results for CPSP.
- Few alternative targets have been investigated for DBS in CPSP management.
Observation:
- A 72-year-old female patient experienced refractory left hemibody pain following a large right hemisphere infarct.
- The patient underwent implantation of three DBS electrodes targeting the right PVG, ventralis caudalis of the thalamus, and nucleus accumbens (NAC).
Findings:
- Individual stimulation of the NAC and PVG resulted in substantial improvement in the patient's pain ratings.
- Combined stimulation of the NAC and PVG provided sustained pain relief for nearly one year post-implantation.
- The nucleus accumbens (NAC) demonstrated potential as an effective DBS target for managing central poststroke pain (CPSP).
Implications:
- The nucleus accumbens (NAC) presents a promising novel target for deep brain stimulation (DBS) in refractory central poststroke pain (CPSP).
- This case study suggests that exploring alternative DBS targets like the NAC could improve treatment outcomes for CPSP patients.
- Further research into the NAC as a DBS target may offer new therapeutic avenues for debilitating poststroke pain syndromes.
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