Thalamic deep brain stimulation for central poststroke pain syndrome: an international multicenter study

Area of Science:

• Neurology
• Neurosurgery
• Pain Medicine

Background:

• Central poststroke pain (CPSP) is a debilitating condition with limited treatment options.
• Deep brain stimulation (DBS) is a potential therapy for CPSP, but optimal targets and predictors of success are unclear.

Purpose of the Study:

• To evaluate the effectiveness and identify optimal stimulation sites for DBS in treating CPSP.
• To assess clinical and neuroimaging predictors of long-term outcomes in patients undergoing DBS for CPSP.

Main Methods:

• Retrospective analysis of international multicenter data from 6 DBS centers.
• Reconstruction and normalization of DBS leads, construction of stimulation maps.
• Projection of lesions and volumes of tissue activated (VTAs) onto a human connectome to analyze connectivity profiles.

Main Results:

• Out of 39 patients, 14 (35.9%) were responders with ≥50% pain relief at 12 months.
• Effective stimulation sites included the posterior limb of the internal capsule and sensorimotor thalamus.
• Responders showed reduced structural connectivity to sensory cortex compared to non-responders.

Conclusions:

• DBS is effective for a significant portion of patients with CPSP.
• The posterior limb of the internal capsule and sensorimotor thalamus are promising targets.
• Connectivity differences may serve as a biomarker for guiding surgical planning in future trials.