Comparative fMRI correlates of PNFS and DBS for facial pain.
Poster No:
1882
Submission Type:
Abstract Submission
Authors:
Clement Chow1, Michelle Paff2, Can Sarica1, Brendan Santyr1, Sriranga Kashyap1, Aaron Loh1, Michael Colditz3, Kimia Pourhossein4, Asma Naheed1, Kâmil Uludağ1, Jürgen Germann1, Alexandre Boutet1, Andres Lozano1, Mojgan Hodaie1
Institutions:
1University Health Network, Toronto, ON, 2University of California Irvine Health, Orange County, CA, 3Royal Brisbane and Women's Hospital, Brisbane, VIC, 4University of Melbourne, Melbourne, VIC
First Author:
Co-Author(s):
Introduction:
Neuromodulation involves the stimulation of pain pathways using implantable devices that deliver electrical currents to achieve reversible modifications in the nociceptive system. Melzack's "Pain Neuromatrix" theory highlights the interplay between sensory-motor, affective-motivational, and cognitive-evaluative components of chronic pain (Melzack, 1999). Peripheral nerve field stimulation (PNFS) is a minimally invasive treatment for refractory trigeminal neuropathic pain, yet its central nervous system responses require clarification (Machado et al., 2013). This study investigates stimulation-related functional responses during PNFS using task-based fMRI and compares them to resting-state functional connectivity (FC) patterns in patients with ventral caudal (Vc)/periventricular gray (PVG) deep brain stimulation (DBS) for chronic neuropathic pain.
Methods:
Two PNFS patients with trigeminal neuropathic pain were studied using a block design paradigm with 30-second ON/OFF stimulation cycles. High- (1 kHz) and low-frequency (30–40 Hz) PNFS settings were applied, and task-based BOLD response maps were generated. Additionally, three DBS patients with chronic neuropathic facial pain (following thalamic hemorrhage, brachial plexus injury, middle cerebral artery stroke) underwent resting-state fMRI during DBS-ON and DBS-OFF conditions. Functional connectivity of the volume of tissue activated (VTA) was analyzed for changes associated with different DBS settings.
Results:
In PNFS, high-frequency stimulation in a non-responder induced BOLD changes in the orbitofrontal cortex, posterior cingulate, and motor cortex, whereas low-frequency stimulation elicited no response. Conversely, in a responder, low-frequency stimulation induced BOLD changes in the anterior cingulate cortex, posterior cingulate cortex, prefrontal cortex, amygdala, nucleus accumbens, primary motor cortex, and primary somatosensory area corresponding to the facial region, while high-frequency stimulation had no changes.
For Vc/PVG DBS patients, the FC of VTAs demonstrated brain-wide differences between DBS-ON and DBS-OFF states. Acute Vc stimulation (Patient 1) resulted in reduced positive connectivity and increased negative connectivity in the medial prefrontal cortex and anterior cingulate cortex. Chronic Vc stimulation (Patients 2 and 3) revealed diminished positive FC with posterior cingulate cortex, precuneus, and medial motor cortices in the DBS-ON condition. PVG stimulation (Patient 2) demonstrated increased negative FC with the PCC, precuneus, and temporal lobes during DBS-ON.
For Vc/PVG DBS patients, the FC of VTAs demonstrated brain-wide differences between DBS-ON and DBS-OFF states. Acute Vc stimulation (Patient 1) resulted in reduced positive connectivity and increased negative connectivity in the medial prefrontal cortex and anterior cingulate cortex. Chronic Vc stimulation (Patients 2 and 3) revealed diminished positive FC with posterior cingulate cortex, precuneus, and medial motor cortices in the DBS-ON condition. PVG stimulation (Patient 2) demonstrated increased negative FC with the PCC, precuneus, and temporal lobes during DBS-ON.
Conclusions:
Functional responses to PNFS vary based on stimulation efficacy and parameters. DBS impacts FC differently in acute and chronic stimulation states, emphasizing dynamic changes in brain connectivity. Further analyses including additional participants will be presented during the conference.
Brain Stimulation:
Deep Brain Stimulation
Invasive Stimulation Methods Other
Modeling and Analysis Methods:
fMRI Connectivity and Network Modeling
Novel Imaging Acquisition Methods:
BOLD fMRI 1
Perception, Attention and Motor Behavior:
Perception: Pain and Visceral 2
Keywords:
Limbic Systems
MRI
Neurological
Pain
Peripheral Nerve
Somatosensory
Thalamus
Other - Neuromodulation
1|2Indicates the priority used for review
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Were any human subjects research approved by the relevant Institutional Review Board or ethics panel? NOTE: Any human subjects studies without IRB approval will be automatically rejected.
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Provide references using APA citation style.
Melzack, R. (1999). From the gate to the neuromatrix. Pain, 82, S121-S126.