Abstract
Background: Pain is highly prevalent in Parkinson's disease and is associated with significant reduction in health-related quality of life. Subthalamic deep brain stimulation can produce significant pain relief in a subset of patients after surgery. However, the mechanism by which deep brain stimulation modulates sensory function in Parkinson's disease remains uncertain.Objective: To describe the motor and pain outcomes of deep brain stimulation applied to a series of patients with Parkinson's disease and to determine whether the structural connectivity between the volume of tissue activated and different regions of the brain was associated with the changes of these outcomes after surgery.Methods: Data from a long-term prospective cohort of 32 Parkinson's disease patients with subthalamic stimulation were combined with available human connectome to identify connections consistently associated with clinical improvement (Unified Parkinson Disease Rating Scale), pain intensity, and experimental cold pain threshold after surgery.Results: The connectivity between the volume of tissue activated and a distributed network of sensory brain regions (prefrontal, insular and cingulate cortex, and postcentral gyrus) was inversely correlated with pain intensity improvement and reduced sensitivity to cold pain after surgery (p < 0.01). The connectivity strength with the supplementary motor area positively correlated with motor and pain threshold improvement (p < 0.05).Conclusions: These data suggest that the pattern of the connectivity between the region stimulated and specific brain cortical area might be responsible, in part, for the successful control of motor and pain symptoms by subthalamic deep brain stimulation in Parkinson's disease.
Highlights
Pain has a prevalence of 40–85% in Parkinson’s disease (PD) patients [1, 2] and is related with a significant reduction in their quality of life [3]
Twenty-three patients (71.9%) had pain related to PD before the surgery
Our primary findings were that: (i) Subthalamic deep brain stimulation (STN DBS) alleviates pain intensity and reduces CPT 12 months after surgery in PD, but these changes differed between patients and were not correlated with each other; (ii) the VTA inside the subthalamic nucleus (STN) does not explain the variance in pain change after surgery; and (iii) the pattern of the connectivity between the stimulated region and specific brain cortical areas may be responsible for this variance in outcome
Summary
Pain has a prevalence of 40–85% in Parkinson’s disease (PD) patients [1, 2] and is related with a significant reduction in their quality of life [3]. Subthalamic deep brain stimulation (STN DBS) is an effective treatment for the motor symptoms of PD [4], but it ameliorates non-motor symptoms, such as pain [5]. The mechanism by which DBS modulates sensory function in PD remains uncertain. Pain is highly prevalent in Parkinson’s disease and is associated with significant reduction in health-related quality of life. Subthalamic deep brain stimulation can produce significant pain relief in a subset of patients after surgery. The mechanism by which deep brain stimulation modulates sensory function in Parkinson’s disease remains uncertain
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