Functional MRI Signature of Chronic Pain Relief From Deep Brain Stimulation in Parkinson Disease Patients

DiMarzio, Marisa BS; Rashid, Tanweer PhD; Hancu, Ileana PhD; Fiveland, Eric MS; Prusik, Julia MPH; Gillogly, Michael BA/BS, RN; Madhavan, Radhika PhD; Joel, Suresh PhD; Durphy, Jennifer MD; Molho, Eric MD; Hanspal, Era MD; Shin, Damian PhD;Pilitsis, Julie G MD, PhD

Author Information

Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York

GE Global Research Center, Niskayuna, New York

Department of Neurosurgery, Albany Medical Center, Albany, New York

GE Global Research Center, Bangalore, India

Department of Neurology, Albany Medical Center, Albany, New York

Correspondence: Julie G. Pilitsis, MD, PhD, Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Physicians Pavilion, 3rd Floor, 47 New Scotland Ave, MC 10, Albany, NY 12208. Email:[email protected]

Neurosurgery85(6):p E1043-E1049, December 2019. |DOI:10.1093/neuros/nyz269

Abstract

BACKGROUND

Chronic pain occurs in 83% of Parkinson disease (PD) patients and deep brain stimulation (DBS) has shown to result in pain relief in a subset of patients, though the mechanism is unclear.

OBJECTIVE

To compare functional magnetic resonance imaging (MRI) data in PD patients with chronic pain without DBS, those whose pain was relieved (PR) with DBS and those whose pain was not relieved (PNR) with DBS.

METHODS

Functional MRI (fMRI) with blood oxygen level-dependent activation data was obtained in 15 patients in control, PR, and PNR patients. fMRI was obtained in the presence and absence of a mechanical stimuli with DBS ON and DBS OFF. Voxel-wise analysis using pain OFF data was used to determine which regions were altered during pain ON periods.

RESULTS

At the time of MRI, pain was scored a 5.4 ± 1.2 out of 10 in the control, 4.25 ± 1.18 in PNR, and 0.8 ± 0.67 in PR cohorts. Group analysis of control and PNR groups showed primary somatosensory (SI) deactivation, whereas PR patients showed thalamic deactivation and SI activation. DBS resulted in more decreased activity in PR than PNR (P < .05) and more activity in anterior cingulate cortex (ACC) in PNR patients (P < .05).

CONCLUSION

Patients in the control and PNR groups showed SI deactivation at baseline in contrast to the PR patients who showed SI activation. With DBS ON, the PR cohort had less activity in SI, whereas the PNR had more anterior cingulate cortex activity. We provide pilot data that patients whose pain responds to DBS may have a different fMRI signature than those who do not, and PR and PNR cohorts produced different brain responses when DBS is employed.