Long-term results of Deep Brain Stimulation of the Anterior Cingulate Cortex for Neuropathic Pain.
Boccard SG., Prangnell SJ., Pycroft L., Cheeran B., Moir L., Pereira EA., Fitzgerald JJ., Green AL., Aziz TZ.
BACKGROUND: Deep Brain Stimulation of the Anterior Cingulate Cortex is a recent technique that has shown some promising short-term results in patients with chronic refractory neuropathic pain. Three years after the first case-series, we assessed its efficacy on a larger cohort, with longer follow-up. METHODS: 24 patients (19 males; 49.1 years) with neuropathic pain underwent bilateral ACC DBS. Patient reported outcome measures were collected pre- and post-surgery, using the Numerical Rating Scale (NRS), Short-Form 36 quality of life (SF-36), McGill pain (MPQ) and EuroQol-5D questionnaires. RESULTS: 22 patients after a trial week were fully internalized and 12 had a mean follow-up of 38.9 months. Six months post-surgery the mean NRS score dropped from 8.0 to 4.27 (P=.004). There was a significant improvement in the MPQ (mean -36%; P=.021) and EQ-5D score significantly decreased (mean -21%; P=.036). The PF domain of SF-36 was significantly improved (mean +54.2%; P=.01). Furthermore, in 83% of these patients: at 6 months NRS was improved by 60% (P<.001) and MPQ decreased by 47% (P<.01). After 1 year, NRS decreased by 43% (P< .01), EQ-5D was significantly reduced (mean -30.8; P=.05) and significant improvements were also observed for different domains of the SF-36. At longer follow-ups, efficacy was sustained up to 42 months in some patients, with a NRS as low as 3. CONCLUSIONS: Follow-up results confirm that ACC DBS alleviates chronic neuropathic pain refractory to pharmacotherapy and improves quality of life in a significant number of patients.