Spinal cord stimulation modulates cerebral function: an fMRI study
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FUNCTIONAL NEURORADIOLOGY
Spinal cord stimulation modulates cerebral function: an fMRI study M. Moens & S. Sunaert & P. Mariën & R. Brouns & A. De Smedt & S. Droogmans & P. Van Schuerbeek & R. Peeters & J. Poelaert & B. Nuttin Received: 15 April 2012 / Accepted: 16 August 2012 / Published online: 2 September 2012 # Springer-Verlag 2012
Abstract Introduction Although spinal cord stimulation (SCS) is widely used for chronic neuropathic pain after failed spinal surgery, little is known about the underlying physiological mechanisms. This study aims to investigate the neural substrate underlying short-term (30 s) SCS by means of functional magnetic resonance imaging in 20 patients with failed back surgery syndrome (FBSS). Methods Twenty patients with FBSS, treated with externalized SCS, participated in a blocked functional magnetic resonance imaging design with stimulation and rest phases of 30 s each, repeated eight times in a row. During scanning, patients rated pain intensity over time using an 11-point
numerical rating scale with verbal anchors (00no pain at all to 100worst pain imaginable) by pushing buttons (left hand, lesser pain; right hand, more pain). This scale was back projected to the patients on a flat screen allowing them to manually direct the pain indicator. To increase the signalto-noise ratio, the 8-min block measurements were repeated three times. Results Marked deactivation of the bilateral medial thalamus and its connections to the rostral and caudal cingulate cortex and the insula was found; the study also showed immediate pain relief obtained by short-term SCS correlated negatively with activity in the inferior olivary nucleus, the cerebellum, and the rostral anterior cingulate cortex.
M. Moens (*) Department of Neurosurgery and Center for Neuroscience, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium e-mail: [email protected]
P. Van Schuerbeek Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
S. Sunaert : R. Peeters Department of Radiology, UZ Leuven, Katholieke Universiteit Leuven, Herestraat 49, 3000 Leuven, Belgium P. Mariën Department of Neurology, ZNA Middelheim General Hospital, Lindendreef 1, 2020 Antwerp, Belgium R. Brouns : A. De Smedt Department of Neurology and Center for Neuroscience, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium S. Droogmans Department of Cardiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
J. Poelaert Department of Anesthesiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
B. Nuttin Department of Neurosurgery, UZ Leuven, Katholieke Universiteit Leuven, Herestraat 49, 3000 Leuven, Belgium
P. Mariën Department of Clinical and Experimental Neurolinguistics, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
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Neuroradiology (2012) 54:1399–1407
Conclusions Results indicate the key role of the medial thalamus as a mediator and the involvement of a corticocerebellar network implica
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