Deep brain stimulation of the ventral anterior limb of the internal capsule for m

Summary

Principal Investigator: Andre Guelman Machado
Abstract: DESCRIPTION (Provided by the applicant) Abstract: Chronic neuropathic pain is a common cause of disability in the population. Most treatment options for patients with medically refractory neuropathic pain, such as spinal cord stimulation, thalamic deep brain stimulation or intrathecal infusion of narcotics, are aimed at producing analgesia and are known to have limited efficacy. We propose an innovative neuromodulation-based approach to treat patients with central thalamic pain syndrome, a particularly severe form of neuropathic pain characterized by relentless anesthesia dolorosa resulting from injury to the thalamic sensory pathways. We depart from the traditional goal of intervening in the sensory discriminative neural pathways of pain transmission in order to produce analgesia. Instead, we plan to target with deep brain stimulation (DBS) the ventral area of the anterior limb of the internal capsule (ALIC), a region densely populated by fibers related to neural networks related to the control of behavior and emotion. By electrically stimulating these networks, we expect to modulate the affective sphere of patients with otherwise intractable pain and, consequently, reduce pain related disability. We hypothesize that the improvement in pain related disability associated with modulation of the affective pain sphere will not be dependent on analgesic effects. For this reason, the visual analog scale will be used as a secondary outcome measure to control for pain levels and analgesia but the primary outcome measure of the study will be the pain disability index. Patients enrolled in this research will undergo baseline and post-DBS double blinded evaluations for a period of six months, followed by chronic open label stimulation. The neural circuits of emotion control and the effects of DBS upon these networks will be studied at regular intervals with functional magnetic resonance imaging and magnetoencephalography. Public Health Relevance: Chronic neuropathic pain is very common in the population, affecting 8% of individuals enrolled in family practices. It is a leading cause of disability in the United States and other countries. Although several treatment options exist, large shares of patients with chronic pain (up to 50%) fail to respond and remain disabled. In this proposal, we describe an innovative approach to alleviate suffering and disability among those with severe and refractory chronic neuropathic pain.
Funding Period: 2009-09-30 - 2014-08-31
more information: NIH RePORT

Top Publications

  1. pmc Central neuromodulation for refractory pain
    Nina Z Moore
    Department of Neurosurgery, Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk S31, Cleveland, OH 44195, USA
    Neurosurg Clin N Am 25:77-83. 2014
  2. pmc Effectiveness and neural mechanisms associated with tDCS delivered to premotor cortex in stroke rehabilitation: study protocol for a randomized controlled trial
    Ela B Plow
    Department of Biomedical Engineering, Lerner Research Instt, Cleveland Clinic, 9500 Euclid Avenue, ND20, Cleveland, OH, 44195, USA
    Trials 14:331. 2013
  3. pmc The use of contact heat evoked potential stimulator (CHEPS) in magnetoencephalography for pain research
    Raghavan Gopalakrishnan
    Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH 44195, USA Electronic address
    J Neurosci Methods 220:55-63. 2013
  4. pmc Deep brain stimulation of the ventral striatum/anterior limb of the internal capsule in thalamic pain syndrome: study protocol for a pilot randomized controlled trial
    Ela B Plow
    Department of Biomedical Engineering, Department of Physical Medicine and Rehabilitation and Center for Neurological Restoration, Cleveland Clinic, 9500 Euclid Avenue, ND20, Cleveland, OH 44195, USA
    Trials 14:241. 2013
  5. pmc Magnetoencephalography correlate of EEG POSTS (positive occipital sharp transients of sleep)
    Yosuke Kakisaka
    Epilepsy Center, Department of Neurology, The Cleveland Clinic, Cleveland, OH 44195, USA
    J Clin Neurophysiol 30:235-7. 2013
  6. pmc Cerebral stimulation for the affective component of neuropathic pain
    Andre G Machado
    Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
    Neuromodulation 16:514-8. 2013
  7. pmc Clinical evidence for the utility of movement compensation algorithm in magnetoencephalography: successful localization during focal seizure
    Yosuke Kakisaka
    Epilepsy Center, Department of Neurology, The Cleveland Clinic, Cleveland, OH 44195, USA
    Epilepsy Res 101:191-6. 2012
  8. pmc Voxel-based morphometric MRI post-processing in MRI-negative focal cortical dysplasia followed by simultaneously recorded MEG and stereo-EEG
    Z I Wang
    Epilepsy Center, Neurological Institute, Cleveland Clinic Foundation, United States
    Epilepsy Res 100:188-93. 2012
  9. pmc Magnetoencephalography's higher sensitivity to epileptic spikes may elucidate the profile of electroencephalographically negative epileptic seizures
    Yosuke Kakisaka
    Epilepsy Center, Department of Neurology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
    Epilepsy Behav 23:171-3. 2012
  10. pmc Different cortical involvement pattern of generalized and localized spasms: a magnetoencephalography study
    Yosuke Kakisaka
    Epilepsy Center, Department of Neurology, The Cleveland Clinic, Cleveland, OH 44195, USA
    Epilepsy Behav 22:599-601. 2011

Scientific Experts

  • Yosuke Kakisaka
  • John C Mosher
  • Richard C Burgess
  • Ela B Plow
  • Andreas V Alexopoulos
  • Zhong I Wang
  • Andre Machado
  • Andre G Machado
  • Anne Sophie Dubarry
  • Nina Z Moore
  • Raghavan Gopalakrishnan
  • Donald A Malone
  • Rei Enatsu
  • Z I Wang
  • Scott F Lempka
  • Alexandria Wyant
  • Erik Beall
  • Guang H Yue
  • Ela Plow
  • Xiao Feng Wang
  • Stephen Jones
  • Kenneth B Baker
  • Ken Sakaie
  • Mark Lowe
  • David A Cunningham
  • Corin Bonnett
  • Y Kakisaka
  • J A Gonzalez-Martinez
  • Prakash Kotagal
  • S E Jones
  • J C Mosher
  • Dileep R Nair
  • R C Burgess
  • C Wong
  • I M Najm
  • A J Ristic
  • K Jin
  • F Schneider
  • A V Alexopoulos
  • D Nair
  • Ajay Gupta

Detail Information

Publications10

  1. pmc Central neuromodulation for refractory pain
    Nina Z Moore
    Department of Neurosurgery, Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk S31, Cleveland, OH 44195, USA
    Neurosurg Clin N Am 25:77-83. 2014
    ..Conclusive effectiveness studies are still needed to demonstrate the best targets as well as the reliability of the results with these approaches. ..
  2. pmc Effectiveness and neural mechanisms associated with tDCS delivered to premotor cortex in stroke rehabilitation: study protocol for a randomized controlled trial
    Ela B Plow
    Department of Biomedical Engineering, Lerner Research Instt, Cleveland Clinic, 9500 Euclid Avenue, ND20, Cleveland, OH, 44195, USA
    Trials 14:331. 2013
    ..We assess safety, feasibility and efficacy of targeting an alternate locus during rehabilitation- the premotor cortex. In anticipating variance across patients, we measure neural markers differentiating response from non-response...
  3. pmc The use of contact heat evoked potential stimulator (CHEPS) in magnetoencephalography for pain research
    Raghavan Gopalakrishnan
    Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH 44195, USA Electronic address
    J Neurosci Methods 220:55-63. 2013
    ..In this paper, we summarize our experiences using the CHEPS in MEG to study pain using an experimental paradigm, and propose a novel method for managing its artifact...
  4. pmc Deep brain stimulation of the ventral striatum/anterior limb of the internal capsule in thalamic pain syndrome: study protocol for a pilot randomized controlled trial
    Ela B Plow
    Department of Biomedical Engineering, Department of Physical Medicine and Rehabilitation and Center for Neurological Restoration, Cleveland Clinic, 9500 Euclid Avenue, ND20, Cleveland, OH 44195, USA
    Trials 14:241. 2013
    ..Instead, we hypothesize that targeting structures representing emotion and affective behavior-ventral striatum/anterior limb of the internal capsule, may alleviate disability...
  5. pmc Magnetoencephalography correlate of EEG POSTS (positive occipital sharp transients of sleep)
    Yosuke Kakisaka
    Epilepsy Center, Department of Neurology, The Cleveland Clinic, Cleveland, OH 44195, USA
    J Clin Neurophysiol 30:235-7. 2013
    ..The purpose of this article was to show the characteristic MEG profile of positive occipital sharp transients of sleep...
  6. pmc Cerebral stimulation for the affective component of neuropathic pain
    Andre G Machado
    Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
    Neuromodulation 16:514-8. 2013
    ....
  7. pmc Clinical evidence for the utility of movement compensation algorithm in magnetoencephalography: successful localization during focal seizure
    Yosuke Kakisaka
    Epilepsy Center, Department of Neurology, The Cleveland Clinic, Cleveland, OH 44195, USA
    Epilepsy Res 101:191-6. 2012
    ..This study provides the first clinical evidence for utility of MC in magnetoencephalography for localizing focal seizures...
  8. pmc Voxel-based morphometric MRI post-processing in MRI-negative focal cortical dysplasia followed by simultaneously recorded MEG and stereo-EEG
    Z I Wang
    Epilepsy Center, Neurological Institute, Cleveland Clinic Foundation, United States
    Epilepsy Res 100:188-93. 2012
    ..When confirmed to be epileptogenic, such MAP abnormalities may reflect an underlying subtle cortical dysplasia whose complete resection can lead to seizure-free outcome...
  9. pmc Magnetoencephalography's higher sensitivity to epileptic spikes may elucidate the profile of electroencephalographically negative epileptic seizures
    Yosuke Kakisaka
    Epilepsy Center, Department of Neurology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
    Epilepsy Behav 23:171-3. 2012
    ..Therefore, some epileptic seizures, even though generated identically to the MEG-positive seizures, could be EEG-negative because of their smaller magnitude...
  10. pmc Different cortical involvement pattern of generalized and localized spasms: a magnetoencephalography study
    Yosuke Kakisaka
    Epilepsy Center, Department of Neurology, The Cleveland Clinic, Cleveland, OH 44195, USA
    Epilepsy Behav 22:599-601. 2011
    ..In this case, MEG provided new insight into the mechanisms underlying the two types of ESs: both types were generated from the same focus, and in generalized ESs, abnormal excitation spread to cortical areas diffusely...