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Personalizing Dual-Target Cortical Stimulation with Bayesian Parameter Optimization Successfully Treats Central Post-Stroke Pain: A Case Report

Central pain disorders, such as central post-stroke pain, remain clinically challenging to treat, despite many decades of pharmacological advances and the evolution of neuromodulation. For treatment refractory cases, previous studies have highlighted some benefits of cortical stimulation. Recent adv...

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Autores principales: Dastin-van Rijn, Evan M., König, Seth D., Carlson, Danielle, Goel, Vasudha, Grande, Andrew, Nixdorf, Donald R., Benish, Sarah, Widge, Alik S., Nahas, Ziad, Park, Michael C., Netoff, Tay I., Herman, Alexander B., Darrow, David P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8773936/
https://www.ncbi.nlm.nih.gov/pubmed/35053769
http://dx.doi.org/10.3390/brainsci12010025
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author Dastin-van Rijn, Evan M.
König, Seth D.
Carlson, Danielle
Goel, Vasudha
Grande, Andrew
Nixdorf, Donald R.
Benish, Sarah
Widge, Alik S.
Nahas, Ziad
Park, Michael C.
Netoff, Tay I.
Herman, Alexander B.
Darrow, David P.
author_facet Dastin-van Rijn, Evan M.
König, Seth D.
Carlson, Danielle
Goel, Vasudha
Grande, Andrew
Nixdorf, Donald R.
Benish, Sarah
Widge, Alik S.
Nahas, Ziad
Park, Michael C.
Netoff, Tay I.
Herman, Alexander B.
Darrow, David P.
author_sort Dastin-van Rijn, Evan M.
collection PubMed
description Central pain disorders, such as central post-stroke pain, remain clinically challenging to treat, despite many decades of pharmacological advances and the evolution of neuromodulation. For treatment refractory cases, previous studies have highlighted some benefits of cortical stimulation. Recent advances in new targets for pain and the optimization of neuromodulation encouraged our group to develop a dual cortical target approach paired with Bayesian optimization to provide a personalized treatment. Here, we present a case report of a woman who developed left-sided facial pain after multiple thalamic strokes. All previous pharmacologic and interventional treatments failed to mitigate the pain, leaving her incapacitated due to pain and medication side effects. She subsequently underwent a single burr hole for placement of motor cortex (M1) and dorsolateral prefrontal cortex (dlPFC) paddles for stimulation with externalization. By using Bayesian optimization to find optimal stimulation parameters and stimulation sites, we were able to reduce pain from an 8.5/10 to a 0/10 during a 5-day inpatient stay, with pain staying at or below a 2/10 one-month post-procedure. We found optimal treatment to be simultaneous stimulation of M1 and dlPFC without any evidence of seizure induction. In addition, we found no worsening in cognitive performance during a working memory task with dlPFC stimulation. This personalized approach using Bayesian optimization may provide a new foundation for treating central pain and other functional disorders through systematic evaluation of stimulation parameters.
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spelling pubmed-87739362022-01-21 Personalizing Dual-Target Cortical Stimulation with Bayesian Parameter Optimization Successfully Treats Central Post-Stroke Pain: A Case Report Dastin-van Rijn, Evan M. König, Seth D. Carlson, Danielle Goel, Vasudha Grande, Andrew Nixdorf, Donald R. Benish, Sarah Widge, Alik S. Nahas, Ziad Park, Michael C. Netoff, Tay I. Herman, Alexander B. Darrow, David P. Brain Sci Case Report Central pain disorders, such as central post-stroke pain, remain clinically challenging to treat, despite many decades of pharmacological advances and the evolution of neuromodulation. For treatment refractory cases, previous studies have highlighted some benefits of cortical stimulation. Recent advances in new targets for pain and the optimization of neuromodulation encouraged our group to develop a dual cortical target approach paired with Bayesian optimization to provide a personalized treatment. Here, we present a case report of a woman who developed left-sided facial pain after multiple thalamic strokes. All previous pharmacologic and interventional treatments failed to mitigate the pain, leaving her incapacitated due to pain and medication side effects. She subsequently underwent a single burr hole for placement of motor cortex (M1) and dorsolateral prefrontal cortex (dlPFC) paddles for stimulation with externalization. By using Bayesian optimization to find optimal stimulation parameters and stimulation sites, we were able to reduce pain from an 8.5/10 to a 0/10 during a 5-day inpatient stay, with pain staying at or below a 2/10 one-month post-procedure. We found optimal treatment to be simultaneous stimulation of M1 and dlPFC without any evidence of seizure induction. In addition, we found no worsening in cognitive performance during a working memory task with dlPFC stimulation. This personalized approach using Bayesian optimization may provide a new foundation for treating central pain and other functional disorders through systematic evaluation of stimulation parameters. MDPI 2021-12-26 /pmc/articles/PMC8773936/ /pubmed/35053769 http://dx.doi.org/10.3390/brainsci12010025 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Dastin-van Rijn, Evan M.
König, Seth D.
Carlson, Danielle
Goel, Vasudha
Grande, Andrew
Nixdorf, Donald R.
Benish, Sarah
Widge, Alik S.
Nahas, Ziad
Park, Michael C.
Netoff, Tay I.
Herman, Alexander B.
Darrow, David P.
Personalizing Dual-Target Cortical Stimulation with Bayesian Parameter Optimization Successfully Treats Central Post-Stroke Pain: A Case Report
title Personalizing Dual-Target Cortical Stimulation with Bayesian Parameter Optimization Successfully Treats Central Post-Stroke Pain: A Case Report
title_full Personalizing Dual-Target Cortical Stimulation with Bayesian Parameter Optimization Successfully Treats Central Post-Stroke Pain: A Case Report
title_fullStr Personalizing Dual-Target Cortical Stimulation with Bayesian Parameter Optimization Successfully Treats Central Post-Stroke Pain: A Case Report
title_full_unstemmed Personalizing Dual-Target Cortical Stimulation with Bayesian Parameter Optimization Successfully Treats Central Post-Stroke Pain: A Case Report
title_short Personalizing Dual-Target Cortical Stimulation with Bayesian Parameter Optimization Successfully Treats Central Post-Stroke Pain: A Case Report
title_sort personalizing dual-target cortical stimulation with bayesian parameter optimization successfully treats central post-stroke pain: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8773936/
https://www.ncbi.nlm.nih.gov/pubmed/35053769
http://dx.doi.org/10.3390/brainsci12010025
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