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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...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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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. |
format | Online Article Text |
id | pubmed-8773936 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
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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