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Long term success of deep brain stimulation for chronic pain: Standardized outcomes in 965 reported cases
s9
A PROLONGED
RELIEF OF CANCER PAINS BY ELECTROT. FUJITA, COAGULATION OF THE PITUITARY GLAND. pi Y. KITANI: & Y. HASEGAWA* Dept. of Anesthesiology, Gunma University Hospital,Maebashi,Gunma,JAPAN,371. An electric stumulation on the pituitary gland Purpose: In order causes a transient pain relief for cancer patients. to prolong this pain relief, authors coagulated the site on inquiring to patient as to pain relief followed by electric stimulation of pituitary gland. C-shaped bipolar electrode Methods: (1) Under fluoroscope, laid on near to the pars intermedia of the pituitary gland When patients state pain relief on elec-tric transphenoidally. stimulation (25cps, 4,%9volts, 0.2msec square wave), the site (Bio-electronic's lesion was coagulated by radiofrequency. generator). (2) With concent by patients, SSEP, threshold of pain and CSF by spinal tap obtained before and after 24hrs. Non-invasive measurement of r-CBF and r-CMR02 obtained by
positron emission CT scanning (PET) of the brain. Result: 12 out of 15 cases relieve pain, but prolonged complete pain relief over 2 month obtained only two out of survived 9 cases. AVP (B-arginine Vasopressin) in CSF increased over 100 times in complete pain relieved as well as raised pain threshold together with prolonged latency in late component of SSEP. PET exhibited depressed rCMR02 in the whole brain while rCBF was not changed. Conclusion: Electrocoagulation of the pituitary gland is effective to relieve cancer pain as well as NALP. Meanwhile the pituitary function kept intact. LONG TERM SUCCESS OF DEEP BRAIN STIMULATION FOR CHRONIC PAIN: STANDARDIZED OUTCOMES IN 965 REPORTED CASES. --;_I M.D., PhD., S. Lamb, R.N., and J. Adams, M.D., Department of Neurological Surgery, University of California, San Prancisco, CA 94143, USA. Several investigatorshave recently reported their long term experience with deep brain stimulation (DBS) for chronic intractable pain. Comparison of these data is difficult because of inconsistentdefinitions of success and failure and incomplete reporting of specific pain syndromes and stimulation sites. To determine the efficacy of DBS, we pooled our data on 141 operated patients with 824 patients reported in the literature. Data were normalized with respect to specific pain state, location of stimulating electrodes and the definition of success. 628 patients in 11 studies underwent DES for deafferentationpain states. The range of follow-up was 1 to 168 months; mean follow-up times ranged from 10 to 80 months. Initial success rates, reported in 7 of these studies, ranged from 29% to 82%. The overall long term success rate was 47% (296/628). 337 patients in 9 studies underwent DBS for nociceptive pain. Initial success rates, available for 5 studies, ranged from 40% to 98%. The overall long term success rate was 60% (201/337). Several factors might lead to improved results, including improved patient selection criteria, careful selection of stimulation targets based upon the nature of the patient's pain and accurate electrode placement using introperativestimulation. These results suggest that DBS should be considered in those patients modes of therapy.
with chronic
severe pain who have failed other
A PROLONGED
RELIEF OF CANCER PAINS BY ELECTROT. FUJITA, COAGULATION OF THE PITUITARY GLAND. pi Y. KITANI: & Y. HASEGAWA* Dept. of Anesthesiology, Gunma University Hospital,Maebashi,Gunma,JAPAN,371. An electric stumulation on the pituitary gland Purpose: In order causes a transient pain relief for cancer patients. to prolong this pain relief, authors coagulated the site on inquiring to patient as to pain relief followed by electric stimulation of pituitary gland. C-shaped bipolar electrode Methods: (1) Under fluoroscope, laid on near to the pars intermedia of the pituitary gland When patients state pain relief on elec-tric transphenoidally. stimulation (25cps, 4,%9volts, 0.2msec square wave), the site (Bio-electronic's lesion was coagulated by radiofrequency. generator). (2) With concent by patients, SSEP, threshold of pain and CSF by spinal tap obtained before and after 24hrs. Non-invasive measurement of r-CBF and r-CMR02 obtained by
positron emission CT scanning (PET) of the brain. Result: 12 out of 15 cases relieve pain, but prolonged complete pain relief over 2 month obtained only two out of survived 9 cases. AVP (B-arginine Vasopressin) in CSF increased over 100 times in complete pain relieved as well as raised pain threshold together with prolonged latency in late component of SSEP. PET exhibited depressed rCMR02 in the whole brain while rCBF was not changed. Conclusion: Electrocoagulation of the pituitary gland is effective to relieve cancer pain as well as NALP. Meanwhile the pituitary function kept intact. LONG TERM SUCCESS OF DEEP BRAIN STIMULATION FOR CHRONIC PAIN: STANDARDIZED OUTCOMES IN 965 REPORTED CASES. --;_I M.D., PhD., S. Lamb, R.N., and J. Adams, M.D., Department of Neurological Surgery, University of California, San Prancisco, CA 94143, USA. Several investigatorshave recently reported their long term experience with deep brain stimulation (DBS) for chronic intractable pain. Comparison of these data is difficult because of inconsistentdefinitions of success and failure and incomplete reporting of specific pain syndromes and stimulation sites. To determine the efficacy of DBS, we pooled our data on 141 operated patients with 824 patients reported in the literature. Data were normalized with respect to specific pain state, location of stimulating electrodes and the definition of success. 628 patients in 11 studies underwent DES for deafferentationpain states. The range of follow-up was 1 to 168 months; mean follow-up times ranged from 10 to 80 months. Initial success rates, reported in 7 of these studies, ranged from 29% to 82%. The overall long term success rate was 47% (296/628). 337 patients in 9 studies underwent DBS for nociceptive pain. Initial success rates, available for 5 studies, ranged from 40% to 98%. The overall long term success rate was 60% (201/337). Several factors might lead to improved results, including improved patient selection criteria, careful selection of stimulation targets based upon the nature of the patient's pain and accurate electrode placement using introperativestimulation. These results suggest that DBS should be considered in those patients modes of therapy.
with chronic
severe pain who have failed other