Spinal cord stimulation modulates cerebral neurobiology: a proton magnetic resonance spectroscopy study.

Maarten Moens, Peter Mariën, Raf Brouns, Jan Poelaert, Ann De Smedt, Ronald Buyl, Steven Droogmans, Peter Van Schuerbeek, Stefan Sunaert, Bart Nuttin

Journal: Neuroradiology 2014;55(8):1039-1047

PMID: 23665999

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Abstract

INTRODUCTION

Although spinal cord stimulation (SCS) is a widely used treatment for chronic neuropathic pain secondary to spinal surgery, little is known about the underlying physiological mechanisms.

METHODS

The primary aim of this study is to investigate the neural substrate underlying short-term SCS by means of (1)H MR spectroscopy with short echo time, in 20 patients with failed back surgery syndrome.

RESULTS

Marked increase of γ-aminobutyric acid (GABA) and decrease in glucose in the ipsilateral thalamus were found between baseline situation without SCS and after 9' of SCS, indicating the key role of the ipsilateral thalamus as a mediator of chronic neuropathic pain. In addition, this study also showed a progressive decrease in glucose in the ipsilateral thalamus over time, which is in line with the findings of previous studies reporting deactivation in the ipsilateral thalamic region.

CONCLUSIONS

The observation of GABA increase and glucose decrease over time in the ipsilateral thalamus may be the causal mechanism of the pain relief due to SCS or an epiphenomenon.

Address: Department of Neurosurgery and Center for Neuroscience, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium. [email protected].; Department of Neurology, ZNA Middelheim General Hospital, Lindendreef 1, 2020, Antwerp, Belgium.; Department of Clinical and Experimental Neurolinguistics, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.; Neurology and Center for Neuroscience, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.; Anesthesiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.; Department of Biostatistics and Medical Informatics, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium.; Cardiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.; Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.; Department of Radiology, UZ Leuven, Katholieke Universiteit Leuven, Herestraat 49, 3000, Leuven, Belgium.; Neurosurgery, UZ Leuven, Katholieke Universiteit Leuven, Herestraat 49, 3000, Leuven, Belgium.

DOI: 10.1007/s00234-013-1200-7

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MeSH Terms: Aged, Chronic Pain, Cohort Studies, Female, Glucose, Humans, Magnetic Resonance Spectroscopy, Male, Middle Aged, Neuralgia, Protons, Spinal Cord Stimulation, Thalamus, Treatment Outcome, Young Adult, gamma-Aminobutyric Acid