Functional magnetic resonance imaging

cerebral function alterations in subthreshold and suprathreshold spinal cord stimulation

Sander De Groote, Mats De Jaeger, Peter Van Schuerbeek, Stefan Sunaert, Ronald Peeters, Dirk Loeckx, Lisa Goudman, Patrice Forget, Ann De Smedt, Maarten Moens

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background and purpose: Failed back surgery syndrome (FBSS) is a common and devastating chronic neuropathic pain disorder. Conventional spinal cord stimulation (SCS) applies electrical suprathreshold pulses to the spinal cord at a frequency of 40–60 Hz and relieves pain in FBSS patients. During the last decade, two major changes have emerged in the techniques of stimulating the spinal cord: paresthesia-free or subthreshold stimulation and administration of higher frequency or higher amounts of energy to the spinal cord. Despite the positive clinical results, the mechanism of action remains unclear. A functional MRI (fMRI) study was conducted to investigate the brain alterations during subthreshold and suprathreshold stimulation at different frequencies. Methods: Ten subjects with FBSS, treated with externalized SCS, received randomly four different stimulation frequencies (4 Hz, 60 Hz, 500 Hz, and 1 kHz) during four consecutive days. At every frequency, the patient underwent sub-and suprathreshold stimulation. Cerebral activity was monitored and assessed using fMRI. Results: Suprathreshold stimulation is generally accompanied with more activity than subthreshold SCS. Suprathreshold SCS resulted in increased bilateral activation of the frontal cortex, thalamus, pre-and postcentral gyri, basal ganglia, cingulate gyrus, insula, thalamus, and claustrum. We observed deactivation of the bilateral parahippocampus, amygdala, precuneus, posterior cingulate gyrus, postcentral gyrus, and unilateral superior temporal gyrus. Conclusion: Suprathreshold stimulation resulted in greater activity (both activation and deactivation) of the frontal brain regions; the sensory, limbic, and motor cortices; and the diencephalon in comparison with subthreshold stimulation. Each type of frequency at suprathreshold stimulation was characterized by an individual activation pattern.
Original languageEnglish
Pages (from-to)2517-2526
Number of pages10
JournalJournal of Pain Research
Volume2018
Issue number11
Early online date24 Oct 2018
DOIs
Publication statusPublished - 2018

Fingerprint

Spinal Cord Stimulation
Failed Back Surgery Syndrome
Magnetic Resonance Imaging
Spinal Cord
Somatosensory Cortex
Gyrus Cinguli
Basal Ganglia
Thalamus
Diencephalon
Parietal Lobe
Somatoform Disorders
Paresthesia
Brain
Frontal Lobe
Neuralgia
Temporal Lobe
Amygdala
Chronic Pain
Pain

Keywords

  • FMRI
  • Frequency
  • Spinal cord stimulation
  • Subthreshold
  • Suprathreshold

Cite this

De Groote, S., De Jaeger, M., Van Schuerbeek, P., Sunaert, S., Peeters, R., Loeckx, D., ... Moens, M. (2018). Functional magnetic resonance imaging: cerebral function alterations in subthreshold and suprathreshold spinal cord stimulation. Journal of Pain Research, 2018(11), 2517-2526. https://doi.org/10.2147/JPR.S160890

Functional magnetic resonance imaging : cerebral function alterations in subthreshold and suprathreshold spinal cord stimulation. / De Groote, Sander; De Jaeger, Mats; Van Schuerbeek, Peter; Sunaert, Stefan; Peeters, Ronald; Loeckx, Dirk; Goudman, Lisa; Forget, Patrice; De Smedt, Ann; Moens, Maarten.

In: Journal of Pain Research, Vol. 2018, No. 11, 2018, p. 2517-2526.

Research output: Contribution to journalArticle

De Groote, S, De Jaeger, M, Van Schuerbeek, P, Sunaert, S, Peeters, R, Loeckx, D, Goudman, L, Forget, P, De Smedt, A & Moens, M 2018, 'Functional magnetic resonance imaging: cerebral function alterations in subthreshold and suprathreshold spinal cord stimulation', Journal of Pain Research, vol. 2018, no. 11, pp. 2517-2526. https://doi.org/10.2147/JPR.S160890
De Groote, Sander ; De Jaeger, Mats ; Van Schuerbeek, Peter ; Sunaert, Stefan ; Peeters, Ronald ; Loeckx, Dirk ; Goudman, Lisa ; Forget, Patrice ; De Smedt, Ann ; Moens, Maarten. / Functional magnetic resonance imaging : cerebral function alterations in subthreshold and suprathreshold spinal cord stimulation. In: Journal of Pain Research. 2018 ; Vol. 2018, No. 11. pp. 2517-2526.
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AU - Sunaert, Stefan

AU - Peeters, Ronald

AU - Loeckx, Dirk

AU - Goudman, Lisa

AU - Forget, Patrice

AU - De Smedt, Ann

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AB - Background and purpose: Failed back surgery syndrome (FBSS) is a common and devastating chronic neuropathic pain disorder. Conventional spinal cord stimulation (SCS) applies electrical suprathreshold pulses to the spinal cord at a frequency of 40–60 Hz and relieves pain in FBSS patients. During the last decade, two major changes have emerged in the techniques of stimulating the spinal cord: paresthesia-free or subthreshold stimulation and administration of higher frequency or higher amounts of energy to the spinal cord. Despite the positive clinical results, the mechanism of action remains unclear. A functional MRI (fMRI) study was conducted to investigate the brain alterations during subthreshold and suprathreshold stimulation at different frequencies. Methods: Ten subjects with FBSS, treated with externalized SCS, received randomly four different stimulation frequencies (4 Hz, 60 Hz, 500 Hz, and 1 kHz) during four consecutive days. At every frequency, the patient underwent sub-and suprathreshold stimulation. Cerebral activity was monitored and assessed using fMRI. Results: Suprathreshold stimulation is generally accompanied with more activity than subthreshold SCS. Suprathreshold SCS resulted in increased bilateral activation of the frontal cortex, thalamus, pre-and postcentral gyri, basal ganglia, cingulate gyrus, insula, thalamus, and claustrum. We observed deactivation of the bilateral parahippocampus, amygdala, precuneus, posterior cingulate gyrus, postcentral gyrus, and unilateral superior temporal gyrus. Conclusion: Suprathreshold stimulation resulted in greater activity (both activation and deactivation) of the frontal brain regions; the sensory, limbic, and motor cortices; and the diencephalon in comparison with subthreshold stimulation. Each type of frequency at suprathreshold stimulation was characterized by an individual activation pattern.

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