Significant clinical improvement after anterior limb of the internal capsule/Ventral striatum- 8-contact DBS for post stroke central pain: two cases report

Background and Importance:
Central poststroke pain (CPSP) is the most common form of central neuropathic pain characterized by sensory abnormalities and disability. There is evidence of a paramount role of ventral striatum (VS) and limbic connections (anterior limb of the internal capsule-ALIC) in the emotional components of pain, although with unclear conclusions about ALIC/VS neuromodulation. Here, we report two cases of patients with CPSP who underwent unilateral ALIC/VS DBS and were follow-up during two years.
Clinical Presentation:
The first case is a 59 years-old woman with a medical history of two ischemic stroke that injured the right thalamus and mesencephalon. She developed untreatable CPSP in the left dimidium. Considering that the anatomy of classical targets for chronic central pain was grossly altered, the ALIC/VS target was selected.
The second case is a 68 years-old man with complaints of persistent pain and allodynia after recurrent ischemic stroke in the right thalamus, occipital lobe and frontal cortex. The same procedure was also performed in this patient.
Pain relief was noted during the procedure and was sustained up to the last follow-up visit (2 yr) in both patients. Scores in Mcgill questionnaire scores were decreased, concomitant improvement in all domains of SF-36 scale and reduction in medication consumption after the surgery.
Conclusion: In the present cases, VS/ALIC DBS provides adequate control of refractory CPSP, improving quality of life, neuropathic pain scores and modulates the affective components of pain up to 2-yr follow-up. VS/ALIC is a promising target for CPSP, mainly in the affective components of pain, however, further investigations are advisable.

Dolor central, dolor neuropatico, estimulación cerebral profunda.

DBS, Central Pain Poststroke, neuropathic pain