Prof. Tipu Z. Azizibro
Research Interests are the role of the upper brain stem in the control of movement, the clinical neurophysiology of movement disorders and neuropathic pain and autonomic responses to deep brain stimulation, use of MR and MEG imaging in functional neurosurgery.
Lecture: Deep brain stimulation for pain
Abstract: Deep brain stimulation (DBS) is a neurosurgical intervention whose efficacy, safety and utility have been shown in the treatment of movement disorders. For the treatment of chronic pain refractory to medical therapies, many prospective case series have been reported, but few have published findings from patients treated during the last decade using current standards of neuroimaging and stimulator technology. We summarise the history, science, selection, assessment, surgery and personal clinical experience of DBS of the ventral posterior thalamus, periventricular / periaqueductal grey matter and latterly rostral anterior cingulate cortex (Cg24) in 100 patients treated now at two centres (John Radcliffe, Oxford and Hospital de São João, Porto) over 12 years.
Several experienced centres continue DBS for chronic pain with success in selected patients, in particular those with pain after amputation, brachial plexus injury, stroke and cephalalgias including anaesthesia dolorosa. Other successes include pain after multiple sclerosis and spine injury. Somatotopic coverage during awake surgery is important in our technique, with cingulate DBS considered for whole body pain or after unsuccessful DBS of other targets.
Findings discussed from neuroimaging modalities, invasive neurophysiological insights from local field potential recording and autonomic assessments may translate into improved patient selection and enhanced efficacy, encouraging larger clinical trials.