• Marisa DiMarzio, Tanweer Rashid, Ileana Hancu, Eric Fiveland, Julia Prusik, Michael Gillogly, Radhika Madhavan, Suresh Joel, Jennifer Durphy, Eric Molho, Era Hanspal, Damian Shin, and Julie G Pilitsis.
• Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York.
• Neurosurgery. 2019 Dec 1; 85 (6): E1043-E1049.

BackgroundChronic pain occurs in 83% of Parkinson disease (PD) patients and deep brain stimulation (DBS) has shown to result in pain relief in a subset of patients, though the mechanism is unclear.ObjectiveTo compare functional magnetic resonance imaging (MRI) data in PD patients with chronic pain without DBS, those whose pain was relieved (PR) with DBS and those whose pain was not relieved (PNR) with DBS.MethodsFunctional MRI (fMRI) with blood oxygen level-dependent activation data was obtained in 15 patients in control, PR, and PNR patients. fMRI was obtained in the presence and absence of a mechanical stimuli with DBS ON and DBS OFF. Voxel-wise analysis using pain OFF data was used to determine which regions were altered during pain ON periods.ResultsAt the time of MRI, pain was scored a 5.4 ± 1.2 out of 10 in the control, 4.25 ± 1.18 in PNR, and 0.8 ± 0.67 in PR cohorts. Group analysis of control and PNR groups showed primary somatosensory (SI) deactivation, whereas PR patients showed thalamic deactivation and SI activation. DBS resulted in more decreased activity in PR than PNR (P < .05) and more activity in anterior cingulate cortex (ACC) in PNR patients (P < .05).ConclusionPatients in the control and PNR groups showed SI deactivation at baseline in contrast to the PR patients who showed SI activation. With DBS ON, the PR cohort had less activity in SI, whereas the PNR had more anterior cingulate cortex activity. We provide pilot data that patients whose pain responds to DBS may have a different fMRI signature than those who do not, and PR and PNR cohorts produced different brain responses when DBS is employed.Copyright © 2019 by the Congress of Neurological Surgeons.

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