Complete resolution of postherpetic neuralgia following pallidotomy: case report

View More View Less
  • 1 Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada;
  • 2 Department of Neurosurgery, University Hospitals Leuven, Vlaams-Brabant, Belgium;
  • 3 Department of Physiology, Toronto Western Hospital and University of Toronto, Ontario, Canada;
  • 4 Krembil Research Institute, University of Toronto, Ontario, Canada; and
  • 5 Division of Neurology, The Edmond J. Safra Program in Parkinson’s Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network Toronto, Ontario, Canada
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

The authors report on a female patient with left-dominant Parkinson’s disease with motor fluctuations and levodopa-induced dyskinesias and comorbid postherpetic neuralgia (PHN), who underwent a right-sided pallidotomy. Besides a substantial improvement in her Parkinson’s symptoms, she reported an immediate and complete disappearance of PHN. This neuralgia had been long-standing, pharmacologically refractory, and severe (preoperative Brief Pain Inventory [BPI] pain severity score of 8.0, BPI pain interference score of 7.3, short-form McGill Pain Questionnaire sensory pain rating index of 7 and affective pain rating index of 10, Present Pain Intensity rank value of 4, and visual analog scale score of 81 mm; all postoperative scores were 0). She continued to be pain free at 16 months postoperatively.

This peculiar finding adds substantially to the largely unrecognized evidence for the role of the pallidum in pain processing, based on previous electrophysiological, metabolic, anatomical, pharmacological, and clinical observations. Therefore, the potential of the pallidum as a neurosurgical target for neuropathic pain warrants further investigation.

ABBREVIATIONS BPI = Brief Pain Inventory; DBS = deep brain stimulation; GPi = globus pallidus internus; LEDD = levodopa equivalent daily dose; MCS = motor cortex stimulation; PD = Parkinson’s disease; PHN = postherpetic neuralgia; UDysRS = Unified Dyskinesia Rating Scale; UPDRS III = Unified Parkinson’s Disease Rating Scale Part III.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Philippe De Vloo: Toronto Western Hospital, University Health Network, Toronto, ON, Canada. philippe.devloo@kuleuven.be.

INCLUDE WHEN CITING Published online September 27, 2019; DOI: 10.3171/2019.7.JNS191050.

Disclosures Dr. De Vloo is supported by Research Foundation-Flanders (FWO G0A5513N), the 2016 Research Grant of the European Society for Stereotactic and Functional Neurosurgery, and the Helaers Foundation; and has received grants for education and travel from the EANS, FWO, KU Leuven, Medtronic, Boston Scientific, and St. Jude-Abbott. Dr. Fasano has received consultancies and honoraria from AbbVie, Medtronic, Boston Scientific, Sunovion, Chiesi Farmaceutici, UCB, and Ipsen; is on the advisory board of AbbVie, Boston Scientific, and Ipsen; has received research grants from the University of Toronto, the Weston Foundation, AbbVie, Medtronic, and Boston Scientific. Dr. Lozano has received consultancies, speaker’s fees, and research grants from Medtronic, Boston Scientific, St. Jude-Abbott, and Insightec.

  • 1

    Anagnostakis Y, Zis V, Spyraki C: Analgesia induced by morphine injected into the pallidum. Behav Brain Res 48:135143, 1992

  • 2

    Becerra L, Breiter HC, Wise R, Gonzalez RG, Borsook D: Reward circuitry activation by noxious thermal stimuli. Neuron 32:927946, 2001

    • Search Google Scholar
    • Export Citation
  • 3

    Becerra L, Morris S, Bazes S, Gostic R, Sherman S, Gostic J, : Trigeminal neuropathic pain alters responses in CNS circuits to mechanical (brush) and thermal (cold and heat) stimuli. J Neurosci 26:1064610657, 2006

    • Search Google Scholar
    • Export Citation
  • 4

    Beck T, Wenzel J, Kuschinsky K, Krieglstein J: Morphine-induced alterations of local cerebral glucose utilization in the basal ganglia of rats. Brain Res 497:205213, 1989

    • Search Google Scholar
    • Export Citation
  • 5

    Belasen A, Youn Y, Gee L, Prusik J, Lai B, Ramirez-Zamora A, : The effects of mechanical and thermal stimuli on local field potentials and single unit activity in Parkinson’s disease patients. Neuromodulation 19:698707, 2016

    • Search Google Scholar
    • Export Citation
  • 6

    Bernard JF, Huang GF, Besson JM: Nucleus centralis of the amygdala and the globus pallidus ventralis: electrophysiological evidence for an involvement in pain processes. J Neurophysiol 68:551569, 1992

    • Search Google Scholar
    • Export Citation
  • 7

    Boccard SGJ, Pereira EAC, Moir L, Aziz TZ, Green AL: Long-term outcomes of deep brain stimulation for neuropathic pain. Neurosurgery 72:221231, 2013

    • Search Google Scholar
    • Export Citation
  • 8

    Borsook D, Upadhyay J, Chudler EH, Becerra L: A key role of the basal ganglia in pain and analgesia—insights gained through human functional imaging. Mol Pain 6:27, 2010

    • Search Google Scholar
    • Export Citation
  • 9

    Braz JM, Nassar MA, Wood JN, Basbaum AI: Parallel “pain” pathways arise from subpopulations of primary afferent nociceptor. Neuron 47:787793, 2005

    • Search Google Scholar
    • Export Citation
  • 10

    Chudler EH: Response properties of neurons in the caudate-putamen and globus pallidus to noxious and non-noxious thermal stimulation in anesthetized rats. Brain Res 812:283288, 1998

    • Search Google Scholar
    • Export Citation
  • 11

    Chudler EH, Dong WK: The role of the basal ganglia in nociception and pain. Pain 60:338, 1995

  • 12

    Chudler EH, Sugiyama K, Dong WK: Nociceptive responses in the neostriatum and globus pallidus of the anesthetized rat. J Neurophysiol 69:18901903, 1993

    • Search Google Scholar
    • Export Citation
  • 13

    Coffey RJ: Deep brain stimulation for chronic pain: results of two multicenter trials and a structured review. Pain Med 2:183192, 2001

    • Search Google Scholar
    • Export Citation
  • 14

    Drolet M, Brisson M, Levin MJ, Schmader KE, Oxman MN, Johnson RW, : A prospective study of the herpes zoster severity of illness. Clin J Pain 26:656666, 2010

    • Search Google Scholar
    • Export Citation
  • 15

    Drolet M, Brisson M, Schmader K, Levin M, Johnson R, Oxman M, : Predictors of postherpetic neuralgia among patients with herpes zoster: a prospective study. J Pain 11:12111221, 2010

    • Search Google Scholar
    • Export Citation
  • 16

    Eggink H, Szlufik S, Coenen MA, van Egmond ME, Moro E, Tijssen MAJ: Non-motor effects of deep brain stimulation in dystonia: a systematic review. Parkinsonism Relat Disord 55:2644, 2018

    • Search Google Scholar
    • Export Citation
  • 17

    Favre J, Burchiel KJ, Taha JM, Hammerstad J: Outcome of unilateral and bilateral pallidotomy for Parkinson’s disease: patient assessment. Neurosurgery 46:344355, 2000

    • Search Google Scholar
    • Export Citation
  • 18

    Gauthier A, Breuer J, Carrington D, Martin M, Rémy V: Epidemiology and cost of herpes zoster and post-herpetic neuralgia in the United Kingdom. Epidemiol Infect 137:3847, 2009

    • Search Google Scholar
    • Export Citation
  • 19

    Gildenberg PL, Krauss JK: History of stereotactic surgery, in Lozano AM, Gildenberg PL, Tasker RR (eds): Textbook of Stereotactic and Functional Neurosurgery, ed 2. Berlin: Springer, 2009, pp 334

    • Search Google Scholar
    • Export Citation
  • 20

    Gracely RH, Petzke F, Wolf JM, Clauw DJ: Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis Rheum 46:13331343, 2002

    • Search Google Scholar
    • Export Citation
  • 21

    Green AL, Nandi D, Armstrong G, Carter H, Aziz T: Post-herpetic trigeminal neuralgia treated with deep brain stimulation. J Clin Neurosci 10:512514, 2003

    • Search Google Scholar
    • Export Citation
  • 22

    Hamani C, Fontaine D, Lozano AM: DBS for persistent non-cancer pain, in Lozano AM, Gildenberg PL, Tasker RR (eds): Textbook of Stereotactic and Functional Neurosurgery, ed 2. Berlin: Springer, 2009, pp 22272238

    • Search Google Scholar
    • Export Citation
  • 23

    Hamani C, Schwalb JM, Rezai AR, Dostrovsky JO, Davis KD, Lozano AM: Deep brain stimulation for chronic neuropathic pain: long-term outcome and the incidence of insertional effect. Pain 125:188196, 2006

    • Search Google Scholar
    • Export Citation
  • 24

    Hariz MI, Hariz GM: Therapeutic stimulation versus ablation. Handb Clin Neurol 116:6371, 2013

  • 25

    Honey CR, Stoessl AJ, Tsui JK, Schulzer M, Calne DB: Unilateral pallidotomy for reduction of parkinsonian pain. J Neurosurg 91:198201, 1999

    • Search Google Scholar
    • Export Citation
  • 26

    Insinga RP, Itzler RF, Pellissier JM, Saddier P, Nikas AA: The incidence of herpes zoster in a United States administrative database. J Gen Intern Med 20:748753, 2005

    • Search Google Scholar
    • Export Citation
  • 27

    Johnson RW, Rice ASC: Clinical practice. Postherpetic neuralgia. N Engl J Med 371:15261533, 2014

  • 28

    Jones AK, Brown WD, Friston KJ, Qi LY, Frackowiak RS: Cortical and subcortical localization of response to pain in man using positron emission tomography. Proc Biol Sci 244:3944, 1991

    • Search Google Scholar
    • Export Citation
  • 29

    Jones AK, Liyi Q, Cunningham VV, Brown DW, Ha-Kawa S, Fujiwara T, : Endogenous opiate response to pain in rheumatoid arthritis and cortical and subcortical response to pain in normal volunteers using positron emission tomography. Int J Clin Pharmacol Res 11:261266, 1991

    • Search Google Scholar
    • Export Citation
  • 30

    Kurklinsky S, Palmer SC, Arroliga MJ, Ghazi SM: Neuromodulation in postherpetic neuralgia: case reports and review of the literature. Pain Med 19:12371244, 2018

    • Search Google Scholar
    • Export Citation
  • 31

    Lee MC, Zambreanu L, Menon DK, Tracey I: Identifying brain activity specifically related to the maintenance and perceptual consequence of central sensitization in humans. J Neurosci 28:1164211649, 2008

    • Search Google Scholar
    • Export Citation
  • 32

    Leite-Almeida H, Valle-Fernandes A, Almeida A: Brain projections from the medullary dorsal reticular nucleus: an anterograde and retrograde tracing study in the rat. Neuroscience 140:577595, 2006

    • Search Google Scholar
    • Export Citation
  • 33

    Loher TJ, Burgunder JM, Weber S, Sommerhalder R, Krauss JK: Effect of chronic pallidal deep brain stimulation on off period dystonia and sensory symptoms in advanced Parkinson’s disease. J Neurol Neurosurg Psychiatry 73:395399, 2002

    • Search Google Scholar
    • Export Citation
  • 34

    Lozano AM, Hutchison WD: Microelectrode recordings in the pallidum. Mov Disord 17 (Suppl 3):S150S154, 2002

  • 35

    Ostergard T, Munyon C, Miller JP: Motor cortex stimulation for chronic pain. Neurosurg Clin N Am 25:693698, 2014

  • 36

    Pereira EAC, Aziz TZ: Neuropathic pain and deep brain stimulation. Neurotherapeutics 11:496507, 2014

  • 37

    Schneider JS, Morse JR, Lidsky TI: Somatosensory properties of globus pallidus neurons in awake cats. Exp Brain Res 46:311314, 1982

  • 38

    Schvarcz JR: Craniofacial postherpetic neuralgia managed by stereotactic spinal trigeminal nucleotomy. Acta Neurochir Suppl (Wien) 46:6264, 1989

    • Search Google Scholar
    • Export Citation
  • 39

    Watson CP: Postherpetic neuralgia: Are there neurosurgical options? In Burchiel KJ (ed): Surgical Management of Pain, ed 2. New York: Thieme Medical Publishers, 2015, Vol 26, pp 260270

    • Search Google Scholar
    • Export Citation
  • 40

    Watson CP, Deck JH, Morshead C, Van der Kooy D, Evans RJ: Post-herpetic neuralgia: further post-mortem studies of cases with and without pain. Pain 44:105117, 1991

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 224 224 55
Full Text Views 44 44 11
PDF Downloads 20 20 2
EPUB Downloads 0 0 0