First In-Human Experience: Deep Brain Stimulation of Subgenual Cingulate Cortex for Chronic Low Back Pain

Saturday, May 4, 2024

4:30 PM – 4:32 PM CT

Location: S405b

Presenting Author(s)

Ausaf Bari, MD PhD FAANS FACS (he/him/his)

Associate Professor
University of California Los Angeles
Los Angeles, CA, US

Co-Author(s)

MW

Michael J. Ward

Medical Student
University of California Los Angeles
Los Angeles, CA, US
Nader Pouratian, MD/PhD

Professor, Chair of Neurological Surgery
UT Southwestern Medical Center
Dallas, TX, US
MT

Meskerem Tolossa, n/a

Lab Coordinator
University of California Los Angeles
Los Angeles, California, United States
ET

Evangelia Tsolaki, PhD

Project Scientist
University of California Los Angeles
Los Angeles, California, United States
WW

Wenxin Wei, n/a

Lab Coordinator
University of California Los Angeles, United States

Disclosure(s):

Ausaf Bari, MD PhD FAANS FACS: Abbott: Grant/Research Support (Ongoing); Boston Scientific: Grant/Research Support (Ongoing); Medtronic: Consultant (Ongoing), Grant/Research Support (Ongoing), Speaker/Honoraria (Ongoing)

Nader Pouratian, MD/PhD: Abbott Laboratories: Consultant (Ongoing); Sensoria Therapeutics: Consultant (Ongoing)

Introduction: Chronic low back pain (CLBP) is a global public health problem and contributor to the opioid epidemic. Accumulating neuroimaging evidence has characterized an association between CLBP and affective neural networks, suggesting CLBP is a disorder of brain circuitry. Given that these networks have known connections to the subgenual cingulate cortex (SCC), we propose that it may serve as a target for deep brain stimulation (DBS) to control CLBP. Here, we present 6-month outcomes from the first in-human trial of DBS of the SCC for CLBP.

Methods: A 50-year-old male with a history of medically refractory CLBP underwent stereotactic implantation of bilateral SCC DBS electrodes and placement of an implantable pulse generator. Probabilistic tractography was used to target the SCC region with connectivity to a combination of participant-specific white matter fibers associated with affective neural networks. Stimulation-related side effects were ruled out using awake intraoperative testing. Participant-reported outcome measures were collected pre- and postoperatively using a Visual Analog Scale (VAS), Pain Anxiety Symptom Scale (PASS SF-20), Oswestry Disability Index (ODI), SF-36 Health Survey, and prescription opioid use was assessed.

Results: The participant tolerated surgery without adverse effects or complications. At the 6-month visit, the VAS pain rating decreased from 8 to 2, PASS-20 improved by 86%, ODI decreased by 90%, and SF-36 demonstrated substantial improvement across all quality of life categories. Opioid frequency and average daily dose were both reduced by 95%. VAS decreased to 0 when reassessed during titration of stimulation parameters. Final stimulation settings were: Left SCC: 4.4 mA, 90 microseconds, 130 Hz, contact 2 negative, case positive, Right SCC: 4.4 mA, 90 microseconds, 130 Hz, contact 10 negative, case positive.

Conclusion : These preliminary results from the first in-human DBS implantation of SCC for CLBP suggest that it is a promising target for refractory chronic low back pain and associated opioid addiction.