Objective: We present the first observation of deep brain stimulation (DBS) effects on spinal nociception as assessed by the nociceptive flection reflex (NFR) during DBS ON compared to DBS OFF in a patient with Parkinson´s disease (PD).

Background: In patients with PD, bilateral DBS of the nucleus subthalamicus (STN) often provides remarkable effects on clinical pain as well as experimental pain sensitivity [1, 2] presumably due to cortical mechanisms [3]. Whether DBS, like dopaminergic treatment [4], also increases descending inhibitory control has not yet been assessed.

Method: Spinal nociception was assessed by the NFR [5, 6] in a 48 years-old female patient with PD since 4 years. She had suffered from motor fluctuations and severe pain before STN-DBS implantation one months ago. NFR measurements were performed by using a recent method twice during DBS activation (before and after deactivation), and twice directly following deactivation. The NFR device employs 6.085 times the standard deviation of the noise signal as cut-off within a predefined time frame from 90-150ms for the RIII response [7]. The threshold was determined by logistic regression including the last 11 stimuli or by the raw data in case of late reflex appearance.

Results: Substantial differences of the NFR thresholds between active and inactive STN-DBS were seen (DBS ON: 20 mA DBS OFF: 11.3 mA) with similar pain reports (responses) (3-3.5, numeric rating scale) at both intensities.

Conclusion: This first data showed that DBS of the STN has a large impact on spinal nociception presumably explaining its clinical effects on PD-related pains. This single observation needs to be confirmed in more PD patients with pain in order to describe the conditions for DBS to have an effect on pain.

References: 1. Cury, R.G., et al., Effects of deep brain stimulation on pain and other nonmotor symptoms in Parkinson disease. Neurology, 2014. 83(16): p. 1403-9.
2. Cury, R.G., et al., Subthalamic deep brain stimulation modulates conscious perception of sensory function in Parkinson’s disease. Pain, 2016. 157(12): p. 2758-2765.
3. DiMarzio, M., et al., Functional MRI Signature of Chronic Pain Relief From Deep Brain Stimulation in Parkinson Disease Patients. Neurosurgery, 2019. 85(6): p. E1043-E1049.
4. Gerdelat-Mas, A., et al., Levodopa raises objective pain threshold in Parkinson’s disease: a RIII reflex study. J Neurol Neurosurg Psychiatry, 2007. 78(10): p. 1140-2.
5. Mylius, V., et al., Pain sensitivity and clinical progression in Parkinson’s disease. Mov Disord, 2011. 26(12): p. 2220-5.
6. Mylius, V., et al., Pain sensitivity and descending inhibition of pain in Parkinson’s disease. J Neurol Neurosurg Psychiatry, 2009. 80(1): p. 24-8.
7. von Dincklage, F., et al., Introduction of a continual RIII reflex threshold tracking algorithm. Brain Res, 2009. 1260: p. 24-9.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/deep-brain-stimulation-increases-descending-inhibitory-control-in-a-patient-with-parkinsons-disease-and-pain/