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Addressing Dual Disorders in a Medium-Term Admission Unit
Case Report

Personalizing Dual-Target Cortical Stimulation with Bayesian Parameter Optimization Successfully Treats Central Post-Stroke Pain: A Case Report

1
Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
2
Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical Center, Minneapolis, MN 55454, USA
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Department of Neurosurgery, University of Minnesota Medical Center, Minneapolis, MN 55455, USA
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Department of Anesthesiology, University of Minnesota Medical Center, Minneapolis, MN 55455, USA
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Department of Diagnostic & Biological Sciences, School of Dentistry, Minneapolis, MN 55455, USA
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Department of Radiology, Medical School, Minneapolis, MN 55455, USA
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Department of Neurology, University of Minnesota Medical Center, Minneapolis, MN 55455, USA
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Academic Editor: Shapour Jaberzadeh
Brain Sci. 2022, 12(1), 25; https://doi.org/10.3390/brainsci12010025
Received: 1 December 2021 / Revised: 22 December 2021 / Accepted: 22 December 2021 / Published: 26 December 2021
(This article belongs to the Section Neuroscience of Pain)
Central pain disorders, such as central post-stroke pain, remain clinically challenging to treat, despite many decades of pharmacological advances and the evolution of neuromodulation. For treatment refractory cases, previous studies have highlighted some benefits of cortical stimulation. Recent advances in new targets for pain and the optimization of neuromodulation encouraged our group to develop a dual cortical target approach paired with Bayesian optimization to provide a personalized treatment. Here, we present a case report of a woman who developed left-sided facial pain after multiple thalamic strokes. All previous pharmacologic and interventional treatments failed to mitigate the pain, leaving her incapacitated due to pain and medication side effects. She subsequently underwent a single burr hole for placement of motor cortex (M1) and dorsolateral prefrontal cortex (dlPFC) paddles for stimulation with externalization. By using Bayesian optimization to find optimal stimulation parameters and stimulation sites, we were able to reduce pain from an 8.5/10 to a 0/10 during a 5-day inpatient stay, with pain staying at or below a 2/10 one-month post-procedure. We found optimal treatment to be simultaneous stimulation of M1 and dlPFC without any evidence of seizure induction. In addition, we found no worsening in cognitive performance during a working memory task with dlPFC stimulation. This personalized approach using Bayesian optimization may provide a new foundation for treating central pain and other functional disorders through systematic evaluation of stimulation parameters. View Full-Text
Keywords: cortical stimulation; stroke; chronic pain; electrophysiology; optimization cortical stimulation; stroke; chronic pain; electrophysiology; optimization
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MDPI and ACS Style

Dastin-van Rijn, E.M.; König, S.D.; Carlson, D.; Goel, V.; Grande, A.; Nixdorf, D.R.; Benish, S.; Widge, A.S.; Nahas, Z.; Park, M.C.; Netoff, T.I.; Herman, A.B.; Darrow, D.P. Personalizing Dual-Target Cortical Stimulation with Bayesian Parameter Optimization Successfully Treats Central Post-Stroke Pain: A Case Report. Brain Sci. 2022, 12, 25. https://doi.org/10.3390/brainsci12010025

AMA Style

Dastin-van Rijn EM, König SD, Carlson D, Goel V, Grande A, Nixdorf DR, Benish S, Widge AS, Nahas Z, Park MC, Netoff TI, Herman AB, Darrow DP. Personalizing Dual-Target Cortical Stimulation with Bayesian Parameter Optimization Successfully Treats Central Post-Stroke Pain: A Case Report. Brain Sciences. 2022; 12(1):25. https://doi.org/10.3390/brainsci12010025

Chicago/Turabian Style

Dastin-van Rijn, Evan M., Seth D. König, Danielle Carlson, Vasudha Goel, Andrew Grande, Donald R. Nixdorf, Sarah Benish, Alik S. Widge, Ziad Nahas, Michael C. Park, Tay I. Netoff, Alexander B. Herman, and David P. Darrow. 2022. "Personalizing Dual-Target Cortical Stimulation with Bayesian Parameter Optimization Successfully Treats Central Post-Stroke Pain: A Case Report" Brain Sciences 12, no. 1: 25. https://doi.org/10.3390/brainsci12010025

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