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American Society for Action on Pain

UI - 000052

AU - Baskin DS

AU - Mehler WR

AU - Hosobuchi Y

AU - Richardson DE

AU - Adams JE

AU - Flitter MA

TI - Autopsy analysis of the safety, efficacy and cartography of electrical stimulation of the central gray in humans

AB - Electrical brain stimulation is effective in controlling certain intractable chronic pain syndromes in

humans, but the specific target site(s) for stimulation producing a maximal analgesic effect is (are) not well

defined. This prospective study correlates the clinical results of chronic stimulation of the periaqueductal

gray (PAG) and periventricular gray (PVG) matter in humans with the anatomic site of electrode placement

as determined at autopsy, and documents the histologic reactions to electrode implantation and electrical

stimulation of the area. Seven patients underwent electrode implantation to control their chronic pain; two

had electrodes implanted bilaterally. All patients obtained complete analgesia with stimulation, although 3

subsequently found the stimulation to have diminished efficacy. The opiate antagonist naloxone reversed the

analgesia in the 4 patients so tested. All 7 patients later died of causes unrelated to electrode implantation or

stimulation. Postmortem analysis showed that, for 6 of the 9 electrodes implanted, the electrode tip was

located in the ventrolateral PAG at the level of the posterior commissure; the other 3 electrodes were found

in the white matter adjacent to the PAG. No evidence of gliosis or parenchymal reaction was observed along

the tracts and tips of the electrodes. The results indicate that the ventrolateral PAG and PVG matter at the

level of the posterior commissure is the optimal site for therapeutic electrical brain stimulation for opiate-

responsive pain in humans

SO - Brain Research 1986;371:231-236