RELATIVE CHANGES IN REGIONAL CEREBRAL BLOOD-FLOW DURING SPINAL-CORD STIMULATION IN PATIENTS WITH REFRACTORY ANGINA-PECTORIS

Spinal cord stimulation applied at thoracic level 1 (T1) has a neurall y mediated anti-anginal effect based on antiischaemic action in the my ocardium. Positron emission tomography was used to study which higher brain centres are influenced by spinal cord stimulation. Nine patients with a spinal cord stimulator for angina pectoris were studied using (H2O)-O-15 as a flow tracer, Relative changes in regional cerebral blo od flow related to stimulation compared with non-stimulation were asse ssed and analysed using the method of statistical parametric mapping. increased regional cerebral blood flow was observed in the left ventro lateral periaqueductal grey, the medial prefrontal cortex [Brodmann ar ea (BA) 9/10], the dorsomedial thalamus bilaterally, the left medial t emporal gyrus (BA 21), the left pulvinar of the thalamus, bilaterally in the posterior caudate nucleus, and the posterior cingulate cortex ( BA 30). Relative decreases in rCBF were noticed bilaterally in the ins ular cortex (BA 20/21 and BA 38), the right inferior temporal gyrus (B A 19/37), the right inferior frontal gyrus (BA 45), the left inferior parietal lobulus (BA 40), the medial temporal gyrus (BA 39) and the ri ght anterior cingulate cortex (BA 24), it is concluded that spinal cor d stimulation used as an additional treatment for angina applied at T1 modulates regional cerebral blood flow in brain areas known to be ass ociated with nociception and in areas associated with cardiovascular c ontrol.