A case of central post-stroke pain with beneficial response to electroconvulsive therapy: a proton magnetic resonance spectroscopy study

We present a 58-year-old male chronic post-stroke central pain patient, whose pain resulted from left thalamic hemorrhage, and whose pain had failed to respond to standard pain treatment, but was resolved by electroconvulsive therapy (ECT). To investigate the potential role of neural function in ECT's analgesic effect, the patient underwent a proton magnetic resonance spectroscopy (H-1-MRS) on a 2 x 2 x 2 cm voxel in the thalamus bilaterally before and after a course of unilateral ECT. The N-acetylaspartate-to-creatine (NAA/Cr) ratio, which reflects neural function, was calculated on the voxel of the thalamus. Before ECT, the left to right thalamus NAA/Cr ratio was 62.3%. The NAA/Cr ratio of the left thalamus increased 32.0% after ECT, compared to the ratio before ECT. The results from the 1 H-MRS suggest that improvement of neural dysfunction in the thalamus may be related to the analgesic efficacy of ECT.