Motor cortex stimulation in neuropathic pain. Correlations between analgesic effect and hemodynamic changes in the brain. A PET study

被引:206
作者
Peyron, Roland
Faillenot, Isabelle
Mertens, Patrick
Laurent, Bernard
Garcia-Larrea, Luis
机构
[1] CHU St Etienne, Dept Neurol, St Etienne, France
[2] CHU St Etienne, Dept Pain Ctr, St Etienne, France
[3] CHU Lyon, Dept Neurosurg, Lyon, France
[4] CERMEP, Lyon, France
[5] Univ Lyon 1, INSERM, U342, F-69003 Lyon, France
[6] Univ St Etienne, F-4200 St Etienne, France
关键词
neuropathic pain; motor cortex stimulation; PET; ACC; PAG;
D O I
10.1016/j.neuroimage.2006.08.037
中图分类号
Q189 [神经科学];
学科分类号
071006 ;
摘要
To investigate brain mechanisms whereby electrical stimulation of the motor cortex (MCS) may induce pain relief in patients with neuropathic pain, cerebral blood flow (CBF) changes were studied using H2O PET in 19 consecutive patients treated with MCS for refractory neuropathic pain. Patients were studied in three conditions, (a) before MCS (Baseline, stimulator stopped 4 weeks before), (b) during a 35-min period of MCS and (c) during a 75-min period after MCS had been discontinued (OFF). Compared to Baseline, turning on the stimulator was associated with CBF increase in the contralateral (anterior) midcingulate cortex (aMCC, BA24 and 32) and in the dorso-lateral prefrontal (BA10) cortices. The most important changes of CBF were observed in the 75 min after discontinuation of MCS (OFF). This post-stimulation period was associated with CBF increases in a large set of cortical and subcortical regions (from posterior MCC (pMCC) to pregenual (pg) ACC, orbitufrontal cortex, putamen, thalami, posterior cingulate and prefrontal areas) and in the brainstem (mesencephalon/periaqueductal grey (PAG) and pons). CBF changes in the post-stimulation period correlated with pain relief. Functional connectivity analysis showed significant correlation between pgACC and PAG, basal ganglia, and lower pons activities, supporting the activation of descending ACC-to-PAG connections. MCS may act in part through descending (top-down) inhibitory controls that involve prefrontal, orbitofrontal and ACC as well as basal ganglia, thalamus and brainstem. These hemodynamic changes are lengthened and might therefore underlie the long-lasting clinical effects that largely outlast the actual stimulation periods. (c) 2006 Elsevier Inc. All rights reserved.
引用
收藏
页码:310 / 321
页数:12
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