Perception of pain in the minimally conscious state with PET activation: an observational study
Perception of pain in the minimally conscious state with PET activation: an observational study
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DOI：
10.1016/s1474-4422(08)70219-9
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发表时间：
2008-11-01
期刊：
影响因子：
48
通讯作者：
Laureys, Steven
中科院分区：
文献类型：
--
作者：
Boly, Melanie;Faymonville, Marie-Elisabeth;Laureys, Steven
背景处于最低意识状态（MCS）的患者表现出有限的自我或环境意识，但无法持续可靠地进行沟通。因此，更好地了解这些患者的大脑伤害性处理具有临床，治疗，方法我们研究了5例MCS患者双侧正中神经电刺激引起的脑激活（18-74岁）与15名对照组相比（19-64岁）和15例患者（19-75岁）处于持续性植物状态（PVS）的患者，采用O-15-放射性标记的水PET。我们还研究了患者和对照组的初级躯体感觉皮层（S1）的功能连接。MCS患者在入院后57天（SD 33）进行扫描，PVS患者在入院后36（9）天进行扫描。MCS患者的刺激强度为8.6（SD 6.7）mA，对照组为7.4（5.9）mA，PVS患者为14.2（8.7）mA。显著的结果阈值小于0.05的p值，并纠正了多重comparation.Findings在MCS和对照组的患者中，伤害性刺激激活丘脑，S1，和次级体感或岛叶，额顶叶，前扣带皮层（称为疼痛矩阵）。MCS患者中没有任何区域的激活低于对照组。皮质疼痛矩阵的所有领域表现出更大的激活MCS患者比PVS。最后，与PVS的患者相比，那些在MCS保留了S1和广泛的皮质网络，包括额顶叶联合cortices.Interpretation大脑之间的功能连接疼痛处理的相关性被发现在一个类似的网络中的控制和MCS的患者，但更广泛的比在PVS的患者。这些发现可能是MCS患者潜在疼痛感知能力的客观证据，这支持了这些患者需要镇痛治疗的观点。
Background Patients in a minimally conscious state (MCS) show restricted self or environment awareness but are unable to communicate consistently and reliably. Therefore, better understanding of cerebral noxious processing in these patients is of clinical, therapeutic, and ethical relevance.Methods We studied brain activation induced by bilateral electrical stimulation of the median nerve in five patients in MCS (aged 18-74 years) compared with 15 controls (19-64 years) and 15 patients (19-75 years) in a persistent vegetative state (PVS) with O-15-radiolabelled water PET By way of psychopbysiological interaction analysis, we also investigated the functional connectivity of the primary somatosensory cortex (S1) in patients and controls. Patients in MCS were scanned 57 (SD 33) days after admission, and patients in PVS 36 (9) days after admission. Stimulation intensifies were 8.6 (SD 6.7) mA in patients in MCS, 7.4 (5.9) mA in controls, and 14.2 (8.7) mA in patients in PVS. Significant results were thresholded at p values of less than 0.05 and corrected for multiple comparisons.Findings In patients in MCS and in controls, noxious stimulation activated the thalamus, S1, and the secondary somatosensory or insular, frontoparietal, and anterior cingulate cortices (known as the pain matrix). No area was less activated in the patients in MCS than in the controls. All areas of the cortical pain matrix showed greater activation in patients in MCS than in those in PVS. Finally, in contrast with patients in PVS, those in MCS had preserved functional connectivity between S1 and a widespread cortical network that includes the frontoparietal associative cortices.Interpretation Cerebral correlates of pain processing are found in a similar network in controls and patients in MCS but are much more widespread than in patients in PVS. These findings might be objective evidence of a potential pain perception capacity in patients in MCS, which supports the idea that these patients need analgesic treatment.