Motor and parietal cortex stimulation for phantom limb pain and sensations
Motor and parietal cortex stimulation for phantom limb pain and sensations
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DOI：
10.1016/j.pain.2013.03.040
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发表时间：
2013-08-01
期刊：
影响因子：
7.4
通讯作者：
Fregni, Felipe
中科院分区：
文献类型：
--
作者：
Bolognini, Nadia;Olgiati, Elena;Fregni, Felipe
截肢可能会导致慢性疼痛的感觉，涉及到缺席的肢体，即幻肢痛（PLP），这可能是由适应不良的可塑性。本研究调查了经颅直流电刺激（tDCS），一种可以调节神经可塑性的非侵入性脑刺激技术，是否可以减少PLP。在单侧下肢或上肢截肢受试者中进行的2项双盲、假对照实验中，我们测量了初级运动皮层（M1）和后顶叶皮层（PPC）的单次tDCS（2 mA，15 min）对PLP、残端疼痛、无痛幻肢感觉和伸缩的影响。M1的阳极tDCS诱导PLP的选择性短暂减少，而PPC的阴极tDCS诱导非疼痛性幻肢感觉的选择性短暂减少;残端疼痛和伸缩不受顶叶或运动tDCS的影响。这些发现表明，疼痛和非疼痛的幻肢感觉是分离的现象。PLP主要与感觉运动网络中的皮质兴奋性变化相关;通过阳极tDCS增加该系统中的兴奋性对PLP具有镇痛作用。相反，非疼痛性幻肢感觉与PPC的过度兴奋相关，可通过阴极tDCS正常化。这一证据突出了不同皮层区域的兴奋性水平之间的关系，这是截肢后适应不良可塑性和幻肢现象学的基础，它为使用tDCS治疗PLP开辟了新的机会。(C)2013年国际疼痛研究协会。Elsevier B. V.出版，保留所有权利。
Limb amputation may lead to chronic painful sensations referred to the absent limb, ie phantom limb pain (PLP), which is likely subtended by maladaptive plasticity. The present study investigated whether transcranial direct current stimulation (tDCS), a noninvasive technique of brain stimulation that can modulate neuroplasticity, can reduce PLP. In 2 double-blind, sham-controlled experiments in subjects with unilateral lower or upper limb amputation, we measured the effects of a single session of tDCS (2 mA, 15 min) of the primary motor cortex (M1) and of the posterior parietal cortex (PPC) on PLP, stump pain, nonpainful phantom limb sensations and telescoping. Anodal tDCS of M1 induced a selective short-lasting decrease of PLP, whereas cathodal tDCS of PPC induced a selective short-lasting decrease of nonpainful phantom sensations; stump pain and telescoping were not affected by parietal or by motor tDCS. These findings demonstrate that painful and nonpainful phantom limb sensations are dissociable phenomena. PLP is associated primarily with cortical excitability shifts in the sensorimotor network; increasing excitability in this system by anodal tDCS has an antalgic effect on PLP. Conversely, nonpainful phantom sensations are associated to a hyperexcitation of PPC that can be normalized by cathodal tDCS. This evidence highlights the relationship between the level of excitability of different cortical areas, which underpins maladaptive plasticity following limb amputation and the phenomenology of phantom limb, and it opens up new opportunities for the use of tDCS in the treatment of PLP. (C) 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.