Intraoperative smile in a multiple sclerosis patient with medication-refractory tremor.
Intraoperative smile in a multiple sclerosis patient with medication-refractory tremor.
复制标题
患有药物难治性震颤的多发性硬化症患者的术中微笑。
DOI：
10.1080/13554794.2013.841952
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发表时间：
2014
期刊：
影响因子：
0.8
通讯作者：
Okun,MichaelS
中科院分区：
文献类型：
--
作者：
Thompson,AmandaJ;Peng-Chen,Zhongxing;Pastrana,Marlon;Foote,KellyD;Haq,Ihtsham;Okun,MichaelS
深部脑刺激已被用于改善帕金森病、肌张力障碍、特发性震颤和其他神经精神综合征（如抑郁症和强迫症）患者的疾病症状。深部脑刺激也被观察到可以改善某些多发性硬化症患者的震颤。在这些多发性硬化症患者的术中刺激期间，研究人员观察到了广泛的运动和感觉现象，但没有刺激诱导的情绪反应的报道。我们详细描述了术中微笑与左丘脑腹侧口前/腹侧口后边缘区刺激的相关性，一例耐药型多发性硬化症震颤患者在术中刺激左丘脑时经历了微笑、大笑和主观欣快。具体而言，在术中刺激左侧丘脑腹侧口侧前缘期间，患者出现对侧微笑，然后发展为双侧微笑，并伴有主观幸福感。微笑在大约60秒内习惯化，并且在重复刺激下可再现。患者可以主观地感觉到面部运动，并且在较高电压下，该运动被描述为牵拉感觉。刺激多发性硬化症患者左侧丘脑的前腹口侧前缘，产生单侧微笑，并迅速发展为双侧微笑，伴有欣快感。在较高电压下存在假定的囊膜副作用。刺激丘脑产生微笑和情绪提升的确切机制尚不清楚，但我们推测微笑可能是由刺激连接对侧面神经核的尾侧扣带运动区的皮质延髓纤维引起的。
Deep brain stimulation has been utilized to improve disease symptoms in patients with Parkinson’s disease, dystonia, essential tremor, and other neuropsychiatric syndromes such as depression and obsessive compulsive disorder. Deep brain stimulation has also been observed to improve tremor for select patients with multiple sclerosis. During intraoperative stimulation in these multiple sclerosis patients, researchers have observed a wide spectrum of motor and sensory phenomena, but no stimulation-induced emotional responses have been reported. We detailed intraoperative smiling associated with stimulation of the ventralis oralis anterior/ventralis oralis posterior border region of the left thalamus. A single patient with medication-resistant multiple sclerosis tremor experienced smiling, laughing, and subjective euphoria during intraoperative stimulation of the left thalamus. Specifically, during intraoperative stimulation of the left thalamic ventralis oralis anterior border, the patient developed a contralateral smile which progressed to a bilateral smile and was accompanied by a feeling of subjective happiness. The smile habituated in approximately 60 seconds and it was reproducible on a repeat stimulation. The patient could subjectively feel the facial movement, and, at higher voltages, the movement was described as a pulling sensation. Stimulation of the anterior ventralis oralis anterior border of the left thalamus in an multiple sclerosis patient produced a unilateral smile that rapidly developed into a bilateral smile accompanied by euphoria. There were presumed capsular side effects at higher voltages. The exact mechanism by which stimulation of the thalamus produced a smile and mood elevation is unknown, but we speculate that the smile could be induced by stimulation of corticobulbar fibers arising from the caudal cingulate motor area connecting the contralateral facial nerve nucleus.