Stimulation of the human cortex and the experience of pain: Wilder Penfield's observations revisited
Stimulation of the human cortex and the experience of pain: Wilder Penfield's observations revisited
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DOI：
10.1093/brain/awr265
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发表时间：
2012-02-01
期刊：
影响因子：
14.5
通讯作者：
Mauguiere, Francois
中科院分区：
文献类型：
--
作者：
Mazzola, Laure;Isnard, Jean;Mauguiere, Francois
由于怀尔德·格雷夫斯·彭菲尔德(Wilder Graves Penfield，1891-1976)在蒙特利尔神经研究所的开创性工作，电刺激在全球范围内被用于定位致痫皮质，并在癫痫手术或病变切除的背景下绘制出功能清晰的区域图。在彭菲尔德通过刺激大脑皮层表面对人类大脑皮层进行了20年的仔细探索后，他描述了基本反应和经验反应的功能图，彭菲尔德没有发现任何“疼痛皮质区”。我们重新研究了这个问题，分析了在连续164名癫痫患者的术前评估期间，在所有皮质叶植入电极超过12年的情况下，对4160次皮质刺激的主观和录像行为反应。疼痛反应很少(1.4%)，集中在顶盖内侧部分和邻近的岛后，痛阈值表现为吻尾减少。在顶盖切除后，Penfield术中对皮质表面的刺激仍然很大程度上无法到达这个深皮质区域。它也不同于Penfield等人描述的主要感觉区域。从这个意义上说，在我们的刺激模式下，疼痛只占反应的10%。像Penfield等人一样，我们在大脑皮层的任何其他地方都没有得到疼痛反应，包括在大多数功能成像研究中持续被疼痛激活的区域，即第一体感区域、第二体感区域的外侧部分、扣带回的前部和中部(中扣带皮质)、额叶的前部、顶叶的后部和辅助运动区。因此，内侧顶盖和后脑岛是电刺激能够触发疼痛皮质网络激活从而体验躯体疼痛的唯一区域。
Thanks to the seminal work of Wilder Graves Penfield (1891-1976) at the Montreal Neurological Institute, electrical stimulation is used worldwide to localize the epileptogenic cortex and to map the functionally eloquent areas in the context of epilepsy surgery or lesion resections. In the functional map of elementary and experiential responses he described through > 20 years of careful exploration of the human cortex via stimulation of the cortical surface, Penfield did not identify any 'pain cortical area'. We reinvestigated this issue by analysing subjective and videotaped behavioural responses to 4160 cortical stimulations using intracerebral electrodes implanted in all cortical lobes that were carried out over 12 years during the presurgical evaluation of epilepsy in 164 consecutive patients. Pain responses were scarce (1.4%) and concentrated in the medial part of the parietal operculum and neighbouring posterior insula where pain thresholds showed a rostrocaudal decrement. This deep cortical region remained largely inaccessible to the intraoperative stimulation of the cortical surface carried out by Penfield after resection of the parietal operculum. It differs also from primary sensory areas described by Penfield et al. in the sense that, with our stimulation paradigm, pain represented only 10% of responses. Like Penfield et al., we obtained no pain response anywhere else in the cortex, including in regions consistently activated by pain in most functional imaging studies, i.e. the first somatosensory area, the lateral part of the secondary somatosensory area, anterior and mid-cingulate gyri (mid-cingulate cortex), anterior frontal, posterior parietal and supplementary motor areas. The medial parietal operculum and posterior insula are thus the only areas where electrical stimulation is able to trigger activation of the pain cortical network and thus the experience of somatic pain.