DIFFUSE NOXIOUS INHIBITORY CONTROLS IN MAN - INVOLVEMENT OF THE SPINORETICULAR TRACT
DIFFUSE NOXIOUS INHIBITORY CONTROLS IN MAN - INVOLVEMENT OF THE SPINORETICULAR TRACT
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DOI：
10.1093/brain/113.4.1223
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发表时间：
1990-08-01
期刊：
影响因子：
14.5
通讯作者：
LEBARS, D
中科院分区：
文献类型：
--
作者：
DEBROUCKER, T;CESARO, P;LEBARS, D
在正常受试者中，异位疼痛刺激诱导疼痛感觉和由腓肠神经的电刺激诱发的脊髓伤害性屈曲（RIII）反射的同时和平行降低。这种对RIII反射的抑制在临床上完全脊髓横断的四肢瘫痪患者中未见，表明脊髓上结构参与了这种类型的抑制，通过“弥漫性伤害抑制控制”（DNIC）介导。在本研究中，异位伤害性刺激对RIII反射的影响进行了研究，在3例单侧丘脑血管病变和3例Wallenberg综合征（WS）。在前者中，在正常受试者中，施加到镇痛手的伤害性电条件反射刺激产生了深刻的抑制RIII反射，然后是持久的后遗症。在WS患者中未观察到抑制。同样的条件反射程序适用于非镇痛手的WS患者产生的抑制和后效应类似于在正常受试者中观察到的。事实上，在丘脑病变的患者中，有害但非疼痛的刺激触发了DNIC，排除了第二个疼痛焦点掩盖疼痛主要是由于注意过程的可能性。它还得出结论，丘系和脊髓丘脑通路不参与触发DNIC的人，它建议脑干和可能的脊髓网状束是关键的神经元链接在循环subserving DNIC的人。
In normal subjects, heterotopic painful stimuli induce simultaneous and parallel decreases in the sensation of pain and in the spinal nociceptive flexion (RIII) reflex evoked by electrical stimulation of the sural nerve. This inhibition of the RIII reflex is not seen in tetraplegic patients with clinically complete spinal cord transection, suggesting that supraspinal structures are involved in this type of inhibition, mediated through ‘Diffuse Noxious Inhibitory Controls’ (DNIC). In the present study, the effects of heterotopic nociceptive stimuli on the RIII reflex were examined in 3 patients with unilateral thalamic vascular lesions and in 3 with Wallenberg's syndrome (WS). In the former, as in normal subjects, nociceptive electrical conditioning stimuli applied to the analgesic hand produced a profound inhibition of the RIII reflex followed by long-lasting after-effects. No inhibition was observed in the WS patients. The same conditioning procedure applied to the nonanalgesic hand of the WS patients resulted inhibition and after-effects similar to those observed in normal subjects. The fact that noxious but nonpainful stimuli triggered DNIC in the patients with thalamic lesions excludes the possibility that masking of pain by a second painful focus is mainly due to attentional processes. It is also concluded that lemniscal and spinothalamic pathways are not involved in the triggering of DNIC in man and it is suggested that the brainstem and probably the spinoreticular tract are key neuronal links in the loop subserving DNIC in man.