Gray matter volume reduction reflects chronic pain in trigeminal neuralgia
Gray matter volume reduction reflects chronic pain in trigeminal neuralgia
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DOI：
10.1016/j.neuroimage.2013.02.029
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发表时间：
2013-07-01
期刊：
影响因子：
5.7
通讯作者：
Katsarava, Zaza
中科院分区：
文献类型：
--
作者：
Obermann, Mark;Rodriguez-Raecke, Rea;Katsarava, Zaza
三叉神经痛（TN）被认为是由于血管扩张影响脑干根部进入区的三叉神经引起的。最近的证据表明，在三叉神经痛的病理生理过程中的一个额外的中央组成部分。因此，我们的目的是确定特定的大脑区域可能与发展或维持TN使用磁共振成像（MRI）基于体素的形态测量（VBM）。60例典型TN患者与49名健康对照进行了比较。18例TN患者伴有持续的面部疼痛，这种情况以前被描述为更差的治疗outcome.We发现，与健康对照组相比，TN患者的初级躯体感觉和眶额皮质，以及次级躯体感觉皮质，丘脑，小脑，前扣带回皮质（ACC），小脑和背外侧前额叶皮质的灰质（GM）体积减少。在TN中，ACC、海马旁和颞叶内的GM体积减少与疾病持续时间增加相关。有和没有伴随持续面部疼痛的患者之间没有差异。没有发现GM增加，相互比较患者亚组和健康controls.The观察到的变化可能反映了影响的多个，每天攻击三叉神经痛在这些患者中类似于以前所描述的其他慢性疼痛条件，并可能被解释为适应机制，慢性疼痛方面的神经元可塑性。ACC，海马旁和颞叶体积减少与疾病的持续时间可能指向这些结构在慢性疼痛中的关键作用。(c)2013 Elsevier Inc. All rights reserved.
Trigeminal neuralgia (TN) is supposedly caused by an ectatic blood vessel affecting the trigeminal nerve at the root entry zone of the brain stem. Recent evidence suggests an additional central component within trigeminal pain-processing in the pathophysiology of TN. Therefore, we aimed to identity specific brain regions possibly associated with the development or maintenance of TN using magnetic resonance imaging (MRI) voxel-based morphometry (VBM).Sixty patients with classical TN were compared to 49 healthy controls. Eighteen patients had TN with concomitant constant facial pain, a condition previously described as a predictor of worse treatment outcome.We found gray matter (GM) volume reduction in TN patients compared to healthy controls in the primary somatosensory and orbitofrontal cortices, as well as the in the secondary somatosensory cortex, thalamus, insula, anterior cingulate cortex (ACC), cerebellum, and dorsolateral prefrontal cortex. GM volume decrease within the ACC, parahippocampus, and temporal lobe correlated with increasing disease duration in TN. There were no differences comparing patients with and without concomitant constant facial pain. No GM increase was found comparing patient subgroups with each other and with healthy controls.The observed changes probably reflect the impact of multiple, daily attacks of trigeminal pain in these patients similar to what was previously described in other chronic pain conditions and may be interpreted as adaptation mechanism to chronic pain in regard to neuronal plasticity. The ACC, parahippocampus and temporal lobe volume reduction in parallel with disease duration may point to a pivotal role of these structures in chronic pain. (c) 2013 Elsevier Inc. All rights reserved.