Roles of the insular cortex in the modulation of pain: insights from brain lesions.
Roles of the insular cortex in the modulation of pain: insights from brain lesions.
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DOI：
10.1523/jneurosci.5173-08.2009
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发表时间：
2009-03-04
期刊：
影响因子：
--
通讯作者：
Coghill RC
中科院分区：
文献类型：
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作者：
Starr CJ;Sawaki L;Wittenberg GF;Burdette JH;Oshiro Y;Quevedo AS;Coghill RC
主观感觉经验是由传入的感觉信息与关于独特的个人内部认知状态的信息整合而构建的。岛叶皮层在解剖学上被定位为传入处理机制和更面向认知的调节系统之间的一个潜在界面。然而，岛叶皮层在这种调节过程中的作用仍然知之甚少。两个人与广泛的病变，以检查，以更好地了解这一大脑区域的主观感觉经验的产生的贡献。尽管岛叶皮层损伤程度存在很大差异，但两个人都有三个共同的发现。首先，这两个主题有实质上更高的疼痛强度评级急性实验伤害性刺激比年龄匹配的对照组。第二，当疼痛相关的激活的初级躯体感觉皮层进行检查，在左侧和右侧的刺激，两个人表现出显着升高的活性的初级躯体感觉皮层同侧的病变的大脑皮层相对于健康对照组。最后，两个人都保留了评估疼痛的能力，尽管有大量的岛叶损伤，没有可检测到的岛叶活动的证据。两者合计，这些结果表明，在调节皮层区域，适当地利用先前的认知信息在传入处理过程中，神经元可能是重要的参与。最后，这些数据表明，主观上可获得的疼痛体验可以通过不需要岛叶皮层的大脑机制来实例化。
Subjective sensory experiences are constructed by the integration of afferent sensory information with information about the uniquely personal internal cognitive state. The insular cortex is anatomically positioned to serve as one potential interface between afferent processing mechanisms and more cognitively-oriented modulatory systems. However, the role of the insular cortex in such modulatory processes remain poorly understood. Two individuals with extensive lesions to the insula were examined to better understand the contribution of this brain region to the generation of subjective sensory experiences. Despite substantial differences in the extent of the damage to the insular cortex, three findings were common to both individuals. First, both subjects had substantially higher pain intensity ratings of acute experimental noxious stimuli than age-matched control subjects. Second, when pain-related activation of the primary somatosensory cortex was examined during left and right-sided stimulation, both individuals exhibited dramatically elevated activity of the primary somatosensory cortex ipsilateral to the lesioned insula in relation to healthy control subjects. Finally, both individuals retained the ability to evaluate pain despite substantial insular damage and no evidence of detectible insular activity. Taken together, these results indicate that the insula may be importantly involved in tuning cortical regions to appropriately utilize prior cognitive information during afferent processing. Finally, these data suggest that a subjectively available experience of pain can be instantiated by brain mechanisms that do not require the insular cortex.