Pharmacologic Unmasking of Neurologic Deficits: A Stress Test for the Brain.
Pharmacologic Unmasking of Neurologic Deficits: A Stress Test for the Brain.
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神经缺陷的药理学揭示：大脑压力测试。
DOI：
10.1097/aln.0000000000002775
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发表时间：
2019
期刊：
影响因子：
8.8
通讯作者：
Mashour,GeorgeA
中科院分区：
文献类型：
--
作者：
Vlisides,PhillipE;Mashour,GeorgeA
神经可塑性仍然是现代神经科学最有趣的方面之一，并且与麻醉学具有临床相关性。事实上，大脑具有通过结构和功能改变来适应各种扰动的非凡能力。例如，中风患者在受伤后通过恢复神经功能而表现出适应迹象，而原始病变本身没有再生。然而，这种适应可以在药理学上逆转，与拮抗胆碱能系统的药物相比，增强γ-氨基丁酸（GABA）传输的药物具有相对选择性。 1 了解脑功能障碍、适应性变化和药理学之间的相互作用对于麻醉学领域非常重要。研究我们的药物对手术患者神经功能的影响可能为了解先前的神经损伤、随后的神经塑性变化以及相关的临床脆弱性提供一个独特的窗口，特别是对于那些已知或怀疑有神经病理学的患者。报告咪达唑仑引起幕上神经胶质瘤患者上肢运动缺陷。 2 这与之前的研究结果一致，证明 GABA 能激动可以揭示脑肿瘤或脑血管疾病患者的神经功能缺陷。 1, 3, 4 Lin 等人当前的研究有何独特之处。图2证明了氟马西尼逆转了这些药理诱导的缺陷，支持了GABA能机制。有趣的是，在这项研究中，运动功能障碍并不局限于对侧肢体。还观察到同侧运动功能障碍，氟马西尼恢复了双侧基线功能。与对照患者的优势手相比，咪达唑仑给药后同侧上肢运动功能障碍也更显着减少。正如手稿中所述，这可能反映了肿瘤的浸润，从而导致病变中心以外的神经功能和结构中断。
Neuroplasticity remains one of the most intriguing aspects of modern neuroscience and is of clinical relevance to anesthesiology. Indeed, the brain possesses a remarkable ability to adapt to various perturbations via structural and functional alterations. For example, stroke patients demonstrate signs of adaptation by regaining neurologic function after injury, without regeneration of the original lesion per se. However, such adaptations can be reversed pharmacologically, with relative selectivity by agents that potentiate the transmission of gamma-aminobutyric acid (GABA) compared with agents that antagonize the cholinergic system. 1 Understanding the interactions of brain dysfunction, adaptive changes, and pharmacology is important for the field of anesthesiology. Studying the effects of our drugs on neurologic function in surgical patients may provide a unique window into prior neurologic injury, subsequent neuroplastic changes, and associated clinical vulnerability, particularly in those with known or suspected neuropathology.In this issue of Anesthesiology, Lin et al. report midazolam-induced upper limb motor deficits in patients with supratentorial gliomas. 2 This aligns with previous work demonstrating that GABAergic agonism unmasks neurologic deficits in patients with brain tumors or cerebrovascular disease. 1, 3, 4 What is unique in the current study by Lin et al. 2 is the demonstration that flumazenil reverses these pharmacologically induced deficits, supporting a GABAergic mechanism. Interestingly, motor dysfunction was not restricted to the contralateral limb in this study; ipsilateral motor dysfunction was observed as well, and flumazenil restored baseline function bilaterally. Ipsilateral upper limb motor dysfunction was also more significantly reduced after midazolam administration compared to the dominant hand of control patients. As described in the manuscript, this may reflect the infiltration of the tumor with consequent interruption of neural function and structure beyond the epicenter of the lesion.
影响因子：
8.8
作者：
Thal, GD;Szabo, MD;Crosby, G
通讯作者：
Crosby, G
影响因子：
--
作者：
M. Saxen
通讯作者：
M. Saxen
影响因子：
8.8
作者：
G. Thal;M. Szabo;M. Lopez;G. Crosby
通讯作者：
G. Crosby