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Motor cortex stimulation therapy for the treatment of post-stroke pain: operation method and pain alleviation mechanism

运动皮层刺激疗法治疗中风后疼痛：操作方法及疼痛缓解机制

基本信息

批准号：
15591553
负责人：
YAMAMOTO Takamitsu
金额：
$ 2.24万
依托单位：
Nihon University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
2003
资助国家：
日本
起止时间：
2003 至 2005
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-15591553/
关键词：
post-stroke pain central pain motor cortex motor evoke potential corticospinal tract D-wave I-wave 大脳皮質運動領痛み運動誘発電位視床痛中枢性疼痛 ketamine drug challenge test pain motor evoked potential

项目摘要

The corticospinal motor evoked potential (MEP) evoked by motor cortex stimulation can be recorded from the epidural space of the spinal cord. The corticospinal MEP response consists of an initial D-wave and a later sequence of volleys termed I-waves. The D-wave, which reflects impulses arising from direct activation of the axons of corticospinal tract neurons and is resistant to anesthetics, was investigated as an intra-operative index for the placement of a stimulating electrode in the epidural space over the motor cortex for the treatment of post-stroke pain.A grid electrode comprising 20 plate electrodes of 5mm in diameter and each separated by 5mm, was placed in the epidural space aiming to cover the motor cortex, sensory cortex, and premotor cortex employing an MRI-guided neuronavigation system in post-stroke pain patients. Initially, the D-wave was recorded with anodal monopolar stimulation of each plate electrode under general anesthesia. Secondly, keeping the grid electrode at the same position, the effect of pain reduction induced by anodal monopolar stimulation of the same epidural plate electrodes was examined using a visual analogue scale (VAS) on a separate day in the awake state without anesthesia.A comparison between the reduction rate of the VAS and the recorded amplitude of the D-wave employing the same stimulation point of the grid electrode revealed a significant correlation. The results obtained indicated the importance of D-wave recording as an intra-operative index for placement of the stimulating electrode over the motor cortex, and we can expect an improvement of the clinical results achieved with motor cortex stimulation.

运动皮质刺激诱发的皮质脊髓运动诱发电位(MEP)可从脊髓硬膜外间隙记录到。皮质脊髓MEP反应由一个初始的D波和后来的一系列称为I波的短波组成。D波反映直接激活皮质脊髓束神经元轴突产生的冲动，对麻醉药具有抵抗力，可作为术中在运动皮质上方的硬膜外间隙放置刺激电极治疗中风后疼痛的指标。采用MRI引导的神经导航系统，在硬膜外间隙放置20个5 mm的板状电极，每个电极间隔5 mm，旨在覆盖运动皮质、感觉皮质和运动前皮质。首先，在全身麻醉下，用阳极单极刺激每个平板电极记录D波。其次，在保持栅极位置不变的情况下，在清醒状态下，用视觉模拟标尺(VAS)检测同一硬膜外板电极的阳极单极刺激所引起的疼痛减轻效果，VAS的缩减率与同一栅极刺激点记录的D波的幅度之间存在显著的相关性。结果表明，D波记录作为术中将刺激电极放置在运动皮质上的指标的重要性，我们可以预期运动皮质刺激的临床效果将得到改善。