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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.

运动皮层刺激引起的皮质脊髓运动诱发电位（MEP）可以从脊髓的硬膜外腔记录。皮质脊髓 MEP 反应由初始 D 波和随后的称为 I 波的齐射序列组成。 D 波反映了皮质脊髓束神经元轴突直接激活产生的脉冲，并且对麻醉剂具有抵抗力，被研究作为在运动皮层上方的硬膜外腔中放置刺激电极以治疗中风后疼痛的术中指标。网格电极由 20 个直径为 5mm 且每个间隔 5mm 的板电极组成。放置在硬膜外腔中，旨在采用 MRI 引导的神经导航系统覆盖中风后疼痛患者的运动皮层、感觉皮层和前运动皮层。最初，在全身麻醉下用每个板电极的阳极单极刺激记录 D 波。其次，将网格电极保持在同一位置，在不同的一天在清醒状态下，在无麻醉的情况下，使用视觉模拟量表（VAS）检查同一硬膜外板电极的阳极单极刺激引起的疼痛减轻效果。VAS的减少率与采用网格电极相同刺激点记录的D波幅度之间的比较显示出显着的相关性。获得的结果表明 D 波记录作为在运动皮层上放置刺激电极的术中指标的重要性，我们可以预期运动皮层刺激所取得的临床结果会有所改善。