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.

可以从脊髓的硬膜外空间记录由运动皮层刺激引起的皮质脊髓电动机（MEP）。皮质脊髓MEP响应由初始的D波和后来称为I波的伏特利序列组成。 D波反映了由皮质脊髓束神经元的轴突直接激活而产生的冲动，并且对麻醉性具有抵抗力，被研究为术中指数，用于将刺激的电极放置在运动型皮层上的刺激电极中的刺激电极通过5mm inme dimy inme dime righ and dime inmer inm dimm。放置在硬膜外空间中，旨在覆盖运动皮层，感觉皮层和前皮层，并在冲程后疼痛患者中采用MRI引导的神经导航系统。最初，在全身麻醉下用阳极单极刺激记录了D波。其次，将网格电极保持在相同的位置，使用视觉模拟量表（VAS（VAS））在没有麻醉的情况下，使用视觉模拟量表（VAS）检查了相同的硬膜板电极引起的疼痛减轻效果。在没有麻醉的情况下，在醒目状态下的一段时间。获得的结果表明，D波记录是将刺激电极放置在运动皮层上的术中指数的重要性，我们可以预期通过运动皮层刺激获得的临床结果会改善。