Effect of drug-induced convulsive tgherapy for intractable chronic pain

本研究的目的：我们已经取得了良好的结果，成功缓解疼痛丘脑疼痛综合征（TPS）和各种顽固性慢性疼痛（ICP）使用我们独特的治疗方法，或“改良药物诱导惊厥疗法; DICT”。然而，这种治疗的机制仍然未知。所有经改良DICT治疗的患者的趋势脑电图（EEG）均出现周期性的不规则波，并可出现顺行性和（或）逆行性遗忘。结果：（1）动物实验：注射后10-20 min左右，可出现不规则波，每隔20-25 min出现1-2 min，持续2-3 h;惊厥性脑电波幅和持续时间与血钠浓度相关 ...更多信息 琥珀酸甲泼尼龙治疗后疼痛相关行为、舔和/或跛行消失。(2)人体脑电波分析。注射后10-20 min左右出现不规则波，以棘波复合体为特征，每20-25 min持续1-2 min，持续2-3 h。惊厥脑电图波幅和持续时间与甲泼尼龙琥珀酸钠浓度相关。病人在第一次抽搐后失去方向感，并主诉没有疼痛。伴慢性疼痛的抑郁症在许多病例中消失。2例喷他佐辛成瘾者完全停用喷他佐辛，大多数病例出现顺行性或逆行性遗忘，1-4周内恢复，有遗忘者疼痛缓解优于无遗忘者。注射MP的脑刺激类似于癫痫状态。众所周知，反复应用电休克疗法（ECT）对抑郁症发作的患者可以有效缓解疼痛。在一次治疗中EEG中出现多个间歇性棘波和波群，因此单次治疗获得了成功的疼痛缓解。在疼痛缓解良好的患者中观察到治疗后的脑电图不规则和遗忘的比较，强烈怀疑脑电图中出现的短暂脑刺激和不规则以及发生的遗忘对于慢性疼痛的恶性循环的出现是必要的。少

Aimms of this study: We have been being obtained good outcome of successful pain relief for the thalamic pain syndrome(TPS) and variety of intractable chronic pain(ICP) using our unique treatment method, or "modified Drug-induced Convulsive Therapy ; DICT". The mechanism of this treatment is, however, still unknown. Periodically occurring irregular waves are found in the trend electroencephalogram(EEG) in all patients treated with modified DICT. Antegrade- and/or retrograde- amnesia is also observed. It might be brought up the interesting problem concerning the pain and memory relationship.In this study, qualitative and quantitative analysis of EEG wave during the treatment were performed to clarify the pain-relief mechanism of the modified DICT.Results:(1) Animal study ; About 10-20 min after the injection, irregular wave which lasts for 1-2 min every 20-25 min were observed for 2-3 hrs. Amplitude and duration of the convulsive EEG wave were correlated with the concentration of sodium … More methylprednisolone succinate. Pain related behavior, licking and/or claudication was disappeared after the treatment.(2) Analysis of human EEG wave. ; About 10-20 min after the injection, irregular wave which is characterized typically by spike ＆ wave complex, and which lasts for 1-2 min every 20-25 min were observed for 2-3 hrs. Amplitude and duration of the convulsive EEG wave were correlated with the concentration of sodium methylprednisolone succinate. Patient was disoriented after the first convulsion, and complained no pain at all. Depression accompanied with chronic pain was disappeared in many cases. The complete disuse of pentazocine was also obtained in two cases of its addiction.Antegrade- or retrograde amnesia which recovered within 1-4 weeks was occurred in most cases and the pain-relief was superior in the patients with amnesia than without amnesia.Discussion : No pain at falling nor memory during seizure were found in poorly controlled epilepsy patient. The cerebral stimuli by MP injection seemed similar to epileptic status. It is known that repeated application of electroconvulsive therapy(ECT) for the patient with episode of depression makes effective pain relief. Multiple intermittent spike and wave complex in the EEG at one treatment so that obtained successful pain relief with single treatment. Comparative EEG irregularity and amnesia after the treatment was observed in the patient who obtained good pain relief.It is strongly suspected that transient cerebral stimuli as much as irregularity is appeared in EEG and occurred amnesia is essential for the emergence from vicious spiral of chronic pain. Less