Fukui Sei, Shigemori Shino, Nosaka Shuichi
Department of Anesthesiology, Shiga University of Medical Science, Shiga, Japan.
Reg Anesth Pain Med. 2002 Sep-Oct;27(5):529-32. doi: 10.1053/rapm.2002.34330.
The aim of the present case series was to examine whether changes in regional cerebral blood flow (rCBF) induced by electroconvulsive therapy (ECT) in the thalamus are related to the efficacy of ECT. Four chronic pain patients with complex regional pain syndrome (CRPS) type-1 (age, 33 to 58 years) who had failed to respond to standard pain treatments received a course of ECT. To investigate the possible mechanisms of the analgesic effect of ECT on chronic CRPS type-1, we measured significant changes in the rCBF of the thalamus using technetium-99m ethyl cysteinate dimer single photon emission computed tomography (99mTc ECD SPECT), before and after ECT and compared these values between responders and nonresponders.
Two of 4 (50.0%) patients responded to ECT treatment (response defined as a reduction of at least 60% on the visual analog scale [VAS]). 99mTc ECD SPECT showed that the mean contralateral thalamus-to-cerebellum ratio increased 11.5% after ECT compared with the ratio before ECT in the 2 responders, but remained unchanged in nonresponders.
The results from the SPECT suggest that normalization of the balance of rCBF in the thalamus may be related to the analgesic efficacy of the ECT on CRPS Type-1.
本病例系列研究的目的是探讨电休克治疗（ECT）诱发的丘脑区域脑血流量（rCBF）变化是否与ECT的疗效相关。4例1型复杂性区域疼痛综合征（CRPS）慢性疼痛患者（年龄33至58岁），对标准疼痛治疗无效，接受了一个疗程的ECT治疗。为研究ECT对慢性1型CRPS镇痛作用的可能机制，我们在ECT治疗前后，使用锝-99m半胱氨酸乙酯二聚体单光子发射计算机断层扫描（99mTc ECD SPECT）测量丘脑rCBF的显著变化，并比较了反应者和无反应者之间的这些值。
4例患者中有2例（50.0%）对ECT治疗有反应（反应定义为视觉模拟量表[VAS]评分至少降低60%）。99mTc ECD SPECT显示，2例反应者ECT治疗后对侧丘脑与小脑的平均比值较ECT治疗前增加了11.5%，而无反应者该比值保持不变。
SPECT结果提示，丘脑rCBF平衡的正常化可能与ECT对1型CRPS的镇痛疗效相关。
