运动皮层刺激治疗幻肢痛：脊髓和丘脑刺激综合疗法

Motor cortex stimulation for phantom limb pain: comprehensive therapy with spinal cord and thalamic stimulation.

作者信息

Katayama Y, Yamamoto T, Kobayashi K, Kasai M, Oshima H, Fukaya C

机构信息

Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.

出版信息

Stereotact Funct Neurosurg. 2001;77(1-4):159-62. doi: 10.1159/000064593.

DOI:10.1159/000064593

PMID:12378068

Abstract

The effects of spinal cord stimulation (SCS), deep brain stimulation (DBS) of the thalamic nucleus ventralis caudalis (VC) and motor cortex stimulation (MCS) were analyzed in 19 patients with phantom limb pain. All of the patients underwent SCS and, if the SCS failed to reduce the pain, the patients were considered for DBS and/or MCS. Satisfactory pain control for the long-term was achieved in 6 of 19 (32%) by SCS, 6 of 10 (60%) by DBS and 1 (20%) of 5 by MCS. SCS and DBS of the VC sometimes produced a dramatic effect on the pain, leading to a long pain-free interval and infrequent use of stimulation. The effects of both DBS of the VC and MCS were tested in four. One patient of them reported better pain control by MCS than by DBS, whereas two reported the opposite results. There is no evidence at present for an advantage of MCS over SCS and DBS of the VC in controlling phantom limb pain.

摘要

对19例幻肢痛患者分析了脊髓刺激（SCS）、丘脑腹侧尾核（VC）的深部脑刺激（DBS）和运动皮层刺激（MCS）的效果。所有患者均接受SCS治疗，若SCS未能减轻疼痛，则考虑对患者进行DBS和/或MCS治疗。19例患者中有6例（32%）通过SCS实现了长期满意的疼痛控制，10例中有6例（60%）通过DBS实现，5例中有1例（20%）通过MCS实现。VC的SCS和DBS有时对疼痛产生显著效果，导致长时间的无痛间隔且刺激使用频率降低。对4例患者测试了VC的DBS和MCS的效果。其中1例患者报告MCS比DBS能更好地控制疼痛，而2例报告了相反的结果。目前没有证据表明在控制幻肢痛方面MCS优于VC的SCS和DBS。