Saitoh Y, Hirayama A, Kishima H, Oshino S, Hirata M, Kato A, Yoshimine T
Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Acta Neurochir Suppl. 2006;99:57-9. doi: 10.1007/978-3-211-35205-2_11.
To treat intractable deafferentation pains, we prefer stimulation of the primary motor cortex (M1). The methods of stimulation we utilize are electrical stimulation and repetitive transcranial magnetic stimulation (rTMS). In our department, we first attempt rTMS, and if this rTMS is effective, we recommend the patient to undergo procedures for motor cortex stimulation (MCS). A 90% intensity of resting motor threshold setting is used for rTMS treatment. In this study ten trains of 5 Hz rTMS for 10 seconds (50 seconds resting interval) were applied to the M1, S1, pre-motor and supplementary motor areas. Only M1 stimulation was effective for pain reduction in 10 of 20 patients (50%). Twenty-nine MCS procedures were performed by subdural implantation of electrodes, and in the case of hand or face pain, electrodes were implanted within the central sulcus (11 cases), because the main part of M1 is located in the central sulcus in humans. The success rate of MCS was around 63%, and seemed to be higher in cases of pain with spinal cord and peripheral origins, while it was lower in cases of post-stroke pain.
为治疗难治性去传入性疼痛，我们更倾向于刺激初级运动皮层（M1）。我们采用的刺激方法是电刺激和重复经颅磁刺激（rTMS）。在我们科室，我们首先尝试rTMS，如果这种rTMS有效，我们会建议患者接受运动皮层刺激（MCS）手术。rTMS治疗采用静息运动阈值设置强度的90%。在本研究中，对M1、S1、运动前区和辅助运动区施加10组5Hz的rTMS，每组持续10秒（间隔50秒休息）。仅M1刺激对20例患者中的10例（50%）有减轻疼痛的效果。通过硬膜下植入电极进行了29例MCS手术，对于手部或面部疼痛的情况，电极植入中央沟内（11例），因为在人类中M1的主要部分位于中央沟。MCS的成功率约为63%，似乎脊髓和外周起源的疼痛病例成功率更高，而中风后疼痛病例的成功率较低。
