Yamamoto Takamitsu, Katayama Yoichi, Obuchi Toshiki, Kano Toshikazu, Kobayashi Kazutaka, Oshima Hideki, Fukaya Chikashi, Kakigi Ryusuke
Division of Applied System Neuroscience, Department of Advanced Medical Science, Nihon University School of Medicine, Tokyo, Japan.
Neurol Med Chir (Tokyo). 2007 Sep;47(9):409-14. doi: 10.2176/nmc.47.409.
The corticospinal motor evoked potential (MEP) evoked by motor cortex stimulation was investigated as an intraoperative index for the placement of stimulation electrodes in the epidural space over the motor cortex for the treatment of post-stroke pain. A grid of plate electrodes was placed in the epidural space to cover the motor cortex, sensory cortex, and premotor cortex employing a magnetic resonance imaging-guided neuronavigation system in two patients with severe post-stroke pain in the right extremities, a 66-year-old man with dysesthesia manifesting as burning and aching sensation, and a 67-year-old woman with dysesthesia manifesting as pricking sensation. The D-wave of the corticospinal MEP was recorded with a flexible wire electrode placed in the epidural space of the spinal cord during anodal monopolar stimulation of each plate electrode under general anesthesia. The grid electrode was fixed in position with dural sutures and the craniotomy closed. The effect of pain reduction induced by anodal monopolar stimulation of the same plate electrodes was examined using the visual analogue scale (VAS) on a separate day in the awake state without anesthesia. Comparison of the percentage VAS reduction and the recorded amplitude of the D-wave employing the same stimulation electrode revealed significant correlations in Case 1 (r = 0.828, p < 0.01) and Case 2 (r = 0.807, p < 0.01). The grid electrode was then replaced with two RESUME electrodes over the hand and foot areas, and the optimum positions were identified by D-wave recording before electrode fixation. Both patients reported satisfactory pain alleviation with lower stimulation voltages than usually required for patients with similar symptoms. These results indicate the potential of D-wave recording as an intraoperative indicator for the placement of stimulating electrodes over the motor cortex for pain relief.
研究了运动皮层刺激诱发的皮质脊髓运动诱发电位（MEP），作为术中指标，用于在运动皮层上方硬膜外间隙放置刺激电极以治疗中风后疼痛。在两名右上肢严重中风后疼痛患者中，使用磁共振成像引导的神经导航系统，将板状电极网格放置在硬膜外间隙，覆盖运动皮层、感觉皮层和运动前皮层。一名66岁男性，感觉异常表现为灼痛和酸痛；另一名67岁女性，感觉异常表现为刺痛。在全身麻醉下，对每个板状电极进行阳极单极刺激时，用放置在脊髓硬膜外间隙的柔性线电极记录皮质脊髓MEP的D波。用硬脑膜缝线将网格电极固定在位，关闭开颅术。在清醒且无麻醉的另一天，使用视觉模拟量表（VAS）检查相同板状电极阳极单极刺激引起的疼痛减轻效果。比较使用相同刺激电极时VAS降低百分比和记录的D波振幅，结果显示病例1（r = 0.828，p < 0.01）和病例2（r = 0.807，p < 0.01）有显著相关性。然后将网格电极替换为手部和足部区域的两个RESUME电极，并在电极固定前通过D波记录确定最佳位置。两名患者均报告疼痛缓解满意，且刺激电压低于有类似症状患者通常所需的电压。这些结果表明，D波记录有可能作为术中指标，用于在运动皮层上方放置刺激电极以缓解疼痛。
