Cioni B, Meglio M, Perotti V, De Bonis P, Montano N
Neurochirurgia Funzionale e Spinale, Università Cattolica, Lg A Gemelli 8, 00168 Roma, Italy.
Neurophysiol Clin. 2007 Dec;37(6):441-7. doi: 10.1016/j.neucli.2007.10.007. Epub 2007 Nov 1.
Chronic motor cortex stimulation is a treatment option for neuropathic drug-resistant pain and possibly associated movement disorders. Preliminary studies suggest the possibility to treat symptoms of Parkinson disease in selected patients. Recently, MCS has been suggested to enhance motor recovery in patients with poststroke hemiparesis. One or more electrodes are placed extradurally over the motor cortex through a burr hole or a small craniotomy, and then connected to a totally implantable neurostimulator. The accurate positioning of the stimulating electrodes over the motor cortex is the key point of the surgical procedure. Motor cortex identification results from the integration of anatomical, neuroradiological, functional, and neurophysiological data, taking into account the huge population variability. Intraoperative neurophysiological mapping of the motor cortex is of paramount importance, in spite of very sophisticated neuroradiological mathematical reconstructions of the motor area. We discuss and compare the different techniques that are utilized by different authors. Moreover, clinical neurophysiology is also helpful in evaluating the results of this neuromodulation procedure and in hypothesizing the mechanisms that are put in play by MCS.
慢性运动皮层刺激是治疗神经性药物难治性疼痛以及可能相关的运动障碍的一种治疗选择。初步研究表明，在部分患者中有可能治疗帕金森病的症状。最近，有人提出运动皮层刺激可促进中风后偏瘫患者的运动恢复。通过骨孔或小开颅手术将一个或多个电极硬膜外放置在运动皮层上方，然后连接到完全植入式神经刺激器。刺激电极在运动皮层上的精确定位是手术过程的关键。运动皮层的识别源于解剖学、神经放射学、功能学和神经生理学数据的整合，同时要考虑到人群的巨大变异性。尽管运动区有非常复杂的神经放射学数学重建，但术中对运动皮层进行神经生理学图谱绘制至关重要。我们讨论并比较了不同作者使用的不同技术。此外，临床神经生理学在评估这种神经调节程序的结果以及推测运动皮层刺激所发挥的机制方面也很有帮助。
