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重复经颅磁刺激(rTMS)对辣椒素诱导疼痛的背外侧前额叶皮层(DLPFC)的影响:对运动皮层兴奋性的调节作用。

Repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex (DLPFC) during capsaicin-induced pain: modulatory effects on motor cortex excitability.

机构信息

Department of Clinical Neurosciences, University of Palermo, Palermo, Italy.

出版信息

Exp Brain Res. 2010 May;203(1):31-8. doi: 10.1007/s00221-010-2206-6. Epub 2010 Mar 16.


DOI:10.1007/s00221-010-2206-6
PMID:20232062
Abstract

Evidence by functional imaging studies suggests the role of left DLPFC in the inhibitory control of nociceptive transmission system. Pain exerts an inhibitory modulation on motor cortex, reducing MEP amplitude, while the effect of pain on motor intracortical excitability has not been studied so far. In the present study, we explored in healthy subjects the effect of capsaicin-induced pain and the modulatory influences of left DLPFC stimulation on motor corticospinal and intracortical excitability. Capsaicin was applied on the dorsal surface of the right hand, and measures of motor corticospinal excitability (test-MEP) and short intracortical inhibition (SICI) and facilitation (ICF) were obtained by paired-pulse TMS on left motor cortex. Evaluations were made before and at different times after capsaicin application in two separate sessions: without and with high-frequency rTMS of left DLPF cortex, delivered 10 min. after capsaicin application. We performed also two control experiments to explore: 1: the effects of Left DLPFC rTMS on capsaicin-induced pain; 2: the modulatory influence of left DLPFC rTMS on motor cortex without capsaicin application. Capsaicin-induced pain significantly reduced test MEP amplitude and decreased SICI leaving ICF unchanged. Left DLPFC rTMS, together with the analgesic effect, was able to revert the effects of capsaicin-induced pain on motor cortex restoring normal MEP and SICI levels. These data support the notion that that tonic pain exerts modulatory influence on motor intracortical excitability; the activation of left DLPFC by hf rTMS could have analgesic effects, reverting also the motor cortex excitability changes induced by pain stimulation.

摘要

功能影像学研究证据表明左背外侧前额叶在抑制伤害性传入系统中起作用。疼痛对运动皮层施加抑制性调制,降低 MEP 幅度,而迄今为止尚未研究疼痛对运动皮层内兴奋性的影响。在本研究中,我们在健康受试者中探讨了辣椒素诱导的疼痛以及左背外侧前额叶刺激对运动皮质脊髓和皮质内兴奋性的调制影响。将辣椒素应用于右手背侧,通过左运动皮层的成对脉冲 TMS 获得运动皮质脊髓兴奋性(测试 MEP)和短程内抑制(SICI)和易化(ICF)的测量。在两个单独的会议中,在辣椒素应用之前和之后的不同时间进行评估:没有和有左背外侧前额叶高频 rTMS,在辣椒素应用 10 分钟后进行。我们还进行了两项对照实验来探索:1:左背外侧前额叶 rTMS 对辣椒素诱导疼痛的影响;2:左背外侧前额叶 rTMS 在没有应用辣椒素的情况下对运动皮层的调制影响。辣椒素诱导的疼痛显著降低了测试 MEP 幅度,并降低了 SICI,而 ICF 不变。左背外侧前额叶 rTMS 与镇痛作用一起,能够逆转辣椒素诱导的疼痛对运动皮层的影响,使 MEP 和 SICI 水平恢复正常。这些数据支持这样的观点,即持续性疼痛对运动皮层内兴奋性产生调制影响;hf rTMS 激活左背外侧前额叶可以产生镇痛作用,还可以逆转疼痛刺激引起的运动皮层兴奋性变化。

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[6]
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[7]
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[8]
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[10]
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本文引用的文献

[1]
Transcranial magnetic stimulation in the acute treatment of major depressive disorder: clinical response in an open-label extension trial.

J Clin Psychiatry. 2008-3

[2]
Unexpected reduction in migraine and psychogenic headaches following rTMS treatment for major depression: a report of two cases.

CNS Spectr. 2007-12

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Pain Res Manag. 2007

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Eur J Neurol. 2007-9

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Neurosci Lett. 2007-3-19

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Recent advances in the treatment of chronic pain with non-invasive brain stimulation techniques.

Lancet Neurol. 2007-2

[9]
A case study of Primary Progressive Aphasia: improvement on verbs after rTMS treatment.

Neurocase. 2006-12

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Motor cortex rTMS restores defective intracortical inhibition in chronic neuropathic pain.

Neurology. 2006-11-14

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