前扣带回皮质的深部脑刺激:针对慢性疼痛的情感成分

Deep brain stimulation of the anterior cingulate cortex: targeting the affective component of chronic pain.

作者信息

Boccard Sandra G J, Pereira Erlick A C, Moir Liz, Van Hartevelt Tim J, Kringelbach Morten L, FitzGerald James J, Baker Ian W, Green Alexander L, Aziz Tipu Z

机构信息

aOxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Departments of Clinical Neuroscience and Surgery bDepartment of Psychiatry, University of Oxford cRussell Cairn Unit, West Wing, John Radcliffe Hospital, Oxford, UK.

出版信息

Neuroreport. 2014 Jan 22;25(2):83-8. doi: 10.1097/WNR.0000000000000039.

Abstract

Deep brain stimulation (DBS) has shown promise for relieving nociceptive and neuropathic symptoms of refractory chronic pain. We assessed the efficacy of a new target for the affective component of pain, the anterior cingulate cortex (ACC). A 49-year-old man with neuropathic pain underwent bilateral ACC DBS. Patient-reported outcome measures were collected before and 2 years after surgery using a Visual Analogue Scale, Short-Form 36 quality of life survey, McGill pain questionnaire, EuroQol-5D questionnaires (EQ-5D; Health State) and neuropsychological assessments. The patient improved with DBS. Two years after surgery, the Visual Analogue Scale decreased from 6.7 to 3.0, McGill pain questionnaire improved by 42% and EQ-5D Health State increased by 150%. Stimulating the ACC at 130 Hz, 330 µs and 3 V facilitated neuropathic pain relief. The DBS remained efficacious during the 2-year follow-up period. Affective ACC DBS can relieve chronic neuropathic pain refractory to pharmacotherapy and restore quality of life.

摘要

深部脑刺激(DBS)已显示出缓解难治性慢性疼痛的伤害性和神经性症状的前景。我们评估了一个针对疼痛情感成分的新靶点——前扣带回皮质(ACC)的疗效。一名患有神经性疼痛的49岁男性接受了双侧ACC DBS治疗。在手术前和术后2年使用视觉模拟量表、简短36项生活质量调查问卷、麦吉尔疼痛问卷、欧洲五维度健康量表问卷(EQ-5D;健康状态)和神经心理学评估收集患者报告的结局指标。该患者通过DBS治疗有所改善。术后2年,视觉模拟量表从6.7降至3.0,麦吉尔疼痛问卷改善了42%,EQ-5D健康状态提高了150%。以130赫兹、330微秒和3伏刺激ACC有助于缓解神经性疼痛。在2年的随访期内,DBS仍然有效。针对情感性ACC的DBS可以缓解药物治疗难治的慢性神经性疼痛并恢复生活质量。

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