Schwertner André, Zortea Maxciel, Torres Felipe V, Caumo Wolnei
Post-graduation Program in Medicine: Medical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
Laboratory of Pain & Neuromodulation, Clinical Hospital of Porto Alegre, Porto Alegre, Brazil.
Front Behav Neurosci. 2018 Apr 16;12:70. doi: 10.3389/fnbeh.2018.00070. eCollection 2018.
Ketamine is a non-competitive N-Methyl-D-Aspartate (NMDA) receptor antagonist whose effect in subanesthetic doses has been studied for chronic pain and mood disorders treatment. It has been proposed that ketamine could change the perception of nociceptive stimuli by modulating the cortical connectivity and altering the top-down mechanisms that control conscious pain perception. As this is a strictly central effect, it would be relevant to provide fresh insight into ketamine's effect on cortical response to external stimuli. Event-related potentials (ERPs) reflect the combined synchronic activity of postsynaptic potentials of many cortical pyramidal neurons similarly oriented, being a well-established technique to study cortical responses to sensory input. Therefore, the aim of this study was to examine the current evidence of subanesthetic ketamine doses on patterns of cortical activity based on ERPs in healthy subjects. To answer the question whether ERPs could be potential markers of the cortical effects of ketamine, we conducted a systematic review of ketamine's effect on ERPs after single and repeated doses. We have searched PubMed, EMBASE and Cochrane Databases and pre-selected 141 articles, 18 of which met the inclusion criteria. Our findings suggest that after ketamine administration some ERP parameters are reduced (reduced N2, P2, and P3 amplitudes, PN and MMN) while others remain stable or are even increased (P50 reduction, PPI, P1, and N1 amplitudes). The current understanding of these effects is that ketamine alters the perceived contrast between distinct visual and auditory stimuli. The analgesic effect of ketamine might also be influenced by a decreased affective discrimination of sensorial information, a finding from studies using ketamine as a model for schizophrenia, but that can give an important hint not only for the treatment of mood disorders, but also to treat pain and ketamine abuse.
氯胺酮是一种非竞争性N - 甲基 - D - 天冬氨酸(NMDA)受体拮抗剂,其在亚麻醉剂量下对慢性疼痛和情绪障碍治疗的作用已得到研究。有人提出,氯胺酮可通过调节皮层连接性和改变控制有意识疼痛感知的自上而下机制来改变对伤害性刺激的感知。由于这是一种严格的中枢效应,因此有必要对氯胺酮对皮层对外界刺激反应的影响提供新的见解。事件相关电位(ERP)反映了许多方向相似的皮层锥体神经元突触后电位的联合同步活动,是研究皮层对感觉输入反应的成熟技术。因此,本研究的目的是基于健康受试者的ERP来检验亚麻醉剂量氯胺酮对皮层活动模式的现有证据。为了回答ERP是否可能是氯胺酮皮层效应的潜在标志物这一问题,我们对单次和重复给药后氯胺酮对ERP的影响进行了系统综述。我们检索了PubMed、EMBASE和Cochrane数据库,预先筛选了141篇文章,其中18篇符合纳入标准。我们的研究结果表明,氯胺酮给药后,一些ERP参数降低(N2、P2和P3波幅降低,PN和MMN),而其他参数保持稳定甚至增加(P50降低、PPI、P1和N1波幅)。目前对这些效应的理解是,氯胺酮改变了不同视觉和听觉刺激之间的感知对比度。氯胺酮的镇痛作用也可能受到感觉信息情感辨别力下降的影响,这是使用氯胺酮作为精神分裂症模型的研究结果,但这不仅可以为情绪障碍的治疗提供重要线索,也可为疼痛治疗和氯胺酮滥用治疗提供重要线索。