Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York.
GE Global Research Center, Niskayuna, New York.
Neurosurgery. 2019 Dec 1;85(6):E1043-E1049. doi: 10.1093/neuros/nyz269.
Chronic pain occurs in 83% of Parkinson disease (PD) patients and deep brain stimulation (DBS) has shown to result in pain relief in a subset of patients, though the mechanism is unclear.
To compare functional magnetic resonance imaging (MRI) data in PD patients with chronic pain without DBS, those whose pain was relieved (PR) with DBS and those whose pain was not relieved (PNR) with DBS.
Functional MRI (fMRI) with blood oxygen level-dependent activation data was obtained in 15 patients in control, PR, and PNR patients. fMRI was obtained in the presence and absence of a mechanical stimuli with DBS ON and DBS OFF. Voxel-wise analysis using pain OFF data was used to determine which regions were altered during pain ON periods.
At the time of MRI, pain was scored a 5.4 ± 1.2 out of 10 in the control, 4.25 ± 1.18 in PNR, and 0.8 ± 0.67 in PR cohorts. Group analysis of control and PNR groups showed primary somatosensory (SI) deactivation, whereas PR patients showed thalamic deactivation and SI activation. DBS resulted in more decreased activity in PR than PNR (P < .05) and more activity in anterior cingulate cortex (ACC) in PNR patients (P < .05).
Patients in the control and PNR groups showed SI deactivation at baseline in contrast to the PR patients who showed SI activation. With DBS ON, the PR cohort had less activity in SI, whereas the PNR had more anterior cingulate cortex activity. We provide pilot data that patients whose pain responds to DBS may have a different fMRI signature than those who do not, and PR and PNR cohorts produced different brain responses when DBS is employed.
83%的帕金森病（PD）患者会出现慢性疼痛，深部脑刺激（DBS）已显示可减轻一部分患者的疼痛，但机制尚不清楚。
比较慢性疼痛且未接受 DBS 治疗的 PD 患者、疼痛缓解（PR）的 DBS 治疗患者和疼痛未缓解（PNR）的 DBS 治疗患者的功能磁共振成像（fMRI）数据。
对 15 名患者进行了 DBS 开/关状态下有无机械刺激的功能 MRI（fMRI）检测。利用疼痛关闭期的数据进行体素分析，以确定在疼痛开启期哪些区域发生了改变。
在 MRI 检查时，对照组疼痛评分为 5.4±1.2（满分 10 分），PNR 组为 4.25±1.18，PR 组为 0.8±0.67。对对照组和 PNR 组的组间分析显示，初级躯体感觉（SI）区去激活，而 PR 患者则显示丘脑去激活和 SI 区激活。与 PNR 组相比，PR 组 DBS 治疗后激活减少（P<0.05），而 PNR 组前扣带回皮质（ACC）区激活增加（P<0.05）。
对照组和 PNR 组患者在基线时显示 SI 区去激活，而 PR 组患者则显示 SI 区激活。在 DBS 开启时，PR 组 SI 区活性减少，而 PNR 组前扣带回皮质活性增加。我们提供了初步数据，表明对 DBS 治疗有反应的患者的 fMRI 特征可能与无反应的患者不同，并且在使用 DBS 时，PR 和 PNR 组产生了不同的大脑反应。
