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重复性非侵入性前额叶刺激通过神经重塑在小鼠中逆转神经性疼痛。

Repetitive non-invasive prefrontal stimulation reverses neuropathic pain via neural remodelling in mice.

机构信息

Institute of Pharmacology, Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 366, 69120 Heidelberg, Germany.

Institute of Pharmacology, Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 366, 69120 Heidelberg, Germany.

出版信息

Prog Neurobiol. 2021 Jun;201:102009. doi: 10.1016/j.pneurobio.2021.102009. Epub 2021 Feb 20.

Abstract

Chronic neuropathic pain presents a major challenge to pharmacological therapy and neurostimulation-based alternatives are gaining interest. Although invasive and non-invasive motor cortex stimulation has been the focus of several studies, very little is known about the potential of targeting the prefrontal cortex. This study was designed to elucidate the analgesic potential of prefrontal stimulation in a translational context and to uncover the neural underpinnings thereof. Here, we report that non-invasive, repetitive direct anodal current transcranial stimulation (tDCS) of the prefrontal cortex exerted analgesia in mice with neuropathic pain for longer than a week. When applied at chronic stages of neuropathic pain, prefrontal tDCS reversed established allodynia and suppressed aversion and anxiety-related behaviours. Activity mapping as well as in vivo electrophysiological analyses revealed that although the cortex responds to acute tDCS with major excitation, repetitive prefrontal tDCS brings about large-scale silencing of cortical activity. Different classes of different classes of GABAergic interneurons and classes of excitatory neurons differs dramatically between single, acute vs and repetitive tDCS. Repetitive prefrontal tDCS alters basal activity as well as responsivity of a discrete set of distant cortical and sub-cortical areas to tactile stimuli, namely the rostral anterior cingulate cortex, the insular cortex, the ventrolateral periaqueductal grey and the spinal dorsal horn. This study thus makes a strong case for harnessing prefrontal cortical modulation for non-invasive transcranial stimulation paradigms to achieve long-lasting pain relief in established neuropathic pain states and provides valuable insights gained on neural mechanistic underpinnings of prefrontal tDCS in neuropathic pain.

摘要

慢性神经性疼痛对药物治疗提出了重大挑战,神经刺激为基础的替代方法正引起人们的兴趣。尽管侵入性和非侵入性运动皮层刺激已成为几项研究的焦点,但对于靶向前额皮层的潜在作用知之甚少。本研究旨在阐明前额刺激在转化背景下的镇痛潜力,并揭示其神经基础。在这里,我们报告说,非侵入性、重复性直接阳极电流经颅刺激(tDCS)对神经性疼痛的小鼠具有长达一周以上的镇痛作用。当应用于神经性疼痛的慢性阶段时,前额 tDCS 逆转了已建立的感觉过敏,并抑制了厌恶和焦虑相关的行为。活动映射以及体内电生理分析表明,尽管皮层对急性 tDCS 有主要的兴奋反应,但重复性前额 tDCS 会引起皮层活动的大规模沉默。不同类型的 GABA 能中间神经元和兴奋性神经元在单次急性 tDCS 与重复性 tDCS 之间存在显著差异。重复性前额 tDCS 改变了基础活动以及对触觉刺激的离散的远皮质和皮质下区域(即前扣带皮层的喙部、岛叶皮层、腹外侧导水管周围灰质和脊髓背角)的反应性。因此,本研究强烈支持利用前额皮质调节进行非侵入性经颅刺激范式,以在已建立的神经性疼痛状态下实现持久的疼痛缓解,并提供了关于神经性疼痛中前额 tDCS 的神经机制基础的宝贵见解。

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