Pelliccia Veronica, Del Vecchio Maria, Avanzini Pietro, Revay Martina, Sartori Ivana, Caruana Fausto
"Claudio Munari" Epilepsy Surgery Center, ASST GOM Niguarda, Milano, Italy; and.
Institute of Neuroscience, National Research Council of Italy (CNR), Parma, Italy.
J Clin Neurophysiol. 2023 Sep 1;40(6):491-500. doi: 10.1097/WNP.0000000000000961. Epub 2023 Mar 16.
In this review, we retrace the results of 70 years of human cingulate cortex (CC) intracerebral electrical stimulation and discuss its contribution to our understanding of the anatomofunctional and clinical aspects of this wide cortical region. The review is divided into three main sections. In the first section, we report the results obtained by the stimulation of the anterior, middle, and posterior CC, in 30 studies conducted on approximately 1,000 patients from the 1950s to the present day. These studies show that specific manifestations can be reliably associated with specific cingulate subfields, with autonomic, interoceptive, and emotional manifestations clustered in the anterior cingulate, goal-oriented motor behaviors elicited from the anterior midcingulate and a variety of sensory symptoms characterizing the posterior cingulate regions. In the second section, we compare the effect of CC intracerebral electrical stimulation with signs and manifestations characterizing cingulate epilepsy, showing that the stimulation mapping of CC subfields provides precious information for understanding cingulate epileptic manifestations. The last section tackles the issue of the discrepancy emerging when comparing the results of clinical (electrical stimulation, epilepsy) studies-revealing the quintessential affective and motor nature of the CC-with that reported by neuroimaging studies-which focus on high-level cognitive functions. Particular attention will be paid to the hypothesis that CC hosts a "Pain Matrix" specifically involved in pain perception, which we will discuss in the light of the fact that the stimulation of CC (as well as cingulate epileptic seizures) does not induce nociceptive effects.
在本综述中，我们回顾了70年来人类扣带回皮质（CC）脑内电刺激的结果，并讨论了其对我们理解这个广泛皮质区域的解剖功能和临床方面的贡献。本综述分为三个主要部分。在第一部分中，我们报告了从20世纪50年代至今对约1000名患者进行的30项研究中，刺激前扣带回、中扣带回和后扣带回所获得的结果。这些研究表明，特定表现可与特定扣带回子区域可靠关联，自主神经、内感受和情感表现集中在前扣带回，前扣带回中部引发目标导向的运动行为，而后扣带回区域则表现出各种感觉症状。在第二部分中，我们将CC脑内电刺激的效果与扣带回癫痫的体征和表现进行比较，表明CC子区域的刺激映射为理解扣带回癫痫表现提供了宝贵信息。最后一部分解决了在比较临床（电刺激、癫痫）研究结果（揭示CC的典型情感和运动性质）与神经影像学研究结果（侧重于高级认知功能）时出现的差异问题。我们将特别关注CC存在一个专门参与疼痛感知的“疼痛矩阵”这一假设，并根据刺激CC（以及扣带回癫痫发作）不会产生伤害性效应这一事实进行讨论。
