雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Brain and Nerve No to Shinkei Volume 37, Issue 8 （August 1985）

Brain and Nerve 脳と神経 37巻8号（1985年8月発行）

Japanese English

原著

頑痛患者における髄液中β—endorphinおよびmonoamine代謝産物—とくに中枢神経系の電気刺激前後における濃度変動について β-ENDORPHIN AND MONOAMINE METABOLITE CONCENTRATIONS IN PATIENTS WITH INTRACTABLE PAIN:CHANGES BEFORE AND AFTER DEEP BRAIN OR SPINAL DORSAL COLUMN STIMULATION 難波真平 ¹ , 藤原則章 ¹ , 難波洋一郎 ¹ , 西本詮 ¹ Shimpei Namba ¹ , Noriaki Fujiwara ¹ , Yoichiro Namba ¹ , Akira Nishimoto ¹ ¹岡山大学脳神経外科 ¹Department of Neurological Surgery, Okayama University Medical School pp.775-783

発行日 1985年8月1日 Published Date 1985/8/1

DOI https://doi.org/10.11477/mf.1406205561

PDF(6230KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside

　抄録　頑痛患者18例，コントロール37名の腰椎穿刺による髄液（LCSF）および脳室内髄液（VCSF）中β—endorphin （β—EP）およびmonoamine代謝産物（MHPG,HVA,5—HIAA）の基礎値をまず測定した。また脳深部（DBS）6例，脊髄硬膜外刺激（DCS）2例の電極埋込み手術後1週〜3年1ヵ月後における刺激前後のβ—EPおよびモノアミン代謝産物の濃度変動を検討した。L—およびVCSF　β—EP濃度には有意差はみられなかった。LCSF　β—EPはdeafferented painで有意に高値で，モノアミン代謝産物は末梢性疼痛においてMHPGのみが高値であった。刺激前後のLCSFβ—EPはDBS全例で変動せず，DCSで上昇がみられた。LCSFモノアミン代謝産物ではDBS 6例中除痛効果excellentの1例のみでHVA,5—HIAAが明らかに上昇し，DCS 2例では3種全ての代謝産物が上昇した。DBSにおけるモノアミン代謝産物の変動を検討した報告はほとんどなく，また，DCSにおけるMHPGの顕著な．上昇は下行性痛み抑制系におけるnorepine—phrine系の関与をも示唆するものといえよう。

Baseline concentrations of β-endorphin (β-EP) and monoamine metabolites (MHPG: 3-methoxy-4- hydroxy-phenylglycol, HVA: homovanillic acid, 5-HIAA: 5-hydroxyindoleacetic acid) in lumbar CSF (LCSF) and ventricular CSF (VCSF) were measured in 18 patients with intractable pain; 10 with deafferented pain and 8 with peripheral pain. Control values were obtained from 37 individuals of various ages. Changes in the concentrations of these substances were determined before and after giving stimulations (2-5V, 0.2-0.5msec, 40-50 Hz, 20-sec duration) to 6 patients through electrodes implanted in deep brain structures (DBS; posterior limb of the internal capsule in 5 patients and rostral mesencephalic lemniscus medialis in one pa-tient), and to 2 other patients through electrodes implanted in the spinal dorsal column (DCS).

The control value of β-EP in LCSF was 57.6± 24.7 pg/mi, which was not significantly different from that of VCSF. Great variation in the indi-vidual control LCSF β-EP concentrations was found, but it was not related to differences in age. The mean baseline LCSF β-EP concentration was significantly higher (p<O.05) than the control in the patients with deaffernted pain before stimulation. One of the monoamine-metabolites, MHPG, showed higher level in the patients with peripheral pain (p<0.01). The LCSF β-EP con-centration was not affected by deep brain stim-ulation, but was increased by dorsal column stim-ulation. In one patient with excellent pain relief by stimulation of the posterior limb of the internal capsule, the LCSF HVA and 5-HIAA concentrations were conspicuously increased. Significant increases in β-EP, HVA and 5-HIAA concentrations in LCSF were observed after stim-ulation of the DCS, especially in a patient with excellent pain relief by stimulation.

Baseline monoamine metabolite concentrations and changes in these concentrations after stim-ulation through implanted electrodes have seldom been investigated in patients with intractable pain. The norepinephrine-mediated descending pain inhibiting pathway may play an important role in the control of intractable pain, as well as the serotonin and dopamine pathways.