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Neurological Surgery No Shinkei Geka Volume 25, Issue 4 （April 1997）

Neurological Surgery 脳神経外科 25巻4号（1997年4月発行）

Japanese English

研究

視床痛に対する大脳皮質運動野刺激療法 Motor cortex stimulation therapy in patients with thalamic pain 藤井正美 ¹ , 大本芳範 ¹ , 北原哲博 ¹ , 杉山修一 ¹ , 上杉政司 ¹ , 山下哲男 ² , 城山雄二郎 ³ , 伊藤治英 ¹ Masami FUJII ¹ , Yoshinori OHMOTO ¹ , Tetsuhiro KITAHARA ¹ , Shuichi SUGIYAMA ¹ , Seiji UESUGI ¹ , Tetsuo YAMASHITA ² , Yujiro SHIROYAMA ³ , Haruhide ITO ¹ ¹山口大学脳神経外科 ²山口県立中央病院脳神経外科 ³山口労災病院脳神経外科 ¹Department of Neurosurgery, Yamaguchi University School of Medicine ²Department of Neurosurgery, Yamaguchi Prefectural Hospital ³Department of Neurosurgery, Yamaguchi Rosai Hospital キーワード： thalamic pain , motor cortex , electrical stimulation , MRI , stimulus rate Keyword: thalamic pain , motor cortex , electrical stimulation , MRI , stimulus rate pp.315-319

発行日 1997年4月10日 Published Date 1997/4/10

DOI https://doi.org/10.11477/mf.1436901371

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Abstract 文献概要
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I．はじめに

　視床痛を中心とする中枢性疼痛は一般に薬物治療が困難なことが多い．そこで外科的治療として，視床破壊術^{3,15,18,25）}や視床知覚中継核^{5,10,11,24）}，内包後脚^1），脊髄後索^20）の電気刺激が試みられているが，その効果に関して多くの議論がある．近年，中枢性疼痛に対して大脳皮質運動野電気刺激療法の有効例が報告されてはいるが，その効果についても意見が分かれている^13,14,19）．また大脳皮質運動野の電気刺激療法を行う際，刺激効果に与える重要な因子の一つとして刺激条件が挙げられるが，その刺激条件についての一致した見解は得られていないように思われる．そこで今回われわれは脳梗塞または脳出血後に発症した中枢性疼痛の患者に対し大脳皮質運動野の硬膜外電気刺激療法を行い，その臨床的効果および至適刺激条件について検討したので，若干の文献的考察を加え報告する．

Seven patients with thalamic pain were treated by electrical stimulation of the motor cortex. Patients ranged from 55 to 71 years of age. There were six men and one woman. Causes of thalamic pain were thalamic infarction in 2 patients and thalamic hemorrhage in five. Six patients had intractable pain associated with dysesthesia in the upper and lower limb (upper limb dominant). One patient had intractable pain in the face contralateral to the lesion. Magnetic resonance images (MRI) were performed in 5 patients and showed the deposit of hemosiderin in the internal capsule, postero-lateral nucleus and pulvinar. Electrodes were placed on the motor cortex epidurally in seven patients. Elec-trodes were implanted permanently in six patients and removed in one patient after an unsatisfactory result of test stimulation. Motor cortex stimulation provided satisfactory pain relief in all six patients for a month af-ter the beginning of stimulation, however, by the time three months had passed, pain relief had become gra-dually unsatisfactory in five patients. We compared pain relief between 10 Hz and 100Hz of stimulus rate in four patients and observed that all patients complained of fatigue in the upper extremity at the 100Hz of stimu-lus rate, though no difference in pain relief was obtained according to which of these two stimulus rates were used.

We concluded that motor cortex stimulation brought about pain inhibition in patients with thalamic pain, but pain control tended to become less gradual within several months after the beginning of stimulation.