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Emvalomenos GM, Kang JWM, Jupp B, Mychasiuk R, Keay KA, Henderson LA. Recent developments and challenges in positron emission tomography imaging of gliosis in chronic neuropathic pain. Pain 2024; 165:2184-2199. [PMID: 38713812 DOI: 10.1097/j.pain.0000000000003247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/05/2024] [Indexed: 05/09/2024]
Abstract
ABSTRACT Understanding the mechanisms that underpin the transition from acute to chronic pain is critical for the development of more effective and targeted treatments. There is growing interest in the contribution of glial cells to this process, with cross-sectional preclinical studies demonstrating specific changes in these cell types capturing targeted timepoints from the acute phase and the chronic phase. In vivo longitudinal assessment of the development and evolution of these changes in experimental animals and humans has presented a significant challenge. Recent technological advances in preclinical and clinical positron emission tomography, including the development of specific radiotracers for gliosis, offer great promise for the field. These advances now permit tracking of glial changes over time and provide the ability to relate these changes to pain-relevant symptomology, comorbid psychiatric conditions, and treatment outcomes at both a group and an individual level. In this article, we summarize evidence for gliosis in the transition from acute to chronic pain and provide an overview of the specific radiotracers available to measure this process, highlighting their potential, particularly when combined with ex vivo / in vitro techniques, to understand the pathophysiology of chronic neuropathic pain. These complementary investigations can be used to bridge the existing gap in the field concerning the contribution of gliosis to neuropathic pain and identify potential targets for interventions.
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Affiliation(s)
- Gaelle M Emvalomenos
- School of Medical Sciences [Neuroscience], and the Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - James W M Kang
- School of Medical Sciences [Neuroscience], and the Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Bianca Jupp
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Kevin A Keay
- School of Medical Sciences [Neuroscience], and the Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Luke A Henderson
- School of Medical Sciences [Neuroscience], and the Brain and Mind Centre, The University of Sydney, Sydney, Australia
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2
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Fan F, Yin T, Wu B, Zheng J, Deng J, Wu G, Hu S. The role of spinal neurons targeted by corticospinal neurons in central poststroke neuropathic pain. CNS Neurosci Ther 2024; 30:e14813. [PMID: 38887838 PMCID: PMC11183184 DOI: 10.1111/cns.14813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 05/15/2024] [Accepted: 06/03/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Central poststroke pain (CPSP) is one of the primary sequelae following stroke, yet its underlying mechanisms are poorly understood. METHODS By lesioning the lateral thalamic nuclei, we first established a CPSP model that exhibits mechanical and thermal hypersensitivity. Innocuous mechanical stimuli following the thalamic lesion evoked robust neural activation in somatosensory corticospinal neurons (CSNs), as well as in the deep dorsal horn, where low threshold mechanosensory afferents terminate. In this study, we used viral-based mapping and intersectional functional manipulations to decipher the role of somatosensory CSNs and their spinal targets in the CPSP pathophysiology. RESULTS We first mapped the post-synaptic spinal targets of lumbar innervating CSNs using an anterograde trans-synaptic AAV1-based strategy and showed these spinal interneurons were activated by innocuous tactile stimuli post-thalamic lesion. Functionally, tetanus toxin-based chronic inactivation of spinal neurons targeted by CSNs prevented the development of CPSP. Consistently, transient chemogenetic silencing of these neurons alleviated established mechanical pain hypersensitivity and innocuous tactile stimuli evoked aversion linked to the CPSP. In contrast, chemogenetic activation of these neurons was insufficient to induce robust mechanical allodynia typically observed in the CPSP. CONCLUSION The CSNs and their spinal targets are required but insufficient for the establishment of CPSP hypersensitivity. Our study provided novel insights into the neural mechanisms underlying CPSP and potential therapeutic interventions to treat refractory central neuropathic pain conditions.
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Affiliation(s)
- Fenqqi Fan
- Department of Pain, Yueyang Hospital of Integrated Traditional Chinese and Western MedicineShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Tianze Yin
- Department of Pain, Yueyang Hospital of Integrated Traditional Chinese and Western MedicineShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Biwu Wu
- Department of Neurosurgery and Neurocritical Care, Huashan HospitalFudan UniversityShanghaiChina
| | - Jiajun Zheng
- Department of Neurosurgery and Neurocritical Care, Huashan HospitalFudan UniversityShanghaiChina
| | - Jiaojiao Deng
- Department of Neurosurgery and Neurocritical Care, Huashan HospitalFudan UniversityShanghaiChina
| | - Gang Wu
- Department of Neurosurgery and Neurocritical Care, Huashan HospitalFudan UniversityShanghaiChina
| | - Shukun Hu
- Department of Neurosurgery and Neurocritical Care, Huashan HospitalFudan UniversityShanghaiChina
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3
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Wu Z, Feng K, Huang J, Ye X, Yang R, Huang Q, Jiang Q. Brain region changes following a spinal cord injury. Neurochem Int 2024; 174:105696. [PMID: 38354751 DOI: 10.1016/j.neuint.2024.105696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/16/2024] [Accepted: 02/10/2024] [Indexed: 02/16/2024]
Abstract
Brain-related complications are common in clinical practice after spinal cord injury (SCI); however, the molecular mechanisms of these complications are still unclear. Here, we reviewed the changes in the brain regions caused by SCI from three perspectives: imaging, molecular analysis, and electrophysiology. Imaging studies revealed abnormal functional connectivity, gray matter volume atrophy, and metabolic abnormalities in brain regions after SCI, leading to changes in the structure and function of brain regions. At the molecular level, chemokines, inflammatory factors, and damage-associated molecular patterns produced in the injured area were retrogradely transmitted through the corticospinal tract, cerebrospinal fluid, or blood circulation to the specific brain area to cause pathologic changes. Electrophysiologic recordings also suggested abnormal changes in brain electrical activity after SCI. Transcranial magnetic stimulation, transcranial direct current stimulation, and deep brain stimulation alleviated pain and improved motor function in patients with SCI; therefore, transcranial therapy may be a new strategy for the treatment of patients with SCI.
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Affiliation(s)
- Zhiwu Wu
- Department of Neurosurgery, Ganzhou People's Hospital (Ganzhou Hospital-Nanfang Hospital, Southern Medical University), 16th Mei-guan Avenue, Ganzhou, 341000, China
| | - Kaiming Feng
- Department of Neurosurgery, Ganzhou People's Hospital (Ganzhou Hospital-Nanfang Hospital, Southern Medical University), 16th Mei-guan Avenue, Ganzhou, 341000, China
| | - Jinqing Huang
- Department of Neurosurgery, Ganzhou People's Hospital (Ganzhou Hospital-Nanfang Hospital, Southern Medical University), 16th Mei-guan Avenue, Ganzhou, 341000, China
| | - Xinyun Ye
- Department of Neurosurgery, Ganzhou People's Hospital (Ganzhou Hospital-Nanfang Hospital, Southern Medical University), 16th Mei-guan Avenue, Ganzhou, 341000, China
| | - Ruijin Yang
- Department of Neurosurgery, Ganzhou People's Hospital (Ganzhou Hospital-Nanfang Hospital, Southern Medical University), 16th Mei-guan Avenue, Ganzhou, 341000, China
| | - Qianliang Huang
- Department of Neurosurgery, Ganzhou People's Hospital (Ganzhou Hospital-Nanfang Hospital, Southern Medical University), 16th Mei-guan Avenue, Ganzhou, 341000, China.
| | - Qiuhua Jiang
- Department of Neurosurgery, Ganzhou People's Hospital (Ganzhou Hospital-Nanfang Hospital, Southern Medical University), 16th Mei-guan Avenue, Ganzhou, 341000, China.
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4
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Rosner J, de Andrade DC, Davis KD, Gustin SM, Kramer JLK, Seal RP, Finnerup NB. Central neuropathic pain. Nat Rev Dis Primers 2023; 9:73. [PMID: 38129427 PMCID: PMC11329872 DOI: 10.1038/s41572-023-00484-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Abstract
Central neuropathic pain arises from a lesion or disease of the central somatosensory nervous system such as brain injury, spinal cord injury, stroke, multiple sclerosis or related neuroinflammatory conditions. The incidence of central neuropathic pain differs based on its underlying cause. Individuals with spinal cord injury are at the highest risk; however, central post-stroke pain is the most prevalent form of central neuropathic pain worldwide. The mechanisms that underlie central neuropathic pain are not fully understood, but the pathophysiology likely involves intricate interactions and maladaptive plasticity within spinal circuits and brain circuits associated with nociception and antinociception coupled with neuronal hyperexcitability. Modulation of neuronal activity, neuron-glia and neuro-immune interactions and targeting pain-related alterations in brain connectivity, represent potential therapeutic approaches. Current evidence-based pharmacological treatments include antidepressants and gabapentinoids as first-line options. Non-pharmacological pain management options include self-management strategies, exercise and neuromodulation. A comprehensive pain history and clinical examination form the foundation of central neuropathic pain classification, identification of potential risk factors and stratification of patients for clinical trials. Advanced neurophysiological and neuroimaging techniques hold promise to improve the understanding of mechanisms that underlie central neuropathic pain and as predictive biomarkers of treatment outcome.
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Affiliation(s)
- Jan Rosner
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Daniel C de Andrade
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Karen D Davis
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Surgery and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Sylvia M Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - John L K Kramer
- International Collaboration on Repair Discoveries, ICORD, University of British Columbia, Vancouver, Canada
- Department of Anaesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Rebecca P Seal
- Pittsburgh Center for Pain Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Departments of Neurobiology and Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nanna B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
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5
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Ziegler K, Folkard R, Gonzalez AJ, Burghardt J, Antharvedi-Goda S, Martin-Cortecero J, Isaías-Camacho E, Kaushalya S, Tan LL, Kuner T, Acuna C, Kuner R, Mease RA, Groh A. Primary somatosensory cortex bidirectionally modulates sensory gain and nociceptive behavior in a layer-specific manner. Nat Commun 2023; 14:2999. [PMID: 37225702 DOI: 10.1038/s41467-023-38798-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 05/16/2023] [Indexed: 05/26/2023] Open
Abstract
The primary somatosensory cortex (S1) is a hub for body sensation of both innocuous and noxious signals, yet its role in somatosensation versus pain is debated. Despite known contributions of S1 to sensory gain modulation, its causal involvement in subjective sensory experiences remains elusive. Here, in mouse S1, we reveal the involvement of cortical output neurons in layers 5 (L5) and 6 (L6) in the perception of innocuous and noxious somatosensory signals. We find that L6 activation can drive aversive hypersensitivity and spontaneous nocifensive behavior. Linking behavior to neuronal mechanisms, we find that L6 enhances thalamic somatosensory responses, and in parallel, strongly suppresses L5 neurons. Directly suppressing L5 reproduced the pronociceptive phenotype induced by L6 activation, suggesting an anti-nociceptive function for L5 output. Indeed, L5 activation reduced sensory sensitivity and reversed inflammatory allodynia. Together, these findings reveal a layer-specific and bidirectional role for S1 in modulating subjective sensory experiences.
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Affiliation(s)
- Katharina Ziegler
- Medical Biophysics, Institute for Physiology and Pathophysiology, Heidelberg University, Heidelberg, Germany
| | - Ross Folkard
- Medical Biophysics, Institute for Physiology and Pathophysiology, Heidelberg University, Heidelberg, Germany
| | - Antonio J Gonzalez
- Medical Biophysics, Institute for Physiology and Pathophysiology, Heidelberg University, Heidelberg, Germany
| | - Jan Burghardt
- Medical Biophysics, Institute for Physiology and Pathophysiology, Heidelberg University, Heidelberg, Germany
| | - Sailaja Antharvedi-Goda
- Medical Biophysics, Institute for Physiology and Pathophysiology, Heidelberg University, Heidelberg, Germany
| | - Jesus Martin-Cortecero
- Medical Biophysics, Institute for Physiology and Pathophysiology, Heidelberg University, Heidelberg, Germany
| | - Emilio Isaías-Camacho
- Medical Biophysics, Institute for Physiology and Pathophysiology, Heidelberg University, Heidelberg, Germany
| | - Sanjeev Kaushalya
- Department of Molecular Pharmacology, Institute for Pharmacology, Heidelberg University, Heidelberg, Germany
| | - Linette Liqi Tan
- Department of Molecular Pharmacology, Institute for Pharmacology, Heidelberg University, Heidelberg, Germany
| | - Thomas Kuner
- Institute for Anatomy and Cell Biology, Heidelberg University, Heidelberg, Germany
| | - Claudio Acuna
- Chica and Heinz Schaller Research Group, Institute for Anatomy and Cell Biology, Heidelberg University, Heidelberg, Germany
| | - Rohini Kuner
- Department of Molecular Pharmacology, Institute for Pharmacology, Heidelberg University, Heidelberg, Germany
| | - Rebecca Audrey Mease
- Medical Biophysics, Institute for Physiology and Pathophysiology, Heidelberg University, Heidelberg, Germany.
| | - Alexander Groh
- Medical Biophysics, Institute for Physiology and Pathophysiology, Heidelberg University, Heidelberg, Germany.
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6
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Brunelle DL, Llano DA. Role of auditory-somatosensory corticothalamic circuit integration in analgesia. Cell Calcium 2023; 111:102717. [PMID: 36931195 PMCID: PMC10755628 DOI: 10.1016/j.ceca.2023.102717] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023]
Abstract
Our sensory environment is permeated by a diverse array of auditory and somatosensory stimuli. The pairing of acoustic signals with concurrent or forthcoming tactile cues are abundant in everyday life and various survival contexts across species, thus deeming the ability to integrate sensory inputs arising from the combination of these stimuli as crucial. The corticothalamic system plays a critical role in orchestrating the construction, integration and distribution of the information extracted from these sensory modalities. In this mini-review, we provide a circuit-level description of the auditory corticothalamic pathway in conjunction with adjacent corticothalamic somatosensory projections. Although the extent of the functional interactions shared by these pathways is not entirely elucidated, activation of each of these systems appears to modulate sensory perception in the complementary domain. Several specific issues are reviewed. Under certain environmental noise conditions, the spectral information of a sound could induce modulations in nociception and even induce analgesia. We begin by discussing recent findings by Zhou et al. (2022) implicating the corticothalamic system in mediating sound-induced analgesia. Next, we describe relevant components of the corticothalamic pathway's functional organization. Additionally, we describe an emerging body of literature pointing to intrathalamic circuitry being optimal for controlling and selecting sensory signals across modalities, with the thalamic reticular nucleus being a candidate mechanism for directing cross-modal interactions. Finally, Ca2+ bursting in thalamic neurons evoked by the thalamic reticular nucleus is explored.
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Affiliation(s)
- Dimitri L Brunelle
- Neuroscience Program, University of Illinois at Urbana-Champaign, Urbana, IL 61801, United States of America
| | - Daniel A Llano
- Neuroscience Program, University of Illinois at Urbana-Champaign, Urbana, IL 61801, United States of America; Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, United States of America; Department of Molecular and Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, United States of America.
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7
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Zhang Q, Hu S, Talay R, Xiao Z, Rosenberg D, Liu Y, Sun G, Li A, Caravan B, Singh A, Gould JD, Chen ZS, Wang J. A prototype closed-loop brain-machine interface for the study and treatment of pain. Nat Biomed Eng 2023; 7:533-545. [PMID: 34155354 PMCID: PMC9516430 DOI: 10.1038/s41551-021-00736-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/22/2021] [Indexed: 12/25/2022]
Abstract
Chronic pain is characterized by discrete pain episodes of unpredictable frequency and duration. This hinders the study of pain mechanisms and contributes to the use of pharmacological treatments associated with side effects, addiction and drug tolerance. Here, we show that a closed-loop brain-machine interface (BMI) can modulate sensory-affective experiences in real time in freely behaving rats by coupling neural codes for nociception directly with therapeutic cortical stimulation. The BMI decodes the onset of nociception via a state-space model on the basis of the analysis of online-sorted spikes recorded from the anterior cingulate cortex (which is critical for pain processing) and couples real-time pain detection with optogenetic activation of the prelimbic prefrontal cortex (which exerts top-down nociceptive regulation). In rats, the BMI effectively inhibited sensory and affective behaviours caused by acute mechanical or thermal pain, and by chronic inflammatory or neuropathic pain. The approach provides a blueprint for demand-based neuromodulation to treat sensory-affective disorders, and could be further leveraged for nociceptive control and to study pain mechanisms.
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Affiliation(s)
- Qiaosheng Zhang
- Department of Anesthesiology, Perioperative Care and Pain, New York University School of Medicine, New York, NY, USA
| | - Sile Hu
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Robert Talay
- Department of Anesthesiology, Perioperative Care and Pain, New York University School of Medicine, New York, NY, USA
| | - Zhengdong Xiao
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - David Rosenberg
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Yaling Liu
- Department of Anesthesiology, Perioperative Care and Pain, New York University School of Medicine, New York, NY, USA
| | - Guanghao Sun
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Anna Li
- Department of Anesthesiology, Perioperative Care and Pain, New York University School of Medicine, New York, NY, USA
| | - Bassir Caravan
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Amrita Singh
- Department of Anesthesiology, Perioperative Care and Pain, New York University School of Medicine, New York, NY, USA
| | - Jonathan D Gould
- College of Arts and Sciences, New York University, New York, NY, USA
| | - Zhe S Chen
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA.
- Department of Neuroscience & Physiology, New York University School of Medicine, New York, NY, USA.
- Neuroscience Institute, New York University School of Medicine, New York, NY, USA.
| | - Jing Wang
- Department of Anesthesiology, Perioperative Care and Pain, New York University School of Medicine, New York, NY, USA.
- Department of Neuroscience & Physiology, New York University School of Medicine, New York, NY, USA.
- Neuroscience Institute, New York University School of Medicine, New York, NY, USA.
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8
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Matthews LG, Puryear CB, Correia SS, Srinivasan S, Belfort GM, Pan MK, Kuo SH. T-type calcium channels as therapeutic targets in essential tremor and Parkinson's disease. Ann Clin Transl Neurol 2023; 10:462-483. [PMID: 36738196 PMCID: PMC10109288 DOI: 10.1002/acn3.51735] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 02/05/2023] Open
Abstract
Neuronal action potential firing patterns are key components of healthy brain function. Importantly, restoring dysregulated neuronal firing patterns has the potential to be a promising strategy in the development of novel therapeutics for disorders of the central nervous system. Here, we review the pathophysiology of essential tremor and Parkinson's disease, the two most common movement disorders, with a focus on mechanisms underlying the genesis of abnormal firing patterns in the implicated neural circuits. Aberrant burst firing of neurons in the cerebello-thalamo-cortical and basal ganglia-thalamo-cortical circuits contribute to the clinical symptoms of essential tremor and Parkinson's disease, respectively, and T-type calcium channels play a key role in regulating this activity in both the disorders. Accordingly, modulating T-type calcium channel activity has received attention as a potentially promising therapeutic approach to normalize abnormal burst firing in these diseases. In this review, we explore the evidence supporting the theory that T-type calcium channel blockers can ameliorate the pathophysiologic mechanisms underlying essential tremor and Parkinson's disease, furthering the case for clinical investigation of these compounds. We conclude with key considerations for future investigational efforts, providing a critical framework for the development of much needed agents capable of targeting the dysfunctional circuitry underlying movement disorders such as essential tremor, Parkinson's disease, and beyond.
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Affiliation(s)
| | - Corey B Puryear
- Praxis Precision Medicines, Boston, Massachusetts, 02110, USA
| | | | - Sharan Srinivasan
- Praxis Precision Medicines, Boston, Massachusetts, 02110, USA.,Department of Neurology, University of Michigan, Ann Arbor, Michigan, 48109, USA
| | | | - Ming-Kai Pan
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei, 10051, Taiwan.,Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, 10617, Taiwan.,Department of Medical Research, National Taiwan University Hospital, Taipei, 10002, Taiwan.,Cerebellar Research Center, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, 64041, Taiwan
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University, New York, New York, 10032, USA.,Initiative for Columbia Ataxia and Tremor, Columbia University, New York, New York, 10032, USA
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9
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Magara AE, Gallay MN, Moser D, Jeanmonod D. Complete resolution of chronic cluster headache following central lateral thalamotomy using incisionless MRI-guided focused ultrasound with 6 years of follow-up: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22259. [PMID: 36443956 PMCID: PMC9705522 DOI: 10.3171/case22259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/29/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The authors reported the case of a 66-year-old male patient with a 14-year history of right-sided severe episodic and therapy-resistant cluster headache (CH) who underwent bilateral central lateral thalamotomy (CLT) using incisionless transcranial magnetic resonance imaging-guided focused ultrasound (MRgFUS). OBSERVATIONS The patient experienced a single cluster headache attack 5 weeks after the procedure. There were no more pain attacks over the next 6 years of follow-up. LESSONS This treatment success may indicate a common pathophysiology for CH and neurogenic (neuropathic) pain, which has been treated with CLT for more than 30 years. Further experience is needed to assess the reproducibility of this case.
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10
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Sola RG, Pulido P. Neurosurgical Treatment of Pain. Brain Sci 2022; 12:1584. [PMID: 36421909 PMCID: PMC9688870 DOI: 10.3390/brainsci12111584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 12/01/2023] Open
Abstract
The aim of this review is to draw attention to neurosurgical approaches for treating chronic and opioid-resistant pain. In a first chapter, an up-to-date overview of the main pathophysiological mechanisms of pain has been carried out, with special emphasis on the details in which the surgical treatment is based. In a second part, the principal indications and results of different surgical approaches are reviewed. Cordotomy, Myelotomy, DREZ lesions, Trigeminal Nucleotomy, Mesencephalotomy, and Cingulotomy are revisited. Ablative procedures have a limited role in the management of chronic non-cancer pain, but they continues to help patients with refractory cancer-related pain. Another ablation lesion has been named and excluded, due to lack of current relevance. Peripheral Nerve, Spine Cord, and the principal possibilities of Deep Brain and Motor Cortex Stimulation are also revisited. Regarding electrical neuromodulation, patient selection remains a challenge.
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Affiliation(s)
- Rafael G. Sola
- Innovation in Neurosurgery, Department of Surgery, Autonomous University of Madrid, 28049 Madrid, Spain
| | - Paloma Pulido
- Department of Surgery, Autonomous University of Madrid, 28049 Madrid, Spain
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11
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Relief of chronic pain associated with increase in midline frontal theta power. Pain Rep 2022; 7:e1040. [PMID: 36247110 PMCID: PMC9555895 DOI: 10.1097/pr9.0000000000001040] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/27/2022] [Accepted: 08/11/2022] [Indexed: 11/26/2022] Open
Abstract
Unique electroencephalogram signatures of relief from chronic pain demonstrate theta power increase in the midline frontal cortex. Introduction: Objectives: Methods: Results: Conclusion:
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12
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Allam AK, Larkin MB, McGinnis JP, Viswanathan A. Neuroablative central lateral thalamotomy for chronic neuropathic pain. FRONTIERS IN PAIN RESEARCH 2022; 3:999891. [PMID: 36176711 PMCID: PMC9513204 DOI: 10.3389/fpain.2022.999891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic neuropathic pain refractory to medical management can be debilitating and can seriously affect one's quality of life. The interest of ablative surgery for the treatment or palliation of chronic neuropathic pain, cancer-related or chemotherapy-induced, has grown. Numerous regions along the nociceptive pathways have been prominent targets including the various nuclei of the thalamus. Traditional targets include the medial pulvinar, central median, and posterior complex thalamic nuclei. However, there has been little research regarding the role of the central lateral nucleus. In this paper, we aim to summarize the anatomy, pathophysiology, and patient experiences of the central lateral thalamotomy.
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Affiliation(s)
- Anthony K. Allam
- School of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - M. Benjamin Larkin
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - John P. McGinnis
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
- Department of Neurosurgery, University of Texas, MD Anderson, Houston, TX, United States
- Correspondence: Ashwin Viswanathan
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13
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Defrin R, Gruener H, Gaidukov E, Bondi M, Rachamim-Katz O, Ringler E, Blumen N, Zeilig G. From acute to long-term alterations in pain processing and modulation after spinal cord injury: mechanisms related to chronification of central neuropathic pain. Pain 2022; 163:e94-e105. [PMID: 33863855 DOI: 10.1097/j.pain.0000000000002315] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/10/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT A severe and debilitating consequence of a spinal cord injury (SCI) is central neuropathic pain (CNP). Our aim was to investigate the processes leading to CNP emergence and chronification by analyzing causal relationship over time between spinothalamic function, pain excitability, and pain inhibition after SCI. This longitudinal follow-up study included 53 patients with acute SCI and 20 healthy controls. Spinothalamic, pain excitability, and intrasegmental and extrasegmental pain inhibition indices were repeatedly evaluated at 1.5, 3, and 6 months post-SCI. Between- and within-group analyses were conducted among those patients who eventually developed CNP and those who did not. Healthy controls were evaluated twice for repeatability analysis. Patients who developed CNP, compared with those who did not, exhibited increased thermal thresholds (P < 0.05), reduced pain adaptation (P < 0.01), and conditioned pain modulation (P < 0.05), early post-injury, and the CNP group's manifestations remained worse throughout the follow-up. By contrast, allodynia frequency was initially similar across SCI groups, but gradually increased in the subacute phase onward only among the CNP group (P < 0.001), along with CNP emergence. Early worse spinothalamic and pain inhibition preceded CNP and predicted its occurrence, and early worse pain inhibition mediated the link between spinothalamic function and CNP. Crossover associations were observed between early and late pain inhibition and excitability. Inefficient intrasegmental and extrasegmental inhibition, possibly resulting from spinothalamic deafferentation, seems to ignite CNP chronification. Pain excitability probably contributes to CNP maintenance, possibly via further exhaustion of the inhibitory control. Preemptive treatment promoting antinociception early post-SCI may mitigate or prevent CNP.
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Affiliation(s)
- Ruth Defrin
- Department of Physical Therapy at Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Hila Gruener
- Department of Physical Therapy at Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Evgeni Gaidukov
- Department of Neurological Rehabilitation, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Department of Rehabilitation Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Bondi
- Department of Neurological Rehabilitation, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Department of Rehabilitation Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orna Rachamim-Katz
- Barzilai Day Care Rehabilitation Unit, Barzilai Medical Center, Ashkelon, Israel
| | - Erez Ringler
- Department of Neurological Rehabilitation, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Department of Rehabilitation Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nava Blumen
- Department of Neurological Rehabilitation, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Department of Rehabilitation Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gabi Zeilig
- Department of Neurological Rehabilitation, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Department of Rehabilitation Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Zhang P, Jiang Y, Liu G, Han J, Wang J, Ma L, Hu W, Zhang J. Altered brain functional network dynamics in classic trigeminal neuralgia: a resting-state functional magnetic resonance imaging study. J Headache Pain 2021; 22:147. [PMID: 34895135 PMCID: PMC8903588 DOI: 10.1186/s10194-021-01354-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/06/2021] [Indexed: 12/20/2022] Open
Abstract
Background Accumulating studies have indicated a wide range of brain alterations with respect to the structure and function of classic trigeminal neuralgia (CTN). Given the dynamic nature of pain experience, the exploration of temporal fluctuations in interregional activity covariance may enhance the understanding of pain processes in the brain. The present study aimed to characterize the temporal features of functional connectivity (FC) states as well as topological alteration in CTN. Methods Resting-state functional magnetic resonance imaging and three-dimensional T1-weighted images were obtained from 41 CTN patients and 43 matched healthy controls (HCs). After group independent component analysis, sliding window based dynamic functional network connectivity (dFNC) analysis was applied to investigate specific FC states and related temporal properties. Then, the dynamics of the whole brain topological organization were estimated by calculating the coefficient of variation of graph-theoretical properties. Further correlation analyses were performed between all these measurements and clinical data. Results Two distinct states were identified. Of these, the state 2, characterized by complicated coupling between default mode network (DMN) and cognitive control network (CC) and tight connections within DMN, was expressed more in CTN patients and presented as increased fractional windows and dwell time. Moreover, patients switched less frequently between states than HCs. Regarding the dynamic topological analysis, disruptions in global graph-theoretical properties (including network efficiency and small-worldness) were observed in patients, coupled with decreased variability in nodal efficiency of anterior cingulate cortex (ACC) in the salience network (SN) and the thalamus and caudate nucleus in the subcortical network (SC). The variation of topological properties showed negative correlation with disease duration and attack frequency. Conclusions The present study indicated disrupted flexibility of brain topological organization under persistent noxious stimulation and further highlighted the important role of “dynamic pain connectome” regions (including DMN/CC/SN) in the pathophysiology of CTN from the temporal fluctuation aspect. Additionally, the findings provided supplementary evidence for current knowledge about the aberrant cortical-subcortical interaction in pain development. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-021-01354-z.
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Affiliation(s)
- Pengfei Zhang
- Second Clinical School, Lanzhou University, Lanzhou, 730000, China.,Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, 730000, China
| | - Yanli Jiang
- Second Clinical School, Lanzhou University, Lanzhou, 730000, China.,Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, 730000, China
| | - Guangyao Liu
- Second Clinical School, Lanzhou University, Lanzhou, 730000, China.,Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, 730000, China
| | - Jiao Han
- Second Clinical School, Lanzhou University, Lanzhou, 730000, China
| | - Jun Wang
- Second Clinical School, Lanzhou University, Lanzhou, 730000, China.,Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, 730000, China
| | - Laiyang Ma
- Second Clinical School, Lanzhou University, Lanzhou, 730000, China.,Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, 730000, China
| | - Wanjun Hu
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, 730000, China
| | - Jing Zhang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, 730000, China. .,Gansu Province Clinical Research Center for Functional and Molecular Imaging, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, P. R. China.
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15
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Liu Y, Xu H, Sun G, Vemulapalli B, Jee HJ, Zhang Q, Wang J. Frequency Dependent Electrical Stimulation of PFC and ACC for Acute Pain Treatment in Rats. FRONTIERS IN PAIN RESEARCH 2021; 2:728045. [PMID: 35295497 PMCID: PMC8915567 DOI: 10.3389/fpain.2021.728045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/02/2021] [Indexed: 11/13/2022] Open
Abstract
As pain consists of both sensory and affective components, its management by pharmaceutical agents remains difficult. Alternative forms of neuromodulation, such as electrical stimulation, have been studied in recent years as potential pain treatment options. Although electrical stimulation of the brain has shown promise, more research into stimulation frequency and targets is required to support its clinical applications. Here, we studied the effect that stimulation frequency has on pain modulation in the prefrontal cortex (PFC) and the anterior cingulate cortex (ACC) in acute pain models in rats. We found that low-frequency stimulation in the prelimbic region of the PFC (PL-PFC) provides reduction of sensory and affective pain components. Meanwhile, high-frequency stimulation of the ACC, a region involved in processing pain affect, reduces pain aversive behaviors. Our results demonstrate that frequency-dependent neuromodulation of the PFC or ACC has the potential for pain modulation.
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Affiliation(s)
- Yaling Liu
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, NY, United States
| | - Helen Xu
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, NY, United States
| | - Guanghao Sun
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, NY, United States
- Interdisciplinary Pain Research Program, New York University Langone Health, New York, NY, United States
- Department of Psychiatry, New York University School of Medicine, New York, NY, United States
| | - Bharat Vemulapalli
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, NY, United States
| | - Hyun Jung Jee
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, NY, United States
| | - Qiaosheng Zhang
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, NY, United States
- Interdisciplinary Pain Research Program, New York University Langone Health, New York, NY, United States
- *Correspondence: Qiaosheng Zhang
| | - Jing Wang
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, NY, United States
- Interdisciplinary Pain Research Program, New York University Langone Health, New York, NY, United States
- Department of Neuroscience & Physiology, New York University School of Medicine, New York, NY, United States
- Neuroscience Institute, New York University School of Medicine, New York, NY, United States
- Jing Wang
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16
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Hirato M, Miyagishima T, Takahashi A, Yoshimoto Y. Thalamic anterior part of the ventral posterolateral nucleus and central lateral nucleus in the genesis of central post-stroke pain. Acta Neurochir (Wien) 2021; 163:2121-2133. [PMID: 33990885 DOI: 10.1007/s00701-021-04743-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 01/27/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The genesis of central post-stroke pain (CPSP) is important but difficult to understand. We evaluated the involvement of the thalamic anterior part of the ventral posterolateral nucleus (VPLa) and central lateral nucleus (CL) in the occurrence of CPSP. METHOD Stereotactic thalamotomy was performed on the posterior part of the ventral lateral nucleus (VLp)-VPLa and CL in 9 patients with CPSP caused by deep-seated intracerebral hemorrhage. Computed tomography (CT) did not reveal definite thalamic lesion in 5 patients but did in 4 patients. Electrophysiological studies of these thalamic nuclei were carried out during the surgery. Anatomical studies using CT were performed in another 20 patients with thalamic hemorrhage who had clear consciousness but had sensory disturbance at onset. RESULTS Neural activities were preserved and hyperactive and unstable discharges (HUDs) were often recognized along the trajectory in the thalamic VLp-VPLa in 5 patients without thalamic lesion. Surgical modification of this area ameliorated pain, particularly movement-related pain. Neural activities were hypoactive in the other 4 patients with thalamic lesion. However, neural activities were preserved and HUDs were sometimes recognized in the CL. Sensory responses were seen, but at low rate, in the sensory thalamus. Anatomical study showed that the thalamic lesion was obviously smaller in the patients with developing pain in the chronic stage. CONCLUSIONS Change in neural activities around the cerebrovascular disease lesion in the thalamic VPLa or CL might affect the perception of sensory impulses or sensory processing in those thalamic nuclei, resulting in the genesis of CPSP.
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Affiliation(s)
- Masafumi Hirato
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
- Department of Neurosurgery, National Hospital Organization Shibukawa Medical Center, Shibukawa, Gunma, Japan.
| | - Takaaki Miyagishima
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Akio Takahashi
- Department of Neurosurgery, National Hospital Organization Shibukawa Medical Center, Shibukawa, Gunma, Japan
| | - Yuhei Yoshimoto
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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17
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Abdallat M, Saryyeva A, Blahak C, Wolf ME, Weigel R, Loher TJ, Runge J, Heissler HE, Kinfe TM, Krauss JK. Centromedian-Parafascicular and Somatosensory Thalamic Deep Brain Stimulation for Treatment of Chronic Neuropathic Pain: A Contemporary Series of 40 Patients. Biomedicines 2021; 9:731. [PMID: 34202202 PMCID: PMC8301341 DOI: 10.3390/biomedicines9070731] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/17/2021] [Accepted: 06/20/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction: The treatment of neuropathic and central pain still remains a major challenge. Thalamic deep brain stimulation (DBS) involving various target structures is a therapeutic option which has received increased re-interest. Beneficial results have been reported in several more recent smaller studies, however, there is a lack of prospective studies on larger series providing long term outcomes. Methods: Forty patients with refractory neuropathic and central pain syndromes underwent stereotactic bifocal implantation of DBS electrodes in the centromedian-parafascicular (CM-Pf) and the ventroposterolateral (VPL) or ventroposteromedial (VPM) nucleus contralateral to the side of pain. Electrodes were externalized for test stimulation for several days. Outcome was assessed with five specific VAS pain scores (maximum, minimum, average pain, pain at presentation, allodynia). Results: The mean age at surgery was 53.5 years, and the mean duration of pain was 8.2 years. During test stimulation significant reductions of all five pain scores was achieved with either CM-Pf or VPL/VPM stimulation. Pacemakers were implanted in 33/40 patients for chronic stimulation for whom a mean follow-up of 62.8 months (range 3-180 months) was available. Of these, 18 patients had a follow-up beyond four years. Hardware related complications requiring secondary surgeries occurred in 11/33 patients. The VAS maximum pain score was improved by ≥50% in 8/18, and by ≥30% in 11/18 on long term follow-up beyond four years, and the VAS average pain score by ≥50% in 10/18, and by ≥30% in 16/18. On a group level, changes in pain scores remained statistically significant over time, however, there was no difference when comparing the efficacy of CM-Pf versus VPL/VPM stimulation. The best results were achieved in patients with facial pain, poststroke/central pain (except thalamic pain), or brachial plexus injury, while patients with thalamic lesions had the least benefit. Conclusion: Thalamic DBS is a useful treatment option in selected patients with severe and medically refractory pain.
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Affiliation(s)
- Mahmoud Abdallat
- Department of Neurosurgery, Hannover Medical School, 30625 Hannover, Germany; (M.A.); (R.W.); (J.R.); (H.E.H.); (J.K.K.)
- Department of Neurosurgery, University of Jordan, Amman 11183, Jordan
| | - Assel Saryyeva
- Department of Neurosurgery, Hannover Medical School, 30625 Hannover, Germany; (M.A.); (R.W.); (J.R.); (H.E.H.); (J.K.K.)
| | - Christian Blahak
- Department of Neurology, University Hospital Mannheim, 68167 Mannheim, Germany; (C.B.); (M.E.W.)
- Department of Neurology, Ortenau-Klinikum Lahr-Ettenheim, 77933 Lahr Ettenheim, Germany
| | - Marc E. Wolf
- Department of Neurology, University Hospital Mannheim, 68167 Mannheim, Germany; (C.B.); (M.E.W.)
- Department of Neurology, Katharinenhospital, 70174 Stuttgart, Germany
| | - Ralf Weigel
- Department of Neurosurgery, Hannover Medical School, 30625 Hannover, Germany; (M.A.); (R.W.); (J.R.); (H.E.H.); (J.K.K.)
- Department of Neurosurgery, St. Katharinen Krankenhaus, 60389 Frankfurt, Germany
| | | | - Joachim Runge
- Department of Neurosurgery, Hannover Medical School, 30625 Hannover, Germany; (M.A.); (R.W.); (J.R.); (H.E.H.); (J.K.K.)
| | - Hans E. Heissler
- Department of Neurosurgery, Hannover Medical School, 30625 Hannover, Germany; (M.A.); (R.W.); (J.R.); (H.E.H.); (J.K.K.)
| | - Thomas M. Kinfe
- Department of Neurosurgery, Division of Functional Neurosurgery and Stereotaxy, Friedrich-Alexander University, 91054 Erlangen-Nürnberg, Germany;
| | - Joachim K. Krauss
- Department of Neurosurgery, Hannover Medical School, 30625 Hannover, Germany; (M.A.); (R.W.); (J.R.); (H.E.H.); (J.K.K.)
- Center for Systems Neuroscience, 30559 Hannover, Germany
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18
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Chehade HD, Kobaïter-Maarrawi S, Komboz F, Farhat JP, Magnin M, Garcia-Larrea L, Maarrawi J. Somatosensory Thalamic Activity Modulation by Posterior Insular Stimulation: Cues to Clinical Application Based on Comparison of Frequencies in a Cat Model. Neuromodulation 2020; 24:229-239. [PMID: 33340196 DOI: 10.1111/ner.13343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/14/2020] [Accepted: 11/30/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The posterior insula (PI) has been proposed as a potential neurostimulation target for neuropathic pain relief as it represents a key-structure in pain processing. However, currently available data remain inconclusive as to efficient stimulation parameters. OBJECTIVE As frequency was shown to be the most correlated parameter to pain relief, this study aims to evaluate the potential modulatory effects of low frequency (LF-IS, 50 Hz) and high-frequency (HF-IS, 150 Hz) posterior insular stimulation on the activity of somatosensory thalamic nuclei. MATERIALS AND METHODS Epidural bipolar electrodes were placed over the PI of healthy adult cats, and extracellular single-unit activities of nociceptive (NS), nonnociceptive (NN), and wide dynamic range (WDR) thalamic cells were recorded within the ventral posterolateral nucleus and the medial division of the thalamic posterior complex. Mean discharge frequency and burst firing mode were analyzed before and after either LF-IS or HF-IS. RESULTS LF-IS showed a significant thalamic modulatory effects increasing the firing rate of NN cells (p ≤ 0.03) and decreasing the burst firing of NS cells (p ≤ 0.03), independently of the thalamic nucleus. Conversely, HF-IS did not induce any change in firing properties of the three recorded cell types. CONCLUSION These data indicate that 50 Hz IS could be a better candidate to control neuropathic pain.
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Affiliation(s)
- Hiba-Douja Chehade
- Laboratory of Research in Neuroscience - Pôle technologie santé - Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Sandra Kobaïter-Maarrawi
- Laboratory of Research in Neuroscience - Pôle technologie santé - Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Fares Komboz
- Laboratory of Research in Neuroscience - Pôle technologie santé - Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Jean-Paul Farhat
- Laboratory of Research in Neuroscience - Pôle technologie santé - Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Michel Magnin
- Laboratory of Research in Neuroscience - Pôle technologie santé - Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Luis Garcia-Larrea
- Laboratory of Research in Neuroscience - Pôle technologie santé - Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Joseph Maarrawi
- Laboratory of Research in Neuroscience - Pôle technologie santé - Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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19
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Shigihara Y, Hoshi H, Fukasawa K, Ichikawa S, Kobayashi M, Sakamoto Y, Negishi K, Haraguchi R, Konno S. Resting-State Magnetoencephalography Reveals Neurobiological Bridges Between Pain and Cognitive Impairment. Pain Ther 2020; 10:349-361. [PMID: 33095348 PMCID: PMC8119570 DOI: 10.1007/s40122-020-00213-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/15/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction Pain has been identified as a risk factor for cognitive dysfunction, which in turn affects pain perception. Although pain, cognitive dysfunction, and their interaction are clinically important, the neural mechanism connecting the two phenomena remains unclear. Methods The resting-state brain activity of 38 participants was measured using magnetoencephalography before and after the patients underwent selective nerve root block (SNRB) for the treatment of their pain. We then assessed the extent to which these data correlated with the subjective levels of pain experienced by the patients across SNRB based on the visual analogue scale and the cognitive status of the patients measured after SNRB using the Japanese versions of the Mini-Mental State Examination (MMSE-J). Results Slow oscillations (delta) in the right precentral gyrus, right middle temporal gyrus, and left superior frontal gyrus were negatively correlated with the subjective level of pain, and fast oscillations (gamma) in the right insular cortex and right middle temporal gyrus before SNRB were negatively correlated with the MMSE-J score afterwards. These correlations disappeared after SNRB. Conclusion The presently observed changes in neural activity, as indicated by oscillation changes, might represent the transient bridge between pain and cognitive dysfunction in patients with severe pain. Our findings underscore the importance of treating pain before a transient diminishment of cognitive function becomes persistent.
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Affiliation(s)
- Yoshihito Shigihara
- Precision Medicine Centre, Hokuto Hospital, Obihiro, Japan. .,Precision Medicine Centre, Kumagaya General Hospital, Kumagaya, Japan.
| | - Hideyuki Hoshi
- Precision Medicine Centre, Hokuto Hospital, Obihiro, Japan
| | | | - Sayuri Ichikawa
- Clinical Laboratory, Kumagaya General Hospital, Kumagaya, Japan
| | - Momoko Kobayashi
- Precision Medicine Centre, Kumagaya General Hospital, Kumagaya, Japan
| | - Yuki Sakamoto
- Precision Medicine Centre, Kumagaya General Hospital, Kumagaya, Japan
| | | | - Rika Haraguchi
- Clinical Laboratory, Kumagaya General Hospital, Kumagaya, Japan
| | - Shin Konno
- Department of Orthopaedics, Kumagaya General Hospital, Kumagaya, Japan
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20
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Abstract
Neural oscillations play an important role in the integration and segregation of brain regions that are important for brain functions, including pain. Disturbances in oscillatory activity are associated with several disease states, including chronic pain. Studies of neural oscillations related to pain have identified several functional bands, especially alpha, beta, and gamma bands, implicated in nociceptive processing. In this review, we introduce several properties of neural oscillations that are important to understand the role of brain oscillations in nociceptive processing. We also discuss the role of neural oscillations in the maintenance of efficient communication in the brain. Finally, we discuss the role of neural oscillations in healthy and chronic pain nociceptive processing. These data and concepts illustrate the key role of regional and interregional neural oscillations in nociceptive processing underlying acute and chronic pains.
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Affiliation(s)
- Junseok A. Kim
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karen D. Davis
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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21
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Hirato M, Miyagishima T, Gouda T, Takahashi A, Yoshimoto Y. Electrical Thalamic Stimulation in the Anterior Part of the Ventral Posterolateral Nucleus for the Treatment of Patients With Central Poststroke Pain. Neuromodulation 2020; 24:361-372. [PMID: 32620052 DOI: 10.1111/ner.13215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The effects of thalamic stimulation of the anterior part of the ventral posterolateral nucleus (VPLa) for central poststroke pain (CPSP) and the pain-related electrophysiological characteristics of this structure were investigated. MATERIALS AND METHODS Nine patients with CPSP manifesting as hemibody pain were enrolled. Stereotactic thalamic VPLa stimulation was implemented, and intraoperative electrophysiological studies on hyperactive and unstable discharges (HUDs) and responses to sensory and electrical stimulation were performed in the sensory thalamus. A preoperative somatosensory-evoked potential (SEP) study was carried out in all nine patients and in eight other patients with localized pain. RESULTS The patients were classified into two groups: a HUD-dominant group (group H, n = 5) and a sensory response-dominant group (group R, n = 4). HUDs were frequently encountered in the thalamic VPLa in the former group. The total number of HUDs and the number along the trajectory to the VPLa in group H were significantly larger than those in group R. The improvements on the pain numeric rating scale in group H were significantly higher than those in group R two years after surgery. The amplitude ratio of the SEP N20s in the ipsilateral to the contralateral side of CVD lesion in the study group was significantly lower than in the localized pain group. CONCLUSIONS Adequate and stable pain relief with thalamic VPLa stimulation is obtainable in patients with CPSP who exhibit hyperactivity and electrical instability along the trajectory to this nucleus. Both responders and nonresponders were found to have severe dysfunction of the lemniscal system.
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Affiliation(s)
- Masafumi Hirato
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.,National Hospital Organization Shibukawa Medical Center, Shibukawa, Gunma, Japan
| | - Takaaki Miyagishima
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tsukasa Gouda
- National Hospital Organization Shibukawa Medical Center, Shibukawa, Gunma, Japan
| | - Akio Takahashi
- National Hospital Organization Shibukawa Medical Center, Shibukawa, Gunma, Japan
| | - Yuhei Yoshimoto
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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22
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The Cerebral Localization of Pain: Anatomical and Functional Considerations for Targeted Electrical Therapies. J Clin Med 2020; 9:jcm9061945. [PMID: 32580436 PMCID: PMC7355617 DOI: 10.3390/jcm9061945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 12/18/2022] Open
Abstract
Millions of people in the United States are affected by chronic pain, and the financial cost of pain treatment is weighing on the healthcare system. In some cases, current pharmacological treatments may do more harm than good, as with the United States opioid crisis. Direct electrical stimulation of the brain is one potential non-pharmacological treatment with a long history of investigation. Yet brain stimulation has been far less successful than peripheral or spinal cord stimulation, perhaps because of our limited understanding of the neural circuits involved in pain perception. In this paper, we review the history of using electrical stimulation of the brain to treat pain, as well as contemporary studies identifying the structures involved in pain networks, such as the thalamus, insula, and anterior cingulate. We propose that the thermal grill illusion, an experimental pain model, can facilitate further investigation of these structures. Pairing this model with intracranial recording will provide insight toward disentangling the neural correlates from the described anatomic areas. Finally, the possibility of altering pain perception with brain stimulation in these regions could be highly informative for the development of novel brain stimulation therapies for chronic pain.
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23
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Nagumo Y, Ueta Y, Nakayama H, Osaki H, Takeuchi Y, Uesaka N, Kano M, Miyata M. Tonic GABAergic Inhibition Is Essential for Nerve Injury-Induced Afferent Remodeling in the Somatosensory Thalamus and Ectopic Sensations. Cell Rep 2020; 31:107797. [DOI: 10.1016/j.celrep.2020.107797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 03/10/2020] [Accepted: 06/01/2020] [Indexed: 11/16/2022] Open
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Gallay MN, Moser D, Jeanmonod D. MR-Guided Focused Ultrasound Central Lateral Thalamotomy for Trigeminal Neuralgia. Single Center Experience. Front Neurol 2020; 11:271. [PMID: 32425870 PMCID: PMC7212452 DOI: 10.3389/fneur.2020.00271] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 03/24/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Trigeminal neuralgia (TN) is a recognized pain condition the treatment of which can be very challenging. Various surgical interventions can be applied in cases of therapy-resistance to drug treatments. The central lateral thalamotomy (CLT) against neurogenic (or neuropathic) pain is based on multiarchitectonic histological as well as physiopathological studies, and integrates the nucleus in a large thalamocortical (TC) and corticocortical network responsible for the sensory, cognitive and affective/emotional components of pain. The advent of the magnetic resonance imaging guided high intensity focused ultrasound (MRgFUS) brought a strong reduction in morbidity and increase in accuracy compared to penetration techniques. Objective: This study was aimed at analyzing the outcome of bilateral MRgFUS CLT for chronic therapy-resistant trigeminal pain, all performed in one single center. Methods: Patients were categorized in Classical, Idiopathic and Secondary TN. By definition, paroxysms lasted for seconds up to 2 min. All patients were screened for trigeminal neurovascular conflict. In case of classical TN, microvascular decompression was proposed. Therapy-resistance and thus indication for MRgFUS CLT was based on the lack of efficacy and/or side effects of antiepileptic and antidepressant drugs. Good outcome was defined by a pain relief ≥50%. Results: Eight patients suffering from chronic therapy-resistant trigeminal neuralgia were treated. All suffered from pain with paroxysmal character. Six patients reported additionally continuous pain. Mean follow-up was 53 months (range: 12-92, median: 60 months). The mean pain relief assessed by patients was 51% (median: 58%, range: 0-90%) at 3 months, 71% (median: 65%, range: 40-100%) at 1 year and 78% (median: 75%, range: 50-100%) at their longest follow-up. This represents 63% good outcomes at 3 months, 88% at 1 year and 100% at last follow-up. Frequency of the mean pain paroxysms decreased from 84 per day preoperative to 3.9 at 1 year postoperatively. There were no serious adverse events in this series. Conclusion: Our study provides preliminary support for the safety and efficacy of MRgFUS CLT, a histologically and pathophysiologically based medial thalamotomy against chronic therapy-resistant trigeminal neuralgia.
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Affiliation(s)
- Marc N. Gallay
- SoniModul, Center for Ultrasound Functional Neurosurgery, Solothurn, Switzerland
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25
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Rodenkirch C, Wang Q. Rapid and transient enhancement of thalamic information transmission induced by vagus nerve stimulation. J Neural Eng 2020; 17:026027. [PMID: 31935689 DOI: 10.1088/1741-2552/ab6b84] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Vagus nerve stimulation (VNS) has been FDA-approved as a long-term, therapeutic treatment for multiple disorders, including pharmacoresistant epilepsy and depression. Here we elucidate the short-term effects of VNS on sensory processing. APPROACH We employed an information theoretic approach to examine the effects of VNS on thalamocortical transmission of sensory-related information along the somatosensory pathway. MAIN RESULTS We found that VNS enhanced the selectivity of the response of thalamic neurons to specific kinetic features in the stimuli, resulting in a significant increase in the efficiency and rate of stimulus-related information conveyed by thalamic spikes. VNS-induced improvements in thalamic sensory processing coincided with a decrease in thalamic burst firing. Importantly, we found VNS-induced enhancement of sensory processing had a rapid onset and offset, completely disappearing one minute after cessation of VNS. The timescales of these effects indicate against an underlying mechanism involving long-term neuroplasticity. We found several patterns of VNS (tonic, standard duty-cycle, and fast duty-cycle) all induced similar improvements in sensory processing. Under closer inspection we noticed that due to the fast timescale of VNS effects on sensory processing, standard duty-cycle VNS induced a fluctuating sensory processing state which may be sub-optimal for perceptual behavior. Fast duty-cycle VNS and continuous, tonic VNS induced quantitatively similar improvements in thalamic information transmission as standard duty-cycle VNS without inducing a fluctuating thalamic state. Further, we found the strength of VNS-induced improvements in sensory processing increased monotonically with amplitude and frequency of VNS. SIGNIFICANCE These results demonstrate, for the first time, the feasibility of utilizing specific patterns of VNS to rapidly improve sensory processing and confirm fast duty-cycle and tonic patterns as optimal for this purpose, while showing standard duty-cycle VNS causes non-optimal fluctuations in thalamic state.
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Affiliation(s)
- Charles Rodenkirch
- Department of Biomedical Engineering, Columbia University, ET351, 500 W. 120th Street, New York, NY 10027, United States of America
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26
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Sun X, Pan X, Ni K, Ji C, Wu J, Yan C, Luo Y. Aberrant Thalamic-Centered Functional Connectivity in Patients with Persistent Somatoform Pain Disorder. Neuropsychiatr Dis Treat 2020; 16:273-281. [PMID: 32158212 PMCID: PMC6986177 DOI: 10.2147/ndt.s231555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/11/2020] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Recent task-based fMRI studies have shown that Persistent Somatoform Pain Disorder (PSPD) patients demonstrated aberrant activity in a wide range of brain regions associated with sensation, cognition and emotion. However, these specific task-based studies could not clearly uncover the alterations in the spontaneous brain networks that were associated with the general pain-related symptoms in PSPD. PATIENTS AND METHODS In the present study, 13 PSPD patients and 23 matched healthy controls (HCs) were enrolled. Resting state and 3D structural imaging data were collected during magnetic resonance imaging (MRI) scans. Ninety regions of interest (ROIs) were selected from the automated anatomical labeling (AAL) template. The functional connectivity toolbox "CONN" was used to calculate the functional connectivity (FC) coefficients. RESULTS Our results showed that PSPD patients exhibited increased FCs between the left thalamus and the right amygdala, the right hippocampus, and multiple sub-regions of the occipital lobe when compared to HCs. Correlation analysis revealed a negative correlation between the left thalamus-right amygdala FC and the level of anxiety in PSPD patients. CONCLUSION These findings suggest that the altered FC between thalamus and amygdala may be the neural mechanisms underlying the pain-related anxiety in PSPD.
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Affiliation(s)
- Xia Sun
- Department of Psychological Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Xiandi Pan
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Kaiji Ni
- Department of Psychological Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Chenfeng Ji
- Department of Psychological Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Jiaxin Wu
- Department of Psychiatry, Tongji Hospital of Tongji University, Shanghai, People's Republic of China
| | - Chao Yan
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Shanghai Changning-ECNU Mental Health Center, School of Psychology and Cognitive Science, East China Normal University, Shanghai, People's Republic of China
| | - Yanli Luo
- Department of Psychological Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
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Vierck C. Mechanisms of Below-Level Pain Following Spinal Cord Injury (SCI). THE JOURNAL OF PAIN 2019; 21:262-280. [PMID: 31493490 DOI: 10.1016/j.jpain.2019.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/05/2019] [Accepted: 08/07/2019] [Indexed: 12/18/2022]
Abstract
Mechanisms of below-level pain are discoverable as neural adaptations rostral to spinal injury. Accordingly, the strategy of investigations summarized here has been to characterize behavioral and neural responses to below-level stimulation over time following selective lesions of spinal gray and/or white matter. Assessments of human pain and the pain sensitivity of humans and laboratory animals following spinal injury have revealed common disruptions of pain processing. Interruption of the spinothalamic pathway partially deafferents nocireceptive cerebral neurons, rendering them spontaneously active and hypersensitive to remaining inputs. The spontaneous activity among these neurons is disorganized and unlikely to generate pain. However, activation of these neurons by their remaining inputs can result in pain. Also, injury to spinal gray matter results in a cascade of secondary events, including excitotoxicity, with rostral propagation of excitatory influences that contribute to chronic pain. Establishment and maintenance of below-level pain results from combined influences of injured and spared axons in the spinal white matter and injured neurons in spinal gray matter on processing of nociception by hyperexcitable cerebral neurons that are partially deafferented. A model of spinal stenosis suggests that ischemic injury to the core spinal region can generate below-level pain. Additional questions are raised about demyelination, epileptic discharge, autonomic activation, prolonged activity of C nocireceptive neurons, and thalamocortical plasticity in the generation of below-level pain. PERSPECTIVE: An understanding of mechanisms can direct therapeutic approaches to prevent development of below-level pain or arrest it following spinal cord injury. Among the possibilities covered here are surgical and other means of attenuating gray matter excitotoxicity and ascending propagation of excitatory influences from spinal lesions to thalamocortical systems involved in pain encoding and arousal.
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Affiliation(s)
- Chuck Vierck
- Department of Neuroscience, University of Florida College of Medicine and McKnight Brain Institute, Gainesville, Florida.
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28
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Kuan YH, Shih HC, Shyu BC. Involvement of P 2X 7 Receptors and BDNF in the Pathogenesis of Central Poststroke Pain. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1099:211-227. [PMID: 30306527 DOI: 10.1007/978-981-13-1756-9_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Central pain is commonly found in patients with neurological complications that are associated with central nervous system insult, such as stroke. It can result directly from central nervous system injury. Impairments in sensory discrimination can make it challenging to differentiate central neuropathic pain from other types of pain or spasticity. Central neuropathic pain may also begin months to years after the injury, further obscuring the recognition of its association with past neurologic injury. This chapter focuses on the involvement of P2X7 receptor and brain-derived neurotrophic factor (BDNF) in central poststroke pain (CPSP). An experimental animal model is introduced that assesses the pathogenesis of central neuropathic pain, and pharmacological approaches and neuromodulatory treatments of this difficult-to-treat pain syndrome are discussed.
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Affiliation(s)
- Yung-Hui Kuan
- Division of Neuroscience, Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Hsi-Chien Shih
- Division of Neuroscience, Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Bai-Chuang Shyu
- Division of Neuroscience, Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.
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29
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Tanei T, Kajita Y, Takebayashi S, Aoki K, Nakahara N, Wakabayashi T. Predictive Factors Associated with Pain Relief of Spinal Cord Stimulation for Central Post-stroke Pain. Neurol Med Chir (Tokyo) 2019; 59:213-221. [PMID: 31061256 PMCID: PMC6580041 DOI: 10.2176/nmc.oa.2018-0292] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The efficacy and predictive factors associated with successful spinal cord stimulation (SCS) for central post-stroke pain (CPSP) have yet to be definitively established. Thus, this study evaluated the rates of pain relief found after more than 12 months and the predictive factors associated with the success of SCS for CPSP. The degree of pain after SCS in 18 patients with CPSP was assessed using the Visual Analog Scale preoperatively, at 1, 6 and 12 months after surgery, and at the time of the last follow-up. After calculating the percentage of pain relief (PPR), patients were separated into two groups. The first group exhibited continuing PPR ≥30% at more than 12 months (effect group) while the second group exhibited successful/unsuccessful trials followed by decreasing PPR <30% within 12 months (no effect group). Pain relief for more than 12 months was achieved in eight out of 18 (44.4%) patients during the 67.3 ± 35.5 month follow-up period. Statistically significant differences were found for both the age and stroke location during comparisons of the preoperative characteristics between the two groups. There was a significantly younger mean age for the effect versus the no effect group. Patients with stoke in non-thalamus were significantly enriched in effect group compared with those with stoke in thalamus. Multivariable analysis using these two factors found no statistical differences, suggesting that these two factors might possibly exhibit the same behaviors for the SCS effect. These results suggest that SCS may be able to provide pain relief in young, non-thalamus stroke patients with CPSP.
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Affiliation(s)
- Takafumi Tanei
- Department of Neurosurgery, Komaki City Hospital.,Department of Neurosurgery, Nagoya Central Hospital
| | | | | | - Kosuke Aoki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
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30
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Seneviratne U, Karoly P, Freestone DR, Cook MJ, Boston RC. Methods for the Detection of Seizure Bursts in Epilepsy. Front Neurol 2019; 10:156. [PMID: 30873108 PMCID: PMC6400839 DOI: 10.3389/fneur.2019.00156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 02/07/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Seizure clusters and “bursts” are of clinical importance. Clusters are reported to be a marker of antiepileptic drug resistance. Additionally, seizure clustering has been found to be associated with increased morbidity and mortality. However, there are no statistical methods described in the literature to delineate bursting phenomenon in epileptic seizures. Methods: We present three automatic burst detection methods referred to as precision constrained grouping (PCG), burst duration constrained grouping (BCG), and interseizure interval constrained grouping (ICG). Concordance correlation coefficients were used to confirm the pairwise agreement between common bursts isolated using these three automatic burst detection procedures. Additionally, three graphical methods were employed to demonstrate seizure bursts: modified scatter plots, staircase plots, and dropline plots. Burst detection procedures are demonstrated on data from continuous intracranial ambulatory EEG monitoring in a patient diagnosed with drug-refractory focal epilepsy. Results: We analyzed 1,569 seizures, from our assigned index patient, captured on ambulatory intracranial EEG monitoring. A total of 31, 32, and 32 seizure bursts were detected by the three quantitative methods (BCG, ICG, and PCG), respectively. The concordance correlation coefficient was ≥0.99 signifying considerably stronger than chance burst detector agreements with one another. Conclusions: Bursting is a quantifiable temporal phenomenon in epilepsy and seizure bursts can be reliably detected using our methodology.
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Affiliation(s)
- Udaya Seneviratne
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia.,Department of Neuroscience, Monash Medical Centre, Melbourne, VIC, Australia.,Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Philippa Karoly
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia.,Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Dean R Freestone
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia.,Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Mark J Cook
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Ray C Boston
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia
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31
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Electroencephalography and magnetoencephalography in pain research-current state and future perspectives. Pain 2019; 159:206-211. [PMID: 29944612 DOI: 10.1097/j.pain.0000000000001087] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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32
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Abstract
Pain is a salient and complex sensory experience with important affective and cognitive dimensions. The current definition of pain relies on subjective reports in both humans and experimental animals. Such definition lacks basic mechanistic insights and can lead to a high degree of variability. Research on biomarkers for pain has previously focused on genetic analysis. However, recent advances in human neuroimaging and research in animal models have begun to show the promise of a circuit-based neural signature for pain. At the treatment level, pharmacological therapy for pain remains limited. Neuromodulation has emerged as a specific form of treatment without the systemic side effects of pharmacotherapies. In this review, we will discuss some of the current neuromodulatory modalities for pain, research on newer targets, as well as emerging possibility for an integrated brain-computer interface approach for pain management.
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33
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Acute and Chronic Pain Processing in the Thalamocortical System of Humans and Animal Models. Neuroscience 2018; 387:58-71. [DOI: 10.1016/j.neuroscience.2017.09.042] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/24/2017] [Accepted: 09/24/2017] [Indexed: 02/07/2023]
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34
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North RY, Lazaro TT, Dougherty PM. Ectopic Spontaneous Afferent Activity and Neuropathic Pain. Neurosurgery 2018; 65:49-54. [PMID: 31076785 DOI: 10.1093/neuros/nyy119] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/04/2018] [Indexed: 12/17/2022] Open
Affiliation(s)
- Robert Y North
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Tyler T Lazaro
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Patrick M Dougherty
- The Departments of Pain Medicine Research, The Division of Anesthesia, Critical Care and Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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35
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Henderson LA. Trigeminal neuropathic pain: Evidence of central changes from human brain imaging investigations. AUST ENDOD J 2018. [DOI: 10.1111/aej.12250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Luke A. Henderson
- Department of Anatomy and Histology; University of Sydney; Sydney New South Wales Australia
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36
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Impairment of frequency-specific responses associated with altered electrical activity patterns in auditory thalamus following focal and general demyelination. Exp Neurol 2018; 309:54-66. [PMID: 30048715 DOI: 10.1016/j.expneurol.2018.07.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 07/17/2018] [Accepted: 07/20/2018] [Indexed: 11/21/2022]
Abstract
Multiple sclerosis is characterized by intermingled episodes of de- and remyelination and the occurrence of white- and grey-matter damage. To mimic the randomly distributed pathophysiological brain lesions observed in MS, we assessed the impact of focal white and grey matter demyelination on thalamic function by directing targeted lysolecithin-induced lesions to the capsula interna (CI), the auditory cortex (A1), or the ventral medial geniculate nucleus (vMGN) in mice. Pathophysiological consequences were compared with those of cuprizone treatment at different stages of demyelination and remyelination. Combining single unit recordings and auditory stimulation in freely behaving mice revealed changes in auditory response profile and electrical activity pattern in the thalamus, depending on the region of the initial insult and the state of remyelination. Cuprizone-induced general demyelination significantly diminished vMGN neuronal activity and frequency-specific responses. Targeted lysolecithin-induced lesions directed either to A1 or to vMGN revealed a permanent impairment of frequency-specific responses, an increase in latency of auditory responses and a reduction in occurrence of burst firing in vMGN neurons. These findings indicate that demyelination of grey matter areas in the thalamocortical system permanently affects vMGN frequency specificity and the prevalence of bursting in the auditory thalamus.
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37
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Shiao R, Lee-Kubli CA. Neuropathic Pain After Spinal Cord Injury: Challenges and Research Perspectives. Neurotherapeutics 2018; 15:635-653. [PMID: 29736857 PMCID: PMC6095789 DOI: 10.1007/s13311-018-0633-4] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Neuropathic pain is a debilitating consequence of spinal cord injury (SCI) that remains difficult to treat because underlying mechanisms are not yet fully understood. In part, this is due to limitations of evaluating neuropathic pain in animal models in general, and SCI rodents in particular. Though pain in patients is primarily spontaneous, with relatively few patients experiencing evoked pains, animal models of SCI pain have primarily relied upon evoked withdrawals. Greater use of operant tasks for evaluation of the affective dimension of pain in rodents is needed, but these tests have their own limitations such that additional studies of the relationship between evoked withdrawals and operant outcomes are recommended. In preclinical SCI models, enhanced reflex withdrawal or pain responses can arise from pathological changes that occur at any point along the sensory neuraxis. Use of quantitative sensory testing for identification of optimal treatment approach may yield improved identification of treatment options and clinical trial design. Additionally, a better understanding of the differences between mechanisms contributing to at- versus below-level neuropathic pain and neuropathic pain versus spasticity may shed insights into novel treatment options. Finally, the role of patient characteristics such as age and sex in pathogenesis of neuropathic SCI pain remains to be addressed.
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Affiliation(s)
- Rani Shiao
- Molecular Neurobiology Laboratory, The Salk Institute for Biological Studies, 10010 N. Torrey Pines, La Jolla, California, 92073, USA
| | - Corinne A Lee-Kubli
- Molecular Neurobiology Laboratory, The Salk Institute for Biological Studies, 10010 N. Torrey Pines, La Jolla, California, 92073, USA.
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38
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Botulinum Toxin for Central Neuropathic Pain. Toxins (Basel) 2018; 10:toxins10060224. [PMID: 29857568 PMCID: PMC6024683 DOI: 10.3390/toxins10060224] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 05/26/2018] [Accepted: 05/28/2018] [Indexed: 11/17/2022] Open
Abstract
Botulinum toxin (BTX) is widely used to treat muscle spasticity by acting on motor neurons. Recently, studies of the effects of BTX on sensory nerves have been reported and several studies have been conducted to evaluate its effects on peripheral and central neuropathic pain. Central neuropathic pain includes spinal cord injury-related neuropathic pain, post-stroke shoulder pain, multiple sclerosis-related pain, and complex regional pain syndrome. This article reviews the mechanism of central neuropathic pain and assesses the effect of BTX on central neuropathic pain.
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39
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Quantitative sensory testing profiles in children, adolescents and young adults (6-20 years) with cerebral palsy: Hints for a neuropathic genesis of pain syndromes. Eur J Paediatr Neurol 2018; 22:470-481. [PMID: 29337004 DOI: 10.1016/j.ejpn.2017.12.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 09/20/2017] [Accepted: 12/19/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Many patients with cerebral palsy (CP) suffer chronic pain as one of the most limiting factors in their quality of life. In CP patients, pain mechanisms are not well understood, and pain therapy remains a challenge. Quantitative sensory testing (QST) might provide unique information about the functional status of the somatosensory system and therefore better guide pain treatment. OBJECTIVES To understand better the underlying pain mechanisms in pediatric CP patients, we aimed to assess clinical and pain parameters, as well as QST profiles, which were matched to the patients' cerebral imaging pathology. PATIENTS AND METHODS Thirty CP patients aged 6-20 years old (mean age 12 years) without intellectual impairment underwent standardized assessments of QST. Cerebral imaging was reassessed. QST results were compared to age- and sex-matched controls (multiple linear regression; Fisher's exact test; linear correlation analysis). RESULTS CP patients were less sensitive to all mechanical and thermal stimuli than healthy controls but more sensitive to all mechanical pain stimuli (each p < 0.001). Fifty percent of CP patients showed a combination of mechanical hypoesthesia, thermal hypoesthesia and mechanical hyperalgesia; 67% of CP patients had periventricular leukomalacia (PVL), which was correlated with mechanic (r = 0.661; p < 0.001) and thermal (r = 0.624; p = 0.001) hypoesthesia. CONCLUSION The combination of mechanical hypoesthesia, thermal hypoesthesia and mechanical hyperalgesia in our CP patients implicates lemniscal and extralemniscal neuron dysfunction in the thalamus region, likely due to PVL. We suspect that extralemniscal tracts are involved in the original of pain in our CP patients, as in adults.
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40
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Alshelh Z, Di Pietro F, Mills EP, Vickers ER, Peck CC, Murray GM, Henderson LA. Altered regional brain T2 relaxation times in individuals with chronic orofacial neuropathic pain. NEUROIMAGE-CLINICAL 2018; 19:167-173. [PMID: 30035014 PMCID: PMC6051476 DOI: 10.1016/j.nicl.2018.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/10/2018] [Accepted: 04/12/2018] [Indexed: 01/12/2023]
Abstract
The neural mechanisms underlying the development and maintenance of chronic pain following nerve injury remain unclear. There is growing evidence that chronic neuropathic pain is associated with altered thalamic firing patterns, thalamocortical dysrhythmia and altered infra-slow oscillations in ascending pain pathways. Preclinical and post-mortem human studies have revealed that neuropathic pain is associated with prolonged astrocyte activation in the dorsal horn and we have suggested that this may result in altered gliotransmission, which results in altered resting neural rhythm in the ascending pain pathway. Evidence of astrocyte activation above the level of the dorsal horn in living humans is lacking and direct measurement of astrocyte activation in living humans is not possible, however, there is evidence that regional alterations in T2 relaxation times are indicative of astrogliosis. The aim of this study was to use T2 relaxometry to explore regional brain anatomy of the ascending pain pathway in individuals with chronic orofacial neuropathic pain. We found that in individuals with trigeminal neuropathic pain, decreases in T2 relaxation times occurred in the region of the spinal trigeminal nucleus and primary somatosensory cortex, as well as in higher order processing regions such as the dorsolateral prefrontal, cingulate and hippocampal/parahippocampal cortices. We speculate that these regional changes in T2 relaxation times reflect prolonged astrocyte activation, which results in altered brain rhythm and ultimately the constant perception of pain. Blocking prolonged astrocyte activation may be effective in preventing and even reversing the development of chronic pain following neural injury. Reduced T2 relaxation time in the ascending pain pathway in chronic orofacial pain. These reductions may be associated with astrogliosis. Increase astrocyte activity associated with chronic orofacial pain.
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Affiliation(s)
- Z Alshelh
- Department of Anatomy and Histology, Sydney Medical School, University of Sydney, 2006, Australia
| | - F Di Pietro
- Department of Anatomy and Histology, Sydney Medical School, University of Sydney, 2006, Australia
| | - E P Mills
- Department of Anatomy and Histology, Sydney Medical School, University of Sydney, 2006, Australia
| | - E R Vickers
- Department of Anatomy and Histology, Sydney Medical School, University of Sydney, 2006, Australia
| | - C C Peck
- Faculty of Dentistry, University of Sydney, 2006, Australia
| | - G M Murray
- Faculty of Dentistry, University of Sydney, 2006, Australia
| | - L A Henderson
- Department of Anatomy and Histology, Sydney Medical School, University of Sydney, 2006, Australia.
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41
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How central is central poststroke pain? The role of afferent input in poststroke neuropathic pain: a prospective, open-label pilot study. Pain 2018; 159:1317-1324. [DOI: 10.1097/j.pain.0000000000001213] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Di Pietro F, Macey PM, Rae CD, Alshelh Z, Macefield VG, Vickers ER, Henderson LA. The relationship between thalamic GABA content and resting cortical rhythm in neuropathic pain. Hum Brain Mapp 2018; 39:1945-1956. [PMID: 29341331 DOI: 10.1002/hbm.23973] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 12/14/2017] [Accepted: 01/05/2018] [Indexed: 12/21/2022] Open
Abstract
Recurrent thalamocortical connections are integral to the generation of brain rhythms and it is thought that the inhibitory action of the thalamic reticular nucleus is critical in setting these rhythms. Our work and others' has suggested that chronic pain that develops following nerve injury, that is, neuropathic pain, results from altered thalamocortical rhythm, although whether this dysrhythmia is associated with thalamic inhibitory function remains unknown. In this investigation, we used electroencephalography and magnetic resonance spectroscopy to investigate cortical power and thalamic GABAergic concentration in 20 patients with neuropathic pain and 20 pain-free controls. First, we found thalamocortical dysrhythmia in chronic orofacial neuropathic pain; patients displayed greater power than controls over the 4-25 Hz frequency range, most marked in the theta and low alpha bands. Furthermore, sensorimotor cortex displayed a strong positive correlation between cortical power and pain intensity. Interestingly, we found no difference in thalamic GABA concentration between pain subjects and control subjects. However, we demonstrated significant linear relationships between thalamic GABA concentration and enhanced cortical power in pain subjects but not controls. Whilst the difference in relationship between thalamic GABA concentration and resting brain rhythm between chronic pain and control subjects does not prove a cause and effect link, it is consistent with a role for thalamic inhibitory neurotransmitter release, possibly from the thalamic reticular nucleus, in altered brain rhythms in individuals with chronic neuropathic pain.
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Affiliation(s)
- Flavia Di Pietro
- Department of Anatomy and Histology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Paul M Macey
- UCLA School of Nursing and Brain Research Institute, University of California, Los Angeles, California
| | | | - Zeynab Alshelh
- Department of Anatomy and Histology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Vaughan G Macefield
- Neuroscience Research Australia, Sydney, Australia.,College of Medicine, Mohammed Bin Rashid University of Medicine & Health Sciences, Dubai, United Arab Emirates
| | - E Russell Vickers
- Department of Anatomy and Histology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Luke A Henderson
- Department of Anatomy and Histology, Sydney Medical School, University of Sydney, Sydney, Australia
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Devetiarov D, Semenova U, Usova S, Tomskiy A, Tyurnikov V, Nizametdinova D, Gushcha A, Belova E, Sedov A. Neuronal activity patterns in the ventral thalamus: Comparison between Parkinson's disease and cervical dystonia. Clin Neurophysiol 2017; 128:2482-2490. [PMID: 29100066 DOI: 10.1016/j.clinph.2017.09.110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 08/16/2017] [Accepted: 09/17/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was to distinguish neuronal activity patterns in the human ventral thalamus and reveal common and disease-specific features in patients with Parkinson's disease (PD) and cervical dystonia (CD). METHODS Single unit activity of neurons was recorded during microelectrode-guided thalamotomies. We classified neurons of surgical target and surrounding area into patterns and compared their characteristics and responsiveness to voluntary movement between PD and CD patients. RESULTS We distinguished five patterns of neuronal activity: single, LTS burst, mixed, non-LTS burst and longburst patterns. The burst and mixed patterns showed significant differences in several basic and burst characteristics. We showed that there were no disease-specific patterns or significant differences in pattern distribution between studied patients. However, burst patterns had an unbalanced distribution between disease conditions. In addition, we found difference in LTS burst characteristics between surgical targets and surrounding nuclei. All identified patterns, except the long burst pattern, were reactive to the motor tasks and to contraction of the pathological muscles. CONCLUSIONS The ventral thalamus was characterised by common neuronal activity patterns which differed in characteristics between PD and CD. SIGNIFICANCE Our findings highlight patterns of neuronal activity of the human ventral thalamus and specific pathological features.
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Affiliation(s)
- Dmitriy Devetiarov
- Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow, Russia
| | - Ulia Semenova
- Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow, Russia.
| | - Svetlana Usova
- Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow, Russia
| | - Alexey Tomskiy
- Burdenko Neurosurgery Institute, Functional Neurosurgery, Moscow, Russia
| | | | | | - Artem Gushcha
- Research Center of Neurology, Functional Neurosurgery, Moscow, Russia
| | - Elena Belova
- Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow, Russia
| | - Alexey Sedov
- Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow, Russia; Moscow Institute of Physics and Technology, Moscow, Russia
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Huang Y, Green AL, Hyam J, Fitzgerald J, Aziz TZ, Wang S. Oscillatory neural representations in the sensory thalamus predict neuropathic pain relief by deep brain stimulation. Neurobiol Dis 2017; 109:117-126. [PMID: 29031639 DOI: 10.1016/j.nbd.2017.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/25/2017] [Accepted: 10/11/2017] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Understanding the function of sensory thalamic neural activity is essential for developing and improving interventions for neuropathic pain. However, there is a lack of investigation of the relationship between sensory thalamic oscillations and pain relief in patients with neuropathic pain. This study aims to identify the oscillatory neural characteristics correlated with pain relief induced by deep brain stimulation (DBS), and develop a quantitative model to predict pain relief by integrating characteristic measures of the neural oscillations. APPROACH Measures of sensory thalamic local field potentials (LFPs) in thirteen patients with neuropathic pain were screened in three dimensional feature space according to the rhythm, balancing, and coupling neural behaviours, and correlated with pain relief. An integrated approach based on principal component analysis (PCA) and multiple regression analysis is proposed to integrate the multiple measures and provide a predictive model. MAIN RESULTS This study reveals distinct thalamic rhythms of theta, alpha, high beta and high gamma oscillations correlating with pain relief. The balancing and coupling measures between these neural oscillations were also significantly correlated with pain relief. SIGNIFICANCE The study enriches the series research on the function of thalamic neural oscillations in neuropathic pain and relief, and provides a quantitative approach for predicting pain relief by DBS using thalamic neural oscillations.
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Affiliation(s)
- Yongzhi Huang
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, China; Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Alexander L Green
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Jonathan Hyam
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - James Fitzgerald
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Tipu Z Aziz
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Shouyan Wang
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, China; Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai 200433, China.
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45
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Differential effect of motor cortex stimulation on unit activities in the ventral posterior lateral thalamus in cats. Pain 2017; 159:157-167. [DOI: 10.1097/j.pain.0000000000001080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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46
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Groh A, Mease R, Krieger P. Wo der Schmerz in das Bewusstsein tritt: das thalamo-kortikale System bei der Schmerzverarbeitung. ACTA ACUST UNITED AC 2017. [DOI: 10.1515/nf-2017-0019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Zusammenfassung
Die Übersetzung von schmerzhaften Reizen in Schmerzempfindungen wird durch mehrere periphere und zentrale Signalwege des Nervensystems verwirklicht. Man nimmt heute an, dass die Organisation dieser Signalwege die beiden Hauptfunktionen der Schmerzwahrnehmung wiederspiegeln: die Bewertung von schmerzhaften Reizen (wo, was, wie stark) und die Generierung negativer Emotionen. Experimentelle Befunde deuten darauf hin, dass aufsteigende Schmerzsignale über zwei Hauptwege im thalamokortikalen (TK) System verlaufen, die diese beiden Funktionen erfüllen. Wir diskutieren daher hier die strukturellen und funktionellen Befunde, die zu der Auffassung führten, dass diskriminierende Schmerzbewertung im lateralen TK-Weg ausgeführt wird, während der mediale TK-Weg schmerzassoziierte aversive Emotionen generiert. Obwohl der Schwerpunkt dieses Übersichtsartikels auf akuter Schmerzverarbeitung liegt, gehen wir zum Schluss darauf ein, wie Veränderungen in diesen Signalwegen zu pathologischen Schmerzempfindungen bei Menschen und Tiermodellen führen können.
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Affiliation(s)
- Alexander Groh
- Klinikum rechts der Isar der Technischen Universität München , Neurochirurgische Klinik und Poliklinik , Ismaninger Straße 22, 81675 München , Deutschland , Tel: 089 4140 7636
| | - Rebecca Mease
- Klinikum rechts der Isar der Technischen Universität München , Neurochirurgische Klinik und Poliklinik , Ismaninger Straße 22, 81675 München , Deutschland , Tel: 089 4140 7636
| | - Patrik Krieger
- Ruhr-Universität Bochum , Medizinische Fakultät, Systemische Neurowissenschaften , Universitätsstrasse 150, 44801 Bochum , Deutschland , Tel: 0234 3223898
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Caspary DM, Llano DA. Auditory thalamic circuits and GABA A receptor function: Putative mechanisms in tinnitus pathology. Hear Res 2017; 349:197-207. [PMID: 27553899 PMCID: PMC5319923 DOI: 10.1016/j.heares.2016.08.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/28/2016] [Accepted: 08/17/2016] [Indexed: 01/02/2023]
Abstract
Tinnitus is defined as a phantom sound (ringing in the ears), and can significantly reduce the quality of life for those who suffer its effects. Ten to fifteen percent of the general adult population report symptoms of tinnitus with 1-2% reporting that tinnitus negatively impacts their quality of life. Noise exposure is the most common cause of tinnitus and the military environment presents many challenging high-noise situations. Military noise levels can be so intense that standard hearing protection is not adequate. Recent studies suggest a role for inhibitory neurotransmitter dysfunction in response to noise-induced peripheral deafferentation as a key element in the pathology of tinnitus. The auditory thalamus, or medial geniculate body (MGB), is an obligate auditory brain center in a unique position to gate the percept of sound as it projects to auditory cortex and to limbic structures. Both areas are thought to be involved in those individuals most impacted by tinnitus. For MGB, opposing hypotheses have posited either a tinnitus-related pathologic decrease or pathologic increase in GABAergic inhibition. In sensory thalamus, GABA mediates fast synaptic inhibition via synaptic GABAA receptors (GABAARs) as well as a persistent tonic inhibition via high-affinity extrasynaptic GABAARs and slow synaptic inhibition via GABABRs. Down-regulation of inhibitory neurotransmission, related to partial peripheral deafferentation, is consistently presented as partially underpinning neuronal hyperactivity seen in animal models of tinnitus. This maladaptive plasticity/Gain Control Theory of tinnitus pathology (see Auerbach et al., 2014; Richardson et al., 2012) is characterized by reduced inhibition associated with increased spontaneous and abnormal neuronal activity, including bursting and increased synchrony throughout much of the central auditory pathway. A competing hypothesis suggests that maladaptive oscillations between the MGB and auditory cortex, thalamocortical dysrhythmia, predict tinnitus pathology (De Ridder et al., 2015). These unusual oscillations/rhythms reflect net increased tonic inhibition in a subset of thalamocortical projection neurons resulting in abnormal bursting. Hyperpolarizing de-inactivation of T-type Ca2+ channels switches thalamocortical projection neurons into burst mode. Thalamocortical dysrhythmia originating in sensory thalamus has been postulated to underpin neuropathies including tinnitus and chronic pain. Here we review the relationship between noise-induced tinnitus and altered inhibition in the MGB.
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Affiliation(s)
- Donald M Caspary
- Department of Pharmacology and Neuroscience, Southern Illinois University School of Medicine, Springfield, IL, USA.
| | - Daniel A Llano
- Neuroscience Program, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Department of Molecular and Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
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48
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LeBlanc BW, Cross B, Smith KA, Roach C, Xia J, Chao YC, Levitt J, Koyama S, Moore CI, Saab CY. Thalamic Bursts Down-regulate Cortical Theta and Nociceptive Behavior. Sci Rep 2017; 7:2482. [PMID: 28559582 PMCID: PMC5449396 DOI: 10.1038/s41598-017-02753-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 04/18/2017] [Indexed: 12/24/2022] Open
Abstract
We tested the relation between pain behavior, theta (4-8 Hz) oscillations in somatosensory cortex and burst firing in thalamic neurons in vivo. Optically-induced thalamic bursts attenuated cortical theta and mechanical allodynia. It is proposed that thalamic bursts are an adaptive response to pain that de-synchronizes cortical theta and decreases sensory salience.
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Affiliation(s)
- Brian W LeBlanc
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
- Department of Neuroscience, Brown University, Providence, RI, USA
| | - Brent Cross
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
- Department of Neuroscience, Brown University, Providence, RI, USA
| | - Kelsey A Smith
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
- Department of Neuroscience, Brown University, Providence, RI, USA
| | - Catherine Roach
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
- Department of Neuroscience, Brown University, Providence, RI, USA
| | - Jimmy Xia
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
- Department of Neuroscience, Brown University, Providence, RI, USA
| | - Yu-Chieh Chao
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Joshua Levitt
- Center for Biomedical Engineering, Brown University, Providence, RI, USA
| | - Suguru Koyama
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
- Department of Neuroscience, Brown University, Providence, RI, USA
- Laboratory for Pharmacology, Asahi KASEI Pharma Corporation, Shizuoka, Japan
| | | | - Carl Y Saab
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA.
- Department of Neuroscience, Brown University, Providence, RI, USA.
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49
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Zhang C, Chen RX, Zhang Y, Wang J, Liu FY, Cai J, Liao FF, Xu FQ, Yi M, Wan Y. Reduced GABAergic transmission in the ventrobasal thalamus contributes to thermal hyperalgesia in chronic inflammatory pain. Sci Rep 2017; 7:41439. [PMID: 28150719 PMCID: PMC5288727 DOI: 10.1038/srep41439] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 12/20/2016] [Indexed: 12/26/2022] Open
Abstract
The ventrobasal (VB) thalamus is innervated by GABAergic afferents from the thalamic reticular nucleus (TRN) and participates in nociception. But how the TRN-VB pathway regulates pain is not fully understood. In the present study, we reported decreased extracellular GABA levels in the VB of rats with CFA-induced chronic inflammatory pain, measured by microdialysis with HPLC analysis. In vitro whole-cell patch-clamp recording showed decreased amplitudes of tonic currents, increased frequencies of mIPSCs, and increased paired-pulse ratios in thalamic slices from chronic inflammatory rats (7 days). Microinjection of the GABAAR agonist muscimol and optogenetic activation of the TRN-VB pathway relieved thermal hyperalgesia in chronic inflammatory pain. By contrast, microinjecting the extrasynaptic GABAAR agonist THIP or selective knockout of synaptic GABAAR γ2 subunits aggravated thermal hyperalgesia in the chronic stage of inflammatory pain. Our findings indicate that reduced GABAergic transmission in the VB contributes to thermal hyperalgesia in chronic inflammatory pain, which could be a synaptic target for pharmacotherapy.
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Affiliation(s)
- Chan Zhang
- Neuroscience Research Institute and Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, 100191, P.R. China.,Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, P.R. China
| | - Rong-Xiang Chen
- Research Center for Medicine and Biology, Zunyi Medical University, Zunyi, 563000, P.R. China
| | - Yu Zhang
- Neuroscience Research Institute and Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, 100191, P.R. China
| | - Jie Wang
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, 430071, P.R. China
| | - Feng-Yu Liu
- Neuroscience Research Institute and Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, 100191, P.R. China
| | - Jie Cai
- Neuroscience Research Institute and Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, 100191, P.R. China
| | - Fei-Fei Liao
- Neuroscience Research Institute and Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, 100191, P.R. China
| | - Fu-Qiang Xu
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, 430071, P.R. China
| | - Ming Yi
- Neuroscience Research Institute and Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, 100191, P.R. China.
| | - You Wan
- Neuroscience Research Institute and Department of Neurobiology, School of Basic Medical Sciences, Peking University, Beijing, 100191, P.R. China. .,Key Laboratory for Neuroscience, Ministry of Education/National Health and Family Planning Commission, Beijing, 100191, P.R. China.
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50
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Karoly PJ, Nurse ES, Freestone DR, Ung H, Cook MJ, Boston R. Bursts of seizures in long-term recordings of human focal epilepsy. Epilepsia 2017; 58:363-372. [PMID: 28084639 DOI: 10.1111/epi.13636] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We report on temporally clustered seizures detected from continuous long-term ambulatory human electroencephalographic data. The objective was to investigate short-term seizure clustering, which we have termed bursting, and consider implications for patient care, seizure prediction, and evaluating therapies. METHODS Chronic ambulatory intracranial electroencephalography (EEG) data collected for the purpose of seizure prediction were annotated to identify seizure events. A detection algorithm was used to identify bursts of events. Burst events were compared to nonburst events to evaluate event dispersion, duration and dynamics. RESULTS Bursts of seizures were present in 6 of 15 subjects, and detections were consistent over long-term monitoring (>2 years). Subjects with bursts of seizures had highly overdispersed seizure rates, compared to other subjects. There was a complicated relationship between bursts and clinical seizures, although bursts were associated with multimodal distributions of seizure duration, and poorer predictive outcomes. For three subjects, bursts demonstrated distinctive preictal dynamics compared to clinical seizures. SIGNIFICANCE We have previously hypothesized that there are distinct physiologic pathways underlying short- and long-duration seizures. Herein we show that burst seizures fall almost exclusively within the short population of seizure durations; however, a short duration event was not sufficient to induce or imply bursting. We can therefore conclude that in addition to distinct mechanisms underlying seizure duration, there are separate factors regulating bursts of seizures. We show that bursts were a robust phenomenon in our patient cohort, which were consistent with overdispersed seizure rates, suggesting long-memory dynamics.
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Affiliation(s)
- Philippa J Karoly
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia.,Department of Electrical and Electronic Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Ewan S Nurse
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia.,Department of Electrical and Electronic Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Dean R Freestone
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia
| | - Hoameng Ung
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Mark J Cook
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia
| | - Ray Boston
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia
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