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Kollenburg L, Kurt E, Arnts H, Vinke S. Cingulotomy: the last man standing in the battle against medically refractory poststroke pain. Pain Rep 2024; 9:e1149. [PMID: 38529477 PMCID: PMC10962879 DOI: 10.1097/pr9.0000000000001149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/29/2023] [Accepted: 01/20/2024] [Indexed: 03/27/2024] Open
Abstract
Introduction Central poststroke pain (CPSP) places a huge burden on patient lives because patients are often refractory to conventional strategies and have little chance for spontaneous recovery. A subset of patients is even given approval for euthanasia and is without any perspective. Because the anterior cingulate cortex historically seems to be a promising target for patients with both mental and chronic pain disorders, lesioning of this central "hub" with cingulotomy may be a useful strategy for medically refractory CPSP. However, limited research is available on cingulotomy for central pain. Hence, we represent a rare case in which cingulotomy is performed on a patient with CPSP. Objectives To describe the potential of cingulotomy in a case with CPSP. Methods The case presented in this study concerns a 60-year-old woman who experienced CPSP, caused by a hemorrhagic stroke in the basal ganglia and thalamus. The patient visited several centers and tried multiple off-label treatments; however, she was told nothing else could be done and was even given approval for euthanasia. Hence, anterior cingulotomy was performed. Results After surgery, no transient adverse events occurred, except for vocabulary disturbances post stroke, which disappeared after several weeks. After 14 weeks, changes in pain behavior were observed, followed by a decreased pain intensity. At a later follow-up, the pain had completely disappeared. Conclusion Anterior cingulotomy seems to be a suitable "last-resort" option for patients with CPSP. Future research, including homogenous groups, to define the best location for lesioning is required to allow the revival of this "old" technique in the current era.
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Affiliation(s)
- Linda Kollenburg
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erkan Kurt
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hisse Arnts
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Saman Vinke
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Center for Brain, Cognition and Behaviour, Department of Neurosurgery
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2
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van Gool R, Far A, Drenthen GS, Jansen JFA, Goijen CP, Backes WH, Linden DEJ, Merkies ISJ, Faber CG, Upadhyay J, Hoeijmakers JGJ. Peripheral Pain Captured Centrally: Altered Brain Morphology on MRI in Small Fiber Neuropathy Patients With and Without an SCN9A Gene Variant. THE JOURNAL OF PAIN 2024; 25:730-741. [PMID: 37921732 DOI: 10.1016/j.jpain.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/05/2023] [Accepted: 10/03/2023] [Indexed: 11/04/2023]
Abstract
The current study aims to characterize brain morphology of pain as reported by small fiber neuropathy (SFN) patients with or without a gain-of-function variant involving the SCN9A gene and compare these with findings in healthy controls without pain. The Neuropathic Pain Scale was used in patients with idiopathic SFN (N = 20) and SCN9A-associated SFN (N = 12) to capture pain phenotype. T1-weighted, structural magnetic resonance imaging (MRI) data were collected in patients and healthy controls (N = 21) to 1) compare cortical thickness and subcortical volumes and 2) quantify the association between severity, quality, and duration of pain with morphological properties. SCN9A-associated SFN patients showed significant (P < .017, Bonferroni corrected) higher cortical thickness in sensorimotor regions, compared to idiopathic SFN patients, while lower cortical thickness was found in more functionally diverse regions (eg, posterior cingulate cortex). SFN patient groups combined demonstrated a significant (Spearman's ρ = .44-.55, P = .005-.049) correlation among itch sensations (Neuropathic Pain Scale-7) and thickness of the left precentral gyrus, and midcingulate cortices. Significant associations were found between thalamic volumes and duration of pain (left: ρ = -.37, P = .043; right: ρ = -.40, P = .025). No associations were found between morphological properties and other pain qualities. In conclusion, in SCN9A-associated SFN, profound morphological alterations anchored within the pain matrix are present. The association between itch sensations of pain and sensorimotor and midcingulate structures provides a novel basis for further examining neurobiological underpinnings of itch in SFN. PERSPECTIVE: Cortical thickness and subcortical volume alterations in SFN patients were found in pain hubs, more profound in SCN9A-associated neuropathy, and correlated with itch and durations of pain. These findings contribute to our understanding of the pathophysiological pathways underlying chronic neuropathic pain and symptoms of itch in SFN.
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Affiliation(s)
- Raquel van Gool
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Amir Far
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands; Department of Neurology, Maastricht University Medical Center+, Maastricht, Limburg, The Netherlands
| | - Gerhard S Drenthen
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, Limburg, The Netherlands
| | - Jacobus F A Jansen
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, Limburg, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, North Brabant, The Netherlands
| | - Celine P Goijen
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands; Department of Neurology, Maastricht University Medical Center+, Maastricht, Limburg, The Netherlands
| | - Walter H Backes
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, Limburg, The Netherlands
| | - David E J Linden
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands; Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Ingemar S J Merkies
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands; Department of Neurology, Maastricht University Medical Center+, Maastricht, Limburg, The Netherlands; Department of Neurology, Curaçao Medical Center, Willemstad, Kingdom of the Netherlands, Curaçao
| | - Catharina G Faber
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands; Department of Neurology, Maastricht University Medical Center+, Maastricht, Limburg, The Netherlands
| | - Jaymin Upadhyay
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Massachusetts
| | - Janneke G J Hoeijmakers
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands; Department of Neurology, Maastricht University Medical Center+, Maastricht, Limburg, The Netherlands
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3
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Kotikalapudi R, Kincses B, Zunhammer M, Schlitt F, Asan L, Schmidt-Wilcke T, Kincses ZT, Bingel U, Spisak T. Brain morphology predicts individual sensitivity to pain: a multicenter machine learning approach. Pain 2023; 164:2516-2527. [PMID: 37318027 PMCID: PMC10578427 DOI: 10.1097/j.pain.0000000000002958] [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: 08/19/2022] [Revised: 02/18/2023] [Accepted: 03/23/2023] [Indexed: 06/16/2023]
Abstract
ABSTRACT Sensitivity to pain shows a remarkable interindividual variance that has been reported to both forecast and accompany various clinical pain conditions. Although pain thresholds have been reported to be associated to brain morphology, it is still unclear how well these findings replicate in independent data and whether they are powerful enough to provide reliable pain sensitivity predictions on the individual level. In this study, we constructed a predictive model of pain sensitivity (as measured with pain thresholds) using structural magnetic resonance imaging-based cortical thickness data from a multicentre data set (3 centres and 131 healthy participants). Cross-validated estimates revealed a statistically significant and clinically relevant predictive performance (Pearson r = 0.36, P < 0.0002, R2 = 0.13). The predictions were found to be specific to physical pain thresholds and not biased towards potential confounding effects (eg, anxiety, stress, depression, centre effects, and pain self-evaluation). Analysis of model coefficients suggests that the most robust cortical thickness predictors of pain sensitivity are the right rostral anterior cingulate gyrus, left parahippocampal gyrus, and left temporal pole. Cortical thickness in these regions was negatively correlated to pain sensitivity. Our results can be considered as a proof-of-concept for the capacity of brain morphology to predict pain sensitivity, paving the way towards future multimodal brain-based biomarkers of pain.
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Affiliation(s)
- Raviteja Kotikalapudi
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Medicine Essen, Essen, Germany
| | - Balint Kincses
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Medicine Essen, Essen, Germany
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Medicine Essen, Essen, Germany
| | - Matthias Zunhammer
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Medicine Essen, Essen, Germany
| | - Frederik Schlitt
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Medicine Essen, Essen, Germany
| | - Livia Asan
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Medicine Essen, Essen, Germany
| | - Tobias Schmidt-Wilcke
- Institute for Clinical Neuroscience and Medical Psychology, Heinrich Heine University, Düsseldorf, Germany
- Neurocenter, District Hospital Mainkofen, Deggendorf, Germany
| | - Zsigmond T. Kincses
- Departments of Neurology and
- Radiology, University of Szeged, Szeged, Hungary
| | - Ulrike Bingel
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Medicine Essen, Essen, Germany
| | - Tamas Spisak
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Medicine Essen, Essen, Germany
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4
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Kowalski JL, Morse LR, Troy K, Nguyen N, Battaglino RA, Falci SP, Linnman C. Resting state functional connectivity differentiation of neuropathic and nociceptive pain in individuals with chronic spinal cord injury. Neuroimage Clin 2023; 38:103414. [PMID: 37244076 PMCID: PMC10238876 DOI: 10.1016/j.nicl.2023.103414] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 05/29/2023]
Abstract
Many individuals with spinal cord injury live with debilitating chronic pain that may be neuropathic, nociceptive, or a combination of both in nature. Identification of brain regions demonstrating altered connectivity associated with the type and severity of pain experience may elucidate underlying mechanisms, as well as treatment targets. Resting state and sensorimotor task-based magnetic resonance imaging data were collected in 37 individuals with chronic spinal cord injury. Seed-based correlations were utilized to identify resting state functional connectivity of regions with established roles in pain processing: the primary motor and somatosensory cortices, cingulate, insula, hippocampus, parahippocampal gyri, thalamus, amygdala, caudate, putamen, and periaqueductal gray matter. Resting state functional connectivity alterations and task-based activation associated with individuals' pain type and intensity ratings on the International Spinal Cord Injury Basic Pain Dataset (0-10 scale) were evaluated. We found that intralimbic and limbostriatal resting state connectivity alterations are uniquely associated with neuropathic pain severity, whereas thalamocortical and thalamolimbic connectivity alterations are associated specifically with nociceptive pain severity. The joint effect and contrast of both pain types were associated with altered limbocortical connectivity. No significant differences in task-based activation were identified. These findings suggest that the experience of pain in individuals with spinal cord injury may be associated with unique alterations in resting state functional connectivity dependent upon pain type.
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Affiliation(s)
- Jesse L Kowalski
- Spaulding Neuroimaging Laboratory, Spaulding Rehabilitation Hospital, Harvard Medical School, 79/96 13th St, Charlestown, Boston, MA, United States; Department of Rehabilitation Medicine, University of Minnesota, MMC 297, 420 Delaware St. SE, Minneapolis, MN 55455, United States.
| | - Leslie R Morse
- Department of Rehabilitation Medicine, University of Minnesota, MMC 297, 420 Delaware St. SE, Minneapolis, MN 55455, United States.
| | - Karen Troy
- Department of Biomedical Engineering, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA 01609, United States.
| | - Nguyen Nguyen
- Department of Rehabilitation Medicine, University of Minnesota, MMC 297, 420 Delaware St. SE, Minneapolis, MN 55455, United States.
| | - Ricardo A Battaglino
- Department of Rehabilitation Medicine, University of Minnesota, MMC 297, 420 Delaware St. SE, Minneapolis, MN 55455, United States.
| | - Scott P Falci
- Department of Rehabilitation Medicine, University of Minnesota, MMC 297, 420 Delaware St. SE, Minneapolis, MN 55455, United States; Department of Neurosurgery, Swedish Medical Center, 501 E Hampden Ave, Englewood, CO 80113, United States.
| | - Clas Linnman
- Spaulding Neuroimaging Laboratory, Spaulding Rehabilitation Hospital, Harvard Medical School, 79/96 13th St, Charlestown, Boston, MA, United States; Department of Rehabilitation Medicine, University of Minnesota, MMC 297, 420 Delaware St. SE, Minneapolis, MN 55455, United States.
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5
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Robayo LE, Govind V, Salan T, Cherup NP, Sheriff S, Maudsley AA, Widerström-Noga E. Neurometabolite alterations in traumatic brain injury and associations with chronic pain. Front Neurosci 2023; 17:1125128. [PMID: 36908781 PMCID: PMC9997848 DOI: 10.3389/fnins.2023.1125128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
Traumatic brain injury (TBI) can lead to a variety of comorbidities, including chronic pain. Although brain tissue metabolite alterations have been extensively examined in several chronic pain populations, it has received less attention in people with TBI. Thus, the primary aim of this study was to compare brain tissue metabolite levels in people with TBI and chronic pain (n = 16), TBI without chronic pain (n = 17), and pain-free healthy controls (n = 31). The metabolite data were obtained from participants using whole-brain proton magnetic resonance spectroscopic imaging (1H-MRSI) at 3 Tesla. The metabolite data included N-acetylaspartate, myo-inositol, total choline, glutamate plus glutamine, and total creatine. Associations between N-acetylaspartate levels and pain severity, neuropathic pain symptom severity, and psychological variables, including anxiety, depression, post-traumatic stress disorder (PTSD), and post-concussive symptoms, were also explored. Our results demonstrate N-acetylaspartate, myo-inositol, total choline, and total creatine alterations in pain-related brain regions such as the frontal region, cingulum, postcentral gyrus, and thalamus in individuals with TBI with and without chronic pain. Additionally, NAA levels in the left and right frontal lobe regions were positively correlated with post-concussive symptoms; and NAA levels within the left frontal region were also positively correlated with neuropathic pain symptom severity, depression, and PTSD symptoms in the TBI with chronic pain group. These results suggest that neuronal integrity or density in the prefrontal cortex, a critical region for nociception and pain modulation, is associated with the severity of neuropathic pain symptoms and psychological comorbidities following TBI. Our data suggest that a combination of neuronal loss or dysfunction and maladaptive neuroplasticity may contribute to the development of persistent pain following TBI, although no causal relationship can be determined based on these data.
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Affiliation(s)
- Linda E Robayo
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL, United States.,Neuroscience Graduate Program, University of Miami, Miami, FL, United States
| | - Varan Govind
- Department of Radiology, University of Miami, Miami, FL, United States
| | - Teddy Salan
- Department of Radiology, University of Miami, Miami, FL, United States
| | - Nicholas P Cherup
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL, United States
| | - Sulaiman Sheriff
- Department of Radiology, University of Miami, Miami, FL, United States
| | - Andrew A Maudsley
- Department of Radiology, University of Miami, Miami, FL, United States
| | - Eva Widerström-Noga
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL, United States.,Neuroscience Graduate Program, University of Miami, Miami, FL, United States.,Department of Neurological Surgery, University of Miami, Miami, FL, United States
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6
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Rodríguez-Lozano DC, Meza-Rodríguez MDP, Cruz-Orozco OP, Sánchez-Ramírez B, Olguin-Ortega A, Silvestri-Tomassoni JR, Corona-Barsse G, Escobar-Ponce LF, Solis-Paredes JM, Dominguez-Trejo B, Camacho-Arroyo I. Emotional dysregulation in women with endometriosis with cyclical and non-cyclical chronic pelvic pain. BMC Womens Health 2022; 22:525. [PMID: 36526995 PMCID: PMC9758838 DOI: 10.1186/s12905-022-02066-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Endometriosis is a pathophysiological condition characterized by glands and stroma outside the uterus in regions such as the bladder, ureter, fallopian tubes, peritoneum, ovaries, and even in extra pelvic sites. One of the main clinical problems of endometriosis is chronic pelvic pain (CPP), which considerably affects the patients' quality of life. Patients with endometriosis may, cyclically or non-cyclically (80% of cases) experience CPP. High levels of anxiety and depression have been described in patients with endometriosis related to CPP; however, this has not been evaluated in endometriosis women with different types of CPP. Therefore, the research question of this study was whether there is a difference in the emotional dysregulation due to the type of pain experienced by women with endometriosis? METHODS This work was performed in the National Institute of Perinatology (INPer) in Mexico City from January 2019 to March 2020 and aimed to determine if there are differences in emotional dysregulation in patients with cyclical and non-cyclical CPP. 49 women from 18 to 52 years-old diagnosed with endometriosis presenting cyclical and non-cyclical CPP answered several batteries made up of Mini-Mental State Examination, Visual Analog Scale, Beck's Depression Inventory, State Trait-Anxiety Inventory, and Generalized Anxiety Inventory. Mann-Whitney U and Student's t-test for independent samples to compare the difference between groups was used. Relative risk estimation was performed to determine the association between non-cyclical and cyclical CPP with probability of presenting emotional dysregulation. RESULTS We observed that patients with non-cyclical CPP exhibited higher levels of depression and anxiety (trait-state and generalized anxiety) than patients with cyclical pain, p < 0.05 was considered significant. No differences were observed in pain intensity, but there was a higher probability of developing emotional dysregulation (anxiety or depression) in patients with non-cyclical CPP. No differences were observed in cognitive impairment. CONCLUSIONS Our data suggest that patients with non-cyclical (persistent) CPP present a higher emotional dysregulation than those with cyclical pain.
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Affiliation(s)
- Dulce Carolina Rodríguez-Lozano
- grid.9486.30000 0001 2159 0001Unidad de Investigación en Reproducción Humana, Instituto Nacional de Perinatología-Facultad de Química, Universidad Nacional Autónoma de México, 04510 Mexico City, (CD MX) Mexico
| | - María del Pilar Meza-Rodríguez
- grid.419218.70000 0004 1773 5302Departamento de Neurociencias, Instituto Nacional de Perinatología, Av. Montes Urales # 800. Col. Lomas de Virreyes, 11000 Mexico City, CD MX Mexico
| | - Olivier Paul Cruz-Orozco
- grid.419218.70000 0004 1773 5302Departamento de Ginecología, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Brenda Sánchez-Ramírez
- grid.419218.70000 0004 1773 5302Departamento de Ginecología, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Andrea Olguin-Ortega
- grid.419218.70000 0004 1773 5302Departamento de Ginecología, Instituto Nacional de Perinatología, Mexico City, Mexico
| | | | - Guillermo Corona-Barsse
- grid.419218.70000 0004 1773 5302Departamento de Ginecología, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Luis Fernando Escobar-Ponce
- grid.419218.70000 0004 1773 5302Departamento de Ginecología, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Juan Mario Solis-Paredes
- grid.419218.70000 0004 1773 5302Departamento de Genética y Genómica Humana, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Benjamín Dominguez-Trejo
- grid.9486.30000 0001 2159 0001Facultad de Psicología, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ignacio Camacho-Arroyo
- grid.9486.30000 0001 2159 0001Unidad de Investigación en Reproducción Humana, Instituto Nacional de Perinatología-Facultad de Química, Universidad Nacional Autónoma de México, 04510 Mexico City, (CD MX) Mexico
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7
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Dissecting neuropathic from poststroke pain: the white matter within. Pain 2022; 163:765-778. [PMID: 35302975 DOI: 10.1097/j.pain.0000000000002427] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/27/2021] [Indexed: 12/13/2022]
Abstract
ABSTRACT Poststroke pain (PSP) is a heterogeneous term encompassing both central neuropathic (ie, central poststroke pain [CPSP]) and nonneuropathic poststroke pain (CNNP) syndromes. Central poststroke pain is classically related to damage in the lateral brainstem, posterior thalamus, and parietoinsular areas, whereas the role of white matter connecting these structures is frequently ignored. In addition, the relationship between stroke topography and CNNP is not completely understood. In this study, we address these issues comparing stroke location in a CPSP group of 35 patients with 2 control groups: 27 patients with CNNP and 27 patients with stroke without pain. Brain MRI images were analyzed by 2 complementary approaches: an exploratory analysis using voxel-wise lesion symptom mapping, to detect significant voxels damaged in CPSP across the whole brain, and a hypothesis-driven, region of interest-based analysis, to replicate previously reported sites involved in CPSP. Odds ratio maps were also calculated to demonstrate the risk for CPSP in each damaged voxel. Our exploratory analysis showed that, besides known thalamic and parietoinsular areas, significant voxels carrying a high risk for CPSP were located in the white matter encompassing thalamoinsular connections (one-tailed threshold Z > 3.96, corrected P value <0.05, odds ratio = 39.7). These results show that the interruption of thalamocortical white matter connections is an important component of CPSP, which is in contrast with findings from nonneuropathic PSP and from strokes without pain. These data can aid in the selection of patients at risk to develop CPSP who could be candidates to pre-emptive or therapeutic interventions.
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8
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Manuello J, Mancuso L, Liloia D, Cauda F, Duca S, Costa T. A co-alteration parceling of the cingulate cortex. Brain Struct Funct 2022; 227:1803-1816. [PMID: 35238998 PMCID: PMC9098570 DOI: 10.1007/s00429-022-02473-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 02/14/2022] [Indexed: 11/24/2022]
Abstract
The cingulate cortex is known to be a complex structure, involved in several cognitive and emotional functions, as well as being altered by a variety of brain disorders. This heterogeneity is reflected in the multiple parceling models proposed in the literature. At the present, sub-regions of the cingulate cortex had been identified taking into account functional and structural connectivity, as well as cytological and electrochemical properties. In the present work, we propose an innovative node-wise parceling approach based on meta-analytic Bayesian co-alteration. To this aim, 193 case-control voxel-based morphometry experiments were analyzed, and the Patel's κ index was used to assess probability of morphometric co-alteration between nodes placed in the cingulate cortex and in the rest of the brain. Hierarchical clustering was then applied to identify nodes in the cingulate cortex exhibiting a similar pattern of whole-brain co-alteration. The obtained dendrogram highlighted a robust fronto-parietal cluster compatible with the default mode network, and being supported by the interplay between the retrosplenial cortex and the anterior and posterior cingulate cortex, rarely described in the literature. This ensemble was further confirmed by the analysis of functional patterns. Leveraging on co-alteration to investigate cortical organization could, therefore, allow to combine multimodal information, resolving conflicting results sometimes coming from the separate use of singular modalities. Crucially, this provides a valuable way to understand the pathological brain using data driven, whole-brain informed and context-specific evidence in a way not yet explored in the field.
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Affiliation(s)
- Jordi Manuello
- GCS fMRI, Koelliker Hospital and University of Turin, Turin, Italy.,FOCUS Lab, Department of Psychology, University of Turin, Turin, Italy
| | - Lorenzo Mancuso
- FOCUS Lab, Department of Psychology, University of Turin, Turin, Italy
| | - Donato Liloia
- GCS fMRI, Koelliker Hospital and University of Turin, Turin, Italy. .,FOCUS Lab, Department of Psychology, University of Turin, Turin, Italy.
| | - Franco Cauda
- GCS fMRI, Koelliker Hospital and University of Turin, Turin, Italy.,FOCUS Lab, Department of Psychology, University of Turin, Turin, Italy.,Neuroscience Institute of Turin, Turin, Italy
| | - Sergio Duca
- GCS fMRI, Koelliker Hospital and University of Turin, Turin, Italy.,FOCUS Lab, Department of Psychology, University of Turin, Turin, Italy
| | - Tommaso Costa
- GCS fMRI, Koelliker Hospital and University of Turin, Turin, Italy.,FOCUS Lab, Department of Psychology, University of Turin, Turin, Italy
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