症例報告: 中央脳卒中後の痛みの際の,ペリアクエドゥクタルのグレーとベントラルの後部タラムスの非対称的な二重標的深部脳刺激による多次元鎮痛
Shiming Wan1,2, Kanglin Liu1,2, Jiaxi Zhao1,2
1The Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Neurology and therapy
|September 6, 2025
まとめ
二重標的深層脳刺激 (DBS) は,患者の中枢性脳卒中後の痛みを効果的に治療しました. このアプローチは 周水管のグレーとタラムスを標的とし 痛みやうつ病の症状を 大幅に軽減しました
科学分野:
- 神経学
- 痛みの治療
- 神経外科
背景:
- 中枢性脳卒中後の痛み (CPSP) は,治療の選択肢が限られている神経疾患です.
- 深層脳刺激 (DBS) は 感覚と内生的な痛み経路を調節することで 潜在的介入を提供します
- CPSPにおける二重標的DBSの臨床的証拠は限られている.
研究 の 目的:
- 治療不可能なCPSPの管理における非対称的な二重標的DBSの有効性を評価する.
- 痛みの強度,神経疾患症状,それに伴ううつ病に対するDBSの影響を評価する.
- 痛みを和らげるためにペリアクエドゥクタル・グレイ (PAG) とベントラル・ポステリア・タラムス (VP) の両方をターゲットにする可能性を調査する.
主な方法:
- 54歳の女性の症例報告 胸部出血の後にCPSPを患った
- 右辺水管灰 (R-PAG) と左側腹部後部タラムス (L-VP) に非対称なDBSの埋め込み
- 視覚アナログスケール (VAS),神経痛スケール4 (DN4),ハミルトンうつ病スケール (HAMD) を用いて12ヶ月の長期評価.
- 痛みや麻痺の管理に周期的な刺激 (5分間のオン/オフ間隔) を適用する.
主要な成果:
- 痛みの強度の持続的な減少 (VAS: 7〜1)
- 神経病的な症状の顕著な改善 (DN4: 4〜1).
- 鬱症状の有意な減少 (HAMD: 22〜8) が12ヶ月のフォローアップで確認されました.
- 周期的な刺激で痛みを軽減し,一時的な麻痺を軽減します.
結論:
- PAGとVPを含む非対称的な二重標的DBSは,CPSPにおける多次元鎮痛の可能性を示しています.
- 研究結果は,神経疾患の痛みにおけるDBSの患者選択,標的選択,および刺激パラメータの最適化を示唆しています.
- このケースは 慢性疼痛の神経経路の理解を高めます 感覚と感情の相互作用も含まれます
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