Elsevier.com | MedConnect.com.au | Medconnect.com.sg | Lancet.cn | JOA中文版

刺激人类大脑皮层与疼痛体验

Stimulation of the human cortex and the experience of pain: Wilder Penfield's observations revisited
2012-06-13 15:02点击:19次发表评论
作者:Mazzola, L..., Isnard, J..., Peyron, R... 【View at publisher】
期刊: Brain2012年6月期卷 专家评级:★★★ 循证评级:B

Thanks to the seminal work of Wilder Graves Penfield (1891–1976) at the Montreal Neurological Institute, electrical stimulation is used worldwide to localize the epileptogenic cortex and to map the functionally eloquent areas in the context of epilepsy surgery or lesion resections. In the functional map of elementary and experiential responses he described through >20years of careful exploration of the human cortex via stimulation of the cortical surface, Penfield did not identify any ‘pain cortical area’. We reinvestigated this issue by analysing subjective and videotaped behavioural responses to 4160 cortical stimulations using intracerebral electrodes implanted in all cortical lobes that were carried out over 12years during the presurgical evaluation of epilepsy in 164 consecutive patients. Pain responses were scarce (1.4%) and concentrated in the medial part of the parietal operculum and neighbouring posterior insula where pain thresholds showed a rostrocaudal decrement. This deep cortical region remained largely inaccessible to the intraoperative stimulation of the cortical surface carried out by Penfield after resection of the parietal operculum. It differs also from primary sensory areas described by Penfield et al. in the sense that, with our stimulation paradigm, pain represented only 10% of responses. Like Penfield et al., we obtained no pain response anywhere else in the cortex, including in regions consistently activated by pain in most functional imaging studies, i.e. the first somatosensory area, the lateral part of the secondary somatosensory area, anterior and mid-cingulate gyri (mid-cingulate cortex), anterior frontal, posterior parietal and supplementary motor areas. The medial parietal operculum and posterior insula are thus the only areas where electrical stimulation is able to trigger activation of the pain cortical network and thus the experience of somatic pain.

学科代码:神经病学   关键词:刺激人类大脑皮层与疼痛体验
顶一下(0
您可能感兴趣的文章
    发表评论网友评论(0)
      发表评论
      登录后方可发表评论,点击此处登录
      友情链接: 中文版柳叶刀 | MD CONSULT | Journals CONSULT | Procedures CONSULT | eClips CONSULT  | Imaging CONSULT  
        好大夫   |  医师网  | 丁香园  | 论文吧  | 世界医学书库  | 好医生论坛  |  医心网  | 环球医学  | 白天使  | 医脉通 
      中华外科杂志  | 中国妇产科网  |  新青年麻醉论坛  | 杏树林  | 医学论坛网  | 春雨掌上医生  |协和青年之家