Pain perception in patients with chronic disorders of consciousness: What can limbic system tell us?

被引：24

作者：

Calabro, Rocco Salvatore ^{[1
]}

Naro, Antonino ^{[1
]}

Manuli, Alfredo ^{[1
]}

Leo, Antonino ^{[1
]}

De Luca, Rosaria ^{[1
]}

Lo Buono, Viviana ^{[1
]}

Russo, Margherita ^{[1
]}

Bramanti, Alessia ^{[1
]}

Bramanti, Placido ^{[1
]}

机构：

[1] IRCCS, Ctr Neurolesi Bonino Pulejo, SS 113,Contrada Casazza, I-98124 Messina, Italy

来源：

CLINICAL NEUROPHYSIOLOGY | 2017年 / 128卷 / 03期

关键词：

Limbic system; LORETA; MCS; UWS; HRV; Pain perception; ANTERIOR CINGULATE CORTEX; HEART-RATE-VARIABILITY; VEGETATIVE STATE; UNRESPONSIVE WAKEFULNESS; SOMATOSENSORY STIMULI; AUTONOMIC SYSTEM; BRAIN-FUNCTION; RECOVERY; SCALE; COMA;

D O I：

10.1016/j.clinph.2016.12.011

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Objective: Although it is believed that patients with Unresponsive Wakefulness Syndrome (UWS) do not feel pain, recent neuroimaging and neurophysiologic studies have demonstrated some residual traces of nociceptive processing. Methods: To confirm this growing evidence, we evaluated 21 patients suffering from chronic disorders of consciousness (DOC) ( both UWS, n = 11, and Minimally Conscious State - MCS -, n = 10), using an Event-Related Potential (ERP) Low-Resolution Brain Electromagnetic Tomography (LORETA) approach, based on nociceptive repeated laser stimulation (RLS). We delivered laser stimuli to the dorsum of both hands and analysed the gamma-band LORETA activations and the ERP gamma-power magnitude induced by laser stimulation, as well as the heart rate variability (HRV). Results: We found partially preserved cortical activations and ERP gamma-power magnitude in all MCS and two UWS individuals. These effects were paralleled by a purposeful behaviour, and a reduced HRV concerning nociceptive stimulation, whereas the two UWS individuals showed no more than reflex behaviours, besides a strong limbic activation. Conclusions: Some UWS patients may somehow perceive the affective components of nociceptive stimulation. Significance: The diagnosis of functional locked-in syndrome should be taken into account when dealing with DOC differential diagnosis. (C) 2017 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

引用

页码：454 / 462

页数：9

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