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
收藏
页码：454 / 462
页数：9
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