运动皮层电刺激治疗丘脑痛3例并文献复习

Report of 3 patients with thalamic pain treated by motor cortex stimulation and literature review

目的探讨运动皮层电刺激治疗丘脑痛的安全性及有效性。方法回顾性分析2017年1月至2018年12月首都医科大学三博脑科医院采用运动皮层电刺激治疗的3例丘脑梗死或出血后导致的对侧肢体疼痛的临床资料。结果术前表现为持续性疼痛,间断性加重,疼痛性质为烧灼样或刀割样,伴肢体发紧,视觉模拟量表(VAS)评分9~10分,均服用阿司匹林、布洛芬、曲马多等多种镇痛药物及抗抑郁药物,效果不佳。术后VAS评分2~3分,下降超过70%。术后无癫痫等并发症,四肢肌力同术前,右侧躯体及肢体疼痛较术前有明显改善。术后随访6~12个月,病人反映疼痛缓解程度较前有所降低,增大刺激电压后,疼痛再次缓解。结论运动皮层电刺激治疗丘脑痛安全有效,并能改善病人的生活质量,具有创伤小、并发症少等优点。

Objective To explore the curative effects of motor cortex stimulation(MCS)on the thalamic pain and its safety.Methods MCS was performed from January,2017 to December,2018 in 3 patients with unilateral limb pain induced by thalamic infarct or hemorrhage,in whom the pain was persistent,sharp and burn-like ache and intermittently aggravated.Visual analogue scale(VAS)score was 9~10 points before the MCS in the patients.The patients were treated by the drugs such as aspirin,ibuprofen and tramadol before MCS,but the pain was not relieved.The stimulative parameters were adjusted after the stimulator starting up in order to achieve the best results.All the patients were followed up for half a year.The relevant literature was reviewed.Results The postoperative VAS score was 2~3 point in the patient,in whom the limb pain was significantly relieved compared with the preoperation.Conclusion MCS is a safe and effective method to treat thalamic pain.MCS can improve the quality of the patients'life,and also it has the advantages such as less trauma and few complications.