Background Deafferentation pain is a kind of chronic pain syndrome and hard to manipulate. To evaluate the effectiveness and safety of junctional dorsal root entry zone （DREZ） coagulation, 23 consecutive patients wi...Background Deafferentation pain is a kind of chronic pain syndrome and hard to manipulate. To evaluate the effectiveness and safety of junctional dorsal root entry zone （DREZ） coagulation, 23 consecutive patients with intractable deafferentation pain syndrome were studied.Methods Twenty-three patients underwent junctional DREZ coagulation （C5-T1 for upper extremities and L2-S1 for lower extremities） under general anesthesia. The pain severity was evaluated by the short McGill pain questionnaire （MPQ） and the visual analog scale （VAS）, and the depression and anxiety of patients were assessed by Hamilton rating scale for depression （HRSD）, Hamilton anxiety scale （HAMA）, self-rating anxiety scale （SAS） and self-rating depression scale （SDS）.Results All the patients experienced significant pain reduction immediately after surgery. The scales of short MPQ and VAS at pre-operation, 6-month and 12-month follow-up were 31.5±3.4 and 8.8±1.5, 6.5±1.9 and 2.5±2.2, 7.1±2.1 and 2.9±1.9, respectively. The postoperative scores comparing to pre-operative scores showed a statistically significant difference （P 〈0.01）. The depression and anxiety state was also significantly relieved. At 12-month follow-up 6 patients had complete pain relief, 11 had excellent results with more than 75% pain relief, 17 had good results with more than 50% pain relief （73.9%）. The main postoperative complications were transient slight hemiplegia （8）, hypesthesia and paresthesia （15）, a bearing down feeling of affected extremity （6）, and deep sensory disability in the lower limbs （4） on the operated side. Because of the long time and prone position of the operation, 13 cases had a transient hyperalgesia in the upper chest. Conclusion DREZ coagulation is a safe and effective procedure in the treatment of deafferentation pain syndromes.展开更多
AIM To investigate proprioceptive discrepancies in the lower extremity in persons with type 2 diabetes mellitus(T2DM). METHODS In this cross-sectional study, a total of 46 older persons were divided into a T2DM group(...AIM To investigate proprioceptive discrepancies in the lower extremity in persons with type 2 diabetes mellitus(T2DM). METHODS In this cross-sectional study, a total of 46 older persons were divided into a T2DM group(n = 23) and a control group who did not have T2 DM(n = 23). Participants were given a brief warm up with stretching exercises. Diabetic neuropathy scores were collected prior to proprioceptive testing. For proprioceptive testing, participants performed leg extensions to randomized target positions of 15°, 30°, 45, 60° degrees of elevation in the sagittal plane, each target was repeated a total of four times. Subjects were guided to target positions in the absence of visual feedback via auditory cues from a custom JPS application. When the participant entered the target position, they memorized the location of their limb in space and subsequently attempted to relocate this position in space. Proprioceptive errors were measured from the target positioned, target remembered, target repositioned protocol. RESULTS Proprioceptive accuracy was lower in the diabetic groupat all levels of target angle than the control group(P < 0.05). The diabetic group had 46% greater inaccuracy than the control group at all levels of target position. Diabetics also reported greater neuropathy scores than controls in the past 12 mo P < 0.01. CONCLUSION Deficits in lower limb localization and greater diabetic neuropathy scores were identified in this study. Our findings may be associated with deafferentation as peripheral neuropathy is a common complication with the disease. These findings may help to explain the declining balance function in the older persons with T2DM which is also commonly reported.展开更多
Our aim is to determine the cause(s) of migraine auras. Our understanding of how migraines and migraine auras originate is very imperfect. An important observation is that migraines occur more frequently in women at r...Our aim is to determine the cause(s) of migraine auras. Our understanding of how migraines and migraine auras originate is very imperfect. An important observation is that migraines occur more frequently in women at reproductive age than in men at a similar age. This suggests that gonadal hormones may be relevant triggers. The occurrence of classical (typical auras without headache) auras in one author (WB) has been recorded. Every aura in six years (85) has been noted, studied and analysed statistically. The auras occur predominantly in Spring and Autumn, especially in the longer reproductive season of Spring. This association is supported statistically. The results support the idea of gonadal hormones as relevant triggers, the strongest candidate being estrogen. Basic mechanisms underlying the auras are discussed, especially the phenomenon of cortical spreading depression. We also propose that both auras and migraines depend upon previous injury to the head or to the brain, giving rise to a condition of “deafferentation hypersensitivity”.展开更多
Trigeminal ganglia neurons significantly affect the amplitude and type of 5-HT receptor gene expression following activation of their axon terminals and sensitisation by painful stimuli. Moreover, these neurons signif...Trigeminal ganglia neurons significantly affect the amplitude and type of 5-HT receptor gene expression following activation of their axon terminals and sensitisation by painful stimuli. Moreover, these neurons significantly alter gene expression in cytoskeletal proteins following injury. The aim of the present study was to determine whether peripheral and/or central deafferenting lesions affect gene expression in serotonergic receptors that are involved in pain transmission. Adult rats were subjected to unilateral ablation of the facial sensory and motor cortices. Fifteen days after the surgery, degeneration of the cortico-trigeminal pathway was observed. Presynaptic deafferentation of the primary trigeminal neurons and central afferents of the contralateral ganglia was conducted. As a consequence of the excision of the meninges covering the ablated cortices, the peripheral axotomy of the trigeminal-vascular primary neurons of the ipsi-lateral side was induced. Serotonergic receptor (5-HT5A/5B/1B/1D/1F) gene expression was analysed in both sides of the trigeminal ganglia neurons. The results of the present study showed a significant increase in 5-HT5A/5B/1B/1D receptor gene expression in the primary sensory neurons of both ganglia, with the highest levels of expression noted in the ganglia contralateral to the lesion. 5-HT1F receptor expression, however, was more strongly expressed in the ganglia ipsilateral to the lesion. Our results also confirm that the adaptive response of primary trigeminal neurons to injury involves anatomical remodelling, as well as changes in receptor gene expression involved in sensory transmission. This may explain the distortion of sensory signals observed in trigeminal neuropathic states, and may lead to the development of novel pharmacological interventions.展开更多
文摘Background Deafferentation pain is a kind of chronic pain syndrome and hard to manipulate. To evaluate the effectiveness and safety of junctional dorsal root entry zone （DREZ） coagulation, 23 consecutive patients with intractable deafferentation pain syndrome were studied.Methods Twenty-three patients underwent junctional DREZ coagulation （C5-T1 for upper extremities and L2-S1 for lower extremities） under general anesthesia. The pain severity was evaluated by the short McGill pain questionnaire （MPQ） and the visual analog scale （VAS）, and the depression and anxiety of patients were assessed by Hamilton rating scale for depression （HRSD）, Hamilton anxiety scale （HAMA）, self-rating anxiety scale （SAS） and self-rating depression scale （SDS）.Results All the patients experienced significant pain reduction immediately after surgery. The scales of short MPQ and VAS at pre-operation, 6-month and 12-month follow-up were 31.5±3.4 and 8.8±1.5, 6.5±1.9 and 2.5±2.2, 7.1±2.1 and 2.9±1.9, respectively. The postoperative scores comparing to pre-operative scores showed a statistically significant difference （P 〈0.01）. The depression and anxiety state was also significantly relieved. At 12-month follow-up 6 patients had complete pain relief, 11 had excellent results with more than 75% pain relief, 17 had good results with more than 50% pain relief （73.9%）. The main postoperative complications were transient slight hemiplegia （8）, hypesthesia and paresthesia （15）, a bearing down feeling of affected extremity （6）, and deep sensory disability in the lower limbs （4） on the operated side. Because of the long time and prone position of the operation, 13 cases had a transient hyperalgesia in the upper chest. Conclusion DREZ coagulation is a safe and effective procedure in the treatment of deafferentation pain syndromes.
基金Supported by The Willamette University Mary Stuart Rogers Science Collaborative Research Program Endowment
文摘AIM To investigate proprioceptive discrepancies in the lower extremity in persons with type 2 diabetes mellitus(T2DM). METHODS In this cross-sectional study, a total of 46 older persons were divided into a T2DM group(n = 23) and a control group who did not have T2 DM(n = 23). Participants were given a brief warm up with stretching exercises. Diabetic neuropathy scores were collected prior to proprioceptive testing. For proprioceptive testing, participants performed leg extensions to randomized target positions of 15°, 30°, 45, 60° degrees of elevation in the sagittal plane, each target was repeated a total of four times. Subjects were guided to target positions in the absence of visual feedback via auditory cues from a custom JPS application. When the participant entered the target position, they memorized the location of their limb in space and subsequently attempted to relocate this position in space. Proprioceptive errors were measured from the target positioned, target remembered, target repositioned protocol. RESULTS Proprioceptive accuracy was lower in the diabetic groupat all levels of target angle than the control group(P < 0.05). The diabetic group had 46% greater inaccuracy than the control group at all levels of target position. Diabetics also reported greater neuropathy scores than controls in the past 12 mo P < 0.01. CONCLUSION Deficits in lower limb localization and greater diabetic neuropathy scores were identified in this study. Our findings may be associated with deafferentation as peripheral neuropathy is a common complication with the disease. These findings may help to explain the declining balance function in the older persons with T2DM which is also commonly reported.
文摘Our aim is to determine the cause(s) of migraine auras. Our understanding of how migraines and migraine auras originate is very imperfect. An important observation is that migraines occur more frequently in women at reproductive age than in men at a similar age. This suggests that gonadal hormones may be relevant triggers. The occurrence of classical (typical auras without headache) auras in one author (WB) has been recorded. Every aura in six years (85) has been noted, studied and analysed statistically. The auras occur predominantly in Spring and Autumn, especially in the longer reproductive season of Spring. This association is supported statistically. The results support the idea of gonadal hormones as relevant triggers, the strongest candidate being estrogen. Basic mechanisms underlying the auras are discussed, especially the phenomenon of cortical spreading depression. We also propose that both auras and migraines depend upon previous injury to the head or to the brain, giving rise to a condition of “deafferentation hypersensitivity”.
文摘Trigeminal ganglia neurons significantly affect the amplitude and type of 5-HT receptor gene expression following activation of their axon terminals and sensitisation by painful stimuli. Moreover, these neurons significantly alter gene expression in cytoskeletal proteins following injury. The aim of the present study was to determine whether peripheral and/or central deafferenting lesions affect gene expression in serotonergic receptors that are involved in pain transmission. Adult rats were subjected to unilateral ablation of the facial sensory and motor cortices. Fifteen days after the surgery, degeneration of the cortico-trigeminal pathway was observed. Presynaptic deafferentation of the primary trigeminal neurons and central afferents of the contralateral ganglia was conducted. As a consequence of the excision of the meninges covering the ablated cortices, the peripheral axotomy of the trigeminal-vascular primary neurons of the ipsi-lateral side was induced. Serotonergic receptor (5-HT5A/5B/1B/1D/1F) gene expression was analysed in both sides of the trigeminal ganglia neurons. The results of the present study showed a significant increase in 5-HT5A/5B/1B/1D receptor gene expression in the primary sensory neurons of both ganglia, with the highest levels of expression noted in the ganglia contralateral to the lesion. 5-HT1F receptor expression, however, was more strongly expressed in the ganglia ipsilateral to the lesion. Our results also confirm that the adaptive response of primary trigeminal neurons to injury involves anatomical remodelling, as well as changes in receptor gene expression involved in sensory transmission. This may explain the distortion of sensory signals observed in trigeminal neuropathic states, and may lead to the development of novel pharmacological interventions.
