<原著>大脳皮質運動領野刺激による除痛の線維結合的背景

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概要

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• Recentry, electrical stimulation of motor cortex has been employed for the treatment of central deafferentation pain. The mechanism responsible for this effect remains unknown. In this paper, the anatomical basis of this electrical stimulation therapy was investigated with respect to fiber connections in the cats. The intrinsic degenerating axons from a small lesion in area 4 of the feline cortex were traced by the Fink-Heimer method into area 3a and 3b, in addition to degenerating fibers in the pyramidal tract. The labelled cells were studied by the retrograde axonal transport method with wheat germ agglutinin conjugated to horseradish peroxidase (WGA-HRP) which was injected into the ventral posterolateral nucleus (VPL) or motor cortex. In the fomer case, retrogradely labelled cells were found within the sensory cortex and motor cortex. It has thus become clear that the motor cortex projects efferent fibers both to the sensory cortex and VPL nucleus of the thalamus by both the Fink-Heimer and WGA-HRP studies. In the latter case, when the injection site of WGA-HRP was limited to the motor cortex (area 4), retrogradely labelled cells were found in areas 3a, 3b, 1,2 and 5a of the cortex, in periaqueductal gray and nucleus caeruleus (CAE). Thus, motor cortex stimulation will proceduce modulation effect upon the retrogradely labelled cells in the sensory cortex, thalamus and brain stem. When injected WGA-HRP diffused into the underlying white matter and the sensory cortex, the distribution of retrogradely labelled cells were shown to extend into central lateral nucleus, paracentral nucleus, centre median nucleus and posterolatera1 ventral nucleus of the thalamus and the dorsal nucleus of the raphe, CAE and nucleus parabrachialis of the pons. Supposing that the extent of diffused WGA-HRP might be similar to the extent of electrical stimulation by current spread, this current spreads into the white matter and adjacent sensory cortex would additionally influence the afferent fibers from the nucleicited above. The pain-relieving mechanism of motor cortex stimulation was discussed from the view point of these complex fiber connections involving the motor cortex.

• 近畿大学の論文
• 1994-12-25

著者

• 古田 義博

  近畿大学医学部脳神経外学教室

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