幻肢痛における大脳皮質再構築の経頭蓋磁気刺激, 脳磁図, 感覚誘発電位による検討

概要

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Cortical reorganization (CR) following peripheral deafferentation is thought to cause phantom limb pain, though few electrophysiological examinations on human have been performed. We examined a patient who suffers from phantom limb pain following amputation of his left leg; he has been relieved of the pain by repetitive transcranial magnetic stimulation (rTMS) and motor cortex stimulation (MCS). We performed cortical mapping using navigation-guided rTMS, somatosensory evoked magnetic fields (SEF) with magnetic encephalography (MEG) and sensory evoked potential (SEP) with subdural electrodes. Navigation-guided rTMS revealed that rTMS of a wide area of bilateral cortices caused paresthesias of phantom limb and pain reduction. Sensory evoked potential with MEG showed that the receptive field of his normal leg was remarkably displaced to the phantom limb. Also, displacement of the receptive field was observed with SEP using subdural electrodes. This evidence of CR suggests that it seems to cause phantom limb pain; rTMS and MCS can modulate cortical reorganization and reduce pain.
日本疼痛学会の論文