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Thalamic pain and motor cortical electrical stimulation

Thalamic pain defines thalamic pain, also known as D é jerine roussy thalamic pain syndrome. It is usually secondary to hemorrhage or infarction of thalamic striatal artery or thalamic geniculate artery. It is a common sequelae after thalamic stroke and belongs to typical post-stroke central pain (CPSP), with an incidence of 8% ~ 17%

Ni Bing, Department of functional neurosurgery, Xuanwu Hospital, Capital Medical University

Etiology: thalamic hemorrhage, thalamic infarction, thalamic regional surgery, vasculitis? Clinical manifestations: contralateral spontaneous pain, contralateral hemiplegia, contralateral shallow hypoesthesia or abnormality (temperature perception), mild deep hypoesthesia, contralateral involuntary movement, ataxia, hand and foot movement, depression, anxiety, sleep disorder, language and cognitive impairment caused by primary disease, cranial nerve injury and other pain characteristics. Time of occurrence: immediately after stroke, Or within several months to half a year, a few more than 1 year; Location: the location is vague and diffuse, and the contralateral limbs are more than the head and face, with great individual differences; Duration: mostly persistent pain; Features: burning sample, needling sample, pressing sample, knife cutting sample, cold feeling, etc; Aggravating factors: sound, light, wind, touch and emotion; Severity: severe and intolerable, which is not proportional to the size of the lesion. Assist in electromyography and MRI

Therapeutic drugs – antidepressants: amitriptyline, fluvoxamine, fluoxetine; Anticonvulsant drugs: lamotrigine, carbamazepine, gabapentin, pregabalin; Cell membrane stabilizer: mexiletine (p.o.), lidocaine (IV) (short term); NMDA antagonist: Ketamine; Neurotrophic drugs; Opioids; NSAIDs & COX-2 inhibitor treatment – deep brain nucleus damage surgery: conduction bundles such as VPL, VPM, central nucleus (CM), parafascicular nucleus (PF): midbrain spinal colliculus bundle and trigeminal cingulate gyrus treatment – motor cortex stimulation (MCS) Treatment “repetitive transcranial magnetic stimulation (rTMS)” targeted site: corresponding area of contralateral anterior central gyrus “can be used as a test treatment for MCS

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