Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology · 2016
Pain perception in patients with chronic disorders of consciousness: What can limbic system tell us?
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Calabrò Rocco Salvatore, Naro Antonino, Manuli Alfredo, Leo Antonino, De Luca Rosaria, Lo Buono Viviana, Russo Margherita, Bramanti Alessia, Bramanti Placido
Аннотация
OBJECTIVE: Although it is believed that patients with Unresponsive Wakefulness Syndrome (UWS) do not feel pain, recent neuroimaging and neurophysiologic studies have demonstrated some residual traces of nociceptive processing.
METHODS: To confirm this growing evidence, we evaluated 21 patients suffering from chronic disorders of consciousness (DOC) (both UWS, n=11, and Minimally Conscious State - MCS -, n=10), using an Event-Related Potential (ERP) Low-Resolution Brain Electromagnetic Tomography (LORETA) approach, based on nociceptive repeated laser stimulation (RLS). We delivered laser stimuli to the dorsum of both hands and analysed the γ-band LORETA activations and the ERP γ-power magnitude induced by laser stimulation, as well as the heart rate variability (HRV).
RESULTS: We found partially preserved cortical activations and ERP γ-power magnitude in all MCS and two UWS individuals. These effects were paralleled by a purposeful behaviour, and a reduced HRV concerning nociceptive stimulation, whereas the two UWS individuals showed no more than reflex behaviours, besides a strong limbic activation.
CONCLUSIONS: Some UWS patients may somehow perceive the affective components of nociceptive stimulation.
SIGNIFICANCE: The diagnosis of functional locked-in syndrome should be taken into account when dealing with DOC differential diagnosis.
METHODS: To confirm this growing evidence, we evaluated 21 patients suffering from chronic disorders of consciousness (DOC) (both UWS, n=11, and Minimally Conscious State - MCS -, n=10), using an Event-Related Potential (ERP) Low-Resolution Brain Electromagnetic Tomography (LORETA) approach, based on nociceptive repeated laser stimulation (RLS). We delivered laser stimuli to the dorsum of both hands and analysed the γ-band LORETA activations and the ERP γ-power magnitude induced by laser stimulation, as well as the heart rate variability (HRV).
RESULTS: We found partially preserved cortical activations and ERP γ-power magnitude in all MCS and two UWS individuals. These effects were paralleled by a purposeful behaviour, and a reduced HRV concerning nociceptive stimulation, whereas the two UWS individuals showed no more than reflex behaviours, besides a strong limbic activation.
CONCLUSIONS: Some UWS patients may somehow perceive the affective components of nociceptive stimulation.
SIGNIFICANCE: The diagnosis of functional locked-in syndrome should be taken into account when dealing with DOC differential diagnosis.