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Study on the pathophysiology of pallido-, spino-thalamo-cortical system in cases with intractable functional disorders

Research Project

Project/Area Number 09671408
Research Category

Grant-in-Aid for Scientific Research (C)

Allocation TypeSingle-year Grants
Section一般
Research Field Cerebral neurosurgery
Research InstitutionGunma University

Principal Investigator

HIRATO Masafumi  Gunma University, Department of Neurosurgery, Assistant professor, 医学部, 講師 (00173245)

Co-Investigator(Kenkyū-buntansha) TAKAHASHI Akio  Gunma University, Department of Neurosurgery, Assistant doctor, 医学部, 助手 (60261856)
NEGISHI Masatoshi  Gunma University, Department of Neurosurgery, Assistant doctor, 医学部, 助手 (80272235)
Project Period (FY) 1997 – 1999
Project Status Completed (Fiscal Year 1999)
Budget Amount *help
¥2,100,000 (Direct Cost: ¥2,100,000)
Fiscal Year 1999: ¥300,000 (Direct Cost: ¥300,000)
Fiscal Year 1998: ¥300,000 (Direct Cost: ¥300,000)
Fiscal Year 1997: ¥1,500,000 (Direct Cost: ¥1,500,000)
KeywordsParkinson's disease / rigid-akinesia / tremor / central(thalamic) pain / depth microrecording / PET scan / functional MRI / Gamma Knife / termor / n. ventralis intermedius / depth microrecorking / central(thalamic) / trigeminal neuralgia / Parkinson‘s disease / nucleus ventralis intermidius / primary motor area / central(thalamic)pain / supplementary motor area / thalamocortical tract
Research Abstract

(1) In cases with rigid-akinesia type Parkinson's disease(PD), frontal regional cerebral glucose metabolism(rCMRglu) was correlated with dopamine contents in the CSF of 3rd ventricle. Stereotactic posteroventral pallidotomy(PVP) was carried out in 13 cases with rigid-akinesia type PD with aid of depth microrecording. Before operation, a PET study has revealed low regional cerebral glucose metabolism in the prefrontal area in all the patients. Unilateral sequential opposite finger movement(SOFM) induced increase of regional cerebral blood flow(rCBF) both in the supplementary and primary motor area in the effective response groups. Electrophysiological study during the operation showed continuous high-frequency and high-amplitude spike discharges in the internal segment of globus pallidus(Gpi) in the effective response group. If the effect of nigrostriatal dysfunction was restricted in the nigro-striato-pallidal connections, characterized by overactivity in Gpi neurons, without extensive … More ly affecting the motor-related structures in the frontal cortex, we could expect to alleviate the parkinsonian symptoms, such as rigidity or bradykinesia, by pallidotomy(PVP). If, however, the dysfunction extended into the network of motor-related structures in the frontal cortex, particularly in the supplementary motor area, we could no longer expect to improve the parkinsonian symptoms.
(2) Functional mapping study using PET scan and depth microrecording was carried out to elucidate the thalamocortical relation involved in tremor in cases with tremor type Parkinson's disease. In this type of PD, PET study revealed spot-shaped increased zone of rCMRglu and/or rCBF in the frontal precentral area on the side contralateral to tremor. Unilateral SOFM evoked increase of rCBF in the similar precentral area. Moreover, unilateral thumb brushing caused increase of rCBF in the postcentral area just caudal to the precentral rCBF increased zone. The cortical mapping studies revealed that rCMRglu and/or rCBF mainly increased in the primary motor cortex during the appearance of tremor. Both PET and functional MRI study showed spot-shaped high signal area (increased zone of rCBF) in the thalamic ventro-lateral area. Moreover, depth microrecording study showed rhythmic discharges synchronous with contralateral limb tremor in the similar area(=thalamic VIM : nucleus ventralis intermedius). It was postulated that both thalamic VIM and the cortical precentral area, which was functionally identified by brain mapping study, may play important roles in mediating and maintaining tremor in tremor type PD.
(3) Based on the data obtained for the selective thalamotomy with aid of depth microrecording, it was postulated that functional change has occurred in the thalamic sensory nucles just rostral or bottom to original cerebrovascular lesion and in the cerebral cortex adjacent to the central sulcus in cases with thalamic pain.These changes may cause aberrant conduction of sensory signal or hypersensitivity to peripheral sensory stimulation. The therapeutic lesion created by thermo-coagulation or Gamma Knife aimed to ameliorate these abnormal functional states may relieve thalami pain.
(4) A retrospective study was conducted to evaluate the effectiveness of Gamma Knife radiosurgery in the management of idiopathic trigeminal neuralgia. Radiosurgery was performed with a signal 4 mm isocenter targeted at the nerve root entry zone. Gamma Knife radiosurgery is an effective surgical attempt in the management of this intractable pain. These results also showed that peripheral sensory input may play important roles for the genesis of intractable trigeminal neuralgia. Less

Report

(4 results)
  • 1999 Annual Research Report   Final Research Report Summary
  • 1998 Annual Research Report
  • 1997 Annual Research Report
  • Research Products

    (35 results)

All Other

All Publications (35 results)

  • [Publications] M.Hirato: "Gamma Knife radiosurgery for idiopathic trigeminal neuralgia"Pain Research. 14. 45-51 (1999)

    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] M.Hirato: "Study on the function of basal ganglia and frontal cortex using depth microrecording and PET scan in relation to the outcome of pallidotomy for the treatment of rigid-akinesia type Parkinson's disease"Stereotact Funct Neurosurg. 69. 86-92 (1997)

    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] M.Hirato: "微小電極法、PET scanを用いたParkinson病の外科的治療"機能的脳神経外科. 38. 24-25 (1999)

    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] M.Hirato: "視床痛の成因:PET study"ペインクリニック. 19. 593-600 (1998)

    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] M.Hirato: "難治性疼痛(視床痛、三叉神経痛)の治療-より低侵襲の定位的治療をめざして"機能的脳神経外科. 36. 15-22 (1997)

    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] M.Hirato: "Gamma knifeを用いた難治性疼痛(視床痛、三叉神経痛)の治療"定位放射線治療. 1. 17-25 (1997)

    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] M.Hirato: "Current progress in functional brain mapping : Science and applications"Functional mapping studies on the thalamocortical relation involved in tremor in Parkinson's disease using PET and depth microrecording. 2 (1998)

    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] M.Hirato: "難治性疼痛の最近の治療 Bamma Knifeによる難治性疼痛の治療"医学のあゆみ. 6 (1999)

    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] M. Hirato, T. Shibazaki, A. Takahashi, K. Watanabe, C. Ohye, T. Sasaki: "Gamma Knife radiosurgery for idiopathic trigeminal neuralgia"Pain Research. 14. 45-51 (1999)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] M. Hirato, A. Takahashi, M. Negishi, T. Shibazaki, C. Ohye: "Functional mapping studies on the thalamocortical relation involved in tremor in Parkinson's disease using PET and depth microrecording"Current progress in functional brain mapping. 119-120 (1998)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] M. Hirato, C. Ohye, A. Takahashi, M. Negishi, T. Shibazaki: "Study on the function of basal ganglia and frontal cortex using depth microrecording and pet scan in relation to the outcome of pallidotomy for treatment of rigid-akinesia type Parkinson's disease."Stereotact Funct Neurosurg. 69. 86-92 (1997)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] A. Takahashi, K. Watanabe, K. Satake, M. Hirato, C. Ohye: "Effect of electrical stimulation of the thalamic Vim nucleus on hand tremor during stereotactic thalamotomy"Electroenceph clin Neurophysiol. 109. 376-384 (1998)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] M. Hirato, A. Takahashi, K. Watanabe, T. Shibazaki, T. Sasaki, C. Ohye: "Surgical treatment for Parkinson's disease with aid of depth microrecording and PET scan"Funct Neurosurg. 38. 24-25 (1999)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] M. Hirato: "Gamma Knife treatment for the intractable pain"J Clin Exp Med (IGAKU NO AYUMI). 189. 775-780 (1999)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] M. Hirato, T. Sasaki: "Gamma Knife radiosurgery for the treatment of intractable pain"Noshinkeigeka no Saisentan. 15-21 (1999)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] M. Hirato, A. Takahashi, K. Watanabe, T. Shibazaki, C. Ohye: "The role of neurosurgeon for the treatment of intractable pain toward less invasive neurosurgery"Funct Neurosurg. 37. 81-82 (1998)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] M. Hirato, C. Ohye: "Functional changes of thalamus and cerebral cortex around central sulcus in patients with thalamic pain"Pain Clinic. 19. 593-600 (1998)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] M. Hirato, C. Ohye: "Brain stem ・ Basal ganglia [Function ・ Anatomy ・ Surgery] II. Surgical treatment for functional disorders in basal ganglia"New Approach. 6. 74-85 (1998)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] M. Hirato, T. Shibazaki, A. Takahashi, H. Inoue, C. Ohye, Y. Andou: "Stereotactic treatment for the intractable pain (thalamic pain, trigeminal neuralgia) toward less invasive surgery"

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] M. Hirato, T. Shibazaki, C. Ohye, A. Takahashi, H. Inoue, Y. Andou: "Gamma Knife radiosurgery for the treatment of intractable pain (thalamic pain, trigeminal neuralgia)"Stereotactic Radiotherapy. 1. 17-25 (1997)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] A. Takahashi, K. Watanabe, M. Hirato, T. Sasaki, C. Ohye: "Clinical application of functional MRI to Vim-thalamotomy"Funct Neurosurg. 38. 54-55 (1999)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] A. Takahashi, K. Watanabe, M. Hirato, C. Ohye.: "Acute electrical stimulation of the Vim nucleus : Effect on parkinsonian tremor and essential tremor"Funct Neurosurg. 37. 57-58 (1998)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] M.Hirato: "Gamma Knife radiosurgery idiopathic trigeminal neuralgia"Pain Research. 14. 45-51 (1999)

    • Related Report
      1999 Annual Research Report
  • [Publications] M.Hirato: "微小電極法、PET scanを用いたParkinsos病の外科的治療"機能的脳神経外科. 38. 24-25 (1999)

    • Related Report
      1999 Annual Research Report
  • [Publications] A.Takahashi: "functional MRIの定位的視床手術への応用"機能的脳神経外科. 38. 54-55 (1999)

    • Related Report
      1999 Annual Research Report
  • [Publications] M.Hirato: "Gamma Knifeによる難治性疼痛の治療"脳神経外科の最先端. 7 (1999)

    • Related Report
      1999 Annual Research Report
  • [Publications] M. Hirato: "難治性疼痛の最近の治療 ガンマナイフによる治療" 医学のあゆみ. in press. (1999)

    • Related Report
      1998 Annual Research Report
  • [Publications] M. Hirato: "より低侵襲の脳外科的治療を意図した難治性疼痛の治療:脳神経外科医の役割" 機能的脳神経外科. 37. 81-82 (1998)

    • Related Report
      1998 Annual Research Report
  • [Publications] M. Hirato: "Current progress in functional brain mapping : Science and applications" Functional mapping studies on the thalamocortical relation involved in tremorin Parkinson's disease using PET and depth microrecording., (1998)

    • Related Report
      1998 Annual Research Report
  • [Publications] M. Hirato: "図説脳神経外科New Approach 6 脳幹・基底核[機能・解剖・手術]" II.基低核部の手術・機能的疾患の手術, (1998)

    • Related Report
      1998 Annual Research Report
  • [Publications] M.Hirato: "Study on the function of basal ganglia and frontal cortex using depth microrecording and PET scan in relation to the outcome of pallidotomy for the treatment of rigid-akinesia type Parkinson's disease" Stereotact Funct Neurosurg. 67(in press). (1997)

    • Related Report
      1997 Annual Research Report
  • [Publications] M.Hirato: "パーキンソン病後腹側淡蒼球手術例における前頭葉皮質、基底核機能、および術後変化" 機能的脳神経外科. 35. 32-40 (1996)

    • Related Report
      1997 Annual Research Report
  • [Publications] M.Hirato: "視床痛の成因:PET study" ペインクリニック. (in press). (1998)

    • Related Report
      1997 Annual Research Report
  • [Publications] M.Hirato: "難治性疼痛(視床痛、三叉神経痛)の治療-より低侵襲の定位的治療をめざして" 機能的神経外科. 36(in press). (1997)

    • Related Report
      1997 Annual Research Report
  • [Publications] M.Hirato: "Gamma knifeを用いた難治性疼痛(視床痛、三叉神経痛)の治療" 定位放射線治療. 1. 17-25 (1997)

    • Related Report
      1997 Annual Research Report

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Published: 1997-04-01   Modified: 2016-04-21  

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