Effect of an Anterior Cingulotomy on Pain, Cognition, and Sensory Pathways

Wang, Guan-Chyuan; Harnod, Tomor; Chiu, Ted H.; Chen, Kuan-Pin

doi:10.1016/j.wneu.2017.03.053

Cited by 10 publications

(8 citation statements)

References 19 publications

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“…Human neurophysiological studies have also revealed nociceptive responses within SI, SII, insular and cingulate cortices ( Frot et al, 2001 , 2013 , 2014; Liberati et al, 2017 ). Lesions and electrical stimulation in these cortical regions as well as strokes involving the spinothalamic tract in the internal capsule have together confirmed a role of this cortical network in human pain awareness ( Ballantine et al, 1967 ; Berthier et al, 1988 ; Kim, 1992 ; Cereda et al, 2002 ; Torta et al, 2013 ; Boccard et al, 2014 , 2017 ; Hirayama et al, 2014 ; Russo and Sheth, 2015 ; Agarwal et al, 2016 ; Denis et al, 2016 ; Wang et al, 2017 ).…”

Section: Localization Of Pain Awareness In the Human Brainmentioning

confidence: 77%

Designing Brains for Pain: Human to Mollusc

Key

Brown

2018

Front. Physiol.

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There is compelling evidence that the “what it feels like” subjective experience of sensory stimuli arises in the cerebral cortex in both humans as well as mammalian experimental animal models. Humans are alone in their ability to verbally communicate their experience of the external environment. In other species, sensory awareness is extrapolated on the basis of behavioral indicators. For instance, cephalopods have been claimed to be sentient on the basis of their complex behavior and anecdotal reports of human-like intelligence. We have interrogated the findings of avoidance learning behavioral paradigms and classical brain lesion studies and conclude that there is no evidence for cephalopods feeling pain. This analysis highlighted the questionable nature of anthropometric assumptions about sensory experience with increased phylogenetic distance from humans. We contend that understanding whether invertebrates such as molluscs are sentient should first begin with defining the computational processes and neural circuitries underpinning subjective awareness. Using fundamental design principles, we advance the notion that subjective awareness is dependent on observer neural networks (networks that in some sense introspect the neural processing generating neural representations of sensory stimuli). This introspective process allows the observer network to create an internal model that predicts the neural processing taking place in the network being surveyed. Predictions arising from the internal model form the basis of a rudimentary form of awareness. We develop an algorithm built on parallel observer networks that generates multiple levels of sensory awareness. A network of cortical regions in the human brain has the appropriate functional properties and neural interconnectivity that is consistent with the predicted circuitry of the algorithm generating pain awareness. By contrast, the cephalopod brain lacks the necessary neural circuitry to implement such an algorithm. In conclusion, we find no compelling behavioral, functional, or neuroanatomical evidence to indicate that cephalopods feel pain.

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Section: Localization Of Pain Awareness In the Human Brainmentioning

confidence: 77%

Designing Brains for Pain: Human to Mollusc

Key

Brown

2018

Front. Physiol.

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“…18,21,22,25,33,36 The efficacy of ACING was found to be 50%-100% at different follow-up moments for patients with various pain syndromes of benign origin. 7,9,10,13,17,23,29,30,32,34 Of interest, only a total of 4 patients with CPSP were included in these studies, hence contributing to the rareness of the case presented in this study. One of these patients with CPSP was included by Pillay and Hassenbusch, in which significant pain relief was reached in 60% of patients with chronic intractable pain.…”

Section: Discussionmentioning

confidence: 99%

Cingulotomy: the last man standing in the battle against medically refractory poststroke pain

Kollenburg,

Kurt,

Arnts

et al. 2024

PR9

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Introduction: Central poststroke pain (CPSP) places a huge burden on patient lives because patients are often refractory to conventional strategies and have little chance for spontaneous recovery. A subset of patients is even given approval for euthanasia and is without any perspective. Because the anterior cingulate cortex historically seems to be a promising target for patients with both mental and chronic pain disorders, lesioning of this central “hub” with cingulotomy may be a useful strategy for medically refractory CPSP. However, limited research is available on cingulotomy for central pain. Hence, we represent a rare case in which cingulotomy is performed on a patient with CPSP. Objectives: To describe the potential of cingulotomy in a case with CPSP. Methods: The case presented in this study concerns a 60-year-old woman who experienced CPSP, caused by a hemorrhagic stroke in the basal ganglia and thalamus. The patient visited several centers and tried multiple off-label treatments; however, she was told nothing else could be done and was even given approval for euthanasia. Hence, anterior cingulotomy was performed. Results: After surgery, no transient adverse events occurred, except for vocabulary disturbances post stroke, which disappeared after several weeks. After 14 weeks, changes in pain behavior were observed, followed by a decreased pain intensity. At a later follow-up, the pain had completely disappeared. Conclusion: Anterior cingulotomy seems to be a suitable “last-resort” option for patients with CPSP. Future research, including homogenous groups, to define the best location for lesioning is required to allow the revival of this “old” technique in the current era.

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“…There is no uniform standard for the choice of temperature and duration of continuous radiofrequency thermocoagulation. Some studies have suggested that radiofrequency thermocoagulation at a temperature of > 90 °C has more complications, such as facial numbness [ 9 ]. In recent years, our department has directly adopted a thermocoagulation procedure of 90 °C and 120 s continuous radiofrequency.…”

Section: Discussionmentioning

confidence: 99%

CT-Guided Thermocoagulation of the Pterygopalatine Ganglion for Refractory Trigeminal Autonomic Cephalalgia

Liu

et al. 2022

Pain Ther

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Introduction: Trigeminal autonomic cephalalgia (TAC) is a type of one-sided cerebral painful headache, with attacks regularly accompanied by autonomic responses, such as tearing, runny nose, panic, nausea and vomiting on the affected side. Currently, the most common treatment strategies are drugs, nerve grafts and surgery. Clinical understanding of TACs is limited. Here, we report the case of thermocoagulation treatment of the pterygopalatine ganglion in an uncommon TAC under local anesthesia. Case Presentation: A rare case of TAC was treated with computed tomography (CT)-guided thermocoagulation within the pterygopalatine ganglion. Pain and autonomic signs were relieved immediately after surgery, with the patent retaining only slight numbness on the left side of the face. This numbness completely resolved at 6 months of follow-up and there was no recurrence. Discussion: Trigeminal autonomic cephalalgia seriously affects the patient's quality of life, but clinical understanding is limited. In the case reported here, we performed CT-guided thermocoagulation of the pterygopalatine ganglion at 90 °C for 180 s for treatment of a trigeminal autonomic headache. To our knowledge, this is the first report of using thermocoagulation at 90 °C to treat the pterygopalatine ganglion. We found that this strategy results in fewer side effects and is a more cost-effective treatment for such patients than other options. Conclusion: Computedtomography-guided thermocoagulation of the pterygopalatine ganglion at 90 °C for 180 s for treatment of trigeminal autonomic headache is a safe and economical treatment option.

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Effect of an Anterior Cingulotomy on Pain, Cognition, and Sensory Pathways

Cited by 10 publications

References 19 publications

Designing Brains for Pain: Human to Mollusc

Designing Brains for Pain: Human to Mollusc

Cingulotomy: the last man standing in the battle against medically refractory poststroke pain

CT-Guided Thermocoagulation of the Pterygopalatine Ganglion for Refractory Trigeminal Autonomic Cephalalgia

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