Paraqueductal Mesencephalotomy for Facial Central Pain

Schvarcz, J. R.

doi:10.1007/978-3-7091-8482-0_31

Cited by 7 publications

(14 citation statements)

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“…First, there is homology of reactions between spontaneous panic attacks and the e¤ects of DPAG stimulation in humans and animals. Stimulations of the DPAG have been done in humans undergoing surgery and these patients reported intense fear associated with autonomic reactions like tachycardia and hyperventilation remiscent a full-blown panic attack (Nashold et al 1969;Schvarcz 1975). Second, antipanic agents, like high potency benzodiazepines, have been shown to decrease DPAG mediated behaviours, while panicogenic agents like yohimbine and cholecystokinin tetrapeptide increase them (Grae¤ 1990;Jenck et al 1995;Mongeau and Marsden 1996).…”

Section: Introductionmentioning

confidence: 97%

Effect of imipramine treatments on the 5-HT 1A -receptor-mediated inhibition of panic-like behaviours in rats

Mongeau

Marsden

1997

Psychopharmacology

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The escape behaviour induced in rats by injecting D,L-homocysteic acid (DHL) into the dorsal periaqueductal grey area (DPAG) was used as an animal model of panic attacks to investigate the effect of imipramine, a drug used for the treatment of panic disorder, on the sensitivity of 5-HT1A receptors in the DPAG. Rats given imipramine (10 mg/kg per day SC for 3 weeks or IP for 2-3 days) received 250 nl saline or the 5-HT1A agonist 8-OH-DPAT (8.6 nmol) into the DPAG 10 min before inducing the escape response with DLH. As expected, 8-OH-DPAT produced a marked decrease in the average speed of the DLH-induced flight response. The short-term treatment with imipramine changed neither the DLH-induced escape behaviour nor the effect of prior 8-OH-DPAT administration on this response. In contrast, long-term treatment with imipramine enhanced the 5-HT1A-mediated inhibition, as the decrement in the amplitude of the flight response produced by 8-OH-DPAT was 96% after this treatment compared to 41% in controls. The injection of 8-OH-DPAT also significantly decreased the amplitude of the freezing behaviour observed at the end of the flight response in rats given imipramine for 3 weeks, but not in controls. The long-term imipramine treatment, however, did not significantly decrease the amplitude of DLH-induced flight and freezing behaviours in absence of prior 8-OH-DPAT administration. Finally, 8-OH-DPAT failed to inhibit the DLH-induced flight and freezing behaviours in rats withdrawn from imipramine after long-term treatment (10 mg/kg per day x 21 days). It is suggested that an alteration at the level of the DPAG-5-HT1A receptor system is implicated in the therapeutic and withdrawal effect of imipramine in panic disorder.

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Section: Introductionmentioning

confidence: 97%

Effect of imipramine treatments on the 5-HT 1A -receptor-mediated inhibition of panic-like behaviours in rats

Mongeau

Marsden

1997

Psychopharmacology

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“…In the long term, there is 20% to 66.7% relief and 30% improvement. Mesencephalotomy may provide relief in 50% to 70% of patients with painful facial anesthesia, of patiens with thalamic syndrome, of those with brachial plexus roots avulsion, in cases of phantom pain and amputation stump pain [31][32][33][34][35] . Procedure consists in fixation, under local anesthesia, of a stereotaxis device to patients' cephalic segment.…”

Section: Mesencephalotomymentioning

confidence: 99%

“…Complication which may be permanent in 30% of patients is paresis of conjugate gaze up. Dysesthesias are present in 4.3% to 50% of cases 22,[31][32][33][34][35] .…”

Section: Mesencephalotomymentioning

confidence: 99%

Invasive treatment to control neuropathic pain

Júnior¹,

Correa

Ferreira

2016

Revista Dor

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BACKGROUND AND OBJECTIVES: Distress, allied to neuropathic pain persistence and its refractory nature, often leads patients to accept invasive procedures. Neuropathic pain control is a major medical challenge requiring approaches and decisions especially based on effectiveness, risks and costs. This study aimed at reviewing these aspects related to major invasive procedures. CONTENTS: Major invasive procedures to control neuropathic pain are presented. Initially, classically reversible anesthetic blocks; then invasive neuromodulation techniques using electric current application and the magnetic field generated by it becomes a target to be stimulated, inhibited or modified in the nervous system (central, peripheral or autonomic); and, finally, ablative procedures including anesthetic methods administering neurolytic agents rather than anesthetics and neurosurgeries using different methods to injure the nervous system to control painful neuropathic discomfort. CONCLUSION: Patients eligible to invasive procedures to control neuropathic pain have, in addition to pain itself, a mixed distress including the collection of repeated delusions at every treatment failure. They have reserved prognosis with regard to total cure and, unfortunately, relieve obtained with invasive treatment in general does not reach persistent and high rates. In such adverse situation, these partial results of decreasing original pain intensity may be interpreted as acceptable, provided the impact on final quality of life is positive. Maybe, the rare exceptions are good results obtained with typical idiopathic/cryptogenic neuralgias ironically excluded from the stricter interpretation of the new pathophysiologic classification of neuropathic pains. Keywords: Anesthetic blocks, Cordectomy, Cortical electrical stimulation, Deep electrical brain stimulation, DREZotomy, Invasive neuromodulation, Medullary electrical stimulation, Neurolytic blocks, Neuropathic pain, Neurosurgery for neuropathic pain, Spinal drugs RESUMO JUSTFICATIVA E OBJETIVOS: O sofrimento aliado à persistência e refratariedade da dor neuropática frequentemente leva seu portador a aceitar tratamentos invasivos. O controle da dor neuropática representa um desafio médico importante necessitando adoção de condutas e decisões baseadas, principalmente, em efetividade, riscos e custos. O escopo deste estudo foi a revisão desses aspectos relacionados aos principais procedimentos invasivos CONTEÚDO: São apresentados os principais procedimentos invasivos utilizados para o controle da dor neuropática. Inicialmente, os bloqueios anestésicos, classicamente reversíveis; depois as técnicas de neuromodulação invasiva que utilizam a aplicação de corrente elétrica e o campo magnético por ela gerado em alvos a serem estimulados, inibidos ou modificados, no sistema nervoso (central, periférico ou autônomo); e, finalmente, os procedimentos ablativos que incluem os métodos anestésicos que administram agentes neurolíticos ao invés de anestésicos, e, as neurocirurgias que utilizam métodos dive...

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“…Destruction of the midbrain periaqueductal grey matter alone had been done only for the relief of pain of central origin. The procedure seems effective for the relief of this type of pain (Schvarcz, 1977), but its effect on chronic pain of peripheral origin remains unknown. The suffering aspect of central pain has been reported to be affected by this procedure (Schvarcz, 1977).…”

Section: Mesencephalonmentioning

confidence: 99%

The Physiological Mechanisms of Motivation

Pfaff¹

1982

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Paraqueductal Mesencephalotomy for Facial Central Pain

Cited by 7 publications

References 0 publications

Effect of imipramine treatments on the 5-HT 1A -receptor-mediated inhibition of panic-like behaviours in rats

Effect of imipramine treatments on the 5-HT 1A -receptor-mediated inhibition of panic-like behaviours in rats

Invasive treatment to control neuropathic pain

The Physiological Mechanisms of Motivation

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