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Objective. Using data obtained during thalamic surgery, we considered the essential factors involved in the development of central post–stroke pain (CPSP). Subjects and Methods. Subjects consisted of 10 cases of CPSP due to unilateral thalamic cerebrovascular disease lesion, and one case with a brain tumor. Their ages ranged from 55 to 70 years old. Stereotactic Vim–Vcpc thalamotomy was performed in 6 cases, thalamic Vim– Vcpc stimulation in 4 cases, and a thalamic biopsy in one case using depth microrecording. Prior to the operation, we studied somatosensory evoked potentials (SEP) to contralateral median nerve stimulation in 7 out of 10 cases with CPSP. Electrophysiological data obtained during surgery consisted of background neural activity (BNA), sensory response (SR) and burst discharge (burst), and responses to microstimulation in the thalamic sensory nucleus. Results. SEPs (N13, N20) were flat or markedly decreased in all examined cases. From the electrophysiological study during surgery, we could classify patients into 3 groups. In group A (3 cases), we rarely encountered bursts and found SR frequently in the wide area of the thalamic sensory nucleus. In group B (6 cases), we encountered bursts frequently, which were recognized around decreased or voided areas of thalamic neural activity. In 2 of these cases, we found SR in the limited area of the thalamic sensory nucleus (group B–1), however, we could not find SR in this nucleus in the other 4 cases (group B–2). In 2 cases, which were classified into group C, we found a decrease of BNA, few bursts and no SR in the sensory thalamus. We found response to microstimulation in all groups. The perceptive field to microstimulation was not compatible with the receptive field to peripheral natural stimulation. Pain control was achieved in both group A and B. Conclusions. In cases with CPSP, we found both dysfunction of the lemniscal system and functional change of the spino–thalamo–cortical system. It has been suggested that these functional changes affect perception or conduction of sensory impulses in the lateral sensory thalamus, resulting in the development of CPSP.

pain research

&lt;b&gt;Study on neural activity of thalamic sensory nucleus &lt;/b&gt;&lt;b&gt;and microstimulation effect in patients &lt;/b&gt;&lt;b&gt;with central post-stroke pain &lt;/b&gt;