Estimulación medular eléctrica en ráfagas y tónica: mecanismos cerebrales comunes y diferentes.: Publicado originalmente en la revista Neuromodulation 2016; 19:47-59. Traducción: María Eugenia Górriz y María Carla Scolamieri

Dirk De Ridder; Sven Vanneste

doi:10.47924/neurotarget2017157

Autores/as

Dirk De Ridder Departamento de Ciencias Quirúrgicas, Sección de Neurocirugía, Facultad de Medicina de Dunedin, Universidad de Otago, Dunedin, Nueva Zelanda.
Sven Vanneste Laboratorio para Neurociencia Integral & Clínica, Facultad de Ciencias del Cerebro y del Comportamiento, Universidad de Texas en Dallas, Dallas, TX, EE. UU.

DOI:

https://doi.org/10.47924/neurotarget2017157

Palabras clave:

Cingular, Cingular pregenual, en ráfagas, estimulación, médula espinal, parahipocámpico, posterior, tónica

Resumen

Objetivo: La estimulación medular eléctrica se usa generalmente para tratar el dolor médicamente incoercible. Para lograr la supresión del dolor se utilizan distintos diseños de estimulación como la estimulación tónica, la estimulación de alta frecuencia y la estimulación en ráfagas. Un análisis preliminar de los mismos datos utilizados en este estudio demostró que la estimulación en ráfagas probablemente modula las vías mediales de dolor, a diferencia de la estimulación tónica. El tema plantea qué mecanismos supraespinales comunes y diferentes usan la estimulación tónica y en ráfagas.
Materiales y métodos: Se analizaron los datos clínicos y de electroencefalografía (EEG) de cinco pacientes sometidos a estimulación tónica, en ráfagas y simulada para observar las similitudes y las diferencias entre la estimulación en ráfagas y tónica. Se realiza un análisis de sustracción y conjunción de EEG de fuente localizada (sLORETA) en cada condición tanto para actividad como para conectividad funcional. Se calcula una relación entre la corteza cingular anterior dorsal (CCAd) y la corteza cingular anterior pregenual/corteza prefrontal ventromedial (CCAp/CPFvm) para reflejar un equilibrio entre sistemas de tolerancia del dolor y supresión del dolor.
Resultados: Se observan diferencias en la CCAd, la corteza prefrontal dorsolateral, la corteza somatosensorial primaria y la corteza cingular posterior (CCP). La estimulación en ráfagas y tónica comparten la activación en la CCAp, el área parietal inferior, que abarca la corteza somatosensorial secundaria inferior, la CCP y el parahipocampo. La estimulación en ráfagas normaliza el equilibrio tolerancia del dolor/ supresión del dolor en contraposición a la estimulación tónica.
Discusión y conclusión: Estos datos sugieren que tanto la estimulación en ráfagas como la estimulación tónica modulan el sistema descendente inhibidor del dolor (a través de la CCAp), así como también un sistema de memoria aversiva (a través del parahipocampo) contextual autorreferencial (a través de la CCP). No obstante, la estimulación en ráfagas normaliza el equilibrio tolerancia/supresión del dolor en contraposición al modo tónico por un efecto mayor sobre la CCAd.

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