Abstract
Elucidation of the pathophysiological mechanism of central post-stroke pain (CPSP) is essential to the development of effective therapeutic modalities for CPSP. However, the pathophysiological mechanism of CPSP has not yet been clearly elucidated. The recent development of diffusion tensor tractography (DTT), derived from diffusion tensor imaging (DTI), has allowed visualization and estimation of the spinothalamic tract (STT), which has been considered the most plausible neural tract responsible for the pathogenesis of CPSP. In this mini-review, six DTT studies in which CPSP due to STT injury in stroke patients was demonstrated are reviewed. The information provided in the reviewed studies suggests that DTT is useful in the elucidation of the pathophysiological mechanism associated with CPSP. We believe that the reviewed studies will facilitate neurorehabilitation of stroke patients with CPSP. However, DTT studies of CPSP are still in the beginning stage because the total number (six studies) of the reviewed studies is very low and half were case reports. Therefore, further studies involving large numbers of subjects are warranted.
Highlights
Stroke is a leading cause of mortality and morbidity in adults
diffusion tensor tractography (DTT) for reconstruction of the neural tracts usually employs a combined region of interest (ROI) method that reconstructs only neural fibers passing more than two ROI areas
This study was limited because it was a single case report and was without DTT parameter data. In this mini-review article, six DTT studies of Central post-stroke pain (CPSP) related to spinothalamic tract (STT) injury in stroke patients were reviewed
Summary
Central post-stroke pain (CPSP) is a neuropathic pain caused by cerebrovascular insult to the somatosensory pathway in the brain [1]. Despite the high prevalence of CPSP and its negative impact on quality of life in stroke patients, there has been no specific therapeutic modality for complete cure of CPSP [3, 7, 8]. For management of CPSP, medications including antidepressants, antiepileptic drugs, and opioids have commonly been used for a long time [3, 9]. Neuromodulations including deep brain stimulation, repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) have become management modalities for patients with CPSP [1, 10,11,12,13,14,15]. The methods for application of neuromodulations have not been definitively settled upon and are controversial in some aspects [16]
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