卒中后中枢痛诊断与治疗.pptVIP

谢 谢！ * Schematic diagram shows the various locations of stroke producing central poststroke pain. 1 sensory cortex; 2 thalamocortical projection of spinothalamic sensations; 3 ventral posterolateral nucleus of thalamus; 4 Midbrain; 5 Pons and 6 and 7 Medulla. * a, Cranial computed tomography (CT) scan of a patient with central poststroke pain showing left putaminal hemorrhage with capsular extension. b, Schematic diagram of the same patient showing area pain, the density of darkness depicts the intensity of pain. c, Tc99ECD SPECT of the same patient showing hypoperfusion of left frontoparietal and ganglionic region. * 关键信息点： 普瑞巴林和其他抗惊厥药或类似药物的作用机理完全不同。 普瑞巴林对过度兴奋的神经元调控机制如下： 普瑞巴林与神经元突触前膜上电压门控钙通道上的?2-δ亚基结合； 结合后减少突触前末梢的钙内流； 减少的钙内流使兴奋性神经递质的过度释放减少。 临床前动物实验证明普瑞巴林就是通过此机制来发挥其抗惊厥、止痛、和抗焦虑作用的。 参考文献： 1.David J. Dooley,et al. TRENDS in Pharmacological Sciences.2006(28)2:75-82 * 关键信息点： 普瑞巴林可同时调控上行传导通路和下行抑制通路 普瑞巴林与α2-δ结合，通过α2-δ抑制VGCC向背角的转运 普瑞巴林与α2-δ结合，调控突触前膜VGCC的开放，减少钙离子内流，降低神经元兴奋性，从而起到止痛、抗焦虑和抗惊厥作用 普瑞巴林能同时改善疼痛和睡眠、情绪如焦虑和抑郁等症状 普瑞巴林与α2-δ结合，抑制了GABA能神经元(抑制性中间神经元)的活性，从而消弱了GABA能神经元对下行通路中NE的作用，导致下行抑制作用增强，疼痛缓解 * 关键信息点： 疼痛的感知主要包括上行和下行通路，上行通路为疼痛传导的主要通路 不同的药物可能作用位点不同，卡马西平、局部麻醉药、外用止痛药仅作用于外周，三环类抗抑郁药和文拉法辛、度洛西汀作用于下行调节通路 普瑞巴林与其他药物不同，具有多个多用位点，可同时作用于上行和下行调节通路 * * Clinical studies supporting LYRICA? (pregabalin) capsules CV for PHN. Different doses were used across the 3 LYRICA studies for PHN, with total daily dosage ranging from 150 to 600 mg/d, given divided twice or three times daily Patients randomized to 600 mg/d had their dose adjusted to 300 mg/d if they were renally impaired In Sabatowski et al and Dworkin et al, LYRICA was given divided three times daily; it was administered divided twice daily in the van Seventer study Sabatowski et al is Study PHN 3 in the US prescribing information (USPI); Dworkin et al is Study PHN 2 in the USPI; and van Seventer et al is Study PHN 1 in the USPI References: 1. Sabatowski R, Galvez R, Cherry DA, et al, and the 1008-045 Study Group. Prega