Sensations Evoked by Stimulation in the Midbrain of Man

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Severe pain evokes in man a variety of complex physiological and psychological events that are poorly understood. Our current knowledge of the neuroanatomical and physiological substrates for painful experiences have been gathered from clinical observations in humans or by inference from experiments with mute animals. This report concerns observations that have been made in persons suffering from severe chronic pain who were to undergo treatment for their pain by means of stereotaxic lesions localized in the dorsolateral tegmentum that would interrupt the ascending pain pathways. Before placement of the therapeutic lesions, fine electrodes were introduced into the midbrain

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Figures

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    X-ray films of the skull at the time of stereotaxic implantation of depth electrodes. Ventricular system outlined by oxygen and Pantopaque. The electrode introducer can be seen in A and B. The electrodes implanted in midbrain in C and D.

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    Schematic sagittal view of the third ventricle and neighboring structures (adapted from stereotaxic of Schaltenbrand and Bailey12). Composite picture of electrode tracts at the time of implantation. A. Electrodes situated in the medial tegmentum and central gray in the zone 0 to 5 mm lateral from the midsagittal plane of the aqueduct. B. Electrodes located in lateral sagittal planes of the thalamus and mesencephalon. Electrodes with continuous lines located in a zone 5 to 10 mm from the midsagittal plane. The electrodes with the interrupted lines lie 10 to 12 mm from the midsagittal plane.

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    The figure on left shows area of referred sensation from lateral region of mesencephalon (crosshatched). The right figure shows midline reference of sensations from the central gray zone 0 to 5 mm from Sylvian aqueduct (dotted lines).

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    A coronal section of the dorsal mesencephalon at the level of the superior colliculus. The physiological responses elicited by stimulation of the dorsolateral mesencephalon.

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    Effect of frequency and voltage on the sensory responses. Sensory and motor responses from region of the ventral tegmentum and medial lemniscus at level of superior colliculus. The lower frequencies result in rhythmical tremor in contralateral arm. Higher frequencies result in no motor response but sensory phenomena. Unidirectional square waves (Grass stimulator). Pulse duration 1 msec.

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