Galer B S, Jensen M
Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, New York 10003, USA.
J Pain Symptom Manage. 1999 Sep;18(3):213-7. doi: 10.1016/s0885-3924(99)00076-7.
Reflex sympathetic dystrophy (RSD), recently reclassified as a complex regional pain syndrome, type I (CRPS-I), is best known for its disabling sensory symptoms, including pain, allodynia, and abnormal skin temperature. Yet, motor dysfunction is common in CRPS and can result in major disability. In addition to weakness of the involved limb, CRPS patients may develop symptoms akin to a neurological neglect-like syndrome, whereby the limb may feel foreign ("cognitive neglect") and directed mental and visual attention is needed to move the limb ("motor neglect"). Members of the patient support group, the Reflex Sympathetic Dystrophy Syndrome Association (RSDSA), were mailed a questionnaire inserted in their newsletter which inquired about the presence of these neglect-like symptoms; in addition, a separate medical history questionnaire was included to assess adequate documentation for the diagnosis of CRPS. A total of 242 patients returned the questionnaire but only 224 of the questionnaires were analyzed; 15 were excluded due to inadequate documentation of CRPS and 3 were excluded due to non-limb involvement. Eighty-four percent (84%) of these respondents endorsed the presence of at least one neglect symptom and 47% indicated they had both "cognitive" and "motor" neglect symptoms. Of interest, approximately 33% of respondents spontaneously wrote comments regarding the significant disability due to these neglect symptoms and the difficulty explaining these unusual symptoms to their health care providers and family. This patient survey confirms the presence of neglect-like symptoms in a subset of CRPS patients. Neglect-like symptoms need to be addressed and validated by health care providers.
反射性交感神经营养不良（RSD），最近被重新归类为I型复杂性区域疼痛综合征（CRPS-I），以其致残性感觉症状而闻名，包括疼痛、痛觉过敏和皮肤温度异常。然而，运动功能障碍在CRPS中很常见，并且可能导致严重残疾。除了受累肢体无力外，CRPS患者可能会出现类似于神经忽视样综合征的症状，即肢体可能感觉陌生（“认知忽视”），需要有意识的精神和视觉注意力来移动肢体（“运动忽视”）。向反射性交感神经营养不良综合征协会（RSDSA）患者支持小组的成员邮寄了一份插入其时事通讯中的问卷，询问这些忽视样症状的存在情况；此外，还包括一份单独的病史问卷，以评估CRPS诊断的充分记录。共有242名患者返回了问卷，但仅对其中224份问卷进行了分析；15份因CRPS记录不充分而被排除，3份因非肢体受累而被排除。这些受访者中有84%认可至少存在一种忽视症状，47%表示他们同时有“认知”和“运动”忽视症状。有趣的是，约33%的受访者自发写下评论，提及这些忽视症状导致的严重残疾，以及向医护人员和家人解释这些异常症状的困难。这项患者调查证实了一部分CRPS患者中存在忽视样症状。医护人员需要关注并验证这些忽视样症状。
