Sumitani Masahiko, Yozu Arito, Tomioka Toshiya, Miyauchi Satoru, Yamada Yoshitsugu
Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo 113-0033, Japan.
Anesthesiol Res Pract. 2011;2011:494975. doi: 10.1155/2011/494975. Epub 2011 May 3.
We present a case of complex regional pain syndrome (CRPS), in which symptoms, including burning pain and severe allodynia, were alleviated by using a regional intravenous nerve blockade (Bier block) combined with physiotherapy, but reappeared following an epileptic seizure. Symptoms disappeared again following control of epileptic discharges, as revealed by single-photon emission computed tomography (SPECT) and electroencephalography (EEG) results. Although systemic toxicity of a local anesthetic applied by Bier block was suspected as a cause of the first seizure, the patient did not present any other toxic symptoms, and seizures repeatedly occurred after Bier block cessation; the patient was then diagnosed as having temporal symptomatic epilepsy. This case suggests that symptoms of CRPS may be sustained by abnormal brain conditions, and our findings contribute to the understanding of how the central nervous system participates in maintaining pain and allodynia associated with CRPS.
我们报告了一例复杂区域疼痛综合征（CRPS）病例，其中包括灼痛和严重痛觉过敏在内的症状通过区域静脉神经阻滞（比尔阻滞）联合物理治疗得以缓解，但在癫痫发作后再次出现。如单光子发射计算机断层扫描（SPECT）和脑电图（EEG）结果所示，在癫痫放电得到控制后症状再次消失。尽管怀疑比尔阻滞应用的局部麻醉药的全身毒性是首次癫痫发作的原因，但患者未出现任何其他中毒症状，且在比尔阻滞停止后癫痫反复发生；该患者随后被诊断为颞叶症状性癫痫。该病例表明CRPS的症状可能由异常的脑部状况维持，我们的发现有助于理解中枢神经系统如何参与维持与CRPS相关的疼痛和痛觉过敏。
