Cruccu G, Leandri M, Feliciani M, Manfredi M
Department of Neurosciences, University of Rome, La Sapienza, Italy.
J Neurol Neurosurg Psychiatry. 1990 Dec;53(12):1034-42. doi: 10.1136/jnnp.53.12.1034.
The trigeminal reflexes (corneal reflex, blink reflex, masseter inhibitory periods, jaw-jerk) and far field scalp potentials (nerve, root, brainstem, subcortical) evoked by percutaneous infraorbital stimulation were recorded in 30 patients with "idiopathic" trigeminal neuralgia (ITN) and 20 with "symptomatic" trigeminal pain (STP): seven postherpetic neuralgia, five multiple sclerosis, four tumour, two vascular malformation, one Tolosa-Hunt syndrome, and one traumatic fracture. All the patients with STP and two of those with ITN had trigeminal reflex abnormalities; 80% of patients with STP and 30% of those with ITN had evoked potential abnormalities. The results indicate that 1) trigeminal reflexes and evoked potentials are both useful in the examination of patients with trigeminal pain, and in cases secondary to specific pathologies provide 100% sensitivity; 2) in "symptomatic" and "idiopathic" paroxysmal pain the primary lesion affects the afferent fibres in the proximal portion of the root or the intrinsic portion in the pons; 3) primary sensory neurons of the A-beta fibre group are involved in both paroxysmal and constant pain, but in the latter the damage is far more severe.
对30例“特发性”三叉神经痛（ITN）患者和20例“症状性”三叉神经痛（STP）患者记录了经皮眶下刺激诱发的三叉神经反射（角膜反射、瞬目反射、咬肌抑制期、下颌反射）和远场头皮电位（神经、神经根、脑干、皮质下）：7例为带状疱疹后神经痛，5例为多发性硬化，4例为肿瘤，2例为血管畸形，1例为托洛萨-亨特综合征，1例为外伤性骨折。所有STP患者及2例ITN患者存在三叉神经反射异常；80%的STP患者及30%的ITN患者存在诱发电位异常。结果表明：1）三叉神经反射和诱发电位在三叉神经痛患者检查中均有用，在继发于特定病变的病例中敏感性达100%；2）在“症状性”和“特发性”阵发性疼痛中，原发损害影响神经根近端部分的传入纤维或脑桥内的固有部分；3）A-β纤维组的初级感觉神经元参与阵发性和持续性疼痛，但在持续性疼痛中损害更为严重。
