Department for Pediatric Neurology, Psychosomatic and Pain Medicine, Center for Child and Adolescent Medicine Olgahospital, Klinikum Stuttgart, Germany; German Paediatric Pain Centre, Children's and Adolescent's Hospital Datteln, Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health, School of Medicine, Witten, Germany.
Clinic for Neurology, University Hospital Schleswig-Holstein, Ratzeburger Allee, 160 23538, Lübeck, Germany.
Eur J Paediatr Neurol. 2018 May;22(3):470-481. doi: 10.1016/j.ejpn.2017.12.015. Epub 2017 Dec 30.
Many patients with cerebral palsy (CP) suffer chronic pain as one of the most limiting factors in their quality of life. In CP patients, pain mechanisms are not well understood, and pain therapy remains a challenge. Quantitative sensory testing (QST) might provide unique information about the functional status of the somatosensory system and therefore better guide pain treatment.
To understand better the underlying pain mechanisms in pediatric CP patients, we aimed to assess clinical and pain parameters, as well as QST profiles, which were matched to the patients' cerebral imaging pathology.
Thirty CP patients aged 6-20 years old (mean age 12 years) without intellectual impairment underwent standardized assessments of QST. Cerebral imaging was reassessed. QST results were compared to age- and sex-matched controls (multiple linear regression; Fisher's exact test; linear correlation analysis).
CP patients were less sensitive to all mechanical and thermal stimuli than healthy controls but more sensitive to all mechanical pain stimuli (each p < 0.001). Fifty percent of CP patients showed a combination of mechanical hypoesthesia, thermal hypoesthesia and mechanical hyperalgesia; 67% of CP patients had periventricular leukomalacia (PVL), which was correlated with mechanic (r = 0.661; p < 0.001) and thermal (r = 0.624; p = 0.001) hypoesthesia.
The combination of mechanical hypoesthesia, thermal hypoesthesia and mechanical hyperalgesia in our CP patients implicates lemniscal and extralemniscal neuron dysfunction in the thalamus region, likely due to PVL. We suspect that extralemniscal tracts are involved in the original of pain in our CP patients, as in adults.
许多脑瘫（CP）患者患有慢性疼痛，这是影响其生活质量的最主要限制因素之一。CP 患者的疼痛机制尚未完全明确，疼痛治疗仍然具有挑战性。定量感觉测试（QST）可能为躯体感觉系统的功能状态提供独特的信息，从而更好地指导疼痛治疗。
为了更好地了解小儿 CP 患者的潜在疼痛机制，我们旨在评估临床和疼痛参数，以及与患者脑成像病理学相匹配的 QST 特征。
30 名年龄在 6-20 岁（平均年龄 12 岁）的 CP 患者（无智力障碍）接受了 QST 的标准化评估。重新评估了脑部影像学。将 QST 结果与年龄和性别匹配的对照组进行比较（多元线性回归；Fisher 确切检验；线性相关分析）。
CP 患者对所有机械和热刺激的敏感性均低于健康对照组，但对所有机械性疼痛刺激的敏感性更高（均 p < 0.001）。50%的 CP 患者表现为机械性感觉减退、热感觉减退和机械性痛觉过敏的组合；67%的 CP 患者存在脑室周围白质软化症（PVL），与机械性（r = 0.661；p < 0.001）和热（r = 0.624；p = 0.001）感觉减退相关。
我们的 CP 患者存在机械性感觉减退、热感觉减退和机械性痛觉过敏的组合，这提示丘脑区域的薄束和外束神经元功能障碍，可能是由于 PVL 所致。我们怀疑，与成人一样，外束通路可能参与了 CP 患者疼痛的起源。
