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[神经束膜瘤病患者疼痛综合征的病程特点]

[Features of course of pain syndrome in patients with schwannomatosis].

作者信息

Makashova E S, Voloshin A G, Zolotova S V, Strelnikov V V, Golanov A V

机构信息

Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia.

Loginov Moscow Clinical Scientific and Practical Center, Moscow, Russia.

出版信息

Zh Nevrol Psikhiatr Im S S Korsakova. 2024;124(5):48-52. doi: 10.17116/jnevro202412405148.

Abstract

OBJECTIVE

To identify the characteristics of pain syndrome in patients with schwannomas depending on genetic predisposition.

MATERIAL AND METHODS

The study included 46 patients with peripheral, spinal and intracranial schwannomas, corresponding to the schwannomatosis phenotype according to the 2022 clinical criteria. All patients underwent sequencing of the , and and a copy number study in the .

RESULTS

The most severe widespread pain was observed in patients with pathogenic variants, while patients with mosaic variants may not even have local tumor-related pain. Patients with variants may have no pain or have localized pain that responds well to surgical treatment.

CONCLUSION

Further studies of the molecular features of schwannomatosis and driver mutations in the pathogenesis of pain are necessary to improve the effectiveness of pain therapy in this group of patients. Schwannomatosis is a disease from the group of neurofibromatosis, manifested by the development of multiple schwannomas. Neuropathic pain is one of the main symptoms characteristic of peripheral schwannomas, however, the severity and prevalence of the pain syndrome does not always correlate with the location of the tumors. According to modern concepts, the key factors influencing the characteristics of the pain syndrome are the target gene and the type of pathogenic variant. The most severe widespread pain is observed in patients with pathogenic variants in the LZRT1 gene, while patients with mosaic variants may not even have local pain associated with tumors. Patients with variants in SMARCB1 may have no pain or localized pain that responds well to surgical treatment.

摘要

目的

根据遗传易感性确定施万细胞瘤患者疼痛综合征的特征。

材料与方法

该研究纳入了46例患有周围性、脊髓性和颅内施万细胞瘤的患者,根据2022年临床标准符合施万细胞瘤病表型。所有患者均接受了 、 和 的测序以及 在 中的拷贝数研究。

结果

在具有致病性 变异的患者中观察到最严重的广泛性疼痛,而具有嵌合变异的患者甚至可能没有与肿瘤局部相关的疼痛。具有 变异的患者可能没有疼痛或有对手术治疗反应良好的局限性疼痛。

结论

有必要进一步研究施万细胞瘤病的分子特征以及疼痛发病机制中的驱动突变,以提高该组患者疼痛治疗的有效性。施万细胞瘤病是神经纤维瘤病组中的一种疾病,表现为多发性施万细胞瘤的发展。神经性疼痛是周围性施万细胞瘤的主要特征性症状之一,然而,疼痛综合征的严重程度和患病率并不总是与肿瘤的位置相关。根据现代概念,影响疼痛综合征特征的关键因素是靶基因和致病性变异的类型。在LZRT1基因中具有致病性变异的患者中观察到最严重的广泛性疼痛,而具有嵌合变异的患者甚至可能没有与肿瘤相关的局部疼痛。具有SMARCB1变异的患者可能没有疼痛或有对手术治疗反应良好的局限性疼痛。

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