Thermal hypoaesthesia differentiates secondary restless legs syndrome associated with small fibre neuropathy from primary restless legs syndrome
Thermal hypoaesthesia differentiates secondary restless legs syndrome associated with small fibre neuropathy from primary restless legs syndrome
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DOI：
10.1093/brain/awq026
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发表时间：
2010-03-01
期刊：
影响因子：
14.5
通讯作者：
Paulus, Walter
中科院分区：
文献类型：
--
作者：
Bachmann, Cornelius G.;Rolke, Roman;Paulus, Walter
本研究旨在评估原发性特发性不宁腿综合征和继发性不宁腿综合征与小纤维神经病变相关的热和机械感知以及疼痛阈值。21例患者（年龄：53.4 +/- 8.4，n = 3，男性）和13例（年龄：63.0 +/- 8.2，n = 1，男性）继发性不宁腿综合征与小纤维神经病变与20名健康受试者（年龄：58.0 +/- 7.0; n = 2，男性）进行了比较。与小纤维神经病变相关的继发性不宁腿综合征的鉴别诊断是基于所有患者的临床症状并经皮肤活检证实。一个全面的定量感觉测试协议，包括热和机械检测和疼痛阈值，由德国神经性疼痛研究网络设计，进行临床上更受影响的脚下午2点至凌晨1点之间，不宁腿综合征的症状，在所有患者。原发性不宁腿综合征患者对钝性压力（P < 0.001）、针刺（P < 0.001）和振动感觉过敏（P < 0.001）表现为痛觉过敏。与小纤维神经病变相关的继发性不宁腿综合征患者表现出对冷（A δ纤维介导）和温暖（C纤维介导）的热感觉减退（均P < 0.001）和对针刺的痛觉过敏（P < 0.001）。原发性和继发性不宁腿综合征中的静态机械性痛觉过敏与伤害性通路的中枢去抑制的概念一致，这可能是由继发性不宁腿综合征中受损小纤维神经元的条件性传入输入引起的。
This study aimed to assess thermal and mechanical perception and pain thresholds in primary idiopathic restless legs syndrome and secondary restless legs syndrome associated with small fibre neuropathy. Twenty-one patients (age: 53.4 +/- 8.4, n = 3, male) with primary restless legs syndrome and 13 patients (age: 63.0 +/- 8.2, n = 1, male) with secondary restless legs syndrome associated with small fibre neuropathy were compared with 20 healthy subjects (age: 58.0 +/- 7.0; n = 2, male). Differential diagnosis of secondary restless legs syndrome associated with small fibre neuropathy was based on clinical symptoms and confirmed with skin biopsies in all patients. A comprehensive quantitative sensory testing protocol encompassing thermal and mechanical detection and pain thresholds, as devised by the German Research Network on Neuropathic Pain, was performed on the clinically more affected foot between 2 pm and 1 am when restless legs syndrome symptoms were present in all patients. Patients with primary restless legs syndrome showed hyperalgesia to blunt pressure (P < 0.001), pinprick (P < 0.001) and vibratory hyperaesthesia (P < 0.001). Patients with secondary restless legs syndrome associated with small fibre neuropathy showed thermal hypoaesthesia to cold (A delta-fibre mediated) and warm (C-fibre mediated) (all P < 0.001) and hyperalgesia to pinprick (P < 0.001). Static mechanical hyperalgesia in primary and secondary restless legs syndrome is consistent with the concept of central disinhibition of nociceptive pathways, which might be induced by conditioning afferent input from damaged small fibre neurons in secondary restless legs syndrome.