Neurophysiologic and quantitative sensory testing in the diagnosis of trigeminal neuropathy and neuropathic pain
Neurophysiologic and quantitative sensory testing in the diagnosis of trigeminal neuropathy and neuropathic pain
复制标题
DOI：
10.1016/j.pain.2005.06.028
复制
发表时间：
2005-10-01
期刊：
影响因子：
7.4
通讯作者：
Forssell, H
中科院分区：
文献类型：
--
作者：
Jääskeläinen, SK;Teerijoki-Oksa, T;Forssell, H
本研究旨在探讨神经生理检查和热定量感觉测试（QST）在三叉神经病变和神经病理性疼痛诊断中的应用。58名患者（14名男性），34名感觉缺损的下牙槽神经（IAN）和24名内的舌神经（LN）分布，被纳入。26例患者（45%）报告了神经性疼痛。患者行瞬目反射（BR）试验和热QST检查;对IAN患者进行感觉神经造影。临床感觉测试的结果可从48例患者的图表中获得，显示77%的IAN和94%的LN患者有异常发现。41%的IAN患者BR试验异常，96%的神经造影异常，91%的QST异常。在LN组中，33%的患者BR异常，100%的患者QST异常。除2例IAN患者（均为陈旧性损伤）和4例LN患者（未行QST）外，所有患者均经神经生理检查和QST证实了主观感觉改变。当异常时，热QST显示升高的温暖和寒冷的检测阈值（低/麻醉），痛觉减退是不太明显，热异常性疼痛只是偶尔存在。14例单侧损伤后出现同侧热感觉减退。与神经病理性疼痛的发生有关（P =0.016）。有疼痛的IAN患者的轴突A β传入损伤较无疼痛的IAN患者轻（P=0.012）。神经生理学检查和热QST为三叉神经病变的准确诊断和人类神经病理性疼痛的病理生理特征的研究提供了敏感的工具。(c)2005年国际疼痛研究协会。Elsevier B. V.出版，保留所有权利。
This study investigated the utility of neurophysiologic examination and thermal quantitative sensory testing (QST) in the diagnosis of trigeminal neuropathy and neuropathic pain. Fifty-eight patients (14 men), 34 with sensory deficit within the inferior alveolar nerve (IAN) and 24 within the lingual nerve (LN) distribution, were included. Twenty-six patients (45%) reported neuropathic pain. Patients underwent blink reflex (BR) test and thermal QST; sensory neurography was done to the IAN patients. Results of clinical sensory testing were available from the charts of 48 patients revealing abnormal findings in 77% of the IAN and in 94% of the LN patients. The BR test was abnormal in 41%, neurography in 96%, and QST in 91% of the IAN patients. In the LN group, BR was abnormal in 33%, and QST in 100% of the patients tested. Neurophysiologic tests and QST verified the subjective sensory alteration in all but 2 IAN patients, both with old injuries, and 4 LN patients who did not undergo QST. When abnormal, thermal QST showed elevation of warm and cold detection thresholds (hypo/anesthesia), hypoalgesia was less marked, and heat allodynia was only occasionally present. Contralateral thermal hypoesthesia after unilateral injury was found in 14 patients. It was associated with the occurrence of neuropathic pain (P =0.016). Axonal A beta afferent damage was less severe in the IAN patients with pain than in those without pain (P=0.012). Neurophysiologic tests and thermal QST provide sensitive tools for accurate diagnosis of trigeminal neuropathy and study of pathophysiological features characteristic to human neuropathic pain. (c) 2005 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.