The trigeminal nociceptive-pain pathway in pediatric mTBI: peripheral and central contributions to photophobia

脑震荡，也被称为轻度创伤性脑损伤(MTBI)，是一种神经疾病，导致 儿童的残疾，并使他们在以后的生活中容易面临挑战，包括重大的身体、认知、 和心理残疾。三叉神经从中枢神经系统延伸至三叉神经 面部和眼睛的更大部分，并可能提供对头部创伤病理生理学的洞察。尤其是令人痛苦的 对光敏感(畏光)、角膜神经病理和脑内非典型功能活动 所有这些都在评估mTBI和三叉神经病理的初步工作中得到了报道。我们的整体 假设三叉神经对mTBI敏感，并解释与疼痛相关的症状。至 验证这一假设，在目标1中，我们将用定量的方法定义mtbi患者的三叉神经病理。 感觉测试(QST)、活体角膜神经显微镜(IVCM)和扩散张量成像(DTI)。在目标2中， 我们将定义与mTBI相关畏光的光诱导通路的中枢神经系统变化 功能磁共振成像和DTI。这项研究可能产生(1)对mTBI敏感的诊断标记物，(2)表明 MTBI相关疼痛症状的神经学来源。这项调查产生的数据可以用来 改善对脑外伤患者的诊断、治疗和监测，并提供 目的为临床决策提供依据。

Concussion, also referred to as mild traumatic brain injury (mTBI), is a neurological disorder that causes disability in children and predisposes them to challenges later in life, including significant physical, cognitive, and psychological disability. The trigeminal nerve extends from the central nervous system to innervate the greater portion of face and eye, and may offer insight into head trauma pathophysiology. In particular, painful sensitivity to light (photophobia), corneal nerve pathology, and atypical functional activity within the brain have all been reported in preliminary work evaluating persons with mTBI and trigeminal nerve pathology. Our overall hypothesis is that the trigeminal nerve is sensitive to mTBI and accounts for pain-related symptomatology. To test this hypothesis, in aim 1, we will define trigeminal nerve pathology in persons with mTBI using quantitative sensory testing (QST), in vivo corneal nerve microscopy (IVCM), and diffusion tensor imaging (DTI). In aim 2, we will define central nervous system changes to light-induced pathways with mTBI-related photophobia using fMRI and DTI. This study is likely to yield (1) a diagnostic marker that is sensitive to mTBI, (2) evince a neurological source of mTBI-related pain symptoms. Data generated from this investigation can be used to improve the diagnosis, treatment and monitoring of patients suffering from head trauma and provide an objective marker to base clinical decision making.