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

脑震荡，也称为轻度创伤性脑损伤（mTBI），是一种神经系统疾病， 残疾，使他们在以后的生活中容易受到挑战，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，支配 更大部分的脸和眼睛，并可能提供深入了解头部创伤病理生理学。尤其是， 对光敏感（恐光症）、角膜神经病变和大脑内的非典型功能活动， 所有这些都在评估mTBI和三叉神经病理学患者的初步工作中报告。我们的整体 假设是三叉神经对mTBI敏感，并解释了疼痛相关的神经病学。到 为了验证这一假设，在目标1中，我们将使用定量方法定义mTBI患者的三叉神经病理学。 感觉测试（QST）、体内角膜神经显微镜检查（IVCM）和扩散张量成像（DTI）。在目标2中， 我们将使用以下方法定义mTBI相关恐惧症的光诱导通路的中枢神经系统变化： fMRI和DTI。这项研究可能会产生（1）对mTBI敏感的诊断标志物，（2）表明mTBI是一种敏感的诊断标志物。 mTBI相关疼痛症状的神经源。调查产生的数据可用于 改善对头部创伤患者的诊断、治疗和监测， 客观指标作为临床决策的基础。

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.