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，可导致 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、 和心理障碍。三叉神经从中枢神经系统延伸出来，支配 面部和眼睛的大部分，可以提供对头部创伤病理生理学的深入了解。特别痛苦 对光的敏感性（畏光）、角膜神经病理学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得到了报告。我们的整体 假设是三叉神经对 mTBI 敏感并且可以解释与疼痛相关的症状。至 检验这一假设，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（IVCM）和扩散张量成像（DTI）。在目标 2 中， 我们将使用 mTBI 相关畏光来定义光诱导通路的中枢神经系统变化 功能磁共振成像和 DTI。这项研究可能会产生 (1) 对 mTBI 敏感的诊断标记物，(2) 证明 mTBI 相关疼痛症状的神经源。本次调查产生的数据可用于 改善头部外伤患者的诊断、治疗和监测，并提供 作为临床决策基础的客观标记。

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.