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P23.3 Evoked potentials and quantitative thermal testing in spinal cord injury patients with neuropathic pain
S164 P23.2 Use of peripheral magnetic stimulation in fibromyalgia syndrome treatment S. Muljadi1 Department of Neurology, Trisakti University, Jakarta, Indonesia
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Fibromyalgia syndrome is the chronic pain of unknown cause. One of the theories is the symphathetic activation in muscle tissue microcirculation that role in muscle hypoxia. The hypoxia makes the pain on the muscle. It can happen in all ages, female > male. Method: We studied 22 patients (from June 2010 October 2010), consist of 15 female and 7 male. All the patients who came to our clinic had diffuse chronic pain on their musculosceletal complaints. The diagnose were made by following The American College of Rheumatology (1990) criterias. The pain was measured by Verbal Descriptor Scale (before and after treatment). We used MagPro R30 and the setting: Frequency: 15 Hz Pulses: 50 Number of train: 30 Inter train interval: 5 seconds Range of the intensities given from 30% to 40% The coil put on the shoulder, back, low back and also arm areas (where the patients felt the pain). We moved the coil (not static) and the stimulation is given only once (1500 pulses). Results: The study showed: • before treatment (verbal descriptor scale) range 6 10 • after treatment (verbal descriptor scale) range 0 2 Conclusion: Peripheral Magnetic Stimulation is quite efficient for Fibromyalgia Syndrome treatment. This is just the beginning of the study which it showed the significant changes. Perhaps Peripheral Magnetic Stimulation could be using as one of the treatment choice for chronic pain in Fibromyalgia Syndrome. We still need the further study with the bigger samples. P23.3 Evoked potentials and quantitative thermal testing in spinal cord injury patients with neuropathic pain H. Kumru1 , D. Soler2 , J. Vidal2 Neurology-Neurophysiology, Institut Guttmann, Badalona, Spain, 2 Neurorehabilitation Unit, Institut Guttmann, Badalona, Spain
1
Introduction: Neuropathic pain (NP) is a common complication of spinal cord injury (SCI), but its pathophysiology remains uncertain. Objective: Here we studied the psychophysical and neurophysiological correlates of NP in SCI patients using contact heat evoked potentials (CHEPs) and quantitative thermal testing (QTT) at different levels. Methods: We examined 32 patients with SCI and subacute or chronic NP. Twenty-two SCI patients without NP and 16 healthy subjects served as controls. We assessed NP intensity using a numerical rating scale (NRS) and determined heat and pain thresholds with thermal probes. CHEPs were recorded to stimuli applied at C4 level, and subjects rated their perception of evoked pain using NRS during CHEPs. Results: CHEPs was not different between three groups. Evoked pain perception (NRS-CHEPs) in patients with NP was significantly higher with respect to patients without NP above the lesion level and healthy controls. Warm detection threshold was significantly higher at level in NP patients than controls. Heat pain detection threshold at and above the level was significantly lower in those patients with NP in comparison to controls and patients without NP. Discussion: This study showed hyperalgesia at and above the lesion level in SCI. Those data indicates that neuropathic pain following SCI can induce generalized sensitization above the lesion level. P23.4 Spatial attention in children with primary headache: a combined neurophysiological and neuropsychological approach E. Iacovelli1 , S. Tarantino1 , C. De Ranieri2 , C. Vollono1 , F. Galli1 , M. De Luca1 , F. Vigevano1 , G. Biondi2 , M. Valeriani1 1 Headache Centre, Division of Neurology, Ospedale Pediatrico Bambino Ges` u, Rome, Italy, 2 Division of Paediatric Psychology, Ospedale Pediatrico Bambino Ges` u, Rome, Italy Introduction: Neurophysiological studies to evaluate spatial attention in children with primary headache are lacking. Previous studies
Poster presentations: Poster session 23. Pain demonstrated that tactile-spatial attention modulates the somatosensory N140 component, with increased N140 amplitude for tactile stimuli delivered to the attended hand. Objectives: The aims of the study are: (1) to investigate the effect of spatial attention on the N140 amplitude in children with migraine, with tension-type headache (TTH) and in healthy children, and (2) to evaluate possible correlations between neurophysiological results and a neuropsychological test for spatial attention (“Deux barrage”). Methods: We studied 16 patients with migraine without aura (MoA) (mean age 11.7 years), 12 TTH children (mean age 12.3 years) and 10 healthy subjects (mean age 11.7 years). “Deux Barrage” test for spatial attention was administered. SEPs to median nerve stimulation were recorded from 4 scalp electrodes (Fz, Cz, T3 and T4) in a neutral condition (NC) and in a spatial attention condition (SAC: the subjects had to count tactile stimuli delivered on the stimulated hand). Results: No significant differences in neuropsychological measures were found between MoA, TTH and healthy subjects. The N140 amplitude increase during SAC, as compared to NC, was significantly higher in patients than in healthy controls. The N140 amplitude increasing during SAC correlated with the R2 index of “Deux Barrage” test in migraineurs, but not in TTH patients. Conclusions: Our results suggest that spatial attention performances in children with headache are as good as those in healthy children. However, the psychophysiological mechanisms underlying spatial attention are different in patients with headache, as compared to controls. In migraineurs, the positive correlation between the N140 amplitude increase in SAC and the R2 index might suggest that a higher amount of attentional resources is needed to reach a normal performance. P23.5 Cardiac pain: a role for the brain? M. Valeriani1 , C. Vollono1 , D. Le Pera2 , C. Pazzaglia3 , D. Virdis3 , A. Sestito4 , G.A. Lanza4 1 Neurology, Ospedale Pediatrico Bambino Ges` u, IRCCS, Rome, Italy, 2 Neurorehabilitation, IRCCS San Raffaele Pisana, Rome, Italy, 3 4 Neurology, Catholic University, Rome, Italy, Cardiology, Catholic University, Rome, Italy Introduction: Although only few evidences have been provided, a possible role of the brain in the pathophysiology of cardiac pain has been supposed. Objective: To investigate the possible involvement of the central nervous system in cardiac pain. Materials: Three groups of patients were recruited for the study: (1) patients with cardiac syndrome X (CSX), submitted to spinal cord stimulation (SCS) for pain relief through a cervical epidural electrode; (2) patients with severe obstructive angina (SA); (3) patients with silent cardiac ischemia (SI), without cardiac pain. The results collected in patients were compared with those obtained in healthy controls. Methods: Laser evoked potentials (LEPs) were obtained to stimulation of both a painful (chest) and a non-painful (right hand dorsum) area. LEPs were recorded from 3 scalp electrodes placed at the Fz, Cz, and T3 positions. An electrode above the right eyebrow recorded the electrooculogram. The reference was at the nose and the ground at Fpz. LEP amplitude habituation was investigated by recording 3 consecutive repetitions of 30 trials each for any stimulation site. The repetitions were separated by 5 minutes intervals. Results: In absence of SCS, patients with CSX showed a reduced LEP habituation as compared to healthy subjects. All our CSX patients referred a clinical improvement after SCS. SCS was also able to restore the LEP habituation. Both SA and SI patients showed a LEP habituation similar to that of healthy subjects. Conclusions: The reduced LEP habituation in our CSX patients suggests an abnormal nociceptive cortex excitability. This is not a cardiac pain epiphenomenon, it being absent in SA patients suffering from a severe painful condition, but it possibly represents a neurological background for the CSX development. This hypothesis is also supported by the normal LEP habituation in SI patients, who do not experience cardiac pain in spite of having cardiac ischemia. Interestingly, our results suggest that SCS improves cardiac pain in CSX patients also by restoring a normal nociceptive cortex excitability.
1
Fibromyalgia syndrome is the chronic pain of unknown cause. One of the theories is the symphathetic activation in muscle tissue microcirculation that role in muscle hypoxia. The hypoxia makes the pain on the muscle. It can happen in all ages, female > male. Method: We studied 22 patients (from June 2010 October 2010), consist of 15 female and 7 male. All the patients who came to our clinic had diffuse chronic pain on their musculosceletal complaints. The diagnose were made by following The American College of Rheumatology (1990) criterias. The pain was measured by Verbal Descriptor Scale (before and after treatment). We used MagPro R30 and the setting: Frequency: 15 Hz Pulses: 50 Number of train: 30 Inter train interval: 5 seconds Range of the intensities given from 30% to 40% The coil put on the shoulder, back, low back and also arm areas (where the patients felt the pain). We moved the coil (not static) and the stimulation is given only once (1500 pulses). Results: The study showed: • before treatment (verbal descriptor scale) range 6 10 • after treatment (verbal descriptor scale) range 0 2 Conclusion: Peripheral Magnetic Stimulation is quite efficient for Fibromyalgia Syndrome treatment. This is just the beginning of the study which it showed the significant changes. Perhaps Peripheral Magnetic Stimulation could be using as one of the treatment choice for chronic pain in Fibromyalgia Syndrome. We still need the further study with the bigger samples. P23.3 Evoked potentials and quantitative thermal testing in spinal cord injury patients with neuropathic pain H. Kumru1 , D. Soler2 , J. Vidal2 Neurology-Neurophysiology, Institut Guttmann, Badalona, Spain, 2 Neurorehabilitation Unit, Institut Guttmann, Badalona, Spain
1
Introduction: Neuropathic pain (NP) is a common complication of spinal cord injury (SCI), but its pathophysiology remains uncertain. Objective: Here we studied the psychophysical and neurophysiological correlates of NP in SCI patients using contact heat evoked potentials (CHEPs) and quantitative thermal testing (QTT) at different levels. Methods: We examined 32 patients with SCI and subacute or chronic NP. Twenty-two SCI patients without NP and 16 healthy subjects served as controls. We assessed NP intensity using a numerical rating scale (NRS) and determined heat and pain thresholds with thermal probes. CHEPs were recorded to stimuli applied at C4 level, and subjects rated their perception of evoked pain using NRS during CHEPs. Results: CHEPs was not different between three groups. Evoked pain perception (NRS-CHEPs) in patients with NP was significantly higher with respect to patients without NP above the lesion level and healthy controls. Warm detection threshold was significantly higher at level in NP patients than controls. Heat pain detection threshold at and above the level was significantly lower in those patients with NP in comparison to controls and patients without NP. Discussion: This study showed hyperalgesia at and above the lesion level in SCI. Those data indicates that neuropathic pain following SCI can induce generalized sensitization above the lesion level. P23.4 Spatial attention in children with primary headache: a combined neurophysiological and neuropsychological approach E. Iacovelli1 , S. Tarantino1 , C. De Ranieri2 , C. Vollono1 , F. Galli1 , M. De Luca1 , F. Vigevano1 , G. Biondi2 , M. Valeriani1 1 Headache Centre, Division of Neurology, Ospedale Pediatrico Bambino Ges` u, Rome, Italy, 2 Division of Paediatric Psychology, Ospedale Pediatrico Bambino Ges` u, Rome, Italy Introduction: Neurophysiological studies to evaluate spatial attention in children with primary headache are lacking. Previous studies
Poster presentations: Poster session 23. Pain demonstrated that tactile-spatial attention modulates the somatosensory N140 component, with increased N140 amplitude for tactile stimuli delivered to the attended hand. Objectives: The aims of the study are: (1) to investigate the effect of spatial attention on the N140 amplitude in children with migraine, with tension-type headache (TTH) and in healthy children, and (2) to evaluate possible correlations between neurophysiological results and a neuropsychological test for spatial attention (“Deux barrage”). Methods: We studied 16 patients with migraine without aura (MoA) (mean age 11.7 years), 12 TTH children (mean age 12.3 years) and 10 healthy subjects (mean age 11.7 years). “Deux Barrage” test for spatial attention was administered. SEPs to median nerve stimulation were recorded from 4 scalp electrodes (Fz, Cz, T3 and T4) in a neutral condition (NC) and in a spatial attention condition (SAC: the subjects had to count tactile stimuli delivered on the stimulated hand). Results: No significant differences in neuropsychological measures were found between MoA, TTH and healthy subjects. The N140 amplitude increase during SAC, as compared to NC, was significantly higher in patients than in healthy controls. The N140 amplitude increasing during SAC correlated with the R2 index of “Deux Barrage” test in migraineurs, but not in TTH patients. Conclusions: Our results suggest that spatial attention performances in children with headache are as good as those in healthy children. However, the psychophysiological mechanisms underlying spatial attention are different in patients with headache, as compared to controls. In migraineurs, the positive correlation between the N140 amplitude increase in SAC and the R2 index might suggest that a higher amount of attentional resources is needed to reach a normal performance. P23.5 Cardiac pain: a role for the brain? M. Valeriani1 , C. Vollono1 , D. Le Pera2 , C. Pazzaglia3 , D. Virdis3 , A. Sestito4 , G.A. Lanza4 1 Neurology, Ospedale Pediatrico Bambino Ges` u, IRCCS, Rome, Italy, 2 Neurorehabilitation, IRCCS San Raffaele Pisana, Rome, Italy, 3 4 Neurology, Catholic University, Rome, Italy, Cardiology, Catholic University, Rome, Italy Introduction: Although only few evidences have been provided, a possible role of the brain in the pathophysiology of cardiac pain has been supposed. Objective: To investigate the possible involvement of the central nervous system in cardiac pain. Materials: Three groups of patients were recruited for the study: (1) patients with cardiac syndrome X (CSX), submitted to spinal cord stimulation (SCS) for pain relief through a cervical epidural electrode; (2) patients with severe obstructive angina (SA); (3) patients with silent cardiac ischemia (SI), without cardiac pain. The results collected in patients were compared with those obtained in healthy controls. Methods: Laser evoked potentials (LEPs) were obtained to stimulation of both a painful (chest) and a non-painful (right hand dorsum) area. LEPs were recorded from 3 scalp electrodes placed at the Fz, Cz, and T3 positions. An electrode above the right eyebrow recorded the electrooculogram. The reference was at the nose and the ground at Fpz. LEP amplitude habituation was investigated by recording 3 consecutive repetitions of 30 trials each for any stimulation site. The repetitions were separated by 5 minutes intervals. Results: In absence of SCS, patients with CSX showed a reduced LEP habituation as compared to healthy subjects. All our CSX patients referred a clinical improvement after SCS. SCS was also able to restore the LEP habituation. Both SA and SI patients showed a LEP habituation similar to that of healthy subjects. Conclusions: The reduced LEP habituation in our CSX patients suggests an abnormal nociceptive cortex excitability. This is not a cardiac pain epiphenomenon, it being absent in SA patients suffering from a severe painful condition, but it possibly represents a neurological background for the CSX development. This hypothesis is also supported by the normal LEP habituation in SI patients, who do not experience cardiac pain in spite of having cardiac ischemia. Interestingly, our results suggest that SCS improves cardiac pain in CSX patients also by restoring a normal nociceptive cortex excitability.