背景:皮肤的无害冷却激活了冷特异性Aδ纤维,因此,冷诱发电位(CEP)的记录可以改善对人体热伤害性功能的客观评估.虽然已经报道了CEP记录在健康人中的可行性,它们的可靠性和在临床条件下的诊断用途尚未得到记录.
方法:这里,我们报告了60例疑似神经性疼痛患者的CEP记录结果,与热痛觉仪器评估的金标准激光诱发电位(LEP)相比。
结果:CEP记录是一种耐受性良好的程序,考试时间只有约15分钟的盈余。CEP的再现性和信噪比低于LEP,特别是对于下肢远端(LLs)。虽然激光反应在所有患者中都是可以解释的,由于未受影响的一方的人工制品或缺乏反应,CEP的解释在5/60中尚无定论。两种技术在73%的患者中产生了一致的结果。在12名患者中,CEP产生异常值,而LEP保持在正常范围内;其中3例患者的临床症状仅限于冷感,包括冷热转换。
结论:CEP似乎是探索疼痛/温度系统的有用技术。优点是设备成本低且无毒。缺点是LL刺激的信噪比低,和对疲劳/习惯的敏感性。CEP和LEP的联合记录可以增加神经生理学技术对纤维脊髓损伤的敏感性。特别是,当冷感异常占优势时。
结论:记录冷诱发电位具有良好的耐受性,廉价且易于使用的程序,可有助于诊断纤维-脊髓丘脑通路的异常。用CEP补充LEP可以巩固诊断,对于一些症状仅限于感冒的患者,CEP而不是LEP可能允许诊断细纤维病理学。最佳的CEP记录条件对于克服低信噪比和习惯性现象非常重要,比LEP不利。
Innocuous cooling of the skin activates cold-specific Aδ fibres, and hence, the recording of cold-evoked potentials (CEPs) may improve the objective assessment of human thermo-nociceptive function. While the feasibility of CEP recordings in healthy humans has been reported, their reliability and diagnostic use in clinical conditions have not been documented.
Here, we report the results of CEP recordings in 60 consecutive patients with suspected neuropathic pain, compared with laser-evoked potentials (LEPs) which are the gold standard for thermo-algesic instrumental assessment.
CEP recording was a well-tolerated procedure, with only ~15 min of surplus in exam duration. The reproducibility and signal-to-noise ratio of CEPs were lower than those of LEPs, in particular for distal lower limbs (LLs). While laser responses were interpretable in all patients, CEPs interpretation was inconclusive in 5/60 because of artefacts or lack of response on the unaffected side. Both techniques yielded concordant results in 73% of the patients. In 12 patients, CEPs yielded abnormal values while LEPs remained within normal limits; 3 of these patients had clinical symptoms limited to cold sensations, including cold-heat transformation.
CEPs appear as a useful technique for exploring pain/temperature systems. Advantages are low cost of equipment and innocuity. Disadvantages are low signal-to-noise ratio for LL stimulation, and sensitivity to fatigue/habituation. Joint recording of CEPs and LEPs can increase the sensitivity of neurophysiological techniques to thin fibre- spinothalamic lesions, in particular, when abnormalities of cold perception predominate.
Recording of cold-evoked potentials is a well-tolerated, inexpensive and easy-to-use procedure that can be helpful in the diagnosis of abnormalities in the thin fibre- spinothalamic pathways. Supplementing LEPs with CEPs allows consolidating the diagnosis and, for some patients suffering from symptoms limited only to cold, CEPs but not LEPs may allow the diagnosis of thin fibre pathology. Optimal CEP recording conditions are important to overcome the low signal-to-noise ratio and habituation phenomena, which are less favourable than with LEPs.