Neuropediatrics 2010; 41 - P1364
DOI: 10.1055/s-0030-1265609

Quantitative Sensory Testing in children and adolescents with cerebral palsy

J Junker 1, B Zernikow 1, N Kraemer 1, F Aksu 2, T Hechler 1, M Blankenburg 1, 2
  • 1Vodafone Foundation Institute for Children's Pain Therapy and Paediatric Palliative Care (VIKP)
  • 2Center for Child Neurology. Clinic for Children and Adolescent Datteln, University Witten/Herdecke

Introduction: Cerebral palsy (CP) is one of the most common reasons for spastic paresis in children. More than half of patients suffer from chronic pain. So far it is unknown if the pain primarily origin from neuropathic ore nociceptive mechanisms. This is important for pain therapy. The German Research Network on Neuropathic Pain (DFNS) established a standardised QST protocol encompassing all somatosensory modalities to assess the functioning of different nerve fibers, the lemniscal and extralemniscal system and other central pathways. The aim of our study was 1. to assess the QST profile in juvenile CP patients, 2. to compare the QST profile with SEP and 3. to elucidate if sensory testing abnormalities correlated with pain and clinical parameters.

Methods: 30 children and adolescents with CP and healthy age and gender matched controls were included. Nerve functions were assessed with the QST protocol of the German research network on neuropathic pain (DFNS) and SEP. Sensory testing results were compared with validated pain questionnaires and the neurological examination.

Results: The patients (18 boys, 12 girls) were 12.2±3.2 years old and suffered from tetraparesis (n=12) or hemiparesis (n=12) with distinct impairment (Karnofsky-Index 68+20) due to perinatal asphyxia (n=14) ore cerebral haemorrhage (n=6) with severe periventricular leukomalacia (n=15). Patients were less sensitive to al thermal and mechanical detection stimuli (cold T=5.9; warm T=6.1, mechanical detection T=8.2; vibration T=3.7; al p<0.0001), but more sensitive to al mechanical pain stimuli (mechanical pain sensitivity T=7.2; pressure pain T=4.8; alle p<0.0001) compared to controls. SEP was pathological in 33% of patients and correlated to mechanical detection thresholds. The mean pain intensity was 5.6 on the NRS and correlated with mechanical pain thresholds.

Conclusion: Our results indicate dysfunction of the lemniscal and the extralemniscal system in children and adolescents with CP and chronic pain. The correlation between pain and extralemniscal dysfunction indicate neuropathic pain for those children.