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Klinische Neurophysiologie 2004; 35(4): 235-240
DOI: 10.1055/s-2004-828532
Originalia
© Georg Thieme Verlag KG Stuttgart · New York

Klinische, elektrophysiologische und bildgebende Befunde bei Patienten mit komplexem regionalen Schmerzsyndrom (CRPS)

Clinical, Electrophysiological and Imaging Findings in Patients Suffering from Complex Regional Pain Syndrome (CRPS)S.  Förderreuther1
  • 1Neurologische Klinik und Poliklinik der Ludwig-Maximilians-Universität, Neurologischer Konsiliardienst - Innenstadtklinikum
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Publication History

Publication Date:
06 December 2004 (online)

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Zusammenfassung

Die Diagnose CRPS wird klinisch gemäß der typischen Anamnese, den klinischen Befunden nach dem Ausschluss anderer entzündlicher Erkrankungen und chirurgischer Komplikationen des Traumas gestellt. Typischerweise entgehen die sensiblen und motorischen Symptome eines CRPS der klinischen Routinediagnostik mit Neurographie, Myographie und evozierten Potenzialen. Neue bildgebende und elektrophysiologische Daten liefern wissenschaftliche Hinweise auf zentralnervöse Pathomechanismen des CRPS. Es kommt zu einer Abnahme der Repräsentation der erkrankten Extremität im primären sensiblen Kortex, deren Ausmaß mit der Schmerzintensität korreliert. Es kommt möglicherweise auch zu bilateralen Änderungen im Zusammenspiel exzitatorischer und inhibitorischer Neurone im motorischen Kortex. Zudem ist die zentrale Regulation der Sympathikusfunktion gestört. Diese Befunde sind möglicherweise das Korrelat für die Sensibilitätsstörungen und motorischen Befunde von CRPS-Patienten. Besonders interessant ist die Korrelation von Änderungen der kortikalen Repräsentation der erkrankten Extremität mit der Schmerzintensität. Hier stellt sich für die künftige Forschung vor allem die Frage, ob und inwieweit Änderungen der kortikalen Repräsentation bei CRPS-Patienten beeinflusst werden können und ob sich dies auf die Schmerzintensität und Chronifizierung auswirkt.

Abstract

The diagnosis CRPS bases on the typical history of an acute injury and the development of a neuropathic pain syndrome with abnormalities in the sensory, motor and autonomic nervous systems. Inflammatory and rheumatologic diseases and complications of the initial trauma have to be excluded. In spite of clinically marked sensory and motor dysfunction electrophysiological routine tests like myography, neurography and evoked potentials typically are normal. From actual experimental studies there is good evidence that mechanisms within the central nervous system might play an important role in the pathophysiology of CRPS. A significant shrinkage of the extension of the cortical area representing the affected limb has been shown. This cortical reorganisation correlates with the pain intensity. There is dysfunction of the central control of sympathetic vascular reflexes. Furthermore, a bilateral disinhibition of the motor cortex was shown in patients with CRPS. These experimental findings might explain otherwise unexplained clinical findings in CRPS patients. The correlation of the extent of cortical reorganisation and pain intensity is of special interest. Further studies should answer the question whether cortical reorganisation can be modulated in CRPS and whether such a modulation has favourable effects on pain intensity and chronification.

Key words

Complex regional pain syndrome - neuropathic pain - cortical reorganisation - neurogenic inflammation

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Dr. Stefanie Förderreuther

Neurologische Klinik und Poliklinik der Ludwig-Maximilians-Universität · Neurologischer Konsiliardienst - Innenstadtklinikum

Ziemssenstraße 1

80336 München

Email: steffi.foerderreuther@med.uni-muenchen.de

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