Klinisch tätige Neurologen setzen täglich elektrophysiologische und sonographische Verfahren ein. Allerdings sind die technischen Grundlagen der eingesetzten Methoden bzw. deren Limitationen bei den einzelnen Fragestellungen bisher häufig nicht bekannt oder verbindlich definiert. Das von der Deutschen Gesellschaft für Klinische Neurophysiologie und funktionelle Bildgebung herausgegebene Buch schließt diese Lücke und fasst erstmals alle gängigen neurophysiologischen Verfahren, wie EEG, EMG, NLG, evozierte Potentiale (sensorisch und motorisch), Polysomnographie, autonome Testung, Hirnstammreflexe, Dopplersonographie und Ultraschall, in einem Buch zusammen. In kurzer und einheitlicher Form werden die verschiedenen Methoden beschrieben sowie die bei den klinischen Fragestellungen zum Einsatz kommenden Ableitungen und die damit verbundenen Probleme vorgestellt. Die Autoren sind international bekannte Fachleute aus Deutschland, Österreich und der Schweiz.

Background aims:Causes of chronic pain are postulated to lie in abnormal pain modulation apparent in many diseases. The nociceptive system is balanced with certain anti- and pro-nociceptive mechanisms. Former includes the spinal inhibitory network assessed by conditioned pain modulation. Latter is due to a sensitization along the nociceptive neuraxis leading to ectopic excitability, contributing to hyperalgesia and allodynia. Temporal summation of pain (TSP) reflects this central sensitization.Methods:This study assesses pain modulation during tonic noxious heat application in three groups: Thoracic spinal cord injury (SCI) patients with and without neuropathic pain (NP), and matched healthy controls. The assessment was performed at the volar forearm in order to investigate a sensory intact area. A thermode was heated to 45u00b0C, and the participant was instructed to rate the pain on a numeric rating scale. Subsequently, they had to keep the pain level constant for two minutes by adjusting the temperature of the thermode (participant-controlled temperature, PCT). Clicking the mouse buttons increased or decreased the temperature, respectively.Results:The binary analysis of TSP occurrence highlighted that NP patients show the highest percentage of TSP occurrences (NP: 88%, nonNP: 63.6%, HC: 80%). Statistical analysis revealed a significant increase of the TSP magnitude and the TSP area under curve between the NP and nonNP SCI group.Conclusions:Increased temporal summation of pain u2013 acting as a proxy for central sensitization - was found in SCI patients with chronic NP. The method of tonic heat profiles enables a continuous measure allowing the analysis of adaptation and the TSP processes.

Abstract: Background Phase-contrast MRI of CSF and spinal cord dynamics has evolved among diseases caused by altered CSF volume (spontaneous intracranial hypotension, normal pressure hydrocephalus) and by altered CSF space (degenerative cervical myelopathy (DCM), Chiari malformation). While CSF seems to be an obvious target for possible diagnostic use, craniocaudal spinal cord motion analysis offers the benefit of fast and reliable assessments. It is driven by volume shifts between the intracranial and the intraspinal compartments (Monro-Kellie hypothesis). Despite promising initial reports, comparison of spinal cord motion data across different centers is challenged by reports of varying value, raising questions about the validity of the findings. Objective To systematically investigate inter-center differences between phase-contrast MRI data. Methods Age- and gender matched, retrospective, pooled-data analysis across two centers: cardiac-gated, sagittal phase-contrast MRI of the cervical spinal cord (segments C2/C3 to C7/T1) including healthy participants and DCM patients; comparison and analysis of different MRI sequences and processing techniques (manual versus fully automated). Results A genuine craniocaudal spinal cord motion pattern and an increased focal spinal cord motion among DCM patients were depicted by both MRI sequences (p 0.01). Higher time-resolution resolved steeper and larger peaks, causing inter-center differences (p 0.01). Comparison of different processing methods showed a high level of rating reliability (ICC 0.86 at segments C2/C3 to C6/C7).brDiscussionbr

Background and aims: Central sensitization is a major factor contributing to the development and persistence of neuropathic pain. The lack of quantitative measures to objectively assess sensitization hampers the development of effective treatment options. As hyperexcitability is observed in both somatosensory and autonomic nervous systems, the aim was to investigate modulation of sensory-autonomic interactions in response to noxious pinprick stimulation after experimentally induced central sensitization. Methods: Twenty healthy individuals underwent 3 blocks of 15 pinprick stimuli (256mN) to the volar forearm before (PRE) and after (POST) an experimental and control intervention, separated by 2 weeks. A repetitive phasic heat pain model was applied to induce secondary hyperalgesia to pinprick in the experimental, but not in the control intervention. The adjacent skin was stimulated to capture the effect of experimentally induced central sensitization on PEP and sympathetic skin response (SSR) habituation. QST was performed prior to the PRE and POST condition. Results: PEP amplitudes (p=0.003) and pain ratings (p=0.0004) to pinprick were increased in the area of secondary hyperalgesia, whereas no changes were observed in the control intervention. PEP habituation from the PRE to the POST assessment did not differ between the experimental and control interventions. Preliminary analysis showed increased amplitudes and reduced habituation of SSR. Conclusions: PEP amplitudes in combination with SSR habituation may represent a useful tool to objectively quantify mechanical hyperalgesia in experimentally and pathology-induced central sensitization. This approach might contribute towards a comprehensive phenotyping of neuropathic pain patients and ultimately provide mechanism-based treatment options.