2016-08-012024-05-18https://scholars.lib.ntu.edu.tw/handle/123456789/712386摘要：小纖維神經是傳導溫度疼痛感覺及控制自律功能之神經，許多系統性疾病如糖尿病常會造成小纖維神經病變(small-fiber neuropathy)。小纖維神經病變常伴隨神經痛的症狀，包括自發性疼痛及誘發痛。目前已有一些工具可以用來評估小纖維神經病變的病理、心理的及生理變化，包括皮膚切片評估表皮上小纖維感覺神經末梢之退化、感覺神經功能檢查評估溫度與疼痛感覺閥值上升及熱刺激誘發電位評估皮膚熱痛刺激所造成的大腦訊號。但是這些檢查與小纖維神經病變神經痛之發生病無明確之關係。神經痛的機制可能牽涉到許多不同層次的、複雜的病生理機轉發生在神經系統不同的位置，包括周邊神經、脊髓和腦部之病生理變化。過去許多研究顯示大腦感覺和運動區之興奮性及感覺運動間之聯結與交互作用的變化可能和神經痛發生的機制有關。但是目前並不清楚小纖維神經病變併神經痛的病人身上大腦感覺運動區之興奮性及感覺運動間之聯結是否有改變? 而這些改變是否與皮膚切片、感覺神經功能檢查、熱刺激誘發電位之結果或臨床症狀有關聯性? 穿顱磁刺激是一項常用來探討中樞神經運動區之興奮性及感覺運動聯結的工具。本計畫將利用穿顱磁刺激檢查搭配不同的刺激模式針對小纖維神經病變併神經痛的病人進行研究。藉由與非疼痛型小纖維神經病變或正常受試者做比較，來了解小纖維神經病變併神經痛之病人，其大腦感覺運動電氣活動之特異性。這些結果將有機會增進對病人神經痛發生的了解並應用於改善病人的治療策略。<br> Abstract: Small-fiber neuropathy (SFN) is a subtype of neuropathy with involvement small diameter myelinated andunmyelinated nerve fibers, and neuropathic pain is common manifestation. In the past years, severalapproaches including skin biopsies and contact heat evoked potential (CHEP) and quantitative sensorytesting have been developed to study the pathological, psychophysical and physiological aspects of SFN.Although the skin denervation is an major pathological markers of SFN, the relationship between skindenervation and occurrence of neuropathic pain was controversy and there should be various pathogenesis atthe central levels other than the nerve terminals contributing to the development of neuropathic pain. Sensorymotor integration is the synergistic relationship between the sensory system and the motor system. The twosystems communicate and coordinate with each other to give correct responses. Abnormalities in theperipheral afferent input due to neuropathy may interfere with the sensory-motor interaction and impair theprocessing of motor programs in the cortical motor areas. Increasing evidence from the past studies showedchanges of sensory and motor excitability, integration and interaction might contributed to the mechanism ofneuropathic pain. However the underlying neurophysiological changes, its association with the parameters ofSFN and its clinical significance are still not well understood in human.Transcranial magnetic stimulation is a non-invasive tool to investigate the cortical excitability, intracorticalcircuit and intercortical connections, and has the potential to modify the brain excitability. The commonlyused paradigms to study the sensory-motor excitability or interaction include dual-site paired pulse TMS,intracortical inhibition, afferent inhibition and paired associative stimulation. In the present plan, we hypothesizedin patients with neuropathic pain due to small-fiber nerve degeneration, there will be biochemical changes orneuroplasticity at the central levels. By applying TMS technique with different paradigms, we will explorethe changes related to sensory and motor system and sensory-motor interaction. We will also explore therelationship between these physiological changes and the parameters of small fiber degeneration, i.e skininnervation, thermal threshold by QST and CHEP, and the clinical symptoms of neuropathic pain.