Conduction velocity of the cold spinal pathway in healthy humans

Leone, C.; Lionardo, Andrea Di; Diotallevi, Giulia; Mollica, Cristina; Pietro, Giuseppe Di; Stefano, Giulia Di; Cesa, S. La; Cruccu, G.; Truini, Andrea

doi:10.1002/ejp.1640

Cited by 5 publications

(3 citation statements)

References 19 publications

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“…Particularly, examining the distal lower extremities in elderly subjects remains a challenge ( 31 ). While improvements in CEP recording could be achieved with advanced thermal stimulators (featuring steep cooling ramps and low target temperatures ( 35 , 75 ), for now, only the Medoc thermal stimulator possesses a CE certificate as a diagnostic tool on patients in clinical routine, facilitating their application in both research and clinical diagnostics.…”

Section: Discussionmentioning

confidence: 99%

“…This is where CEPs might step in: The advantages of CEP assessment as a non-invasive method to measure small fibers and their central pathways are comparable to those of LEPs, but with the upside of a pain-free examination. A study on the conduction velocity of the cold spinal pathway even suggested that CEPs may represent an alternative to LEPs ( 75 ).…”

Section: Discussionmentioning

confidence: 99%

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Cold-evoked potentials in Fabry disease and polyneuropathy

Kersebaum,

Sendel,

Lassen

et al. 2024

Front. Pain Res.

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BackgroundFabry disease (FD) causes cold-evoked pain and impaired cold perception through small fiber damage, which also occurs in polyneuropathies (PNP) of other origins. The integrity of thinly myelinated fibers and the spinothalamic tract is assessable by cold-evoked potentials (CEPs). In this study, we aimed to assess the clinical value of CEP by investigating its associations with pain, autonomic measures, sensory loss, and neuropathic signs.MethodsCEPs were examined at the hand and foot dorsum of patients with FD (n = 16) and PNP (n = 21) and healthy controls (n = 23). Sensory phenotyping was performed using quantitative sensory testing (QST). The painDETECT questionnaire (PDQ), FabryScan, and measures for the autonomic nervous system were applied. Group comparisons and correlation analyses were performed.ResultsCEPs of 87.5% of the FD and 85.7% of the PNP patients were eligible for statistical analysis. In all patients combined, CEP data correlated significantly with cold detection loss, PDQ items, pain, and autonomic measures. Abnormal CEP latency in FD patients was associated with an abnormal heart frequency variability item (r = −0.684; adjusted p = 0.04). In PNP patients, CEP latency correlated significantly with PDQ items, and CEP amplitude correlated with autonomic measures (r = 0.688, adjusted p = 0.008; r = 0.619, adjusted p = 0.024). Furthermore, mechanical pain thresholds differed significantly between FD (gain range) and PNP patients (loss range) (p = 0.01).ConclusionsAbnormal CEPs were associated with current pain, neuropathic signs and symptoms, and an abnormal function of the autonomic nervous system. The latter has not been mirrored by QST parameters. Therefore, CEPs appear to deliver a wider spectrum of information on the sensory nervous system than QST alone.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cold-evoked potentials in Fabry disease and polyneuropathy

Kersebaum,

Sendel,

Lassen

et al. 2024

Front. Pain Res.

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“…In an effort to improve the technique and make it reliable enough for clinical use, important questions have been addressed in the recent years, including the influence of skin type, fixed or variable probe position, inter-stimulus interval and aging (De Keyser et al, 2018;Hüllemann et al, 2016Hüllemann et al, , 2019Leone et al, 2019Leone et al, , 2020Lithfous et al, 2022;Rosner et al, 2019;Scheuren et al, 2022). While these studies substantiate the potentialities of CEPs as a diagnostic tool, clinical studies in patients with NP have been so far limited to selective case reports.…”

Section: Introductionmentioning

confidence: 99%

Cold‐evoked potentials in clinical practice: A head‐to‐head contrast with laser‐evoked responses

Perchet

Hagiwara

Salameh

et al. 2023

European Journal of Pain

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BackgroundInnocuous 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.MethodsHere, 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.ResultsCEP 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.ConclusionsCEPs 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.SignificanceRecording 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.

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