Paroxysmal itching in multiple sclerosis: a report of three cases.

Yamamoto, Mitsutoshi; Yabuki, S; Hayabara, Toshiyuki; Otsuki, Saburo

doi:10.1136/jnnp.44.1.19

Cited by 57 publications

(41 citation statements)

References 8 publications

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“…In clinical practice pruritus has been observed contralateraly to a unilateral thalamic stroke [31][32][33][34][35], or lesion of the parietal lobe or internal capsule due to middle cerebral artery infarction or hemorrhage [35,36]. Yamamoto et al [37] described paroxysmal itching in three multiple sclerosis patients. Each had a presumed spinal cord involvement, but cerebral imaging were not reported so higher level lesions cannot be excluded.…”

Section: Discussionmentioning

confidence: 99%

Pruritus in familial Creutzfeldt–Jakob disease: a common symptom associated with central nervous system pathology

et al. 2010

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Pruritus, a common feature of animal prion diseases such as scrapie, is rarely reported in humans with Creutzfeldt-Jakob disease (CJD), and its anatomical background is not well defined. The present study was undertaken to carry out a methodical prospective search for the prevalence of pruritus in CJD patients and investigate its anatomical substrate by MRI. The study group included consecutive familial and sporadic CJD patients carrying the E200K PRNP mutation followed up in a longitudinal prospective study between the years 2005 and 2008. Pruritus was prospectively screened for and diffusion-weighted imaging (DWI) was used to correlate brain diffusion abnormalities with pruritus in CJD patients. Pruritus was present in 6/31 (19.35%) patients with familial disease (fCJD) and in none of the patients with sporadic disease (sCJD). Pruritus was a presenting symptom in one patient and evolved during the course of the disease in the other five patients. The pruritus was generalized in three patients, regional in two and localized in one patient. It was transient in one patient and continued throughout the disease in five patients. DWI showed that pruritus was significantly associated with reduced diffusion in the several areas known to be affected by CJD, but most significantly in the midbrain periaqueductal grey matter. Pruritus is relatively common in patients with familial CJD carrying the E200K mutation. Our findings point to a central origin that involves damage to the inhibitory gating mechanism for itch in the periaqueductal grey matter.

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Section: Discussionmentioning

confidence: 99%

Pruritus in familial Creutzfeldt–Jakob disease: a common symptom associated with central nervous system pathology

et al. 2010

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“…9 In addition to dermatological and medical conditions, chronic itch can be caused by disorders of the CNS or PNS. 3,21,35,42 A subset of patients with neuropathic itch develop scratching that persists despite self injury. 16 Self-injurious behavior in humans is typically restricted to individuals with severe denervation, consistent with a loss of protective pain sensations.…”

Section: Discussionmentioning

confidence: 99%

Dermatomal Scratching After Intramedullary Quisqualate Injection: Correlation With Cutaneous Denervation

Brewer

Lee

Downs

et al. 2008

The Journal of Pain

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Central nervous system lesions cause peripheral dysfunctions currently attributed to central cell death that compromises function of intact peripheral nerves. Injecting quisqualate (QUIS) into the rat spinal cord models spinal cord injury (SCI) and causes at-level scratching and self-injury. Such overgrooming was interpreted to model pain until patients with self-injurious scratching after SCI reported itch motivated scratching that was painless because of sensory loss. Because self-injurious scratching is difficult to explain by central mechanisms alone, we hypothesized that QUIS injections damage peripheral axons of at-level afferents. QUIS was injected into thoracic spinal cords of 18 Long-Evans rats. Animals were killed 3 days after overgrooming began or 14 days after injection. Spinal cord lesions were localized and DRG-immunolabeled for ATF-3. At-level and control skin samples were PGP9.5-immunabeled to quantify axons. Eighty-four percent of QUIS rats overgroomed. Skin in these regions had lost two-thirds of epidermal innervation as compared with controls (P < .001). Rats that overgroomed had 47% less axon-length than nongrooming rats (P = .006). The presence of ATF-3 immunolabeled neurons within diagnosis-related groups of QUIS rats indicated death of afferent cell bodies. Overgrooming after QUIS injections may not be due entirely to central changes. As in humans, self-injurious neuropathic scratching appeared to require loss of protective pain sensations in addition to peripheral denervation. Perspective This study suggests that intramedullary injection of quisqualic acid in rats causes death of at-level peripheral as well as central neurons. Self-injurious dermatomal scratching that develops in spinal-injured rats may reflect neuropathic itch and loss of protective pain sensations.

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“…Central lesions, most often vertebrobasilar stroke, are said to cause about 1/5 of cases of TTS (29). Central itch has also been described in multiple sclerosis (30,31), tumors within and immediately outside the brain (32,33), and infections and autoimmune disorders (34), as well as other conditions (29). As with other types of neurological dysfunctions, the location of a lesion, not its etiology, determines which neurological symptoms it will evoke.…”

Section: Syndromes Of the Face Head And Neckmentioning

confidence: 95%

“…Various intramedullary lesions have been shown to cause neuropathic itch in both humans and animals, attesting to the importance of the spinal cord as an itchmodulating center Spinal itch has been associated with syringomyelia, tumor, spinal multiple sclerosis, and the Brown-Séquard syndrome after traumatic injury (31,(35)(36)(37). Several investigators have described an association between intramedullary cavernous hemangiomas of the spinal cord and chronic neuropathic itch in the corresponding dermatome (14,38,39).…”

Section: Syndromes Caused By Intramedullary Lesions Within the Spinalmentioning

confidence: 98%

Common Neuropathic Itch Syndromes

Oaklander¹

2012

Acta Derm Venerol

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Patients with chronic itch are diagnosed and treated by dermatologists. However, itch is a neural sensation and some forms of chronic itch are the presenting symptoms of neurological diseases. Dermatologists need some familiarity with the most common neuropathic itch syndromes to initiate diagnostic testing and to know when to refer to a neurologist. This review summarizes current knowledge, admittedly incomplete, on neuropathic itch caused by diseases of the brain, spinal cord, cranial or spinal nerve-roots, and peripheral nerves.

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Paroxysmal itching in multiple sclerosis: a report of three cases.

Cited by 57 publications

References 8 publications

Pruritus in familial Creutzfeldt–Jakob disease: a common symptom associated with central nervous system pathology

Pruritus in familial Creutzfeldt–Jakob disease: a common symptom associated with central nervous system pathology

Dermatomal Scratching After Intramedullary Quisqualate Injection: Correlation With Cutaneous Denervation

Common Neuropathic Itch Syndromes

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