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@article{1745297,
author = {Dimova, V. and Herrnberger, M. S. and EscolanoandLozano, F. and Rittner, H .L. and Vlčková, Eva and Sommer, C. and Maihofner, C. and Birklein, F.},
article_location = {Philadelphia},
article_number = {4},
doi = {http://dx.doi.org/10.1212/WNL.0000000000008736},
keywords = {complex regional pain syndrome},
language = {eng},
issn = {0028-3878},
journal = {Neurology},
title = {Clinical phenotypes and classification algorithm for complex regional pain syndrome},
url = {https://n.neurology.org/content/94/4/e357},
volume = {94},
year = {2020}
}
TY - JOUR
ID - 1745297
AU - Dimova, V. - Herrnberger, M. S. - Escolano-Lozano, F. - Rittner, H .L. - Vlčková, Eva - Sommer, C. - Maihofner, C. - Birklein, F.
PY - 2020
TI - Clinical phenotypes and classification algorithm for complex regional pain syndrome
JF - Neurology
VL - 94
IS - 4
SP - "E357"-"E367"
EP - "E357"-"E367"
PB - LIPPINCOTT WILLIAMS & WILKINS
SN - 00283878
KW - complex regional pain syndrome
UR - https://n.neurology.org/content/94/4/e357
N2 - Objective We pursued the hypothesis that complex regional pain syndrome (CRPS) signs observed by neurologic examination display a structure allowing for alignment of patients to particular phenotype clusters. Methods Clinical examination data were obtained from 3 independent samples of 444, 391, and 202 patients with CRPS. The structure among CRPS signs was analyzed in sample 1 and validated with sample 2 using hierarchical clustering. For patients with CRPS in sample 3, an individual phenotype score was submitted to k-means clustering. Pain characteristics, quantitative sensory testing, and psychological data were tested in this sample as descriptors for phenotypes. Results A 2-cluster structure emerged in sample 1 and was replicated in sample 2. Cluster 1 comprised minor injury eliciting CRPS, motor signs, allodynia, and glove/stocking-like sensory deficits, resembling a CRPS phenotype most likely reflecting a CNS pathophysiology (the central phenotype). Cluster 2, which consisted of edema, skin color changes, skin temperature changes, sweating, and trophic changes, probably represents peripheral inflammation, the peripheral phenotype. In sample 3, individual phenotype scores were calculated as the sum of the mean values of signs from each cluster, where signs from cluster 1 were coded with 1 and from cluster 2 with -1. A k-means algorithm separated groups with 78, 36, and 88 members resembling the peripheral, central, and mixed phenotypes, respectively. The central phenotype was characterized by cold hyperalgesia at the affected limb. Conclusions Statistically determined CRPS phenotypes may reflect major pathophysiologic mechanisms of peripheral inflammation and central reorganization.
ER -
DIMOVA, V., M. S. HERRNBERGER, F. ESCOLANO-LOZANO, H .L. RITTNER, Eva VLČKOVÁ, C. SOMMER, C. MAIHOFNER and F. BIRKLEIN. Clinical phenotypes and classification algorithm for complex regional pain syndrome. \textit{Neurology}. Philadelphia: LIPPINCOTT WILLIAMS \&{} WILKINS, 2020, vol.~94, No~4, p.~''E357''-''E367'', 11 pp. ISSN~0028-3878. Available from: https://dx.doi.org/10.1212/WNL.0000000000008736.
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