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Dejerine-Roussy syndrome, commonly known as thalamic pain syndrome, is a neurological condition that can develop after a stroke that causes damage to the thalamus in the brain. It is also called central post-stroke pain or analgesia dolorosa.

A stroke occurs when the blood and oxygen supply to a part of the brain is cut off.

The thalamus is a small part of the brain that lies between the cerebral cortex and the middle portion of the brain—it is connected to both through an extensive network of nerves. The thalamus controls the motor and sensory functions of the body.

Although considered to be a rare condition (5% of those who suffer a stroke and survive, get it), about 50% of people who have had a thalamic stroke complain of thalamic pain syndrome. The resulting pain can be spontaneous or can be triggered by touch, and can be extremely debilitating as the pain doesn't go away despite treatment.

Named after Joseph Jules Dejerine and Gustave Roussy, who first described the condition in 1906, Dejerine-Roussy syndrome is now more commonly referred to as central post-stroke pain—this is because thalamic pain is considered to be a more generalized term for all pains emerging from the central part of the brain.

Central post-stroke pain or thalamic pain syndrome is also reported along with the feeling of weakness in the arms, face or legs on one side of the body soon after suffering a stroke. Although the weakness is reported to go away with time, some of the other symptoms along with the pain in the thalamus can be permanent.

  1. Thalamic pain syndrome symptoms
  2. Thalamic pain syndrome causes
  3. Thalamic pain syndrome diagnosis
  4. Thalamic pain syndrome treatment

Thalamic pain syndrome symptoms

Thalamic pain syndrome is a type of brain central pain, which in turn is a subdivision of central pain syndrome.

Chronic neuropathic pain is the primary symptom of Dejerin-Roussy syndrome or thalamic pain syndrome, but there are some other symptoms of the condition as well:

  • Heightened pain response (hyperalgesia): these patients experience a lot of pain in response to stimuli that would normally cause minor pain to others.
  • Unexplained pain on one side of the body—arms, legs or the face
  • Tingling or prickling sensation, also known as pins and needles
  • Burning, freezing, stabbing or itching sensations on one side of the body
  • Pain even at the slightest sensation of touch, also known as allodynia.
  • A feeling of additional weight on one side of the body

The sensation of pain in central pain syndrome can be moderate to severe, which is also made worse due to a lot of factors such as:

  • Stress, anger or other strong emotions
  • Touch
  • Movement
  • Sneezing or yawning can also lead to pain
  • Loud noises and bursts of light
  • Changes in weather or temperature
  • Exposure to sun, wind or changes in altitude

Thalamic pain syndrome causes

Thalamic pain syndrome is usually caused by a sudden head injury or one of the following neurological conditions:

Thalamic pain syndrome diagnosis

Central post-stroke pain is extremely difficult to diagnose. For one, the pain experienced by patients can be of varying degrees—the clinical presentation of the pain can also vary. The pain can start immediately after a cerebrovascular accident (problem with the blood supply to the brain) or it can occur up to six months after the event.

In the absence of a single test that can diagnose central post-stroke pain clearly and definitively, doctors usually check the patient for symptoms, ask routine questions about the problems patients are having and the patients' medical history.

Despite the difficulty in diagnosis, the underlying cause of central post-stroke pain remains an episode involving the brain. According to a study published in the Indian Journal of Pain in 2016, almost 70% of the patients with symptoms of central post-stroke pain develop the condition within one month of suffering an episode involving the brain, with the most common cause of the condition being ischaemic stroke, as 85% of patients develop this illness.

In an ischaemic stroke, a blockage in the arteries prevents proper blood supply to a part of the brain. Typically, these arteries are already narrower than they should be because of the build-up of cholesterol plaque.

Thalamic pain syndrome treatment

While thalamic pain syndrome or central post-stroke pain isn’t curable, its symptoms can be managed through effective strategies to control the pain and other problems.

  • Pain medications—including morphine—are the most favoured line of treatment although it isn't always successful in alleviating the symptoms.
  • Doctors may also prescribe medications used to treat epilepsy or anti-depressants.
  • Transdermal creams and patches, muscle relaxants, sedatives as well as sleeping pills can also be recommended by doctors for treatment.
  • Medical marijuana is also known to be used to treat the symptoms of this condition.
  • Neurosurgery is also recommended to patients with severe symptoms or whose symptoms haven't eased even after trying all the conservative options available.

At best, the various strategies can manage the symptoms and lessen or numb the pain. But a complete recovery from this condition isn't possible.

A group of doctors with different specialisations including neurologists, pain management specialists, physiotherapists and even psychologists is needed to effectively manage the symptoms and well-being of the patient suffering from central post-stroke pain.

Do you or anyone in your family have this disease? Please do a survey and help others

References

  1. Bhattacharyya R et al. Clinical features and imaging of central poststroke pain Indian Journal of Pain. 2016 Jan; 30(1): 34-37.
  2. Guedon A et al. Dejerine-Roussy syndrome Historical Neurology. 2019 Oct; 93(14): 624-629.
  3. The Internet Stroke Center: UT Southwestern Medical Center. [Internet] Dallas, Texas, USA. Thalamic Pain Syndrome (Dejerine-Roussy Syndrome)
  4. Keszler M et al. Pain Syndromes Associated With Cerebrovascular Accidents Challenging Neuropathic Pain Syndromes: Chapter 19. 2018: 155-165.
  5. Jahangir MU and Qureshi AI. Dejerine Roussy Syndrome StatPearls. 2020 Jan.

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