Some Lyme patients with hypersensitive skin that is painful to touch (me included) may suffer from Thalamic Syndrome (Dejerine Roussy). Having Dejerine Roussy syndrome most likely indicates Bb growing in the thalamus that is part of your brain. This condition needs to be treated with antibiotic penetrating blood-brain-barrier. If you read it carefully you will notice that authors unaware of the connection confuse carpal tunnel symptoms with Lyme symptoms. We are getting used to many errors in the area of Lyme.
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Thalamic Syndrome (Dejerine Roussy)
Important
It is possible that the main title of the report Thalamic Syndrome (Dejerine Roussy) is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report.
Synonyms
Dejerine-Roussy Syndrome
Posterior Thalamic Syndrome
Retrolenticular Syndrome
Thalamic Hyperesthetic Anesthesia
Thalamic Pain Syndrome
Central Pain Syndrome
Central Post-Stroke Syndrome
Disorder Subdivisions
None
Related Disorders List
Thalamic Syndrome (Dejerine-Roussy) is a rare neurological disorder in which the body becomes hypersensitive to pain as a result of damage to the thalamus, a part of the brain that affects sensation. The thalamus has been described as the brain's sensory relay station. Primary symptoms are pain and loss of sensation, usually in the face, arms, and/or legs.
Pain or discomfort may be felt after being mildly touched or even in the absence of a stimulus. The pain associated with thalamic syndrome may be made worse by exposure to heat or cold and by emotional distress. Sometimes, this may include even such emotions as those brought on by listening to music.
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Symptoms
Thalamic Syndrome (Dejerine-Roussy) is characterized by pain and loss of sensation, especially in the face, arms and/or legs. Many types of sensation can be affected, including touch, pain, and awareness of temperature. Stimulation may increase the discomfort. For example, being touched, or being exposed to cold temperatures may cause spontaneous pain. Taste may be affected; food and drink may have an unusual or different flavor. A slow tremor of the hand, arm, foot, or leg that increases as the patient attempts to move the limb (intention tremor) may become apparent. Hand spasms may also occur. Mild muscular weakness or partial paralysis limited to one side of the body (hemiparesis or hemiparalysis) may be another symptom.
The patient may experience a disagreeable sensation or strong pain in response to touch which, under normal conditions, would not be uncomfortable (hyperpathia). He or she may, at first, have trouble feeling a touch sensation (dysesthesia) and the threshold for pain may be raised; however, once the level of pain that he or she can accept is exceeded, there is an over-reaction to the pain (hyperresponsiveness). The patient may not have a sense of what position the affected part of the body is in. Emotional over-reactions may occur.
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Causes
Thalamic Syndrome (Dejerine-Roussy) stems from damage to the thalamus, usually appearing four to six weeks after the damage has occurred. Symptoms appear when there is loss of nerve cells in the back part of the thalamus. The thalamus is a part of the brain that acts as a coordinating center for nerve impulses from all the senses, relaying them to appropriate areas in the rest of the brain where they are then consciously perceived. The loss of nerve cells may be due to blockage in blood circulation caused by a blood clot (thrombus) or by an abnormal particle such as an air bubble circulating in the blood (embolus). Thalamic Syndrome may also be a consequence of the presence of a tumor or lesion in the thalamus.
When one side of the thalamus is damaged, some or all of the opposite side of the body (face, arm, leg) may be abnormally sensitive to all types of stimuli such as touch (contralateral hypersensitivity). This may cause pain in the areas where there is a loss of sensation (anesthesia dolorosa).
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Affected Populations
Thalamic Syndrome (Dejerine-Roussy) is a rare disorder that affects males and females in equal numbers.
Related Disorders
Reflex Sympathetic Dystrophy Syndrome (RSDS) is a term encompassing a group of chronic pain syndromes. Symptoms include severe pain and alternating constriction and dilation of blood vessels after trauma, often minor in nature. Other cases of RSDS can begin without apparent cause. Symptoms can become chronic if treatment is not begun as soon as possible after diagnosis. However, diagnosis and treatment are difficult due to the wide variety of body areas which can be affected. Also, RSDS can easily be misdiagnosed as a nerve injury which is characterized by similar painful symptoms. (For more information on this disorder, choose "RSDS" as your search term in the Rare Disease Database.)
Guillain-Barre Syndrome occurs when the body's defense system against disease (e.g., antibodies or lymphocytes) attacks the nerves, damaging the nerve's myelin and axon. Nerve signals are delayed and altered, causing weakness and paralysis of the muscles of the legs, arms, and other parts of the body along with abnormal sensations. (For more information on this disorder, choose "Guillain-Barre" as your search term in the Rare Disease Database.)
Major symptoms of Carpal Tunnel Syndrome include a sensation of numbness, tingling, burning and/or slight pain in the hand and wrist. This sensation can be temporary at first, later becoming chronic. It can cause patients to awaken during the night. Left untreated, muscle atrophy in the hand may develop. Symptoms may become worse with activities that require wrist flexing or prolonged gripping such as hammering or driving for long periods of time. Carpal Tunnel Syndrome is a very prevalent disorder that can be treated through weight loss, hand splints or surgery. (For more information on this disorder, choose "Carpal Tunnel" as your search term in the Rare Disease Database.)
Standard Therapies
The usual pain medications, whether taken alone or in combination with stronger painkillers such as codeine, are of limited value.
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Investigational Therapies
Surgical procedures to affect lesions may interrupt the sensory pathway from the brain and help decrease pain without affecting sensory ability. Some patients may be able to experience touch without feeling pain or discomfort after surgical treatment. More experience is needed to determine the long-term efficacy of various surgical procedures.
The antiepileptic drug gabapentin has been used on an experimental basis in the treatment of Thalamic Syndrome. Some antidepressants have also been tried. In each case, more and better clinical trials are required to determine the long-term efficacy and safety of these drugs in the treatment of this disorder.
References
TEXTBOOK
Adams RD, Victor M, Ropper AA. Eds. Principles of Neurology. 6th ed. McGraw-Hill Companies. New York, NY; 1997.
REVIEW ARTICLES
Chuang C, Fahn S, Frucht SJ. The natural history and treatment of acquired hemidystonia: report of 33 cases and review of the literature. J Neurol Neurosurg Psychiatry. 2002;72:59-67.
Karussis D, leker RR, Abramsky O. Cognitive dysfunction following thalamic stroke: a study of 16 cases and review of the literature. J Neurol Sci. 2000;172:25-29.
JOURNAL ARTICLES
Krageloh-Mann I, Helber A, Mader I, et al. Bilateral lesions of thalamus and basal ganglia: origin and outcome. Dev Med Child Neurol. 2002;44:477-84.
Dagenbach D, Kubat-Silman AK, Absher JR. Human verbal working memory impairments associated with thalamic damage. Int J Neurosci. 2001;111:67-87.
Exner C, Weniger G, Irle E. Implicit and explicit memory after focal thalamic lesions. Neurology. 2001;57:2054-63.
Lehericy S, Grand S, Pollack P, et al. Clinical characteristics and topography of lesions in movement disorders due to thalamic lesions. Neurology. 2001;57:1055-66.
Michael GA, Boucart M, Degreef JF, et al. The thalamus interrupts top-down attentional control for permitting exploratory shifting to sensory signals. Neuroreport. 2001;12:2041-48.
Ganzales GR, Lewis SA, Weaver AL. Tactile illusion perception in patients with central pain. Mayo Clin Proc. 2001;76:267-74.
Lee MS, Kim YD, Yang JW, et al. Clinical and anatomical factors associated with thalamic dyskinesias. J Neurol Sci. 2001;182:137-42.
Ohno T, Bando M, Nagura H, et al. Apraxic agraphia due to thalamic infarction. Neurology. 2000;54:2336-39.
FROM THE INTERNET
Pathak M. Thalamic Pain Syndrome. nd. 3pp. www.strokesafe.org/resources/thalamic_pain_syndrome.html
Wozny KH. Central Pain Syndrome. nd. 2pp. www.centralpain.org/index.html
Thalamic Pain. Nd 3pp. www.strokesupport.org/resources/centralpain/faq.htm
[This message has been edited by Areneli (edited 13 February 2005).]