Somatosensory Abnormalities, Dysesthesia and Central Neuropathic Pain in Youth With Cerebral Palsy

Pain is common in people with cerebral palsy. Despite the presence of central nervous system injury, it is unknown whether central neuropathic pain occurs in cerebral palsy and whether unpleasant, abnormal sensations such as dysesthesia are present. The study aims to examine the presence of sensory abnormalities and neuropathic pain in youth with cerebral palsy and relate these findings to specific brain injuries.

This cross-sectional observational study examines 27 ambulant youth with cerebral palsy and 48 healthy controls aged 15-22 using structured interviews, detailed bedside examinations, laser evoked potentials, quantitative sensory testing and MRI.

The prevalence of self-reported sensory abnormalities in the cerebral palsy group was lower than found using bedside sensory mapping (41% vs. 74%, p = 0.003) and quantitative sensory testing (41% vs. 70%, p = 0.021). Furthermore, three had evoked dysesthesia. Ongoing or recurrent pain occurred in 70% of youth with cerebral palsy, without evidence of central neuropathic pain. The relative risk of having sensory loss was 3.2 (95% CI 1.47-7.00) when an injury to the spinothalamic tract, thalamus, insula, or somatosensory cortex was present, while the relative risk of sensory gain was 5.3 (95% CI 0.78-35.85) with the presence of white matter injury from periventricular leucomalacia.

We recommend addressing sensory function and dysesthesia in future studies and cerebral palsy follow-up programs. Brain injury patterns may predict sensory loss or gain and distinct somatosensory topographies could clarify these mechanisms. These insights may enable earlier identification of sensory abnormalities in cerebral palsy.

1) This study highlights the high prevalence yet underrecognition of sensory abnormalities and pain in individuals with cerebral palsy. 2) It explores the subjective experience and perception of sensory abnormalities and is the first to identify and characterize dysesthesia in this population. 3) The findings demonstrate that pain is common among young, ambulant individuals with cerebral palsy; however, central neuropathic pain appears to be absent despite underlying central nervous system injury.