| Disease duration | Pain often develops within the first 2-3 years of symptom onset, though it may precede the diagnosis |
| Motor phenotype | Patients with prominent dystonia and rigidity are more likely to experience pain |
| Underlying pathology | CBD pathology is more strongly associated with pain than PSP pathology when presenting as CBS[@clinical2020] |
| Age | Younger onset age may be associated with higher pain prevalence |
| Thalamic dysfunction | The thalamus serves as a critical relay for pain signals. Thalamic neurodegeneration in CBS may disrupt normal pain processing, leading to hyperexcitability |
| Cortical hyperexcitability | Motor cortex involvement in CBS extends to sensory processing areas, altering pain thresholds |
| Basal ganglia modulation | The basal ganglia participate in pain perception and modulation through connections with the thalamus and cortex |
| Databases | OMIMOrphanetClinicalTrialsPubMed |
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