Bilateral motor cortex disinhibition in complex regional pain syndrome (CRPS) type I of the hand

Krause, Phillip; Foerderreuther, S.; Straube, Andreas

doi:10.1212/wnl.62.9.1654

Cited by 17 publications

(15 citation statements)

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“…In withdrawal reflexes, flexor muscles play a prominent role, and interestingly, in dystonia of CRPS there is a conspicuous involvement of flexor postures, which may hint towards the involvement of spinal motor programs that mediate NWRs [15]. Neurophysiological studies have shown that central disinhibition is a key characteristic of central nervous system involvement in CRPS patients with and without dystonia [28–31]. Both SP‐sensitized NWRs in animal models and dystonia in CRPS patients respond to baclofen, a gamma‐aminobutyric acid (GABA) B receptor agonist which enhances spinal GABA‐ergic inhibition on neurons of the spinal cord [32,33].…”

Section: Mds In Crps: Mechanisms Of Diseasementioning

confidence: 99%

Movement Disorders in Complex Regional Pain Syndrome

Hilten

2010

Pain Med

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About 25% of the patients with complex regional pain syndrome (CRPS) suffer movement disorders, including loss of voluntary control, bradykinesia, dystonia, myoclonus, and tremor. These movement disorders are generally difficult to manage and add considerably to the disease burden. Over the last years, interesting findings have emerged that show how tissue or nerve injury may induce spinal plasticity (central sensitization), which alters sensory transmission and sensorimotor processing in the spinal cord and is associated with disinhibition. These changes, in turn, set the stage for the development of movement disorders seen in CRPS. There are no randomized control studies on the treatment of movement disorders in CRPS but findings from fundamental and clinical research suggest that strategies that enhance the central inhibitory state may benefit these patients.

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Section: Mds In Crps: Mechanisms Of Diseasementioning

confidence: 99%

Movement Disorders in Complex Regional Pain Syndrome

Hilten

2010

Pain Med

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“…Neurophysiological studies in patients with CRPS have found evidence of impaired inhibition at the spinal cord and motor cortex (Avanzino et al, 2008;Eisenberg et al, 2005;Krause et al, 2004;Schwenkreis et al, 2003;Van de Beek et al, 2002). Spinal interneuronal circuits mediating presynaptic and reciprocal inhibition have been implicated to play a role in CRPS-related dystonia (Van de Beek et al, 2002).…”

Section: Spinal Disinhibition / Hyperreflexiamentioning

confidence: 99%

Reflex Mechanisms in CRPS-Related Dystonia

Mugge

2018

Biosystems &Amp; Biorobotics

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“…Beim statistischen Vergleich dieser Differenzen zeigt sich ein signifikanter Unterschied (p=0,05) zwischen Aufteilung nach betroffener/nichtbetroffener Seite und gesunden Probanden sowie bei Aufteilung nach Händigkeit. Die Asymmetrie ist bei Aufteilung nach betroffener/nichtbetroffener Seite am ausgeprägtesten lang eine bilaterale Disinhibition im motorischen Kortex [24] und Reduktion der MEP-Amplituden [13]. Im sensorischen Kortex fanden sich unilaterale Verände-rungen der Handrepräsentation [11,16,21], wobei diskutiert wird, dass es zu einer schmerzinduzierten Zunahme der sensiblen Repräsentation kommt, welche möglicherweise über kortikale Interneurone hemmend auf den Motorkortex wirkt [11].…”

Section: Tab 2 Differenzen Zwischen Kortikaler Repräsentation Der Beunclassified

“…Dies zeigte sich nach künstlicher Schmerzreizung bei gesunden Probanden [14,23], aber auch bei Patienten mit unterschiedlichen Schmerzsyndromen [6,13,24]. Beim komplex regionalen Schmerzsyndrom Typ I (Typ I: ohne periphere Nervenläsion -CRPS I) stehen Schmerzen im Vordergrund [2], die den sog.…”

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“…Auch mit elektrophysiologischen Methoden, wie der transkraniellen Magnetstimulation (TMS), zeigten sich Verände-rungen der motorkortikalen Erregbarkeit bei CRPS-Patienten. Diese Veränderungen sind denen nach artifizieller Schmerzinduktion sehr ähnlich, sodass sich bilateral eine Abnahme der Amplitude des motorisch evozierten Potenzials (MEP) zeigte [13], jedoch auch eine motorkortikale Disinhibition [24] im betroffenen Kortex beschrieben werden konnte.…”

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Motorkortikale Repräsentation beim komplex regionalen Schmerzsyndrom Typ I

Krause

Förderreuther

Straube

2006

Schmerz

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In a group of patients with short- and long-term (chronic) duration of complex regional pain syndrome type I (CRPS I) motor cortical representation was determined, using a transcranial magnetic stimulation (TMS) mapping method. This was done, starting with suprathreshold intensities at the location of the largest MEP amplitude, mapping systematically in all directions. Patients were compared to a group of healthy subjects. In both patient groups we found significantly larger motor cortical representation for the unaffected hand muscles compared to the affected side. This asymmetry was absent in healthy subjects. Such motor cortical representation asymmetry can be considered an effect of altered sensomotor cortical representation. On the other hand, one must also consider the increased use of the unaffected hand and the presence of pain as cortical influencing variables. The real cause must remain speculative at this time.

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Bilateral motor cortex disinhibition in complex regional pain syndrome (CRPS) type I of the hand

Cited by 17 publications

References 2 publications

Movement Disorders in Complex Regional Pain Syndrome

Movement Disorders in Complex Regional Pain Syndrome

Reflex Mechanisms in CRPS-Related Dystonia

Motorkortikale Repräsentation beim komplex regionalen Schmerzsyndrom Typ I

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