Bilateral painful hand-moving fingers: Electrophysiological assessment of the central nervous system oscillator

Jabbari, Bahman; Molloy, Fiona; Erickson, Marleigh E.; Floeter, Mary Kay

doi:10.1002/1531-8257(200011)15:6<1259::aid-mds1032>3.0.co;2-5

Cited by 18 publications

(10 citation statements)

References 14 publications

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“…1 Since then, few cases have been reported, generally in patients with peripheral nerve, plexus, or root disease. [2][3][4] Deep aching or pulling pain often precedes movements by several months. Involuntary movements are composed of complex sequences of flexion/extension and abduction/adduction, which cannot be imitated.…”

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confidence: 99%

“…10 It gained support from experimental data that showed changes in the pattern of neuronal activation after peripheral nerve injury to happen anywhere along the sensory pathways, from the dorsal horn to the somatosensory cortex. However, other authors have advocated supraspinal mechanisms 4 or the combination of both central and peripheral lesions. 2 In our patient, a central mechanism is strongly supported by the different levels of afferent (median nerve, roots C6 and C7) and efferent (radial and ulnar nerves, roots C7 to T1) pathways, along with the delay of several months between trauma and occurrence of symptoms.…”

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Transcranial cerebral herniation after chronic subdural hematoma treatment with no dura closure

Doglietto¹,

Sabatino²,

Policicchio³

et al. 2006

Neurology

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Abstract-The authors report a patient with unilateral painful hand and moving finger in whom tactile stimulation interrupted both the movement and the pain. This effect suggests a gating mechanism at a segmental level. The difference between afferent and efferent pathway levels and the delay of several months between trauma and occurrence of symptoms support a central mechanism, most probably involving sensorimotor reorganization at a segmental level. NEUROLOGY 2006;67:491-493 C. Wider, MD; T. Kuntzer, MD; P. Olivier, MD; D. Debatisse, MSc; R. Nançoz, MD; P. Maeder, MD; J. Bogousslavsky, MD; and F. Vingerhoets, MD Painful hand and moving fingers (PHMF) was first described in 1985 in a patient suffering from radiation-induced brachial plexopathy, with pain and movements of all fingers. 1 Since then, few cases have been reported, generally in patients with peripheral nerve, plexus, or root disease.2-4 Deep aching or pulling pain often precedes movements by several months. Involuntary movements are composed of complex sequences of flexion/extension and abduction/adduction, which cannot be imitated. Treatment is unsatisfactory. Similar symptoms occur in the inferior limb in the much more common syndrome of painful legs and moving toes (PLMT). 5,6 We report a patient with unilateral PHMF after median nerve lesion in whom tactile stimulation in the same territory simultaneously interrupted both the movement and the pain.Case report. A 55-year-old woman was referred to our center for pain and movement in the left hand. Two years before, she had suffered traumatic fracture of the left distal part of the radius bone. After conservative treatment, she developed continuous pain, hyperalgesia, and sudomotor changes and was diagnosed with complex regional pain syndrome (CRPS), treated by pamidronate and calcitonin for 2 years. She reported no abnormal movement. Nine months before our evaluation, she had median nerve surgical decompression of the carpal tunnel. Two months later, she developed involuntary movement of the third left finger, followed after another 2 months by sharp pain in the hand with third finger predominance. Upon notice that it would help both the pain and the movement, she started wearing a glove.Physical examination showed continuous involuntary pseudorhythmic and rapid movements of the third left finger, at a frequency of 3 to 5 Hz, with predominance of flexion/extension but with some abduction/adduction component that sometimes gave it a rotating aspect (see video, segment 1 on the Neurology Web site at www.neurology.org). The patient could not willingly stop the movement, nor would contralateral action either reduce or increase it. Tactile stimulation of the palmar aspect of the first to third fingers immediately, simultaneously, and completely stopped both the movement and the pain (video, segment 2), as would pinprick and fork application. In contrast, stimulation outside the median territory on the internal aspect of the hand or on the dorsal aspect of the fingers did not affect either the moveme...

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Transcranial cerebral herniation after chronic subdural hematoma treatment with no dura closure

Doglietto¹,

Sabatino²,

Policicchio³

et al. 2006

Neurology

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“…A significant majority of these patients have a history of damage to the peripheral nervous system (peripheral nerve, plexus, root) preceding the onset of involuntary limb movements/pain by months or years. However, there is evidence for central mechanisms based on electrophysiology and the clinical course; for example, similar movements may develop in the contralateral leg 67,68. Movements are semi-rhythmic and irregular and EMG often shows periodic discharges similar to myokymia 67.…”

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confidence: 99%

History of Botulinum Toxin Treatment in Movement Disorders

Jabbari

2016

Tremor and Other Hyperkinetic Movements

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“…In a study on a single patient (22) kinesiologic electromyography suggested a common central oscillator for finger movements in bilateral PLME. Electrophysiological assessment of spinal alpha motor neuron excitability, reciprocal inhibition, and Renshaw cell inhibition failed to show any abnormalities.…”

Section: Etiology Of Plmementioning

confidence: 98%

“…Only a few cases of PLME have been described in the upper limb, including cases involving both hand and foot (3, 13, 17, 18, 19, 20, 22, 23). Painless arms/moving fingers (PAMF) is a rare variant of the PLME syndrome characterized by slow involuntary movements of the fingers in the absence of pain (20).…”

Section: Clinical Phenotypes Of Plmtmentioning

confidence: 99%

Painful limbs/moving extremities

Papapetropoulos¹

2008

Acta Neurol Scand

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Painful limbs/moving extremities (PLME) is a disorder characterized by spontaneous, complex, slow (1-2 Hz) involuntary toe or finger movements. The movements that can be bilateral or unilateral are usually accompanied by pain in the affected limbs. Painless variants are less common. PLME has been associated with peripheral and central nervous system disease although idiopathic cases have been reported. Its etiopathogenesis is unknown and treatment approaches remain largely empirical. Nerve blocks and botulinum toxin type A injections as well as oral medication have had some measure of success. Current theories suggest that central oscillator(s) at the spinal or supraspinal levels may be involved. Future research in PLME should include prospective electrophysiological and functional imaging studies as well as clinical trials with botulinum toxin injections and oral pharmacological agents.

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Bilateral painful hand-moving fingers: Electrophysiological assessment of the central nervous system oscillator

Cited by 18 publications

References 14 publications

Transcranial cerebral herniation after chronic subdural hematoma treatment with no dura closure

Transcranial cerebral herniation after chronic subdural hematoma treatment with no dura closure

History of Botulinum Toxin Treatment in Movement Disorders

Painful limbs/moving extremities

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