Remote activation of referred phantom sensation and cortical reorganization in human upper extremity amputees

Grüsser, Sabine M.; Mühlnickel, Werner; Schaefer, Michael; Villringer, Kersten; Christmann, Christoph; Koeppe, Caroline; Flor, Herta

doi:10.1007/s00221-003-1649-4

Cited by 71 publications

(50 citation statements)

References 31 publications

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“…It was later shown that referred sensations such as those described by Ramachandran et al (25) can also be elicited from areas far removed from the amputated limb, for example from the foot in arm amputees. This led to the conclusion that alterations in the organisation of S1 -where arm and foot are represented far apart -are most likely not the neuronal substrate of referred phantom sensations (29,30). Similar results were obtained when the motor cortex was investigated.…”

Section: Phantom Limb Pain and Cortical Reorganisationsupporting

confidence: 76%

Cortical reorganisation and chronic pain: implications for rehabilitation

Flor¹

2003

Journal of Rehabilitation Medicine

269

156

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Recent neuroscientific evidence has revealed that the adult brain is capable of substantial plastic change in such areas as the primary somatosensory cortex that were formerly thought to be modifiable only during early experience. These findings have implications for our understanding of chronic pain. Functional reorganisation in both the somatosensory and the motor system was observed in neuropathic and musculoskeletal pain. In patients with chronic low back pain and fibromyalgia the amount of reorganisational change increases with chronicity; in phantom limb pain and other neuropathic pain syndromes cortical reorganisation is correlated with the amount of pain. These central alterations may be viewed as pain memories that influence the processing of both painful and nonpainful input to the somatosensory system as well as its effects on the motor system. Cortical plasticity related to chronic pain can be modified by behavioural interventions that provide feedback to the brain areas that were altered by somatosensory pain memories or by pharmacological agents that prevent or reverse maladaptive memory formation.

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Section: Phantom Limb Pain and Cortical Reorganisationsupporting

confidence: 76%

Cortical reorganisation and chronic pain: implications for rehabilitation

Flor¹

2003

Journal of Rehabilitation Medicine

269

156

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“…Since the demonstration of cortical somatosensory map reorganization in peripherally deafferented adult primates (Merzenich et al, 1984;Pons et al, 1991) and rats Sanes et al, 1990), attention was turned to mechanisms that could explain phantom sensations in humans, presuming that they might be perceptual correlates of cortical reorganization after amputation (Ramachandran et al, 1992;Flor et al, 1995;Montoya et al, 1997;Grüsser et al, 2004). Most studies in upper limb amputees with phantom pain claim that it would be a correlate of functional remapping within the deafferented cortex (Ramachandran, 1993;Birbaumer et al, 1997;Borsook et al, 1998;Flor et al, 1998;Montoya et al, 1998;Lotze et al, 1999;Dettmers et al, 2001;Grüsser et al, 2001;Karl et al, 2001;Lotze et al, 2001;MacIver et al, 2008).…”

Section: Functional Reorganization Related To Nonpainful Phantom Phenmentioning

confidence: 99%

Functional Expansion of Sensorimotor Representation and Structural Reorganization of Callosal Connections in Lower Limb Amputees

Simões¹,

Bramati²,

Rodrigues³

et al. 2012

J. Neurosci.

110

117

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Previous studies have indicated that amputation or deafferentation of a limb induces functional changes in sensory (S1) and motor (M1) cortices, related to phantom limb pain. However, the extent of cortical reorganization after lower limb amputation in patients with nonpainful phantom phenomena remains uncertain. In this study, we combined functional magnetic resonance (fMRI) and diffusion tensor imaging (DTI) to investigate the existence and extent of cortical and callosal plasticity in these subjects. Nine "painless" patients with lower limb amputation and nine control subjects (sex-and age-matched) underwent a 3-T MRI protocol, including fMRI with somatosensory stimulation. In amputees, we observed an expansion of activation maps of the stump in S1 and M1 of the deafferented hemisphere, spreading to neighboring regions that represent the trunk and upper limbs. We also observed that tactile stimulation of the intact foot in amputees induced a greater activation of ipsilateral S1, when compared with controls. These results demonstrate a functional remapping of S1 in lower limb amputees. However, in contrast to previous studies, these neuroplastic changes do not appear to be dependent on phantom pain but do also occur in those who reported only the presence of phantom sensation without pain. In addition, our findings indicate that amputation of a limb also induces changes in the cortical representation of the intact limb. Finally, DTI analysis showed structural changes in the corpus callosum of amputees, compatible with the hypothesis that phantom sensations may depend on inhibitory release in the sensorimotor cortex.

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“…On the other hand, it is widely considered that somatotopic reorganization is an essential element for phantom referred sensation that can often be induced by tactile stimulation on particular body parts in the amputees (e.g., tactile stimulation on the face induces abnormal sensations on the lost arm/fingers; Ramachandran and Hirstein, 1998). It is thought that peripheral nerve injury causes a contamination of ectopic afferent information in the somatosensory afferent pathway; the abnormal mismatch between incoming and outgoing somatotopic information in the CNS results in distorting perception of own body images, leading to the phantom sensation (Kew et al, 1997; Davis et al, 1998; Grüsser et al, 2004; Flor et al, 2006). In the somatosensory thalamus, microstimulation of the VPL in the amputees whose thalamic receptive fields are largely reorganized can induce phantom sensations (Davis et al, 1998).…”

Section: Discussionmentioning

confidence: 99%

Afferent Fiber Remodeling in the Somatosensory Thalamus of Mice as a Neural Basis of Somatotopic Reorganization in the Brain and Ectopic Mechanical Hypersensitivity after Peripheral Sensory Nerve Injury

Takeuchi¹,

Osaki²,

Yagasaki³

et al. 2017

eNeuro

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Plastic changes in the CNS in response to peripheral sensory nerve injury are a series of complex processes, ranging from local circuit remodeling to somatotopic reorganization. However, the link between circuit remodeling and somatotopic reorganization remains unclear. We have previously reported that transection of the primary whisker sensory nerve causes the abnormal rewiring of lemniscal fibers (sensory afferents) on a neuron in the mouse whisker sensory thalamus (V2 VPM). In the present study, using transgenic mice whose lemniscal fibers originate from the whisker sensory principle trigeminal nucleus (PrV2) are specifically labeled, we identified that the transection induced retraction of PrV2-originating lemniscal fibers and invasion of those not originating from PrV2 in the V2 VPM. This anatomical remodeling with somatotopic reorganization was highly correlated with the rewiring of lemniscal fibers. Origins of the non-PrV2-origin lemniscal fibers in the V2 VPM included the mandibular subregion of trigeminal nuclei and the dorsal column nuclei (DCNs), which normally represent body parts other than whiskers. The transection also resulted in ectopic receptive fields of V2 VPM neurons and extraterritorial pain behavior on the uninjured mandibular region of the face. The anatomical remodeling, emergence of ectopic receptive fields, and extraterritorial pain behavior all concomitantly developed within a week and lasted more than three months after the transection. Our findings, thus, indicate a strong linkage between these plastic changes after peripheral sensory nerve injury, which may provide a neural circuit basis underlying large-scale reorganization of somatotopic representation and abnormal ectopic sensations.

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Remote activation of referred phantom sensation and cortical reorganization in human upper extremity amputees

Cited by 71 publications

References 31 publications

Cortical reorganisation and chronic pain: implications for rehabilitation

Cortical reorganisation and chronic pain: implications for rehabilitation

Functional Expansion of Sensorimotor Representation and Structural Reorganization of Callosal Connections in Lower Limb Amputees

Afferent Fiber Remodeling in the Somatosensory Thalamus of Mice as a Neural Basis of Somatotopic Reorganization in the Brain and Ectopic Mechanical Hypersensitivity after Peripheral Sensory Nerve Injury

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