Tuesday, May 6, 2014

"TMS motor cortical brain mapping in patients with complex regional pain syndrome type I"

from the Journal of Neurophysiology:
"Habenula functional resting-state connectivity in pediatric CRPS"


This is exciting.  I wish more mapping of people with CRPS [including Type 2, for those of us who have both] were being done.  Perhaps it will be a growing sector in the research.

Even though this dates from 2006 (Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology [2006, 117(1):169-176]), it's new to me.  Forgive me if it's old news to you!

These scientists are located in Munich and limited their look to people with one hand/arm involvement. That's how this will have to progress for good science, I suppose, limiting the study, enhancing its specificity.

[I will momentarily bring us all down by noting a meta review article published in the Journal of Pain late last year.  It, too, is obviously worth reading.  The underlying complaint is familiar -- and explicable -- and that is that the cohorts were too small, the risk of bias is too high.  My knee-jerk reaction is that it is nigh unto impossible to assemble a sufficient number of CRPS patients to satisfy the stringent requirements necessary to good, repeatable studies.]

One fine day ("a perfect day for bananafish," at the rate this gimp is going), my cheapo-cheapo no-contract disposable flip phone will ring, anemically, and it will be the bestest CRPS researchers in the whole wide, wide, broad world, asking to map my afflicted brain.  I imagine they'll faint straightaway at the sight of its shifty hemispheres and perverse lack of neuroplasticity.

Remind me, Dear Readers (especially you, Beloved TW) to rain down upon you the hilarious story of my first ever trip to the Emergency Room (or ED, if you're WhiteCoat) for PAIN, something I swore never to do.  Well, swearing is not eternally binding.  At least not according to Tête de Hergé statutes, all put on college-ruled paper by that recently deceased Law & Morals activist, Tante Louise, about ten years ago.  Before that, we were ruled by one of those Mosaic * type tablet thingies. Very heavy, burdensome to have copied, and therefore oft ignored -- but no longer!  It will soon be available online.  We expect a total reworking to surge from that publication of all Judeo-Christian Hammurabi sorts of statute code.

According to the Bible, there were two sets [of stone tablets]. The first, inscribed by God, were smashed by Moses when he was enraged by the sight of the Children of Israel worshiping the Golden Calf; and the second, later cut by Moses and rewritten by God.

I'll give you one of the funnier tidbits about the ER visit, just to tide you elle est belle la seine addicts over until I can fix you a fix:  The radiologist who tried to interpret the x-ray of my left shoulder (the punchline is that I do not HAVE a left shoulder) was valiant in his verbiage as he tried to describe what he saw, as he had never encountered a sentient being lacking a shoulder before... and the referring ER/ED doc forgot to warn him ahead of time.  It was an agonal effort, but hilarious.  

Right!  So!  This is exciting!  
TMS = Transcranial magnetic stimulation

TMS motor cortical brain mapping in patients with complex regional pain syndrome type I

Department of Neurology, University of Munich, Klinikum Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany



ABSTRACT

OBJECTIVE: The motor cortical representation in patients with complex regional pain syndrome type I (CRPS I) was determined under the assumption that the motor cortex undergoes representational adaptations in the course of CRPS.


METHODS: A total of 14 patients with CRPS I and a group of healthy subjects without any known neurological symptoms participated in the study. The motor cortical representation, i.e. the size of representation (cm2), motor-evoked potentials (MEP), the calculated volume (cm2 mV), and the center of gravity (CoG) were measured by transcranial magnetic stimulation. Recordings were made of the long extensor muscles of the forearm of the affected and unaffected hand.

RESULTS: Analyses of the results revealed a significant asymmetry between the two hemispheres: the motor cortical representation corresponding to the unaffected hand was significantly larger. While the CoG data did not differ statistically between the two hemispheres, the CoG coordinates corresponding to the affected hand indicated a larger variability.

CONCLUSIONS: The presence of pain and other CRPS symptoms may induce lasting changes in motor cortical plasticity, as it also does in the sensory cortex.

SIGNIFICANCE: This could be of importance in rehabilitative strategies for the sensory motor system in CRPS I patients.
As I cannot access the article in its entirety from the journal Clinical Neurophysiology due to a scarcity of funds, below please put to good use the references employed in the article -- always a source of gems for background study and getting a better foundation for understanding the work, and its orientation or biases. Giving it a cursory glance, I see well-known, trustworthy, and up-to-date (for its time) sourcing.  As in, no evidence of that Turd, Ochoa, for instance.  It's a Turd Free Zone.

I don't know if I've mentioned it or not, but searchable data from was recently released by NIH listing grant fund recipients and it was appalling to see the amount of money The Turd & his Oregon associates have pilfered.

Appalling, I said.
Money that could have fed hungry people, helped sick people, protected the environment, and provided for finely-targeted extra-judicial executions by drone.  Oregonians, as a whole, are a marvelous group of non-turdish people, and so one would have to be exquisitely precise in the deployment of those drones...

Right!  So!  This is exciting! Put on your slippers and your reading glasses, brew a cuppa, and get to work understanding how TMS motor cortex brain mapping is done and why it matters for CRPS research. Fun,fun, fun!



References 

  1. Amunts K, Jancke L, Mohlberg H, Steinmetz H, Zilles KInterhemispheric asymmetry of the human motor cortex related to handedness and gender. Neuropsychologia2000;38(3):304–312
  2. Birklein FComplex regional pain syndrome. J Neurol2005;252(2):131–138
  3. Bruehl S, Harden RN, Galer BS, Saltz S, Bertram M, Backonja M, et alExternal validation of IASP diagnostic criteria for complex regional pain syndrome and proposed research diagnostic criteria. International Association for the Study of Pain. Pain.1999;81(1–2):147–154
  4. Butefisch CM, Davis BC, Wise SP, Sawaki L, Kopylev L, Classen J, et alMechanisms of use-dependent plasticity in the human motor cortex. Proc Natl Acad Sci USA2000;97(7):3661–3665
    • Butefisch CM, Davis BC, Sawaki L, Waldvogel D, Classen J, Kopylev L, et alModulation of use-dependent plasticity by d-amphetamine. Ann Neurol2002;51(1):59–68
    • Cahn SD, Herzog AG, Pascual-Leone APaired-pulse transcranial magnetic stimulation: effects of hemispheric laterality, gender, and handedness in normal controls. J Clin Neurophysiol2003;20(5):371–374
    • Cheong JY, Yoon TS, Lee SJEvaluations of inhibitory effect on the motor cortex by cutaneous pain via application of capsaicin. Electromyogr Clin Neurophysiol2003;43(4):203–210
    • Cicinelli P, Traversa R, Bassi A, Scivoletto G, Rossini PMInterhemispheric differences of hand muscle representation in human motor cortex. Muscle Nerve1997;20(5):535–542
    • Classen J, Liepert J, Wise SP, Hallett M, Cohen LGRapid plasticity of human cortical movement representation induced by practice. J Neurophysiol1998;79(2):1117–1123
    • Cohen LG, Ziemann U, Chen R, Classen J, Hallett M, Gerloff C, et alStudies of neuroplasticity with transcranial magnetic stimulation. J Clin Neurophysiol1998;15(4):305–324
    • Delvaux V, Alagona G, Gerard P, De P V, Pennisi G, de Noordhout AMPost-stroke reorganization of hand motor area: a 1-year prospective follow-up with focal transcranial magnetic stimulation. Clin Neurophysiol2003;114(7):1217–1225
    • Dettmers C, Adler T, Rzanny R, van Schayck R, Gaser C, Weiss T, et alIncreased excitability in the primary motor cortex and supplementary motor area in patients with phantom limb pain after upper limb amputation. Neurosci Lett.2001;307(2):109–112
    • Fadiga L, Craighero L, Dri G, Facchin P, Destro MF, Porro CACorticospinal excitability during painful self-stimulation in humans: a transcranial magnetic stimulation study. Neurosci Lett2004;361(1–3):250–253
    • Farina S, Valeriani M, Rosso T, Aglioti S, Tamburin S, Fiaschi A, et alTransient inhibition of the human motor cortex by capsaicin-induced pain. A study with transcranial magnetic stimulation. Neurosci Lett2001;314(1–2):97–101
    • Flor H, Elbert T, Knecht S, Wienbruch C, Pantev C, Birbaumer N, et alPhantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature1995;375(6531):482–484
    • Flor H, Braun C, Elbert T, Birbaumer NExtensive reorganization of primary somatosensory cortex in chronic back pain patients. Neurosci Lett1997;224(1):5–8
    • Hallett MPlasticity of the human motor cortex and recovery from stroke. Brain Res Brain Res Rev2001;36(2–3):169–174
      • Hamdy S, Rothwell JC, Fraser C, Power M, Gow D, Thompson DGPatterns of excitability in human esophageal sensorimotor cortex to painful and nonpainful visceral stimulation. Am J Physiol Gastrointest Liver Physiol2002;282(2):G332–G337
      • Janig W, Baron RComplex regional pain syndrome is a disease of the central nervous system. Clin Auton Res.2002;12(3):150–164
      • Janig W, Baron RComplex regional pain syndrome: mystery explained?. Lancet Neurol2003;2(11):687–697
      • Juottonen K, Gockel M, Silen T, Hurri H, Hari R, Forss NAltered central sensorimotor processing in patients with complex regional pain syndrome. Pain2002;98(3):315–323
      • Kaelin-Lang A, Luft AR, Sawaki L, Burstein AH, Sohn YH, Cohen LGModulation of human corticomotor excitability by somatosensory input. J Physiol2002;540(Pt 2):623–633
      • Krause P, Foerderreuther S, Straube ABilateral motor cortex disinhibition in complex regional pain syndrome (CRPS) type I of the hand. Neurology2004;62(9):1654–1655
        • Krause P, Foerderreuther S, Straube A. Effects of conditioning peripheral repetitive magnetic stimulation in patients with complex regional pain syndrome. Neurol Res 2005;27(4):412–417.
          • Le Pera D, Graven-Nielsen T, Valeriani M, Oliviero A, Di L V, Tonali PA, et alInhibition of motor system excitability at cortical and spinal level by tonic muscle pain. Clin Neurophysiol2001;112(9):1633–1641
          • Maihofner C, Handwerker HO, Neundorfer B, Birklein FPatterns of cortical reorganization in complex regional pain syndrome.Neurology2003;61(12):1707–1715
            • Migita K, Uozumi T, Arita K, Monden STranscranial magnetic coil stimulation of motor cortex in patients with central pain.Neurosurgery1995;36(5):1037–1039
            • Miranda PC, de Carvalho M, Conceicao I, Luis ML, Ducla-Soares EA new method for reproducible coil positioning in transcranial magnetic stimulation mapping. Electroencephalogr Clin Neurophysiol1997;105(2):116–123
            • Murase N, Duque J, Mazzocchio R, Cohen LGInfluence of interhemispheric interactions on motor function in chronic stroke. Ann Neurol2004;55(3):400–409
            • Oldfield RCThe assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia1971;9(1):97–113
            • Pascual-Leone A, Torres FPlasticity of the sensorimotor cortex representation of the reading finger in Braille readers.Brain1993;116(Pt 1):39–52
              • Pleger B, Tegenthoff M, Schwenkreis P, Janssen F, Ragert P, Dinse HR, et alMean sustained pain levels are linked to hemispherical side-to-side differences of primary somatosensory cortex in the complex regional pain syndrome I. Exp Brain Res2004;155(1):115–119
              • Pleger B, Janssen F, Schwenkreis P, Volker B, Maier C, Tegenthoff MRepetitive transcranial magnetic stimulation of the motor cortex attenuates pain perception in complex regional pain syndrome type I. Neurosci Lett2004;356(2):87–90
              • Pleger B, Tegenthoff M, Ragert P, Forster AF, Dinse HR, Schwenkreis P, et alSensorimotor returning in complex regional pain syndrome parallels pain reduction. Ann Neurol2005;57(3):425–429
              • Priori A, Oliviero A, Donati E, Callea L, Bertolasi L, Rothwell JCHuman handedness and asymmetry of the motor cortical silent period. Exp Brain Res1999;128(3):390–396
              • Romaniello A, Cruccu G, McMillan AS, Arendt-Nielsen L, Svensson PEffect of experimental pain from trigeminal muscle and skin on motor cortex excitability in humans. Brain Res2000;882(1–2):120–127
              • Rossi S, Rossini PMTMS in cognitive plasticity and the potential for rehabilitation. Trends Cogn Sci2004;8(6):273–279
              • Sanes JN, Donoghue JPPlasticity and primary motor cortex. Annu Rev Neurosci2000;23:393–415
              • Schwenkreis P, Janssen F, Rommel O, Pleger B, Volker B, Hosbach I, et alBilateral motor cortex disinhibition in complex regional pain syndrome (CRPS) type I of the hand. Neurology2003;61(4):515–519
                • Schwenkreis P, Maier C, Tegenthoff MFluctuations of motor cortex excitability in pain syndromes. Suppl Clin Neurophysiol.2003;56:394–399
                • Siebner HR, Rothwell JTranscranial magnetic stimulation: new insights into representational cortical plasticity. Exp Brain Res2003;148(1):1–16
                • Soros P, Knecht S, Bantel C, Imai T, Wusten R, Pantev C, et alFunctional reorganization of the human primary somatosensory cortex after acute pain demonstrated by magnetoencephalography. Neurosci Lett2001;298(3):195–198
                • Thickbroom GW, Byrnes ML, Mastaglia FLA model of the effect of MEP amplitude variation on the accuracy of TMS mapping.Clin Neurophysiol1999;110(5):941–943
                • Ziemann U, Lonnecker S, Steinhoff BJ, Paulus WEffects of antiepileptic drugs on motor cortex excitability in humans: a transcranial magnetic stimulation study. Ann Neurol1996;40(3):367–378
                • Ziemann U, Corwell B, Cohen LGModulation of plasticity in human motor cortex after forearm ischemic nerve block. J Neurosci1998;18(3):1115–1123

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