"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

• Phillip Krause
, 
• Stefanie Förderreuther
, 
• Andreas Straube

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 

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Nolan laughing...

Nolan's mother Brittany wrote:

A few years ago Nolan was laughing hysterically on the couch and I couldn't help but think I better catch this on video. What if he looses his ability to laugh one day? I found it today. With tears streaming down I just listened to it over and over… I miss the sweet sound of his voice.
Brain tumors can take away your ability to walk, talk, eat, show emotions, smile, laugh and the list goes on…

Nolan is not doing well, so laugh for him today, send a good thought, send a prayer.  He and Brayden Martin are good buddies.

Nolan Blake, April 27, 2014

Brayden Martin and Nolan Blake
April 2014

First in, last out

Thanks to Carol for sharing this...

Now, please, just sit back, take a deep breath, and spend 6 minutes being amazed.  Don't be snarky, smart, or even all grown up.  Just be amazed.

Plucky little bastards.  Good luck!

Because Fred and I were discussing whether Kurt Vonnegut may or may not have been the reincarnation of Mark Twain, a whole series of Vonnegut quotes seem appropriate, of a sudden.  For the turtles, for me, for Fred, for you.

"Peculiar travel suggestions are dancing lessons from God."

"Many people need desperately to receive this message: 'I feel and think much as you do, care about many of the things you care about, although most people do not care about them. You are not alone.'"

"I urge you to please notice when you are happy, and exclaim or murmur or think at some point, 'If this isn't nice, I don't know what is.'"

But most of all:

“Hello babies. Welcome to Earth. It's hot in the summer and cold in the winter. It's round and wet and crowded. On the outside, babies, you've got a hundred years here. There's only one rule that I know of, babies-"God damn it, you've got to be kind.”

"but oh, that magic feeling, nowhere to go..."

i'm boring you with another repost of the past glorious because... the title song has been circling 'round my cerebral marquee all day, being the song to which i woke.  yes, the irony -- and you know the irony rule.  

no, not "irony rules!" -- jeez.

rather: "share the irony!" -- duh.

originally published 28 february 2011, just prior to beginning ketamine subanesthetic infusions. "oh, that magic feeling, nowhere to go..." i must have had some foreboding of the proverbial k-hole to come.

I have decided not to be ashamed of my behavior today.  There's nothing to be gained from such shame.

Honestly, the reasons for my outbursts aren't clear, even to me.  Stress, pain, blahblah?  It's likely that I've maxed those accounts out long ago.  There is no further purchase to be had from tired woes.

It started in the elevator, as these things do.

Giggle.

No, it started promptly at 4 am -- as Fred came to bed, I rose.  Sleep hadn't put in an appearance, though I had drifted near a nightmare.  I have had nightmares for the last four or five nights -- real ones, the kind that leave you dripping with sweat, heart pounding, images runningdancingjumping left-to-right and back, fast.  My response is automatic, as much an echo as the dying scream I imagine hearing fade through the cracked bedroom door, slipping quickly around the corner into my office and hiding, crouching behind the freeform green rocking chair that Fred once said frightened him.  ("Can we get rid of that rocker?  It scares me.") (I am still so very sorry to have laughed.  He was very serious.)

The first night of mares had me shouting "I don't know where I am!" --
The second night, I queried, "What is that?" (pointing to a shadow on the ceiling)
The third night I don't remember any words, just a bunch o'guttural goo and a whistle.
Last night -- emphasis on speed -- "I-don't-think-so-I-don't-think-so..." (wherever I was, I was lost)

There's a theme.  It's facile.  Boring, even.

It's the first week off of antibiotics in a month and darned if I don't think these things are related to a resurgence of those feisty bone-smacking bacteria sorts, those pestilent punks.

So, anyway, restorative sleep continues to be a mythic thing.  As Fred faded, I shifted gears and pretended the things I did in that darkling time were important.  The kibble bowls needed scrubbing, the rosemary trimming, online bills scheduling, biscuits a gentle touch -- Nephews needed birthday checks, brothers an unexpected kind word, strange and cancered children prayers.

I finally got myself a Laughing Buddha -- it's been a lifelong desire -- and I do not fail to rub His Belly in these chiaroscuro mornings.  Dobby the Runt Cat rides my lap, leaning into the wind kicked up by this speeding wheelchair, nose raised to the unknown, looking like nothing so much as a faithful dog.  He goes eyeball-to-eyeball with the smiling Buddha and does not blink first.  He's a remarkable cat and loves these early hours.

By the way, if anyone knows how to train a cat to modulate his voice... I need suggestions.  Dobby has adopted a permanent scream that is grating, that flails strips of inner ear and takes tiny melon balls of brain matter... It's truly awful and we don't know exactly when or why it began.  He wants something, desperately, but after checking on hunger and thirst, general comfort, humidity levels, belly rubs and fanny whacks, and yes, even laser lights, we are left with what we had -- a cat that levels an intensely meaningful gaze within a strangely wizened little face, then screams.

I wanted Fred to sleep as long as possible before we had to head out for my ophthalmologist's office, a good 40 minutes of Tête de Hergé highway away. 

Two weeks ago, I reintroduced myself to the good EyeMan, I, the errant glaucoma patient having gone missing due to distraction and a lack of insurance.  Nonetheless, I kept up the eyedrop regime and kind of enjoyed the respite from appointment upon appointment. 

Of course, I was also losing vision, a distressing thing.  It turned out I have cataracts in both eyes and -- much more importantly -- out of control eye pressures, despite the medication.

So he fiddled with the eyedrop prescription and had me back today for a visual field test and another pressure check. 

To get there, of course, we rode in red, red Ruby.
As he and his colleagues are hunkered down on the eighth floor, we took the elevator up.
I don't often board elevators that are full, preferring not to risk being touched.  You'd be amazed at the number of people who think a wheelchair is an invitation to pat a shoulder (oy! always the shoulder!) or to reach down to my sorry knobby knee, all the while speaking to whomever serves as that day's Gimp Escort, because the person in the chair could not possibly have higher brain function.

But I did today.  Get on a crowded elevator -- in case you lost track of the relevant antecedent.

And sat staring into what amounted to a huge mirror as we stopped on every floor.

It wasn't that I did not recognize myself.  I'd know those small, beady, darting eyes anywhere.

But... what happened?  Where did my face go?  When was I smushed down, squashed, and caricatured as an unfinished lumpy dough, resting between rises?  Cast blame on steroids, on a cushingoid effect, on collapsing joints and bones, on a lack of regular tennis and even fewer occasions for a morning run.

So, of course, right there in the blasted reflecting elevator car, I started to cry.  Thankfully, no one noticed, we made it unperturbed to the mighty eighth floor, I had the VF test, and was escorted to an exam room, where I promptly pissed everyone off.  Last visit, I transferred easily from wheelchair to their exam chair, then watched as the nurse laughingly drove my chair into a wall.  "Ooops!  I wish I had me one of these..."

Today, I was dizzy, febrile, and had recently wept.  No question but I was staying put.  The exam chairs slide out of the way very easily and the doctor, I knew from past visits, didn't mind at all.  But the nurse pursed her badly colored lips, went "tsk tsk tsk," and then huffed and puffed her way to a gathering of nurse-types in the hall, where she proceeded to "tsk tsk tsk" with renewed vigor.

Fuck 'er, I say.

And cried while I waited for The EyeMan.

Last time, both eyes were 30, I think.  Today, 29 in the left and 31 in the right.  Actually, I might have that mixed up.  So he added another medication -- and back I will go in a month.  We've picked up right where we left off, he and I.  A regular dance.

The new drops sting and blur my vision.  I threw the package insert away when I saw the prodigious number of side effects. 

Oh, and I cried some more on the way home, but at least had recourse to a pair of dark glasses and a driver distracted by squirrelly traffic.

Thursday looms large, as do my hopes for it.  There is, I think, a psych evaluation necessary for the ketamine infusions, so I'd best quit this bursting into tears business immediately.

Once there was a way to get back homeward

Once there was a way to get back home

Sleep pretty darling do not cry

And I will sing a lullabye

Golden slumbers fill your eyes

Smiles awake you when you rise

Sleep pretty darling do not cry

And I will sing a lullabye

Once there was a way to get back homeward

Once there was a way to get back home

Sleep pretty darling do not cry

And I will sing a lullabye