Structural and functional motor cortex asymmetry in unilateral lower limb amputation with phantom limb pain.
Adult
Amputation, Surgical
Amputees
Brain Mapping
Cortical Excitability
/ physiology
Cross-Sectional Studies
Evoked Potentials, Motor
/ physiology
Female
Functional Laterality
/ physiology
Gray Matter
/ diagnostic imaging
Humans
Lower Extremity
/ physiopathology
Magnetic Resonance Imaging
Male
Middle Aged
Motor Cortex
/ diagnostic imaging
Phantom Limb
/ diagnostic imaging
Transcranial Magnetic Stimulation
Cortical mapping
Magnetic resonance imaging
Phantom limb pain
Journal
Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology
ISSN: 1872-8952
Titre abrégé: Clin Neurophysiol
Pays: Netherlands
ID NLM: 100883319
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
13
01
2020
revised:
27
04
2020
accepted:
01
06
2020
pubmed:
23
8
2020
medline:
27
5
2021
entrez:
23
8
2020
Statut:
ppublish
Résumé
The role of motor cortex reorganization in the development and maintenance of phantom limb pain (PLP) is still unclear. This study aims to evaluate neurophysiological and structural motor cortex asymmetry in patients with PLP and its relationship with pain intensity. Cross-sectional analysis of an ongoing randomized-controlled trial. We evaluated the motor cortex asymmetry through two techniques: i) changes in cortical excitability indexed by transcranial magnetic stimulation (motor evoked potential, paired-pulse paradigms and cortical mapping), and ii) voxel-wise grey matter asymmetry analysis by brain magnetic resonance imaging. We included 62 unilateral traumatic lower limb amputees with a mean PLP of 5.9 (SD = 1.79). We found, in the affected hemisphere, an anterior shift of the hand area center of gravity (23 mm, 95% CI 6 to 38, p = 0.005) and a disorganized and widespread representation. Regarding voxel-wise grey matter asymmetry analysis, data from 21 participants show a loss of grey matter volume in the motor area of the affected hemisphere. This asymmetry seems negatively associated with time since amputation. For TMS data, only the ICF ratio is negatively correlated with PLP intensity (r = -0.25, p = 0.04). There is an asymmetrical reorganization of the motor cortex in patients with PLP, characterized by a disorganized, widespread, and shifted hand cortical representation and a loss in grey matter volume in the affected hemisphere. This reorganization seems to reduce across time since amputation. However, it is not associated with pain intensity. These findings are significant to understand the role of the motor cortex reorganization in patients with PLP, showing that the pain intensity may be related with other neurophysiological factors, not just cortical reorganization.
Identifiants
pubmed: 32828040
pii: S1388-2457(20)30406-5
doi: 10.1016/j.clinph.2020.06.024
pmc: PMC7494252
mid: NIHMS1623229
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
2375-2382Subventions
Organisme : NICHD NIH HHS
ID : R01 HD082302
Pays : United States
Informations de copyright
Copyright © 2020 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of interest The authors report no conflict of interest.
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