Maihöfner Christian, Baron Ralf, DeCol Roberto, Binder Andreas, Birklein Frank, Deuschl Günther, Handwerker Hermann O, Schattschneider Jörn
Department of Neurology, Institute for Physiology and Experimental Pathophysiology, University of Erlangen-Nuremberg, Erlangen, Germany.
Brain. 2007 Oct;130(Pt 10):2671-87. doi: 10.1093/brain/awm131. Epub 2007 Jun 15.
The complex regional pain syndrome (CRPS) is a disabling neuropathic pain condition that may develop following injuries of the extremities. In the present study we sought to characterize motor dysfunction in CRPS patients using kinematic analysis and functional imaging investigations on the cerebral representation of finger movements. Firstly, 10 patients and 12 healthy control subjects were investigated in a kinematic analysis assessing possible changes of movement patterns during target reaching and grasping. Compared to controls, CRPS patients particularly showed a significant prolongation of the target phase in this paradigm. The pattern of motor impairment was consistent with a disturbed integration of visual and proprioceptive inputs in the posterior parietal cortex. Secondly, we used functional MRI (fMRI) and investigated cortical activations during tapping movements of the CRPS-affected hand in 12 patients compared to healthy controls (n = 12). During finger tapping of the affected extremity, CRPS patients showed a significant reorganization of central motor circuits, with an increased activation of primary motor and supplementary motor cortices (SMA). Furthermore, the ipsilateral motor cortex showed a markedly increased activation. When the individual amount of motor impairment was introduced as regressor in the fMRI analysis, we were able to demonstrate that activations of the posterior parietal cortices (i.e. areas within the intraparietal sulcus), SMA and primary motor cortex were correlated with the extent of motor dysfunction. In summary, the results of this study suggest that substantial adaptive changes within the central nervous system may contribute to motor symptoms in CRPS.
复杂性区域疼痛综合征（CRPS）是一种致残性神经病理性疼痛疾病，可能在四肢受伤后发生。在本研究中，我们试图通过运动学分析和对手指运动的大脑表征进行功能成像研究，来描述CRPS患者的运动功能障碍。首先，对10名患者和12名健康对照者进行了运动学分析，评估目标达成和抓握过程中运动模式的可能变化。与对照组相比，CRPS患者在该范式中尤其表现出目标阶段的显著延长。运动障碍模式与顶叶后皮质中视觉和本体感觉输入的整合紊乱一致。其次，我们使用功能磁共振成像（fMRI），研究了12名患者与健康对照者（n = 12）相比，受CRPS影响的手在敲击运动过程中的皮质激活情况。在受影响肢体的手指敲击过程中，CRPS患者表现出中枢运动回路的显著重组，初级运动皮质和辅助运动皮质（SMA）的激活增加。此外，同侧运动皮质的激活明显增加。当在fMRI分析中引入个体运动障碍量作为回归变量时，我们能够证明顶叶后皮质（即顶内沟内的区域）、SMA和初级运动皮质的激活与运动功能障碍程度相关。总之，本研究结果表明，中枢神经系统内的实质性适应性变化可能导致CRPS的运动症状。
