Gunduz Muhammed Enes, Pinto Camila Bonin, Saleh Velez Faddi Ghassan, Duarte Dante, Pacheco-Barrios Kevin, Lopes Fernanda, Fregni Felipe
Laboratory of Neuromodulation & Center for Clinical Research Learning, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States.
Unidad de Investigación Para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru.
Front Neurosci. 2020 Apr 21;14:314. doi: 10.3389/fnins.2020.00314. eCollection 2020.
The purpose of this systematic review is to evaluate motor cortex reorganization in amputees as indexed by transcranial magnetic stimulation (TMS) cortical mapping and its relationship with phantom limb pain (PLP). Pubmed database were systematically searched. Three independent researchers screened the relevant articles, and the data of motor output maps, including the number of effective stimulation sites, center of gravity (CoG) shift, and their clinical correlations were extracted. We calculated a pooled CoG shift for motor cortex TMS mapping. The search yielded 468 articles, 11 were included. Three studies performed correlation between the cortical changes and PLP intensity, and only one study compared cortical mapping changes between amputees with pain and without pain. Results showed (i) enlarged excitable area and a shift of CoG of neighboring areas toward the deafferented limb area; (ii) no correlation between motor cortex reorganization and level of pain and (iii) greater cortical reorganization in patients with PLP compared to amputation without pain. Our review supports the evidence for cortical reorganization in the affected hemisphere following an amputation. The motor cortex reorganization could be a potential clinical target for prevention and treatment response of PLP.
本系统评价的目的是评估经颅磁刺激（TMS）皮层映射所显示的截肢者运动皮层重组情况及其与幻肢痛（PLP）的关系。系统检索了PubMed数据库。由三名独立研究人员筛选相关文章，并提取运动输出图的数据，包括有效刺激部位数量、重心（CoG）移位及其临床相关性。我们计算了运动皮层TMS映射的合并CoG移位。检索得到468篇文章，纳入11篇。三项研究对皮层变化与PLP强度进行了相关性分析，仅有一项研究比较了有疼痛和无疼痛截肢者之间的皮层映射变化。结果显示：（i）可兴奋区域扩大，相邻区域的CoG向去传入肢体区域移位；（ii）运动皮层重组与疼痛程度之间无相关性；（iii）与无疼痛的截肢者相比，PLP患者的皮层重组更明显。我们的评价支持截肢后患侧半球存在皮层重组的证据。运动皮层重组可能是PLP预防和治疗反应的一个潜在临床靶点。
