Investigations on maladaptive plasticity in the sensorimotor cortex of unilateral upper limb CRPS I patients.

Abstract

Patients with a complex regional pain syndrome (CRPS) in the upper limb show a sensory and motor impairment of the hand. Decreased intra-cortical-inhibition (ICI) of the motor representation of the affected hand muscle and decreased somatosensory hand representation size were related to maladaptive plasticity. To achieve new insights about CRPS we examined whether these alterations were present in a single cohort. We used a multi-modal approach comprising behavioral testing, transcranial magnetic stimulation, and high resolution fMRI combined with a new analysis technique for improved neuronal specificity. We found a decreased pinch-grip performance, two-point discrimination on the fingertips, ICI in the motor cortex, and representation size of the hand in Brodmann Area 3b (BA3b) in the somatosensory cortex. Our analysis further showed that correlations with ICI on the non-affected side were absent on the affected side. This study is the first to gather behavioral, neurophysiologic and imaging measurements for one patient cohort and it therefore enables a comprehensive view of collapsed associations of function and representation focused on the hemisphere contralateral to the affected hand.