Space-based, but not arm-based, shift in tactile processing in complex regional pain syndrome and its relationship to cooling of the affected limb
Space-based, but not arm-based, shift in tactile processing in complex regional pain syndrome and its relationship to cooling of the affected limb
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DOI：
10.1093/brain/awp224
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发表时间：
2009-11-01
期刊：
影响因子：
14.5
通讯作者：
Spence, Charles
中科院分区：
文献类型：
--
作者：
Moseley, G. Lorimer;Gallace, Alberto;Spence, Charles
复杂性局部疼痛综合征（CRPS）发生在中风后，但大多数病例发生在外周创伤后，没有脑创伤的证据。然而，CRPS与出现类似于在患有半侧空间忽视的患者中观察到的症状相关。10名参与者（4名男性）与CRPS的一只手臂进行时间顺序判断的振动触觉刺激对，一个交付给每只手，在10个可能的刺激发作的神经元，在两种条件下：武器举行的每一侧的中线和武器越过中线。参与者释放一个脚踏开关，以指示哪只手首先受到刺激。条件的顺序是随机的，开关所处的脚是平衡的。在每种条件下有两个150次试验。刺激开始的刺激性，参与者同样有可能选择任何一只手，主观刺激性（PSS）的点，比较条件之间和左侧或右侧的症状。当手臂不交叉时，参与者优先考虑来自未受影响的肢体的刺激（平均+/- SD PSS = 25 +/- 7.5 ms），PSS的大小与受影响的手比未受影响的手更凉的程度密切相关（r = 0.942，P < 0.001）。当双臂交叉时，效果相反：参与者优先考虑来自受影响肢体的刺激，而不是来自未受影响肢体的刺激[PSS = -18 +/- 13 ms;条件F（1，9）的主效应= 98.6，P < 0.001]。对副作用症状无影响。这些结果表明，CRPS与触觉处理的缺陷有关，触觉处理由受影响肢体通常居住的空间定义，而不是由受影响肢体本身定义，并且与受影响肢体的相对冷却有关。这种模式与中风后半侧空间忽视的数据一致，并提出了慢性CRPS涉及一种空间忽视的可能性。
Complex regional pain syndrome (CRPS) occurs after stroke, but most cases develop after peripheral trauma and without evidence of brain trauma. However, CRPS is associated with symptoms that appear similar to those observed in patients suffering from hemispatial neglect. Ten participants (four males) with CRPS of one arm performed temporal order judgements of pairs of vibrotactile stimuli, one delivered to each hand, at one of 10 possible stimulus onset asynchronies, under two conditions: arms held each side of the midline and arms crossed over the midline. Participants released a foot switch to indicate which hand had been stimulated first. The order of conditions was randomized and the foot under which the switch was positioned was counterbalanced. There were two blocks of 150 trials in each condition. The stimulus onset asynchronicity at which the participants were equally likely to select either hand, the point of subjective simultaneity (PSS), was compared between conditions and between those with left or right-sided symptoms. When arms were not crossed, the participants prioritized stimuli from the unaffected limb over those from the affected limb (mean +/- SD PSS = 25 +/- 7.5 ms) and the magnitude of the PSS strongly related to the degree to which the affected hand was cooler than the unaffected hand (r = 0.942, P < 0.001). When the arms were crossed, the effect was reversed: the participants prioritized stimuli from the affected limb over those from the unaffected limb [PSS = -18 +/- 13 ms; main effect of condition F (1, 9) = 98.6, P < 0.001]. There was no effect of the side of symptoms. These results show that CRPS is associated with a deficit in tactile processing that is defined by the space in which the affected limb normally resides, not by the affected limb itself, and which relates to the relative cooling of the affected limb. This pattern is consistent with data from those with hemispatial neglect after stroke and raises the possibility that chronic CRPS involves a type of spatial neglect.