Reassessing cortical reorganization in the primary sensorimotor cortex following arm amputation.
Reassessing cortical reorganization in the primary sensorimotor cortex following arm amputation.
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DOI：
10.1093/brain/awv161
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发表时间：
2015-08
期刊：
影响因子：
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通讯作者：
Tracey I
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文献类型：
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作者：
Makin TR;Scholz J;Henderson Slater D;Johansen-Berg H;Tracey I
大脑自我重组的能力是我们从受伤中恢复的关键，但随后新旧组织之间的不匹配可能会导致疼痛。马金等人。通过证明上肢截肢者的幻痛与皮质重新映射无关来反对这种“适应不良可塑性”理论。大脑自我重组的能力是我们从受伤中恢复的关键，但随后新旧组织之间的不匹配可能会导致疼痛。马金等人。通过证明上肢截肢者的幻痛与皮质重新映射无关来反对这种“适应不良可塑性”理论。临床界越来越强调皮质活动在产生和消除慢性疼痛中的作用。也许最引人注目的例子是适应不良可塑性理论，根据该理论，幻痛是由于截肢后将皮质相邻表征（下脸）重新映射到缺失的手的区域而产生的。该理论已扩展到广泛的慢性疼痛病症，例如复杂的区域疼痛综合征。然而，尽管适应不良可塑性理论越来越受欢迎，但支持适应不良可塑性理论的证据主要基于疼痛评级与皮质重组的粗略测量之间的相关性，而很少考虑其他临床因素（例如适应性行为）在驱动已确定的大脑可塑性方面的潜在贡献。在这里，我们使用了具有生理意义的皮质重组测量来重新评估其与上肢截肢者幻痛的关系。我们发现，缺失手对侧的嘴唇表征存在小而一致的变化，朝向但不侵入手部区域。然而，我们无法通过这种测量或传统的欧几里得距离测量来确定皮质重组与幻觉或疼痛之间的任何统计关系。相反，我们证明其他因素可能有助于观察到的重新映射。有必要进行进一步的研究，更广泛地重新评估皮质重组与慢性疼痛之间的关系。
The brain’s ability to reorganise itself is key to our recovery from injuries, but the subsequent mismatch between old and new organisation may lead to pain. Makin et al. argue against this ‘maladaptive plasticity’ theory by showing that phantom pain in upper limb amputees is independent of cortical remapping. The brain’s ability to reorganise itself is key to our recovery from injuries, but the subsequent mismatch between old and new organisation may lead to pain. Makin et al. argue against this ‘maladaptive plasticity’ theory by showing that phantom pain in upper limb amputees is independent of cortical remapping. The role of cortical activity in generating and abolishing chronic pain is increasingly emphasized in the clinical community. Perhaps the most striking example of this is the maladaptive plasticity theory, according to which phantom pain arises from remapping of cortically neighbouring representations (lower face) into the territory of the missing hand following amputation. This theory has been extended to a wide range of chronic pain conditions, such as complex regional pain syndrome. Yet, despite its growing popularity, the evidence to support the maladaptive plasticity theory is largely based on correlations between pain ratings and oftentimes crude measurements of cortical reorganization, with little consideration of potential contributions of other clinical factors, such as adaptive behaviour, in driving the identified brain plasticity. Here, we used a physiologically meaningful measurement of cortical reorganization to reassess its relationship to phantom pain in upper limb amputees. We identified small yet consistent shifts in lip representation contralateral to the missing hand towards, but not invading, the hand area. However, we were unable to identify any statistical relationship between cortical reorganization and phantom sensations or pain either with this measurement or with the traditional Euclidian distance measurement. Instead, we demonstrate that other factors may contribute to the observed remapping. Further research that reassesses more broadly the relationship between cortical reorganization and chronic pain is warranted.