Reorganization of motor and somatosensory cortex in upper extremity amputees with phantom limb pain
Reorganization of motor and somatosensory cortex in upper extremity amputees with phantom limb pain
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DOI：
10.1523/jneurosci.21-10-03609.2001
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发表时间：
2001-05-15
影响因子：
5.3
通讯作者：
Flor, H
中科院分区：
文献类型：
--
作者：
Karl, A;Birbaumer, N;Flor, H
截肢者的幻肢痛（PLP）与体感系统的重组变化有关。为了研究体感和运动重组与幻肢痛之间的关系，我们对有或没有幻肢痛的患者使用了运动皮层的局灶性经颅磁刺激（TMS）和体感皮层（SI）的神经电源成像。对于经颅磁刺激，从双侧肱二头肌、颧肌和下唇肌进行记录。对面部和手部皮肤进行体感刺激后获得脑电图的神经电源成像。幻肢痛患者的肱二头肌运动诱发电位较大，与完整侧相比，截肢侧肌肉的输出图更大。仅在幻肢痛患者中，刺激颧骨和降下唇肌的最佳头皮位置明显更向内侧移位（朝向缺失的手部表征）。神经电源成像显示幻肢痛患者面部刺激的偶极子中心有类似的内侧位移。运动和体感皮层中口腔皮层表征向手部区域的转移程度与幻肢痛之间存在高度相关性。这些结果表明，患有幻肢痛的截肢者的运动和体感领域的可塑性都有所增强。
Phantom limb pain (PLP) in amputees is associated with reorganizational changes in the somatosensory system. To investigate the relationship between somatosensory and motor reorganization and phantom limb pain, we used focal transcranial magnetic stimulation (TMS) of the motor cortex and neuroelectric source imaging of the somatosensory cortex (SI) in patients with and without phantom limb pain. For transcranial magnetic stimulation, recordings were made bilaterally from the biceps brachii, zygomaticus, and depressor labii inferioris muscles. Neuroelectric source imaging of the EEG was obtained after somatosensory stimulation of the skin overlying face and hand. Patients with phantom limb pain had larger motor- evoked potentials from the biceps brachii, and the map of outputs was larger for muscles on the amputated side compared with the intact side. The optimal scalp positions for stimulation of the zygomaticus and depressor labii inferioris muscles were displaced significantly more medially (toward the missing hand representation) in patients with phantom limb pain only. Neuroelectric source imaging revealed a similar medial displacement of the dipole center for face stimulation in patients with phantom limb pain. There was a high correlation between the magnitude of the shift of the cortical representation of the mouth into the hand area in motor and somatosensory cortex and phantom limb pain. These results show enhanced plasticity in both the motor and somatosensory domains in amputees with phantom limb pain.