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Neurology 2003;61:515-519
© 2003 American Academy of Neurology

Bilateral motor cortex disinhibition in complex regional pain syndrome (CRPS) type I of the hand

P. Schwenkreis, MD, F. Janssen, MD, O. Rommel, MD, B. Pleger, MD, B. Völker, MD, I. Hosbach, MD, R. Dertwinkel, MD, C. Maier, MD and M. Tegenthoff, MD

From the Departments of Neurology (Drs. Schwenkreis, Janssen, Rommel, Pleger, and Tegenthoff), Anesthesiology, Intensive Care and Pain Treatment (Drs. Hosbach and Dertwinkel), and Pain Treatment (Drs. Völker and Maier), Ruhr-University Bochum, BG-Kliniken Bergmannsheil, Bochum, Germany.

Address correspondence and reprint requests to Dr. Peter Schwenkreis, Department of Neurology, BG-Kliniken Bergmannsheil, Buerkle-de-la-Camp-Platz 1, D-44789 Bochum, Germany; e-mail: Peter.Schwenkreis{at}ruhr-uni-bochum.de

Background: Complex regional pain syndrome type I (CRPS I) develops as a consequence of trauma affecting the limbs, without obvious nerve lesion. Its features include pain, edema, autonomic dysfunction, movement disorder, and trophic changes. CNS involvement is suggested by the symptoms, but the pathophysiology of CRPS I is unknown.

Objective: To assess excitability changes in the motor cortex in patients with CRPS I.

Methods: The authors studied 25 patients with unilateral CRPS I involving the hand by means of transcranial magnetic stimulation using a paired-pulse paradigm. Motor threshold (MT) and intracortical inhibition and facilitation were determined on the affected and the clinically unaffected side. A control group of 20 healthy subjects was studied.

Results: The authors found a significant reduction of intracortical inhibition on both sides of patients with CRPS compared with control subjects, whereas intracortical facilitation and MT did not differ significantly. However, in the patients’ group, the presence of allodynia significantly decreased MT.

Conclusions: The authors showed a bilateral disinhibition of the motor cortex in patients with complex regional pain syndrome.




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Correspondence:

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Bilateral motor cortex disinhibition in complex regional pain syndrome (CRPS) type I of the hand
Phillip Krause, et al.
Neurology Online, 19 Nov 2003 [Full text]
Reply to Krause et al
Peter Schwenkreis, et al.
Neurology Online, 19 Nov 2003 [Full text]

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