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May 13, 2003

Altered central somatosensory processing in chronic pain patients with “hysterical” anesthesia

May 13, 2003 issue
60 (9) 1501-1507

Abstract

Objective: The authors hypothesized that central factors may underlie sensory deficits in patients with nondermatomal somatosensory deficits (NDSD) and that functional brain imaging would reveal altered responses in supraspinal nuclei.
Background: Patients with chronic pain frequently present with NDSD, ranging from hypoesthesia to complete anesthesia in the absence of substantial pathology and often in association with motor weakness and occasional paralysis. Patients with pain and such pseudoneurologic symptoms can be classified as having both a pain disorder and a conversion disorder (Diagnostic and Statistical Manual of Mental Disorders–IV classification).
Methods: The authors tested their hypothesis with functional MRI (fMRI) of brush and noxious stimulation-evoked brain responses in four patients with chronic pain and NDSD.
Results: The fMRI findings revealed altered somatosensory-evoked responses in specific forebrain areas. Unperceived stimuli failed to activate areas that were activated with perceived touch and pain: notably, the thalamus, posterior region of the anterior cingulate cortex (ACC), and Brodmann area 44/45. Furthermore, unperceived stimuli were associated with deactivations in primary and secondary somatosensory cortex (S1, S2), posterior parietal cortex, and prefrontal cortex. Finally, unperceived (but not perceived) stimuli activated the rostral ACC.
Conclusions: Diminished perception of innocuous and noxious stimuli is associated with altered activity in many parts of the somatosensory pathway or other supraspinal areas. The cortical findings indicate a neurobiological component for at least part of the symptoms in patients presenting with nondermatomal somatosensory deficits.

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Information & Authors

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Published In

Neurology®
Volume 60Number 9May 13, 2003
Pages: 1501-1507
PubMed: 12743239

Publication History

Received: June 17, 2002
Accepted: November 29, 2002
Published online: May 13, 2003
Published in print: May 13, 2003

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Authors

Affiliations & Disclosures

A. Mailis-Gagnon, MD
From the Comprehensive Pain Program (Drs. Mailis-Gagnon and Nicholson), Division of Neurosurgery (Dr. Davis), Department of Medical Imaging (Drs. Mikulis and Crawley), and Toronto Western Research Institute (Drs. Mailis, Mikulis, and Davis, and I. Giannoylis, J. Downar, C.L. Kwan, and D.J. Mikulis), Toronto Western Hospital; and Department of Surgery (Dr. Davis) and Institute of Medical Sciences (J. Downar and C.L. Kwan, and Dr. Davis), University of Toronto, Ontario, Canada.
I. Giannoylis, BSc
From the Comprehensive Pain Program (Drs. Mailis-Gagnon and Nicholson), Division of Neurosurgery (Dr. Davis), Department of Medical Imaging (Drs. Mikulis and Crawley), and Toronto Western Research Institute (Drs. Mailis, Mikulis, and Davis, and I. Giannoylis, J. Downar, C.L. Kwan, and D.J. Mikulis), Toronto Western Hospital; and Department of Surgery (Dr. Davis) and Institute of Medical Sciences (J. Downar and C.L. Kwan, and Dr. Davis), University of Toronto, Ontario, Canada.
J. Downar, BSc
From the Comprehensive Pain Program (Drs. Mailis-Gagnon and Nicholson), Division of Neurosurgery (Dr. Davis), Department of Medical Imaging (Drs. Mikulis and Crawley), and Toronto Western Research Institute (Drs. Mailis, Mikulis, and Davis, and I. Giannoylis, J. Downar, C.L. Kwan, and D.J. Mikulis), Toronto Western Hospital; and Department of Surgery (Dr. Davis) and Institute of Medical Sciences (J. Downar and C.L. Kwan, and Dr. Davis), University of Toronto, Ontario, Canada.
C. L. Kwan, MSc
From the Comprehensive Pain Program (Drs. Mailis-Gagnon and Nicholson), Division of Neurosurgery (Dr. Davis), Department of Medical Imaging (Drs. Mikulis and Crawley), and Toronto Western Research Institute (Drs. Mailis, Mikulis, and Davis, and I. Giannoylis, J. Downar, C.L. Kwan, and D.J. Mikulis), Toronto Western Hospital; and Department of Surgery (Dr. Davis) and Institute of Medical Sciences (J. Downar and C.L. Kwan, and Dr. Davis), University of Toronto, Ontario, Canada.
D. J. Mikulis, MD
From the Comprehensive Pain Program (Drs. Mailis-Gagnon and Nicholson), Division of Neurosurgery (Dr. Davis), Department of Medical Imaging (Drs. Mikulis and Crawley), and Toronto Western Research Institute (Drs. Mailis, Mikulis, and Davis, and I. Giannoylis, J. Downar, C.L. Kwan, and D.J. Mikulis), Toronto Western Hospital; and Department of Surgery (Dr. Davis) and Institute of Medical Sciences (J. Downar and C.L. Kwan, and Dr. Davis), University of Toronto, Ontario, Canada.
A. P. Crawley, PhD
From the Comprehensive Pain Program (Drs. Mailis-Gagnon and Nicholson), Division of Neurosurgery (Dr. Davis), Department of Medical Imaging (Drs. Mikulis and Crawley), and Toronto Western Research Institute (Drs. Mailis, Mikulis, and Davis, and I. Giannoylis, J. Downar, C.L. Kwan, and D.J. Mikulis), Toronto Western Hospital; and Department of Surgery (Dr. Davis) and Institute of Medical Sciences (J. Downar and C.L. Kwan, and Dr. Davis), University of Toronto, Ontario, Canada.
K. Nicholson, PhD
From the Comprehensive Pain Program (Drs. Mailis-Gagnon and Nicholson), Division of Neurosurgery (Dr. Davis), Department of Medical Imaging (Drs. Mikulis and Crawley), and Toronto Western Research Institute (Drs. Mailis, Mikulis, and Davis, and I. Giannoylis, J. Downar, C.L. Kwan, and D.J. Mikulis), Toronto Western Hospital; and Department of Surgery (Dr. Davis) and Institute of Medical Sciences (J. Downar and C.L. Kwan, and Dr. Davis), University of Toronto, Ontario, Canada.
K. D. Davis, PhD
From the Comprehensive Pain Program (Drs. Mailis-Gagnon and Nicholson), Division of Neurosurgery (Dr. Davis), Department of Medical Imaging (Drs. Mikulis and Crawley), and Toronto Western Research Institute (Drs. Mailis, Mikulis, and Davis, and I. Giannoylis, J. Downar, C.L. Kwan, and D.J. Mikulis), Toronto Western Hospital; and Department of Surgery (Dr. Davis) and Institute of Medical Sciences (J. Downar and C.L. Kwan, and Dr. Davis), University of Toronto, Ontario, Canada.

Notes

Address correspondence and reprint requests to Dr. Karen D. Davis, Toronto Western Hospital, Division of Neurosurgery, MP14-306, 399 Bathurst Street, Toronto, Ontario, Canada M5T 2S8; e-mail: [email protected]

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