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Motorkortikale Repräsentation beim komplex regionalen Schmerzsyndrom Typ I

Eine TMS-Studie

Motor cortical representation in patients with complex regional pain syndrome

A TMS study

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Zusammenfassung

In einer Gruppe von Patienten mit akutem und chronischem (>6 Monate) Verlauf eines komplex regionalen Schmerzsyndroms Typ I (CRPS I) wurde mittels transkranieller Magnetstimulation (TMS) die Ausdehnung der motorkortikalen Repräsentation betroffener und nichtbetroffener Handmuskeln vermessen. Hierzu wurde mit überschwelligen Einzelreizen (120% der Muskelerregungsschwelle) die Größenausdehnung über dem primär-motorischen Kortex auf dem Schädel detektiert. Diese wurde mit der gesunder Probanden verglichen. Es zeigte sich bei den Patienten eine größere kortikale Repräsentation für Muskeln der nichtbetroffenen Hand im Vergleich zur betroffenen Seite. Diese Asymmetrie fand sich sowohl bei akutem als auch chronischem Verlauf. Eine Veränderung der kortikalen Repräsentation betroffener Muskelgruppen kann, wie schon früher diskutiert wurde, als Folge einer veränderten sensomotorischen Repräsentation gewertet werden. Es müssen jedoch ebenfalls der reduzierte Gebrauch der betroffenen Hand und das Vorhandensein von Schmerz als kortikale Einflussgrößen berücksichtigt werden. Der eigentliche Mechanismus bleibt daher vorerst eine Spekulation.

Abstract

In a group of patients with short- and long-term (chronic) duration of complex regional pain syndrome type I (CRPS I) motor cortical representation was determined, using a transcranial magnetic stimulation (TMS) mapping method. This was done, starting with suprathreshold intensities at the location of the largest MEP amplitude, mapping systematically in all directions. Patients were compared to a group of healthy subjects. In both patient groups we found significantly larger motor cortical representation for the unaffected hand muscles compared to the affected side. This asymmetry was absent in healthy subjects. Such motor cortical representation asymmetry can be considered an effect of altered sensomotor cortical representation. On the other hand, one must also consider the increased use of the unaffected hand and the presence of pain as cortical influencing variables. The real cause must remain speculative at this time.

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  1. Neurologische Klinik und Poliklinik, Klinikum Großhadern der Ludwig-Maximilians-Universität München

    P. Krause, S. Förderreuther & A. Straube

  2. Neurologische Klinik und Poliklinik, Klinikum Großhadern der Ludwig-Maximilians-Universität, Marchioninistraße 15, 81377 , München

    P. Krause

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  1. P. Krause
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  2. S. Förderreuther
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  3. A. Straube
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Correspondence to P. Krause.

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Krause, P., Förderreuther, S. & Straube, A. Motorkortikale Repräsentation beim komplex regionalen Schmerzsyndrom Typ I. Schmerz 20, 181–188 (2006). https://doi.org/10.1007/s00482-005-0417-8

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  • DOI: https://doi.org/10.1007/s00482-005-0417-8

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