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Pathophysiology of Central Poststroke Pain: Motor Cortex Disinhibition and Its Clinical and Sensory Correlates.
Tang, Sung-Chun; Lee, Lukas Jyuhn-Hsiarn; Jeng, Jiann-Shing; Hsieh, Sung-Tsang; Chiang, Ming-Chang; Yeh, Shin-Joe; Hsueh, Hsueh-Wen; Chao, Chi-Chao.
Afiliación
  • Tang SC; From the Department of Neurology, National Taiwan University Hospital, Taipei (S.-C.T., L.J.-H.L., J.-S.J., S.-T.H., S.-J.Y., H.-W.H., C.-C.C.).
  • Lee LJ; From the Department of Neurology, National Taiwan University Hospital, Taipei (S.-C.T., L.J.-H.L., J.-S.J., S.-T.H., S.-J.Y., H.-W.H., C.-C.C.).
  • Jeng JS; National Institute of Environmental Medicine Sciences, National Health Research Institutes, Taiwan (L.J.-H.L.).
  • Hsieh ST; Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei (L.J.-H.L.).
  • Chiang MC; From the Department of Neurology, National Taiwan University Hospital, Taipei (S.-C.T., L.J.-H.L., J.-S.J., S.-T.H., S.-J.Y., H.-W.H., C.-C.C.).
  • Yeh SJ; From the Department of Neurology, National Taiwan University Hospital, Taipei (S.-C.T., L.J.-H.L., J.-S.J., S.-T.H., S.-J.Y., H.-W.H., C.-C.C.).
  • Hsueh HW; Department of Anatomy and Cell Biology (S.-T.H.), National Taiwan University College of Medicine, Taipei.
  • Chao CC; Graduate Institute of Brain and Mind Sciences (S.-T.H.), National Taiwan University College of Medicine, Taipei.
Stroke ; 50(10): 2851-2857, 2019 10.
Article en En | MEDLINE | ID: mdl-31500556
Background and Purpose- Central poststroke pain (CPSP) is a disabling condition in stroke patients, and evidence suggests that altered corticospinal and motor intracortical excitability occurs in neuropathic pain. The objective of this study was to investigate changes in motor cortex excitability and sensorimotor interaction and their correlates with clinical manifestations and alterations in somatosensory systems in CPSP patients. Methods- Fourteen patients with CPSP but no motor weakness were compared with age- and sex-matched healthy controls for motor cortex excitability and sensorimotor interaction assessed by transcranial magnetic stimulation to measure resting motor thresholds, short-interval intracortical inhibition, intracortical facilitation, and afferent inhibitions. The sensory pathway was evaluated by quantitative sensory testing, contact heat evoked potential, and somatosensory evoked potentials. Clinical pain and quality of life were assessed with validated tools. Results- The duration of CPSP was 3.3±3.0 years (ranging 0.5-10 years), and pain significantly impaired quality of life. Compared with the unaffected hemisphere, the stroke hemisphere had higher thermal thresholds, lower contact heat evoked potential amplitudes, and prolonged cortical somatosensory evoked potential latencies. There was no difference in resting motor thresholds between the stroke and unaffected hemisphere or between patients and controls. CPSP patients had a reduction in short-interval intracortical inhibition in the stroke hemisphere compared with that in the unaffected hemispheres of patients and controls. No changes were noted in afferent inhibitions between the stroke and unaffected hemispheres. The short-interval intracortical inhibition of the stroke hemisphere was negatively correlated with self-rated health on a visual analog scale and positively correlated with cortical somatosensory evoked potential latencies. Conclusions- CPSP patients with intact corticospinal tracts showed reduced motor intracortical inhibition in the stroke hemisphere, suggesting defective gamma-aminobutyric acid-ergic inhibition. This disinhibition was associated with impaired quality of life and was related to dorsal column-medial lemniscus pathway dysfunction.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Accidente Cerebrovascular / Corteza Motora / Inhibición Neural / Neuralgia Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Stroke Año: 2019 Tipo del documento: Article

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Accidente Cerebrovascular / Corteza Motora / Inhibición Neural / Neuralgia Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Stroke Año: 2019 Tipo del documento: Article