Basal ganglia dysfunction in complex regional pain syndrome – A valid hypothesis?

Azqueta‐Gavaldon, Monica; Schulte-Göcking, Heike; Storz, Claudia; Azad, Shahnaz Christina; Reiners, A.; Borsook, David; Becerra, Lino; Kraft, Eduard

doi:10.1002/ejp.975

Cited by 28 publications

(26 citation statements)

References 86 publications

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“…Several clinical case series of CRPS have described different MDs in a substantial, yet inconsistent, proportion between 10% and 90% of the patients evaluated. [15] Among the MDs, the most prominent MD in CRPS is dystonia. [15] A larger study with 692 CRPS type 1 patients found 124 (19.9%) cases of dystonia.…”

Section: Discussionmentioning

confidence: 99%

“…[15] Among the MDs, the most prominent MD in CRPS is dystonia. [15] A larger study with 692 CRPS type 1 patients found 124 (19.9%) cases of dystonia. [16] Besides MDs, the basal ganglia may be involved in several key features of central processing and modulation of nociceptive information such as the sensory-discriminative aspect of pain as well as the affective and the cognitive dimension of pain.…”

Section: Discussionmentioning

confidence: 99%

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Pramipexole-induced limb dystonia and its associated complex regional pain syndrome in idiopathic Parkinson's disease

Park

2017

Medicine

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Rationale:This case may be due to basal ganglia dysfunction, which was probably caused by abnormal activation of dopamine 1-like receptor (D1R) boosted by pramipexole binding on dopamine 3-like receptor (D3R) in a situation where D3R was overexpressed by the chronic treatment of L-dopa.Patient concerns:Striatal hand and foot deformities.Diagnoses:Striatal hand and foot deformities with CRPS.Interventions:Steroid treatemnt and withdrawal of the pramipexole.Outcomes:Recovered significantly.Lessons:Since the degree of overexpression of D3R is increased in a high dose of pramipexole, for patients with PD who are treated with L-dopa chronically, a new use of pramipexole and an increase in dose to alleviate the symptoms of PD should be implemented with caution while closely observing the occurrence of drug-induced complications such as dystonia and CRPS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pramipexole-induced limb dystonia and its associated complex regional pain syndrome in idiopathic Parkinson's disease

Park

2017

Medicine

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“…This unique feature of our method makes the involvement of fronto-parietal networks underlying concepts such as body schema and peripersonal space (Cardinali, Brozzoli, & Farnè, 2009) most likely. There is also accumulating evidence that CRPS is accompanied by basal ganglia dysfunctions (for a review see Azqueta-Gavaldon et al, 2017). While their involvement in nociceptive processing has been known for a long time (Chudler & Dong, 1995), their exact role remains elusive to date.…”

Section: Integration With Previous Findings and Outlookmentioning

confidence: 99%

“…It is plausible, however, to draw a line between basal ganglia dysfunctions and the frequently observed motor deficiencies in CRPS patients. Furthermore, in the light of their manifold cortical connections (Choi, Yeo, & Buckner, 2012), Azqueta-Gavaldon et al (2017) suggested that the basal ganglia dysfunctions may be involved in body perception disturbances in CRPS. In the context of body schema and peripersonal space, subcortical mechanisms have received relatively little interest yet.…”

Section: Integration With Previous Findings and Outlookmentioning

confidence: 99%

Altered tactile localization and spatiotemporal integration in complex regional pain syndrome patients

Trojan

Speck

Kleinböhl

et al. 2018

European Journal of Pain

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Background In complex regional pain syndrome (CRPS), altered perception of the affected hand and neglect‐like symptoms of the affected body side are common features. In this study, we presented tactile stimuli to the affected hands in CRPS patients and matched healthy controls. Methods The participants’ task was to point at the perceived positions of the stimuli using a tracking device. The spatial coordinates of the perceived positions were analysed for accuracy and consistency. We also presented patterns consisting of two stimuli at distinct positions with a delay of 100 ms. These patterns are known to induce spatiotemporal integration (“sensory saltation”). Results CRPS patients were less accurate and less consistent in the spatial perception of tactile stimuli on their hands. Furthermore, they showed increased spatiotemporal integration, although these effects were smaller than expected. These deficiencies were related to the clinically assessed intensity of recurrent pain episodes. Surprisingly, the intensity of clinically assessed ongoing pain was associated with increased precision. Conclusions In line with earlier reports, our findings indicate that the representation of the affected hands in CRPS patients is less accurate than in healthy people, probably reflecting reorganization in somatosensory cortices. The exact relationships between these findings and other aspects of CRPS remain to be elucidated. Significance CRPS patients performed poorly in localizing positions on their affected hands via pointing and exhibited increased spatiotemporal integration. The presented method may prove useful in diagnostics as well as psychophysical and neurofunctional research on CRPS and other chronic pain disorders.

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“…Although the pathophysiology in development of myoclonus in CRPS has been the subject of debate, myoclonus is found in 11%-36% of CRPS patients [5]. The pathomechanisms of movement disorders in CRPS are related to brain network alterations, particularly in the cortical and basal ganglia areas [6]. Myoclonus in CRPS also has a subcortical origin [7].…”

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confidence: 99%

Stimulus‐sensitive myoclonus with trigeminal neuralgia

Ryu

Kim

2017

Euro J of Neurology

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Basal ganglia dysfunction in complex regional pain syndrome – A valid hypothesis?

Abstract: This paper presents an overview of our current knowledge about BG pathology in CRPS. A better understanding of the involvement of the BG in the CRPS pathology holds the potential for developing and improving efficacious, mechanism-based treatment modalities.

Cited by 28 publications

References 86 publications

Pramipexole-induced limb dystonia and its associated complex regional pain syndrome in idiopathic Parkinson's disease

Pramipexole-induced limb dystonia and its associated complex regional pain syndrome in idiopathic Parkinson's disease

Altered tactile localization and spatiotemporal integration in complex regional pain syndrome patients

Stimulus‐sensitive myoclonus with trigeminal neuralgia

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