Pain in cervical dystonia: Evidence of abnormal inhibitory control

Tinazzi, Michèle; Squintani, Giovanna; Bhatia, Kailash P.; Segatti, Alessia; Donato, Francesco Di; Valeriani, Massimiliano; Erro, Roberto

doi:10.1016/j.parkreldis.2019.06.009

Cited by 43 publications

(32 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Consistent with previous reports (Tinazzi et al., 2019), we found no significant correlations between NRS scores and N2/P2 amplitude. Our findings show that N2/P2 complex do not depend on pain perception alone but also on the saliency of the eliciting nociceptive stimulus as well (Iannetti et al., 2008).…”

Section: Discussionsupporting

confidence: 93%

“…Its effect consists in a reduction of noxious stimulus (test stimulus) magnitude by the modulation of a conditioning stimulus (Nir & Yarnitsky, 2015). The test stimulus evokes a pain response that can be measured on a subjective pain rating scale (Pud et al., 2009) or by changes in neurophysiological findings (Drummond, 2003; Höffken et al., 2017; Tinazzi et al., 2019). Although CPM is not influenced by stimuli location, it seems to be better evaluated by heterotopic nociceptive conditioning stimulation (HNCS) in which the stimuli are applied to two separate and remote body areas (Klyne et al., 2015).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Conditioned pain modulation affects the N2/P2 complex but not the N1 wave: A pilot study with laser‐evoked potentials

Squintani

Rasera

Segatti

et al. 2020

European Journal of Pain

Self Cite

View full text Add to dashboard Cite

Background The ‘pain‐inhibits‐pain’ effect stems from neurophysiological mechanisms involving endogenous modulatory systems termed diffuse noxious inhibitory controls (DNIC) or conditioned pain modulation (CPM). Laser‐evoked potentials (LEPs) components, the N2/P2 complex, and the N1 wave, reflect the medial and lateral pain pathway, respectively: anatomically, the lateral thalamic nuclei (LT) project mainly to the somatosensory cortex (N1 generator), while the medial thalamic nuclei (MT) are bound to the limbic cortices (N2/P2 generators). Methods We applied a CPM protocol in which the test stimulus was laser stimulation and the conditioning stimulus was a cold pressor test. LEPs recordings were obtained from 15 healthy subjects in three different conditions: baseline, during heterotopic noxious conditioning stimulation (HNCS) and post‐HNCS. Results We observed a significant reduction in N2/P2 amplitude during HNCS and a return to pre‐test amplitude post‐HNCS, whereas the N1 wave remained unchanged during and post‐HNCS. Conclusions Our results indicate that CPM affects only the medial pain system. The spinothalamic tract (STT) transmits to both the LT and the MT, while the spinoreticulothalamic (SRT) projects only to the MT. The reduction in the amplitude of the N2/P2 complex and the absence of change in the N1 wave suggest that DNIC inhibition on the dorsal horn neurons affects only pain transmission via the SRT, while the neurons that give rise to the STT are not involved. The N1 wave can be a reliable neurophysiological parameter for assessment of STT function in clinical practice, as it does not seem to be influenced by CPM. Significance No reports have described the effect of DNIC on lateral and medial pain pathways. We studied the N1 wave and the N2/P2 complex to detect changes during a CPM protocol. We found a reduction in the amplitude of the N2/P2 complex and no change in the N1 wave. This suggests that the DNIC inhibitory effect on dorsal horns neurons affects only pain transmission via the SRT, whereas the neurons that give rise to the STT are not involved.

show abstract

Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Conditioned pain modulation affects the N2/P2 complex but not the N1 wave: A pilot study with laser‐evoked potentials

Squintani

Rasera

Segatti

et al. 2020

European Journal of Pain

Self Cite

View full text Add to dashboard Cite

show abstract

“…The ratio was close to that reported in previous study. So far, causative factors of CD-related pain are still a matter of debate whether excessive muscle contractions or alterations of transmission and processing of nociceptive stimuli [41]. Study has released cutaneous nociceptive pathway function in CD patients is normal [42].…”

Section: Discussionmentioning

confidence: 99%

Abnormal regional homogeneity and its relationship with symptom severity in cervical dystonia: a rest state fMRI study

Wei

Chen

et al. 2021

BMC Neurol

View full text Add to dashboard Cite

Background Although several brain networks play important roles in cervical dystonia (CD) patients, regional homogeneity (ReHo) changes in CD patients have not been clarified. We investigated to explore ReHo in CD patients at rest and analyzed its correlations with symptom severity as measured by Tsui scale. Methods A total of 19 CD patients and 21 gender-, age-, and education-matched healthy controls underwent fMRI scans at rest state. Data were analyzed by ReHo method. Results Patients showed increased ReHo in the right cerebellum crus I and decreased ReHo in the right superior medial prefrontal cortex (MPFC). Moreover, the right precentral gyrus, right insula, and bilateral middle cingulate gyrus also showed increased ReHo values. A significantly positive correlation was observed between ReHo value in the right cerebellum crus I and symptom severity (p < 0.05). Conclusions Our investigation suggested abnormal ReHo existed in brain regions of the “pain matrix” and salience network (the right insula and bilateral middle cingulate gyrus), the motor network (the right precentral gyrus), the cerebellum and MPFC and further highlighted the significance of these networks in the pathology of CD.

show abstract

“…38,39 Thus, we can speculate that pain in NTSD is associated with a dysfunctional pain-modulatory system. 40 More specific studies are needed to decide whether GM modifications are preexisting (and predispose to pain onset) or pain driven.…”

Section: Cortical Alterationsmentioning

confidence: 99%

Brain Structural Changes in Focal Dystonia—What About Task Specificity? A Multimodal MRI Study

et al. 2020

View full text Add to dashboard Cite

Background The neural basis of task specificity in dystonia is still poorly understood. This study investigated gray and white matter (WM) brain alterations in patients with task‐specific dystonia (TSD) and non‐task‐specific dystonia (NTSD). Methods Thirty‐six patients with TSD (spasmodic dysphonia, writer's cramp), 61 patients with NTSD (blepharospasm, cervical dystonia), and 83 healthy controls underwent 3D T1‐weighted and diffusion tensor magnetic resonance imaging (MRI). Whole brain cortical thickness and voxel‐based morphometry; volumes of basal ganglia, thalamus, nucleus accumbens, amygdala, and hippocampus; and WM damage were assessed. Analysis of variance models were used to compare MRI measures between groups, adjusting for age and botulinum toxin (BoNT) treatment. Results The comparison between focal dystonia patients showed cortical thickness and gray matter (GM) volume differences (ie, decreased in NTSD, increased in TSD) in frontal, parietal, temporal, and occipital cortical regions; basal ganglia; thalamus; hippocampus; and amygdala. Cerebellar atrophy was found in NTSD patients relative to controls. WM damage was more severe and widespread in task‐specific relative to NTSD patients. TSD patients receiving BoNT, relative to nontreated patients, had cortical thickening and increased GM volume in frontoparietal, temporal, and occipital regions. NTSD patients experiencing pain showed cortical thickening of areas involved in pain‐inhibitory mechanisms. Conclusions TSD and NTSD are characterized by opposite alterations of the main cortical and subcortical sensorimotor and cognitive‐controlling brain structures, suggesting the possible presence of different pathophysiological and/or compensatory mechanisms underlying the complexity of the two clinical phenotypes of focal dystonia. © 2020 International Parkinson and Movement Disorder Society

show abstract

Pain in cervical dystonia: Evidence of abnormal inhibitory control

Cited by 43 publications

References 19 publications

Conditioned pain modulation affects the N2/P2 complex but not the N1 wave: A pilot study with laser‐evoked potentials

Conditioned pain modulation affects the N2/P2 complex but not the N1 wave: A pilot study with laser‐evoked potentials

Abnormal regional homogeneity and its relationship with symptom severity in cervical dystonia: a rest state fMRI study

Brain Structural Changes in Focal Dystonia—What About Task Specificity? A Multimodal MRI Study

Contact Info

Product

Resources

About