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Case Reports
. 2018 Jan 30;2(1):21-26.
doi: 10.1080/24740527.2017.1422116. eCollection 2018.

Evidence of motor system reorganization in complex regional pain syndrome type 1: A case report

Marie-Philippe Harvey  1   2 , Samuel Maher-Bussières  1 , Elysa Emery  1 , Marylie Martel  1   2 , Francis Houde  1   2 , Yannick Tousignant-Laflamme  3   4 , Guillaume Léonard  2   4
Affiliations
Case Reports

Evidence of motor system reorganization in complex regional pain syndrome type 1: A case report

Marie-Philippe Harvey et al. Can J Pain. .

Abstract
in English, French

Background: Central nervous system reorganization, particularly in networks devoted to somatosensation, is thought to be a significant feature of complex regional pain syndrome (CRPS).

Aims: In the present case report, we evaluated the corticomotor system of a woman suffering from CRPS, as she started and completed her rehabilitation, in order to explore whether CRPS could also be linked to changes in motor networks.

Methods: The patient, a 58-year-old woman, was diagnosed with right-hand CRPS. Transcranial magnetic stimulation measures, reflecting the strength of the corticospinal projections, were evaluated before, during, and after an 8-week graded motor imagery (GMI) program.

Results: Before treatment, the patient reported significant pain and disability, and the strength of the corticospinal projections of the first dorsal interosseous of the affected hand was reduced compared to the healthy, unaffected hand. Pain and disability decreased as the patient completed the GMI program. These changes were paralleled by an increase in the strength of the corticospinal projections.

Conclusions: These observations suggest that corticomotor changes can be observed in individuals suffering from CRPS and that some of the clinical manifestations observed in these patients (e.g., pain, disability) could possibly be linked to these neurophysiological changes.

Contexte: La réorganisation du système nerveux central des réseaux cérébraux, en particulier ceux liés à la somatosensation, est connue comme une caractéristique importante du syndrome douloureux régional complexe (SDRC).But: Dans la présente étude de cas, nous avons évalué le système corticomoteur d’une femme souffrant du SDRC, du début à la fin de sa réadaptation, afin de déterminer si le SDRC pouvait aussi être lié à des changements dans les réseaux moteurs.Méthode: La patiente, une femme âgée de 58 ans, avait reçu un diagnostic de SDRC au niveau de la main droite. Des mesures de stimulation magnétique transcrânienne reflétant la force des projections corticospinales ont été évaluées avant, pendant et après un programme d’imagerie motrice progressive (IMP) d’une durée de huit semaines.Résultats: Avant le traitement, la patiente rapportait douleur et une incapacité importantes, et la force de ses projections corticospinales du premier interosseux dorsal de la main affectée, comparativement à la main saine, non affectée était réduite. La douleur et l’incapacité ont diminué pendant le programme d’IMP. Parallèllement à ces changements, une augmentation de la force des projections corticospinales a été observée.Conclusions: Ces observations suggèrent que des changements corticomoteurs peuvent être observés chez des individus souffrant de SDRC, et que certaines manifestations cliniques observées chez ces patients (ex.: la douleur, l’incapacité) pourraient être liées à ces changements neurophysiologiques.

Keywords: complex regional pain syndrome; graded motor imagery; transcranial magnetic stimulation.

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Figures

Figure 1.
Figure 1.
Evolution of the delta score of the affected limb. The delta score was used to depict the strength of the corticospinal projections, with a higher delta score representing a higher strength of corticospinal projections (delta score = mean MEP amplitude at 130% – mean MEP amplitude at 110%). T0 corresponds to the score obtained at the initial visit (prior to GMI treatment), T1 to the score obtained after 2 weeks (stage 1 GMI), T2 to the score obtained after 4 weeks (stage 2 GMI) and T4 to the score obtained after 8 weeks (stage 4 GMI).
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