Bilateral motor cortex disinhibition in complex regional pain syndrome (CRPS) type I of the hand

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Abstract—BackgroundComplex regional pain syndrome type I (CRPS I) develops as a consequence of trauma affecting the limbs, without obvious nerve lesion. Its features include pain, edema, autonomic dysfunction, movement disorder, and trophic changes. CNS involvement is suggested by the symptoms, but the pathophysiology of CRPS I is unknown.ObjectiveTo assess excitability changes in the motor cortex in patients with CRPS I.MethodsThe authors studied 25 patients with unilateral CRPS I involving the hand by means of transcranial magnetic stimulation using a paired-pulse paradigm. Motor threshold (MT) and intracortical inhibition and facilitation were determined on the affected and the clinically unaffected side. A control group of 20 healthy subjects was studied.ResultsThe authors found a significant reduction of intracortical inhibition on both sides of patients with CRPS compared with control subjects, whereas intracortical facilitation and MT did not differ significantly. However, in the patients’ group, the presence of allodynia significantly decreased MT.ConclusionsThe authors showed a bilateral disinhibition of the motor cortex in patients with complex regional pain syndrome.

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