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The Journal of Neuroscience, May 15, 2001, 21(10):3609-3618

Reorganization of Motor and Somatosensory Cortex in Upper Extremity Amputees with Phantom Limb Pain

Anke Karl¹, Niels Birbaumer^{3, 4}, Werner Lutzenberger³, Leonardo G. Cohen⁵, and Herta Flor²

¹ Department of Biopsychology, Technical University Dresden, D-01062 Dresden, Germany, ² Department of Clinical and Cognitive Neuroscience at the University of Heidelberg, Central Institute of Mental Health D-68159 Mannheim, Germany, ³ Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, D-72074 Tübingen, Germany, ⁴ Department of General Psychology, University of Padua, I-35100 Padua, Italy, and ⁵ Human Cortical Physiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892

Phantom limb pain (PLP) in amputees is associated with reorganizational changes in the somatosensory system. To investigate the relationship between somatosensory and motor reorganization and phantom limb pain, we used focal transcranial magnetic stimulation (TMS) of the motor cortex and neuroelectric source imaging of the somatosensory cortex (SI) in patients with and without phantom limb pain. For transcranial magnetic stimulation, recordings were made bilaterally from the biceps brachii, zygomaticus, and depressor labii inferioris muscles. Neuroelectric source imaging of the EEG was obtained after somatosensory stimulation of the skin overlying face and hand. Patients with phantom limb pain had larger motor-evoked potentials from the biceps brachii, and the map of outputs was larger for muscles on the amputated side compared with the intact side. The optimal scalp positions for stimulation of the zygomaticus and depressor labii inferioris muscles were displaced significantly more medially (toward the missing hand representation) in patients with phantom limb pain only. Neuroelectric source imaging revealed a similar medial displacement of the dipole center for face stimulation in patients with phantom limb pain. There was a high correlation between the magnitude of the shift of the cortical representation of the mouth into the hand area in motor and somatosensory cortex and phantom limb pain. These results show enhanced plasticity in both the motor and somatosensory domains in amputees with phantom limb pain.

Key words: cortical plasticity; sensorimotor reorganization; phantom limb pain; amputation; transcranial magnetic stimulation; neuroelectric source imaging

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Copyright © 2001 Society for Neuroscience  0270-6474/01/21103609-10$05.00/0

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