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Iwatsuki K, Hoshiyama M, Yoshida A, Uemura JI, Hoshino A, Morikawa I, Nakagawa Y, Hirata H. Chronic pain-related cortical neural activity in patients with complex regional pain syndrome. IBRO Neurosci Rep 2021; 10:208-215. [PMID: 34095892 PMCID: PMC8167223 DOI: 10.1016/j.ibneur.2021.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/07/2021] [Accepted: 05/03/2021] [Indexed: 11/04/2022] Open
Abstract
Quantitative objective measurement of chronic pain is important. We elucidated chronic pain-related cortical neural activity and neural connectivity among pain-related brain regions in complex regional pain syndrome (CRPS). Resting-state magnetoencephalography recordings were performed. Cortical current density and neural connectivity, revealed by amplitude envelope correlation (AEC), were estimated on standardized brain magnetic resonance imaging. Intra-experiment pain was assessed subjectively using a visual analogue scale (VAS). The correlation between current density and VAS scores was calculated for the occipital areas and pain-related cortices. Current density in the primary (SI) and secondary (SII) somatosensory cortex and precuneus in both hemispheres was negatively correlated with the pain VAS score. The AEC and VAS values were significantly correlated for the SII and the precuneus and for the SII and insular cortex in the alpha frequency band in the right hemisphere. In the theta frequency band, the AEC and VAS values correlated for the SII and posterior cingulate cortex in the right hemisphere. Our results suggested that disruption of pain processes and functions in the default mode network occurs in CRPS. Our method targeting the neural mechanism of pain has the potential to offer a clinically objective means of evaluating it. Chronic pain can be objectively evaluated with magnetoencephalography. Neural connectivity of pain-related cortices was reduced in complex regional pain syndrome. Default mode network is disrupted in complex regional pain syndrome patients.
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Affiliation(s)
- Katsuyuki Iwatsuki
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Minoru Hoshiyama
- Department of Health Sciences, Faculty of Medicine, Nagoya University, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, Aichi 461-8673, Japan
| | - Akihito Yoshida
- Department of Health Sciences, Faculty of Medicine, Nagoya University, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, Aichi 461-8673, Japan
| | - Jun-Ichi Uemura
- Department of Health Sciences, Faculty of Medicine, Nagoya University, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, Aichi 461-8673, Japan
| | - Aiko Hoshino
- Department of Health Sciences, Faculty of Medicine, Nagoya University, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, Aichi 461-8673, Japan
| | - Izumi Morikawa
- Department of Health Sciences, Faculty of Medicine, Nagoya University, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, Aichi 461-8673, Japan
| | - Yasunobu Nakagawa
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Hitoshi Hirata
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
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Iwatsuki K, Yoneda H, Onishi T, Ishii H, Kurimoto S, Yamamoto M, Tatebe M, Hirata H. Compatibility of magnetic resonance imaging in patients with orthopedic implants: manufacturer questionnaires. NAGOYA JOURNAL OF MEDICAL SCIENCE 2021; 82:79-84. [PMID: 32273635 PMCID: PMC7103874 DOI: 10.18999/nagjms.82.1.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In clinical practice, surgeons have stated that magnetic resonance imaging (MRI) can be performed in patients with titanium alloy implants. However, manufacturers and distributors of many implants may not comply with this common practice. As such, this study aimed to investigate manufacturers’ views on MRI use in patients fitted with their implants. The questionnaire survey was conducted between May and August 2018. Is your product compatible with MRI? ( ) Select from (1) to (3). In case of (1) or (2), up to ( ) Tesla. (1) MRI can be performed even at the sites of implanted fixators. (2) MRI can be performed at sites without implanted fixators. (3) MRI cannot be performed, or the manufacturer does not approve MRI use (cannot issue a certificate). The questionnaire forms were sent to 12 manufacturers, and the response rate was 100%. Manufacturers responded that they could not publicly allow MRI use in patients with their products. These findings do not conclude that MRI cannot be performed in such patients. This survey revealed that currently decisions regarding MRI use is left to the treating physicians. This situation poses a great problem for medical safety and imposes a substantial burden on physicians. As many problems remain in the field of orthopedic surgery, manufacturers of implants should proactively manage issues surrounding the usage of MRI.
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Affiliation(s)
- Katsuyuki Iwatsuki
- Department of Hand surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hidemasa Yoneda
- Department of Hand surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsuro Onishi
- Department of Hand surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hisao Ishii
- Department of Hand surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shigeru Kurimoto
- Department of Hand surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michiro Yamamoto
- Department of Hand surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiro Tatebe
- Department of Hand surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hitoshi Hirata
- Department of Hand surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Yoshida A, Iwatsuki K, Hoshiyama M, Hirata H. Disturbance of somatotopic spatial cognition and extra-territorial pain in carpal tunnel syndrome. NeuroRehabilitation 2020; 46:423-431. [PMID: 32250335 DOI: 10.3233/nre-193007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several studies on carpal tunnel syndrome have reported pain that exists beyond the median nerve territory of the affected hand. However, the mechanism is unknown. PURPOSE We investigated the cause of extra-territorial pain by the analysis of clinical assessments and cortical activity using magnetoencephalography. METHODS To compare patients with and without extra-territorial pain, fourteen patients with carpal tunnel syndrome were assessed using clinical examination, such as patients' profile, paresthesia, physical tests, and psychological tests. The physical assessment included tactile threshold and static and moving two-point discrimination sensations on digital pulp. Neural activation in the cerebral cortex was also measured using z-scores calculated by magnetoencephalography. RESULTS Among fourteen patients, ten patients had pain in the affected median nerve territory only and four patients had extra-territorial pain. When comparing the groups, the static and moving two-point discrimination sensation values in patients with extra-territorial pain were larger than those of patients without the pain (p < 0.05). The supra-marginal gyrus, mid-part of the precentral sulcus, angular gyrus in the left hemisphere, bilateral sensorimotor areas for legs, and bilateral isthmus-cingulate areas showed larger z-scores in patients with extra-territorial pain than in patients without the pain (p < 0.05). CONCLUSIONS The static and moving two-point discrimination sensations signify the ability of tactile spatial acuity. Bilateral sensorimotor areas were activated in sites that were not the hand. Furthermore, the inferior parietal lobule in the left hemisphere, which synthesizes and integrates multiple sensations showed high activation. Our findings suggested that the mechanism of extra-territorial pain was associated with dysfunction of spatial cognition.
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Affiliation(s)
- Akihito Yoshida
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan.,Department of Rehabilitation, Nagoya University Hospital, Aichi, Japan.,Department of Rehabilitation Science, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Katsuyuki Iwatsuki
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Minoru Hoshiyama
- Brain and Mind Research Center, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hitoshi Hirata
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
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Iwatsuki K, Hoshiyama M, Oyama S, Yoneda H, Shimoda S, Hirata H. Electroencephalographic Functional Connectivity With the Tacit Learning System Prosthetic Hand: A Case Series Using Motor Imagery. Front Synaptic Neurosci 2020; 12:7. [PMID: 32184715 PMCID: PMC7058783 DOI: 10.3389/fnsyn.2020.00007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/07/2020] [Indexed: 12/01/2022] Open
Abstract
We previously created a prosthetic hand with a tacit learning system (TLS) that automatically supports the control of forearm pronosupination. This myoelectric prosthetic hand enables sensory feedback and flexible motor output, which allows users to move efficiently with minimal burden. In this study, we investigated whether electroencephalography can be used to analyze the influence of the auxiliary function of the TLS on brain function. Three male participants who had sustained below-elbow amputations and were myoelectric prosthesis users performed a series of physical movement trials with the TLS inactivated and activated. Trials were video recorded and a sequence of videos was prepared to represent each individual's own use while the system was inactivated and activated. In a subsequent motor imagery phase during which electroencephalography (EEG) signals were collected, each participant was asked to watch both videos of themself while actively imagining the physical movement depicted. Differences in mean cortical current and amplitude envelope correlation (AEC) values between supplementary motor areas (SMA) and each vertex were calculated. For all participants, there were differences in the mean cortical current generated by the motor imagery tasks when the TLS inactivated and activated conditions were compared. The AEC values were higher during the movement imagery task with TLS activation, although their distribution on the cortex varied between the three individuals. In both S1 and other brain areas, AEC values increased in conditions with the TLS activated. Evidence from this case series indicates that, in addition to motor control, TLS may change sensory stimulus recognition.
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Affiliation(s)
- Katsuyuki Iwatsuki
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Minoru Hoshiyama
- Department of Health Sciences, Faculty of Medicine, Nagoya University, Nagoya, Japan
| | - Shintaro Oyama
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Hidemasa Yoneda
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Shingo Shimoda
- Center of Brain Science (CBS), CBS–TOYOTA Collaboration Center, RIKEN, Nagoya, Japan
| | - Hitoshi Hirata
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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Iwatsuki K, Hoshiyama M, Yoshida A, Shinohara T, Hirata H. A magnetoencephalographic study of longitudinal brain function alterations following carpal tunnel release. Sci Rep 2019; 9:19776. [PMID: 31874978 PMCID: PMC6930280 DOI: 10.1038/s41598-019-56190-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/03/2019] [Indexed: 11/26/2022] Open
Abstract
We investigate changes in brain function before and after carpal tunnel release. Magnetoencephalography (MEG), during which we recorded somatosensory evoked cortical magnetic fields (SEFs), and a clinical evaluation were performed before surgery and 6 months after. The distance on the vertical axis between the equivalent current dipoles (ECDs) for the first and third digits before surgery was significantly less than after surgery. There were no significant differences in values between the control participant and patients after surgery. In terms of distal motor latency, there was a negative correlation with the distance. The recovery function of the root mean square (RMS) before surgery for the N20m was less suppressed at 10 ms of ISI in patients, compared to controls. There were no significant differences in the RMS values for patients before and after surgery. Our results indicate that treating peripheral nerve lesions, such as in carpal tunnel release, positively modifies brain function.
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Affiliation(s)
- Katsuyuki Iwatsuki
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan.
| | - Minoru Hoshiyama
- Department of Health Sciences, Faculty of Medicine, Nagoya University, Nagoya, Japan.,Brain and Mind Research Center, Nagoya University, Nagoya, Japan
| | - Akihito Yoshida
- Department of Health Sciences, Faculty of Medicine, Nagoya University, Nagoya, Japan.,Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | | | - Hitoshi Hirata
- Department of Hand Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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