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Neurocognitive and Neuroplastic Mechanisms of Novel Clinical Signs in CRPS

Kuttikat, Anoop, Noreika, Valdas, Shenker, Nicholas, Chennu, Srivas, Bekinschtein, Tristan, Brown, Christopher Andrew (2016) Neurocognitive and Neuroplastic Mechanisms of Novel Clinical Signs in CRPS. Frontiers in Human Neuroscience, 10 (16). pp. 1-13. E-ISSN 1662-5161. (doi:10.3389/fnhum.2016.00016) (KAR id:54627)

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Abstract

Complex regional pain syndrome (CRPS) is a chronic, debilitating pain condition that usually arises after trauma to a limb, but its precise etiology remains elusive. Novel clinical signs based on body perceptual disturbances have been reported, but their pathophysiological mechanisms remain poorly understood. Investigators have used functional neuroimaging techniques (including MEG, EEG, fMRI, and PET) to study changes mainly within the somatosensory and motor cortices. Here, we provide a focused review of the neuroimaging research findings that have generated insights into the potential neurocognitive and neuroplastic mechanisms underlying perceptual disturbances in CRPS. Neuroimaging findings, particularly with regard to somatosensory processing, have been promising but limited by a number of technique-specific factors (such as the complexity of neuroimaging investigations, poor spatial resolution of EEG/MEG, and use of modeling procedures that do not draw causal inferences) and more general factors including small samples sizes and poorly characterized patients. These factors have led to an underappreciation of the potential heterogeneity of pathophysiology that may underlie variable clinical presentation in CRPS. Also, until now, neurological deficits have been predominantly investigated separately from perceptual and cognitive disturbances. Here, we highlight the need to identify neurocognitive phenotypes of patients with CRPS that are underpinned by causal explanations for perceptual disturbances. We suggest that a combination of larger cohorts, patient phenotyping, the use of both high temporal, and spatial resolution neuroimaging methods, and the identification of simplified biomarkers is likely to be the most fruitful approach to identifying neurocognitive phenotypes in CRPS. Based on our review, we explain how such phenotypes could be characterized in terms of hierarchical models of perception and corresponding disturbances in recurrent processing involving the somatosensory, salience and executive brain networks. We also draw attention to complementary neurological factors that may explain some CRPS symptoms, including the possibility of central neuroinflammation and neuronal atrophy, and how these phenomena may overlap but be partially separable from neurocognitive deficits.

Item Type: Article
DOI/Identification number: 10.3389/fnhum.2016.00016
Uncontrolled keywords: perceptual disturbance, neuroimaging, cognition, plasticity, neuroinflammation
Subjects: B Philosophy. Psychology. Religion > BF Psychology
Divisions: Faculties > Sciences > School of Computing
Depositing User: Srivas Chennu
Date Deposited: 13 Apr 2016 09:47 UTC
Last Modified: 24 Jan 2020 04:08 UTC
Resource URI: https://kar.kent.ac.uk/id/eprint/54627 (The current URI for this page, for reference purposes)
Chennu, Srivas: https://orcid.org/0000-0002-6840-2941
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