[Nondermatomal somatosensory deficits in chronic pain patients]

Nondermatomal somatosensory deficits (NDSDs) are frequently found in chronic pain patients and allude to pain sensitization and pain centralization. In the clinical examination NDSDs are as a rule accompanied by hyposensitivity to touch and heat perception often with a quadrantal or hemibody distribution. The majority of NDSD patients show a trigger episode with a somatic nociceptive trauma in the case history. These somatic findings, however, never fully explain the pain disorder, analogue to the complex regional pain syndrome (CRPS). Most patients with chronic pain disorders as well as those with NDSD often report an antecedent period of high psychobiological stress. The data from functional imaging reveal a complex pattern of a central nervous dysregulation.

Nondermatomal somatosensory deficits in patients with chronic pain disorder: clinical findings and hypometabolic pattern in FDG-PET

Patients with chronic pain disorders often show somatosensory disturbances that are considered to be functional. This paper aims at a more precise clinical description and at a documentation of functional neuroimaging correlates of this phenomenon. We examined 30 consecutive patients with unilaterally accentuated chronic pain not explained by persistent peripheral tissue damage and ipsilateral somatosensory disturbances including upper and lower extremities and trunk. The patients were assessed clinically and with conventional brain CT or MRI scan. In the last 11 patients functional neuroimaging was carried out (18-fluordeoxyglucose positron emission tomography=FDG-PET). Depressive symptoms were assessed with the Hamilton depression scale (HAMD-17) and pain intensity was rated with a visual analogue scale for pain (VAS). All patients suffered from mild to moderate depressive symptoms. All patients had experienced a prolonged antecedent phase of severe emotional distress; most of them remembered a "trigger episode of somatic pain" on the affected side. Somatosensory deficits were a replicable hyposensitivity to touch and heat perception of nondermatomal distribution. Conventional imaging procedures (brain CT or MRI scans) showed no structural changes. However, in 11 patients functional imaging with FDG-PET showed a significant hypometabolic pattern of changes in cortical and subcortical areas, mainly in the post-central gyrus, posterior insula, putamen, and anterior cingulate cortex. In summary, pain-related nondermatomal somatosensory deficits (NDSDs) are a phenomenon involving biological as well as psychosocial factors with replicable neuroperceptive clinical findings and a complex neurodysfunctional pattern in the FDG-PET.

Impaired verbal memory in Parkinson disease: relationship to prefrontal dysfunction and somatosensory discrimination

OBJECTIVE: To study the neurocognitive profile and its relationship to prefrontal dysfunction in non-demented Parkinson's disease (PD) with deficient haptic perception. METHODS: Twelve right-handed patients with PD and 12 healthy control subjects underwent thorough neuropsychological testing including Rey complex figure, Rey auditory verbal and figural learning test, figural and verbal fluency, and Stroop test. Test scores reflecting significant differences between patients and healthy subjects were correlated with the individual expression coefficients of one principal component, obtained in a principal component analysis of an oxygen-15-labeled water PET study exploring somatosensory discrimination that differentiated between the two groups and involved prefrontal cortices. RESULTS: We found significantly decreased total scores for the verbal learning trials and verbal delayed free recall in PD patients compared with normal volunteers. Further analysis of these parameters using Spearman's ranking correlation showed a significantly negative correlation of deficient verbal recall with expression coefficients of the principal component whose image showed a subcortical-cortical network, including right dorsolateral-prefrontal cortex, in PD patients. CONCLUSION: PD patients with disrupted right dorsolateral prefrontal cortex function and associated diminished somatosensory discrimination are impaired also in verbal memory functions. A negative correlation between delayed verbal free recall and PET activation in a network including the prefrontal cortices suggests that verbal cues and accordingly declarative memory processes may be operative in PD during activities that demand sustained attention such as somatosensory discrimination. Verbal cues may be compensatory in nature and help to non-specifically enhance focused attention in the presence of a functionally disrupted prefrontal cortex.

Self-motion perception training: thresholds improve in the light but not in the dark

We investigated perceptual learning in self-motion perception. Blindfolded participants were displaced leftward or rightward by means of a motion platform and asked to indicate the direction of motion. A total of eleven participants underwent 3,360 practice trials, distributed over twelve (Experiment 1) or 6 days (Experiment 2). We found no improvement in motion discrimination in both experiments. These results are surprising since perceptual learning has been demonstrated for visual, auditory, and somatosensory discrimination. Improvements in the same task were found when visual input was provided (Experiment 3). The multisensory nature of vestibular information is discussed as a possible explanation of the absence of perceptual learning in darkness.

Investigating interocclusal perception in tactile teeth sensibility using symmetric and asymmetric analysis

The purpose of this clinical trial was to determine the active tactile sensibility of natural teeth and to obtain a statistical analysis method fitting a psychometric function through the observed data points. On 68 complete dentulous test persons (34 males, 34 females, mean age 45.9 ± 16.1 years), one pair of healthy natural teeth each was tested: n = 24 anterior teeth and n = 44 posterior teeth. The computer-assisted, randomized measurement was done by having the subjects bite on thin copper foils of different thickness (5-200 µm) inserted between the teeth. The threshold of active tactile sensibility was defined by the 50% value of correct answers. Additionally, the gradient of the sensibility curve and the support area (90-10% value) as a description of the shape of the sensibility curve were calculated. For modeling the sensibility curve, symmetric and asymmetric functions were used. The mean sensibility threshold was 14.2 ± 12.1 µm. The older the subject, the higher the tactile threshold (r = 0.42, p = 0.0006). The support area was 41.8 ± 43.3 µm. The higher the 50% threshold, the smaller the gradient of the curve and the larger the support area. The curves showing the active tactile sensibility of natural teeth demonstrate a tendency towards asymmetry, so that the active tactile sensibility of natural teeth can mathematically best be described by using the asymmetric Weibull function.

[Chronic right-sided pain-associated nondermatomal somatosensory deficit following an accident]

We present the case of a 48-year old man who, eight years after an industrial accident, presents with chronic right-sided nondermatomal pain and hypaesthesia to heat and touch. During symmetric peripheral touch functional magnetic resonance imaging revealed hypometabolism in the left thalamus, somatosensory cortex, and anterior cingulate cortex. Pain-associated nondermatomal somatosensory deficits (NDSDs) localizing to one side of the body are a frequent clinical entity, which are often triggered by an accident. The tendency of NDSDs to extend to adjunct ipsilateral body parts and to become chronic points to maladaptive adjustment of pain-processing areas in the central nervous system. Psychological stress prior to or around the triggering event seems an important risk factor for NDSDs.

Slowdown of gist perception in colour diagnostic scenes

Humans perceive the content (gist) of a scene very rapidly within about 40 ms [Castelhano and Henderson, 2008 Journal of Experimental Psychology Human Perception and Performance 43(3) 660-675]. It has also been demonstrated that colours contribute to the perception of the gist of a scene if the colours are diagnostic for the distinction of scenes (Oliva and Schyns, 2000 Cognitive Psychology 41 176-210). We presented 320 coloured photographs of 2 diagnostic (mountains and coasts) and 2 nondiagnostic colour scenes (cities and rooms), 80 per category, in a masking paradigm. The mask consisted of randomly distributed colour patches. SOA was varied between 20 and 80 ms, in steps of 20 ms and subjects had to indicate the gist of the scene (4AFC). A control condition without masking was also included. In line with previous results we have found that the gist of nondiagnostic coloured scenes is extracted within 40 ms. However, if colour comes into play, the extraction of the scene gist is prolonged by about 20 ms. A possible reason for this outcome might be that nondiagnostic colour scenes are identified by their luminance components which are processed faster than the colour information, which in turn mediates the identification of diagnostic colour scenes