Dysynchiria - a possible explanation

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A possible explanation of Dysynchiria, based on some research by Acerra and Moseley, Neurology 2005;65:751–3

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Dysynchiria - a possible explanation

  1. 1. Lorimer Moseley NHMRC Senior Research Fellow Prince of Wales Medical Research Institute & School of Medical Sciences, University of New South Wales, Sydney, Australia Team leader The GAMFI project University of Oxford, UK
  2. 2. Dysynchiria Watching the mirror image of the unaffected limb elicits pain on the affected side Acerra & Moseley 2005 Neurology 65: 751-3
  3. 3. This
is
Nicole.
 She
is
touching
 the
good
hand
 of
someone
 with
CRPS,
 who
has
their
 bad
hand
 behind

 the
mirror.
 Acerra & Moseley 2005 Neurology 65: 751-3
  4. 4. So,
one
puts
 their
hands
 either
side
of
a
 mirror….
 Acerra & Moseley 2005 Neurology 65: 751-3
  5. 5. So,
one
puts
their
hands
either
 side
of
a
mirror….then
moves
 their
head
a
bit
so
that
it
looks
 like
they
are
seeing
both
hands

 when
they
are
actually
seeing
 the
right
hand
and
its
mirror
 image.
 Acerra & Moseley 2005 Neurology 65: 751-3
  6. 6. So,
one
puts
their
hands
either
 side
of
a
mirror….then
moves
 their
head
a
bit
so
that
it
looks
 like
they
are
seeing
both
hands

 when
they
are
actually
seeing
 the
right
hand
and
its
mirror
 image.
 Acerra & Moseley 2005 Neurology 65: 751-3
  7. 7. experience When you touch the good hand, nothing normal extraordinary happens….. Acerra & Moseley 2005 Neurology 65: 751-3
  8. 8. experience When you touch the intact hand, one feels the touch on BOTH hands Phantom/stroke “Synchiria” Acerra & Moseley 2005 Neurology 65: 751-3
  9. 9. pain experience When you touch the good hand, one feels that touch on that hand but it CRPS1 also HURTS the other hand. “dysynchiria” Acerra & Moseley 2005 Neurology 65: 751-3
  10. 10. A Parasthaesia
 Allodynia
 x x x x x x x x x x x x x x x x x x x x x x x x x xx p pp p p p x x op x x xx x Response
to
light
 p x p ppp o p p o o o p p x p p touch
 o o o B ooo Before
Rx
 ooo ADer
Rx
 opo ooo p pp x po o p p p o o o o x o o x p o oo oo o x x x o o o o o x oo oo o oo xx oo o Acerra & Moseley 2005 Neurology 65: 751-3
  11. 11. S1
‘representaJve’
neurons
 S2
‘representaJve’
neurons
 with
bimodal
input
 Visual
field
input
 Wide
diameter
sensory
neuron
 This
is
a
possible
explanaJon
for
the
phenomenon
of
 dysynchiria.
 Acerra & Moseley 2005 Neurology 65: 751-3
  12. 12. S1
‘representaJve’
neurons
 S2
‘representaJve’
neurons
 with
bimodal
input
 Visual
field
input
 Wide
diameter
sensory
neuron
 Acerra & Moseley 2005 Neurology 65: 751-3
  13. 13. S1
‘representaJve’
neurons
 S2
‘representaJve’
neurons
 with
bimodal
input
 Visual
field
input
 Normal
state
 Wide
diameter
sensory
neuron
 Acerra & Moseley 2005 Neurology 65: 751-3
  14. 14. S1
‘representaJve’
neurons
 S2
‘representaJve’
neurons
 with
bimodal
input
 Visual
field
input
 SensiJsed
state
 Wide
diameter
sensory
neuron
 This
is
a
possible
explanaJon
for
the
phenomenon
of
 dysynchiria.
 In
a
sensiJsed
state,
the
visually‐evoked
acJvaJon
of
 bimodal
neurons
in
S2
might
be
enough
to
‘ignite’
the
 network
of
neurons
that
evokes
pain.

 Acerra & Moseley 2005 Neurology 65: 751-3

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