Dysynchiria - a possible explanation

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

Dysynchiria Watching the mirror image of the unaffected limb elicits pain on the affected side Acerra & Moseley 2005 Neurology 65: 751-3

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

So, one puts  their hands  either side of a  mirror….  Acerra & Moseley 2005 Neurology 65: 751-3

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

experience When you touch the good hand, nothing normal extraordinary happens….. Acerra & Moseley 2005 Neurology 65: 751-3

experience When you touch the intact hand, one feels the touch on BOTH hands Phantom/stroke “Synchiria” Acerra & Moseley 2005 Neurology 65: 751-3

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

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

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

S1 ‘representaJve’ neurons  S2 ‘representaJve’ neurons  with bimodal input  Visual ﬁeld input  Wide diameter sensory neuron  Acerra & Moseley 2005 Neurology 65: 751-3

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

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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Dysynchiria - a possible explanation

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