TY - JOUR
T1 - Primary somatosensory/motor cortical thickness distinguishes paresthesia-dominant from pain-dominant carpal tunnel syndrome
AU - Maeda, Yumi
AU - Kettner, Norman
AU - Kim, Jieun
AU - Kim, Hyungjun
AU - Cina, Stephen
AU - Malatesta, Cristina
AU - Gerber, Jessica
AU - Mcmanus, Claire
AU - Libby, Alexandra
AU - Mezzacappa, Pia
AU - Mawla, Ishtiaq
AU - Morse, Leslie R.
AU - Audette, Joseph
AU - Napadow, Vitaly
N1 - Funding Information:
This work was supported by the following NIH grants: R01-AT004714, R01-AT004714-02S1, P01-AT002048, P41EB015896, S10-RR021110, S10RR023401, and S10-RR023043.
Publisher Copyright:
© 2016 International Association for the Study of Pain.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - Paresthesia-dominant and pain-dominant subgroups have been noted in carpal tunnel syndrome (CTS), a peripheral neuropathic disorder characterized by altered primary somatosensory/motor (S1/M1) physiology. We aimed to investigate whether brain morphometry dissociates these subgroups. Subjects with CTS were evaluated with nerve conduction studies, whereas symptom severity ratings were used to allocate subjects into paresthesia-dominant (CTS-paresthesia), pain-dominant (CTS-pain), and pain/paresthesia nondominant (not included in further analysis) subgroups. Structural brain magnetic resonance imaging data were acquired at 3T using a multiecho MPRAGE T1-weighted pulse sequence, and gray matter cortical thickness was calculated across the entire brain using validated, automated methods. CTS-paresthesia subjects demonstrated reduced median sensory nerve conduction velocity (P 0.05) compared with CTS-pain subjects. In addition, cortical thickness in precentral and postcentral gyri (S1/M1 hand area) contralateral to the more affected hand was significantly reduced in CTS-paresthesia subgroup compared with CTS-pain subgroup. Moreover, in CTS-paresthesia subjects, precentral cortical thickness was negatively correlated with paresthesia severity (r(34) -0.40, P 0.016) and positively correlated with median nerve sensory velocity (r(36) 0.51, P 0.001), but not with pain severity. Conversely, in CTS-pain subjects, contralesional S1 (r(9) 0.62, P 0.042) and M1 (r(9) 0.61, P 0.046) cortical thickness were correlated with pain severity, but not median nerve velocity or paresthesia severity. This double dissociation in somatotopically specific S1/M1 areas suggests a neuroanatomical substrate for symptom-based CTS subgroups. Such fine-grained subgrouping of CTS may lead to improved personalized therapeutic approaches, based on superior characterization of the linkage between peripheral and central neuroplasticity.
AB - Paresthesia-dominant and pain-dominant subgroups have been noted in carpal tunnel syndrome (CTS), a peripheral neuropathic disorder characterized by altered primary somatosensory/motor (S1/M1) physiology. We aimed to investigate whether brain morphometry dissociates these subgroups. Subjects with CTS were evaluated with nerve conduction studies, whereas symptom severity ratings were used to allocate subjects into paresthesia-dominant (CTS-paresthesia), pain-dominant (CTS-pain), and pain/paresthesia nondominant (not included in further analysis) subgroups. Structural brain magnetic resonance imaging data were acquired at 3T using a multiecho MPRAGE T1-weighted pulse sequence, and gray matter cortical thickness was calculated across the entire brain using validated, automated methods. CTS-paresthesia subjects demonstrated reduced median sensory nerve conduction velocity (P 0.05) compared with CTS-pain subjects. In addition, cortical thickness in precentral and postcentral gyri (S1/M1 hand area) contralateral to the more affected hand was significantly reduced in CTS-paresthesia subgroup compared with CTS-pain subgroup. Moreover, in CTS-paresthesia subjects, precentral cortical thickness was negatively correlated with paresthesia severity (r(34) -0.40, P 0.016) and positively correlated with median nerve sensory velocity (r(36) 0.51, P 0.001), but not with pain severity. Conversely, in CTS-pain subjects, contralesional S1 (r(9) 0.62, P 0.042) and M1 (r(9) 0.61, P 0.046) cortical thickness were correlated with pain severity, but not median nerve velocity or paresthesia severity. This double dissociation in somatotopically specific S1/M1 areas suggests a neuroanatomical substrate for symptom-based CTS subgroups. Such fine-grained subgrouping of CTS may lead to improved personalized therapeutic approaches, based on superior characterization of the linkage between peripheral and central neuroplasticity.
KW - Carpal tunnel syndrome
KW - Entrapment neuropathy
KW - Neuropathic pain
KW - Paresthesia
KW - Primary somatosensory/motor cortex
UR - http://www.scopus.com/inward/record.url?scp=84964768879&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84964768879&partnerID=8YFLogxK
U2 - 10.1097/j.pain.0000000000000486
DO - 10.1097/j.pain.0000000000000486
M3 - Article
C2 - 26761384
AN - SCOPUS:84964768879
SN - 0304-3959
VL - 157
SP - 1085
EP - 1093
JO - Pain
JF - Pain
IS - 5
ER -