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Caloric Vestibular Stimulation Reduces Pain and Somatoparaphrenia in a Severe Chronic Central Post-Stroke Pain Patient: A Case Study.

Spitoni GF, Pireddu G, Galati G, Sulpizio V, Paolucci S, Pizzamiglio L - PLoS ONE (2016)

Bottom Line: To date, there is limited evidence for the effective treatments of this disease.Resting-state functional magnetic resonance imaging was used to assess the neurological effects of this treatment.This evidence can be applied to theoretical models of pain and body delusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychology-Sapienza University of Rome, Rome, Italy.

ABSTRACT
Central post-stroke pain is a neuropathic syndrome characterized by intolerable contralesional pain and, in rare cases, somatic delusions. To date, there is limited evidence for the effective treatments of this disease. Here we used caloric vestibular stimulation to reduce pain and somatoparaphrenia in a 57-year-old woman suffering from central post-stroke pain. Resting-state functional magnetic resonance imaging was used to assess the neurological effects of this treatment. Following vestibular stimulation we observed impressive improvements in motor skills, pain, and somatic delusions. In the functional connectivity study before the vestibular stimulation, we observed differences in the patient's left thalamus functional connectivity, with respect to the thalamus connectivity of a control group (N = 20), in the bilateral cingulate cortex and left insula. After the caloric stimulation, the left thalamus functional connectivity with these regions, which are known to be involved in the cortical response to pain, disappeared as in the control group. The beneficial use of vestibular stimulation in the reduction of pain and somatic delusion in a CPSP patient is now documented by behavioral and imaging data. This evidence can be applied to theoretical models of pain and body delusions.

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Related in: MedlinePlus

MRI scan of patient SF and behavioral results before and after CVS.(A) T1–weighted sequence reveals subcortical lesions that were also present in a small portion of the left lateral thalamus. (B–E) The effects of CVS were determined for several symptoms including pain (B), motor function (C), somatoparaphrenia (D), and articulation (E). All the histograms refer to the patient’s subjective evaluation. In graphs B-C-D, the Y axis shows the level of impairment (0 = no impairment; 100 = totally impaired). In graph E Y axis = 0 excellent (no altered articulation characteristics), 1 slight disorder, 2 moderate disorder, 3 severe disorder]. In all panels, post–CVS (5’) refers to measurements collected immediately after CVS, and post–CVS (30’) refers to measurements collected 30 minutes after the CVS.
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pone.0151213.g001: MRI scan of patient SF and behavioral results before and after CVS.(A) T1–weighted sequence reveals subcortical lesions that were also present in a small portion of the left lateral thalamus. (B–E) The effects of CVS were determined for several symptoms including pain (B), motor function (C), somatoparaphrenia (D), and articulation (E). All the histograms refer to the patient’s subjective evaluation. In graphs B-C-D, the Y axis shows the level of impairment (0 = no impairment; 100 = totally impaired). In graph E Y axis = 0 excellent (no altered articulation characteristics), 1 slight disorder, 2 moderate disorder, 3 severe disorder]. In all panels, post–CVS (5’) refers to measurements collected immediately after CVS, and post–CVS (30’) refers to measurements collected 30 minutes after the CVS.

Mentions: An MRI scan revealed subcortical lesions in the white matter at the level of the corona radiata and the centrum semiovale of the left hemisphere. The periventricular lesion included a very small portion (volume = 68 mm3) of the left lateral thalamus (see Fig 1A); see also S1 Fig in Supporting Information).


Caloric Vestibular Stimulation Reduces Pain and Somatoparaphrenia in a Severe Chronic Central Post-Stroke Pain Patient: A Case Study.

Spitoni GF, Pireddu G, Galati G, Sulpizio V, Paolucci S, Pizzamiglio L - PLoS ONE (2016)

MRI scan of patient SF and behavioral results before and after CVS.(A) T1–weighted sequence reveals subcortical lesions that were also present in a small portion of the left lateral thalamus. (B–E) The effects of CVS were determined for several symptoms including pain (B), motor function (C), somatoparaphrenia (D), and articulation (E). All the histograms refer to the patient’s subjective evaluation. In graphs B-C-D, the Y axis shows the level of impairment (0 = no impairment; 100 = totally impaired). In graph E Y axis = 0 excellent (no altered articulation characteristics), 1 slight disorder, 2 moderate disorder, 3 severe disorder]. In all panels, post–CVS (5’) refers to measurements collected immediately after CVS, and post–CVS (30’) refers to measurements collected 30 minutes after the CVS.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4814090&req=5

pone.0151213.g001: MRI scan of patient SF and behavioral results before and after CVS.(A) T1–weighted sequence reveals subcortical lesions that were also present in a small portion of the left lateral thalamus. (B–E) The effects of CVS were determined for several symptoms including pain (B), motor function (C), somatoparaphrenia (D), and articulation (E). All the histograms refer to the patient’s subjective evaluation. In graphs B-C-D, the Y axis shows the level of impairment (0 = no impairment; 100 = totally impaired). In graph E Y axis = 0 excellent (no altered articulation characteristics), 1 slight disorder, 2 moderate disorder, 3 severe disorder]. In all panels, post–CVS (5’) refers to measurements collected immediately after CVS, and post–CVS (30’) refers to measurements collected 30 minutes after the CVS.
Mentions: An MRI scan revealed subcortical lesions in the white matter at the level of the corona radiata and the centrum semiovale of the left hemisphere. The periventricular lesion included a very small portion (volume = 68 mm3) of the left lateral thalamus (see Fig 1A); see also S1 Fig in Supporting Information).

Bottom Line: To date, there is limited evidence for the effective treatments of this disease.Resting-state functional magnetic resonance imaging was used to assess the neurological effects of this treatment.This evidence can be applied to theoretical models of pain and body delusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychology-Sapienza University of Rome, Rome, Italy.

ABSTRACT
Central post-stroke pain is a neuropathic syndrome characterized by intolerable contralesional pain and, in rare cases, somatic delusions. To date, there is limited evidence for the effective treatments of this disease. Here we used caloric vestibular stimulation to reduce pain and somatoparaphrenia in a 57-year-old woman suffering from central post-stroke pain. Resting-state functional magnetic resonance imaging was used to assess the neurological effects of this treatment. Following vestibular stimulation we observed impressive improvements in motor skills, pain, and somatic delusions. In the functional connectivity study before the vestibular stimulation, we observed differences in the patient's left thalamus functional connectivity, with respect to the thalamus connectivity of a control group (N = 20), in the bilateral cingulate cortex and left insula. After the caloric stimulation, the left thalamus functional connectivity with these regions, which are known to be involved in the cortical response to pain, disappeared as in the control group. The beneficial use of vestibular stimulation in the reduction of pain and somatic delusion in a CPSP patient is now documented by behavioral and imaging data. This evidence can be applied to theoretical models of pain and body delusions.

Show MeSH
Related in: MedlinePlus