Complex regional pain syndrome (CRPS) impairs visuospatial perception,whereas post-herpetic neuralgia does not: possible implications for supraspinal mechanism of CRPS

<p><b>INTRODUCTION</b>Complex regional pain syndrome (CRPS) patients show impaired visuospatial perception in the dark, as compared to normal patients with acute nociceptive pain. The purpose of this study is 2-fold: (i) to ascertain whether this distorted visuospatial perception is related to the chronicity of pain, and (ii) to analyse visuospatial perception of CRPS in comparison with another neuropathic pain condition.</p><p><b>MATERIALS AND METHODS</b>We evaluated visual subjective body-midline (vSM) representation in 27 patients with post-herpetic neuralgia (PHN) and 22 with CRPS under light and dark conditions. A red laser dot was projected onto a screen and moved horizontally towards the sagittal plane of the objective body-midline (OM). Each participant was asked to direct the dot to a position where it crossed their vSM. The distance between the vSM and OM was analysed to determine how and in which direction the vSM deviated.</p><p><b>RESULTS</b>Under light condition, all vSM judgments approximately matched the OM. However, in the dark, CRPS patients, but not PHN patients, showed a shifted vSM towards the affected side.</p><p><b>CONCLUSION</b>We demonstrated that chronic pain does not always impair visuospatial perception. The aetiology of PHN is limited to the peripheral nervous system, whereas the distorted visuospatial perception suggests a supraspinal aetiology of CRPS.</p>

Ambulation in Patients with Open Myelomeningocele followed from Infancy until over 15 Years of Age / The Japanese Journal of Rehabilitation Medicine

Ambulation in patients with spina bifida is affected by many factors, of which neurosegmental level is the most influential. In addition, some ambulatory patients experience deterioration over time, though longitudinal studies are scarce. This study investigated patient ambulation and its related factors in 21 patients with open myelomeningocele who were followed from infancy until over 15 years of age. In five patients, ambulation at the final visit exceeded the goal set up by Oki according to the patient's neurosegmental level. As these patients had L3 or L4 paralysis, our estimation of their neurosegmental level made according to Menelaus, which differs from that made using Sharrard's classification, may have influenced this result. Ambulation in five patients was below the goal, and two patients among this group experienced ambulatory deterioration during the follow-up period. In these five patients, as compared with the remaining 11 patients, the incidence of scoliosis, hip dysplasias, and obesity was higher, which may have influenced their lower ambulation status.