Research papersCerebral activation during motor imagery in complex regional pain syndrome type 1 with dystoniaGieteling, Esther W.a,c,*; van Rijn, Monique A.b; de Jong, Bauke M.a,c; Hoogduin, Johannes M.c; Renken, Remcoc; van Hilten, Jacobus J.b; Leenders, Klaus L.a Author Information aDepartment of Neurology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands bDepartment of Neurology, Leiden University Medical Center, Leiden, The Netherlands cBCN-NeuroImaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands *Corresponding author. Tel.: +31 (0)50 3616161; fax: +31 (0)50 3611707. E-mail: [email protected] Submitted September 14, 2006; received in revised form March 24, 2007; accepted April 23, 2007. Pain: February 2008 - Volume 134 - Issue 3 - p 302-309 doi: 10.1016/j.pain.2007.04.029 Buy Metrics Abstract The pathogenesis of dystonia in Complex Regional Pain Syndrome type 1 (CRPS-1) is unclear. In primary dystonia, functional magnetic resonance imaging (fMRI) has revealed changes in cerebral networks during execution of movement. The aim of this study was to determine cerebral network function in CRPS-1 patients with dystonic postures. Cerebral processing related to both execution and imagining of hand movements in patients and controls was assessed with fMRI. Eight CRPS-1 patients with dystonic postures of the right upper extremity and 17 age-matched healthy controls were studied. Compared with controls, imaginary movement of the affected hand in patients showed reduced activation ipsilaterally in the premotor and adjacent prefrontal cortex, and in a cluster comprising frontal operculum, the anterior part of the insular cortex and the superior temporal gyrus. Contralaterally, reduced activation was seen in the inferior parietal and adjacent primary sensory cortex. There were no differences between patients and controls when they executed movements, nor when they imagined moving their unaffected hand. The altered cerebral activation pattern in patients with CRPS-1 linked dystonia most likely reflects an interface between pain-associated circuitry and higher order motor control, which points at a specific mechanistic pathophysiology of this type of dystonia. © 2008 Lippincott Williams & Wilkins, Inc.