The eloquence of silent cortex: analysis of afferent input to deafferented cortex in arm amputees

Cortical reorganisation after limb amputation includes topographic displacements of body representation areas and changes of areal extent. Remarkably, truncated nerves, which had innervated amputated limb parts and remained in the residual limbs, can retain access to the deafferented somatosensory cortex. Using somatosensory evoked potentials (SEP) we characterized afferences from electrically stimulated truncated nerves to the brachial plexus and cortex in 12 arm amputees. While peripheral responses were highly variable, thalamocortical input to S-1, as reflected by the primary cortical SEP component, was present in 11 of 12 patients. Despite long-term deafferentation, macroscopic phenomena of inhibition/refractoriness, as assessed by stimulus rate variations, appeared to be changed only marginally. Thus, deafferented cortex remains responsive when given artificial phantom input and could provide a neuronal substrate for spontaneous phantom limb sensations, including phantom pain.