Referred Sensation Areas in a Bilateral Toes Amputee

Various mechanisms in generating phantom limb pain (PLP) have been hypothesized in the literature. However, there still is no clear understanding of how PLP develops and why it presents. Amputation leads to permanent anatomical and physiological changes of the neural path previously supplying the brain with sensory input, as well as to formation of referred sensation areas (RSAs) on the stump or its vicinity. Sensations may be evoked in the lost body part upon stimulation of RSAs that may be exploited as artificial sensory input. In this work, we present the analysis of RSA maps from a 45-year-old female with bilateral toes amputation. Maps of the RSAs were identified in eight sessions over 107 days, characterized by dynamics in both location and type of associated evoked sensation. The evoked sensations were reported to be felt like current through and brushing of the phantom toes at low intensities close to the sensation threshold. Sensations evoked by electrical stimuli delivered through electrodes covering one or more RSAs approximated the sensation of summation of sensations evoked by mechanical stimuli (light brushing). No painful evoked sensations were observed.Clinical Relevance- The technique presented may be further improved by using various profiles for stimulation over a longer period of time for possible efficient PLP treatment with artificially generated sensory input.