Painful muscle spasms complicating algodystrophy: central or peripheral disease?

Area of Science:

• Neurology
• Orthopedics
• Pain Medicine

Background:

• Sudeck's atrophy, also known as Complex Regional Pain Syndrome (CRPS), is a debilitating condition often developing after an injury.
• Chronic Achilles tendinitis can be a precursor to the development of Sudeck's atrophy.
• Complications can include severe pain, autonomic dysfunction, and involuntary motor disturbances.

Observation:

• A 21-year-old female patient with Sudeck's atrophy of the right foot, secondary to chronic Achilles tendinitis, experienced painful leg muscle spasms and urinary incontinence.
• The observed muscle spasms exhibited characteristics of both tonic ambulatory foot responses and spinal flexor reflexes.
• These involuntary movements ceased during sleep and were abolished by regional anesthesia of the affected leg, both within and outside the anesthetic region.

Findings:

• Electroencephalogram (EEG) backaveraging revealed a cortical potential preceding the involuntary spasms, resembling a readiness potential.
• This finding suggests a central nervous system, specifically a cortical, involvement in the pathophysiology of the muscle spasms associated with Sudeck's atrophy.
• The response to regional anesthesia further supports a complex interplay between peripheral and central mechanisms.

Implications:

• The study highlights a potential cortical contribution to the motor symptoms in Sudeck's atrophy, challenging purely peripheral explanations.
• Understanding the central mechanisms may lead to novel therapeutic strategies targeting the brain for managing motor dysfunction in CRPS.
• Further research into neurophysiological markers could aid in the diagnosis and treatment of complex pain syndromes.