Case reports and hypothesis: A neglect-like syndrome may be responsible for the motor disturbance in reflex sympathetic dystrophy (complex regional pain syndrome-1)

Abstract

Reflex sympathetic dystrophy (RSD, Complex Regional Pain Syndrome-1, CRPS-1) is a chronic pain disorder associated with autonomic dysregulation that most commonly involves a limb. In addition to pain, motor dysfunction in the involved extremity may be a significant cause of disability. To spur reassessment of underlying mechanisms and development of novel rehabilitative approaches for RSD, we propose a new hypothesis: a neurologic neglect-like syndrome may explain the motor dysfunction that occurs in a subgroup of RSD patients. This hypothesis is based on a selected series of 11 patients who underwent specific neglect testing. The etiology of neglect in RSD is not clear, but we hypothesize that changes within central nervous system (CNS) structures may occur following persistent abnormal activation of the peripheral and autonomic nervous systems, which then may result in a neglect-like syndrome. Further study is needed to verify our clinical observations and test this hypothesis.