caa a22 4500 445376392 CHVBK 20180317143003.0 cr unu---uuuuu 170323e20110901xx s 000 0 eng 10.1007/s00702-011-0601-1 doi (NATIONALLICENCE)springer-10.1007/s00702-011-0601-1 Spreading of complex regional pain syndrome: not a random process [Elektronische Daten] [Monique van Rijn, Johan Marinus, Hein Putter, Sarah Bosselaar, G. Moseley, Jacobus van Hilten] Complex regional pain syndrome (CRPS) generally remains restricted to one limb but occasionally may spread to other limbs. Knowledge of the spreading pattern of CRPS may lead to hypotheses about underlying mechanisms but to date little is known about this process. The objective is to study patterns of spread of CRPS from a first to a second limb and the factors associated with this process. One hundred and eighty-five CRPS patients were retrospectively evaluated. Cox's proportional hazards model was used to evaluate factors that influenced spread of CRPS symptoms. Eighty-nine patients exhibited CRPS in multiple limbs. In 72 patients spread from a first to a second limb occurred showing a contralateral pattern in 49%, ipsilateral pattern in 30% and diagonal pattern in 14%. A trauma preceded the onset in the second limb in 37, 44 and 91%, respectively. The hazard of spread of CRPS increased with the number of limbs affected. Compared to patients with CRPS in one limb, patients with CRPS in multiple limbs were on average 7years younger and more often had movement disorders. In patients with CRPS in multiple limbs, spontaneous spread of symptoms generally follows a contralateral or ipsilateral pattern whereas diagonal spread is rare and generally preceded by a new trauma. Spread is associated with a younger age at onset and a more severely affected phenotype. We argue that processes in the spinal cord as well as supraspinal changes are responsible for spontaneous spread in CRPS. The Author(s), 2011 CRPS nationallicence Spread nationallicence Multiple nationallicence Peripheral trauma nationallicence TREND Study nationallicence van Rijn Monique Department of Neurology (K5Q), Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands aut Marinus Johan Department of Neurology (K5Q), Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands aut Putter Hein Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands aut Bosselaar Sarah Department of Neurology (K5Q), Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands aut Moseley G. Prince of Wales Medical Research Institute & The University of New South Wales, Corner of Easy & Barker Streets, 2031, Randwick, Australia aut van Hilten Jacobus Department of Neurology (K5Q), Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands aut Journal of Neural Transmission Springer Vienna 118/9(2011-09-01), 1301-1309 0300-9564 118:9<1301 2011 118 702 https://doi.org/10.1007/s00702-011-0601-1 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00702-011-0601-1 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- van Rijn Monique Department of Neurology (K5Q), Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands aut NATIONALLICENCE 700 1- Marinus Johan Department of Neurology (K5Q), Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands aut NATIONALLICENCE 700 1- Putter Hein Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands aut NATIONALLICENCE 700 1- Bosselaar Sarah Department of Neurology (K5Q), Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands aut NATIONALLICENCE 700 1- Moseley G. Prince of Wales Medical Research Institute & The University of New South Wales, Corner of Easy & Barker Streets, 2031, Randwick, Australia aut NATIONALLICENCE 700 1- van Hilten Jacobus Department of Neurology (K5Q), Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands aut NATIONALLICENCE 773 0- Journal of Neural Transmission Springer Vienna 118/9(2011-09-01), 1301-1309 0300-9564 118:9<1301 2011 118 702 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer