[Phantom limb after amputation--overview and new knowledge].

Abstract

Almost all patients who have an extremity amputated will experience a phantom limb. Amputations of other parts of the body can also cause phantom sensations. One fourth of all women who undergo mastectomy relates phantom breast sensations. Phantoms are common following rectum amputation and may be significant as indicators of rectal tumor relapse. Visual phantoms can appear in patients who undergo eye amputation. Phantom phenomena occur after tooth extraction, ureterocystectomy, penectomy, plexus avulsion or spinal cord injury. The causes underlying phantom sensations are unknown. Sensory deprivation in animals causes reorganization of the cortical and subcortical maps: the areas representing the deprived input shrink and the neighbouring areas expand. The mapping allocates areas to represent the most used peripheral inputs. Every level of the nervous system seems to exhibit plasticity. The primary site seems to be the cortex. The cellular basis of plasticity is unclear. Significant sensory and motor reorganization was found in humans suffering phantom pain. There was a strong relationship between the amount of cortical reorganization and the intensity of phantom pain. These findings may influence the rehabilitation of the amputee. It was shown that pain and cortical reorganization can be reduced or even prevented by the active use of prostheses.