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Living With Ghostly Limbs

Living With Ghostly Limbs

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Published by Mrs. Jiuston
Artículo extraído de la revista Scientific American Mind.
Artículo extraído de la revista Scientific American Mind.

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Published by: Mrs. Jiuston on Nov 05, 2010
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07/05/2014

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Living with Ghostly LimbsScientists are pinpointing the neurological roots of the vivid and painfulillusion of phantom limbs in amputees –and finding ways to curb itby Miguel NicolelisOne morning in my fourth year of medical school, a vascular surgeon at theUniversity Hosptal in Sao Paulo, Brazil, invited me to visit the orthopedicsinpatient ward. “Today we will talk to a ghost”, the doctor said. “Do not getfrightened. Try to stay calm. The patient has not accepted what hashappened yet, and he is very shaken.”A boy around 12 years old with hazy blue eyes and blond curly hair satbefore me. Drops of sweat soaked his face, contorted in an expression of horror. The chil’ds body, which I now watched closely, writhed from pain of uncertain origin.“It really hurts, doctor; it burns. It seems as if something is crushing myleg,” he said. I felt a lump in my throat, slowly strangling me. “Where does ithurt?” I asked. He replied: “In my left foot, my calf, the whole leg,everywhere belong my knee!”As I lifted the sheets that covered the boy, I was stunned to find that his leftleg was half-missing; it had been amputated right below the knee afterbeing run over by a car. I suddenly realized that the child’s pain came froma part of his body that no longer existed. Outside the ward I heard thesurgeon saying, “It was not him speaking; it was his phantom limb.”At that time, I did not know that at least 90 percent of amputees –millionsworldwide—have experienced a phantom limb: the strange and errantfeeling that a missing body part is still present and attached to their body.In some cases, the part moves; in others, it is locked in a place. Suchghostly appendages are often defined by a diffuse tingling sensation thatextends throughout the amputated limb and effectively reconstructs it. These phantoms are often very painful and terrifyingly vivid. In some cases,they endure for years.Although scientists are still struggling to identify the biological basis for suchapparitions, recent research suggests that they are not the product of erroneous neural signals emanating from an amputee’s stump. Rather, mostneuroscientists now believe, they arise largely from activity in networks of neurons distributed throughout the brain. These networks enable a person
 
to create an anatomical image. Studies of such cerebral representations andhow they change after amputation have led to new experimental therapiesfor phantom limb syndrome.Painful AppendagesScientists, doctors and laypeople have known about phantom limbs forcenturies. During the Middle Ages, for instance, European folklore glorifiedthe miraculous restoration of sensation in amputated limbs in soldiers.In one account, which dates back to the fourth century, twin boys tried tophysically reattach limbs onto patients who had lost an arm or leg. Theamputees supposedly developed the feeling of the divine presence in themissing part of their body –presumably the result of a phantom. The boyslater became official saints of the Catholic Church; amputees who prayed totheir memory felt their limbs coming back. In the 1500's French militarysurgeon Ambroise Paré, whose improved surgical techniques boostedsurvival for amputees, described many cases of the phenomenon in soldiersreturning from European battlefields.In 1872 American neurologist Silas Weir Mitchell coined the term "phantomlimb" to describe the sensations that mutilated Civil War soldiers felt in theirlost limbs. Since then, scientists have written up hundreds of case studies,revealing various manifestations. Interviews with amputees suggest thatintense limb p ain before amputation, say, from a severe fracture, deepulcer, burn or gangrene, is a major risk factor for developing phantom painafterward—as if the pain were etched in memory so that it remains evenafter its source is gone. More than 70 percent of patients find their phantomlimbs painful inmediately after surgery; in many cases, the pain persists foryears.Phantom Limbs sometimes perform phantom movements. Recen amputeesay even wake up screaming that their nonexistent leg is "trying to leave thebed on its own to walk around the room". In one third of afflicted people,however the absent limb becomes completely paralyzed, often agonizinglyso—for instance, embedded in an ice cube, permanently twisted in a spiralor tortuously pinned to the back.Researches now know that phantom sensations can occur in any excisedbody part, not just the arms and legs; people who have lost their breasts,
 
teeth, genitals and even internal organs have had them. Women withhysterectomies, for example, have felt illusory menstrual pain and laborlikeuterine contractions.Pain from phantom limbs can also be very debilitating. Amputees with suchpain are much less likely to use a prosthetic limb, studies have shown,restricting their ability to care for themselves, visit friends and engage inother activities.And unfortunately, only a tiny fraction of such patients find relief from thedozens of available pain therapies.Blaming the brainDespite decades of investigation, scientists have not pinned down thebiological origins of this disturbing illusion. An early notion, put forth duringthe second half of the 20th century, came from the late neuroscientistPatrick Wall, then at University College London. Wall placed blame for thephantom limb phenomenon on the severed nerve fibers in the scarredregion of the amputee's stump. These fibers form nodules, or neuromas,which were thought to send erroneous signals through the spinal cord to thebrain that might be misinterpreted as tingling or pain in the absent limb.When doctors attempted to treat phantom limb sensations by cutting thesensory nerves leading to the spinal cord, severing nerves in the cord, oreven removing parts of the brain that receive the sensory neuronal tracts,the phantoms nonetheless persisted. Sometimes the patients' paintemporarily vanished but then returned. Thus, many researches rejected the idea that problems with the peripheralnerves could fully account for the syndrome.In the late 1980s psychologist Ronald Melzack of Mc Gill University and hiscolleagues put forth the alternative notion that illusory body parts arise atleast in part from neural activity within the brain. Such a view echoed earlierwritings from naturalist Erasmus Darwin, an 18th-century British intellectualand grandfather to Charles Darwin, who once penned: "Does it not seemclear that such a (phantom) phenomenon indicates that our ideas andsensations emerge from our brains, and not from our tactile organs?"In Mezlack's view, the brain not only detects sensory signals from the bodybut also generates its own neural pattern, or neural signature, thatrepresents the body in its intact state. This signature inscribes the psyche

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