Temporo-spatial analysis of cortical activation by phasic innocuous and noxious cold stimuli -: a magnetoencephalographic study

Clinical findings and recent non-invasive functional imaging studies pinpoint the insular cortex as the crucial brain area involved in cold sensation. By contrast, the role of primary (SI) and secondary (SII) somatosensory cortices in central processing of cold is controversial. So far, temporal activation patterns of cortical areas involved in cold processing have not been examined, Using magnetoencephalography, we studied, in seven healthy subjects, the temporo-spatial dynamics of brain processes evoked by innocuous and noxious cold stimulation as compared to tactile stimuli. For this purpose, a newly designed and magnetically silent cold-stimulator was employed. In separate runs, cold and painful cold stimuli were delivered to the dorsum of the right hand. Tactile afferents were Stimulated by pneumatic tactile stimulation. Following innocuous cold stimulation (DeltaT = 5 +/- 0.3degreesC in 50 +/- 2 ms). magnetic source imaging revealed an exclusive activation of the contra- and ipsilateral posterior insular cortex. The mean peak latencies were 194.3 +/- 38.1 and 241.0 +/- 31.7 ms for the response in the ipsi-and contralateral insular cortex. respectively. Based on the measurement of onset latencies, the estimated conduction velocity of peripheral nerve fibres mediating cold fell in the range of Ab-fibres (7.4 +/- 0.8 m/s). Noxious cold stimulation (DeltaT = 35 +/- 5degreesC in 70 +/- 12 ms) initially activated the contra- and ipsilateral insular cortices in the same latency ranges as innocuous cold stimuli. Additionally. we found an activation of the contra- and ipsilateral SII areas (peak latencies 304 +/- 22.7 and 310.1 +/- 19.4 ms, respectively) and a variable activation of the cingulate cortex, Notably, neither cold- nor painful cold stimulation produced an activation of SI. By contrast. the evoked cortical responses following tactile stimulation could be located to the contralateral SI cortex and bilateral SII. In conclusion, this study strongly corroborates the posterior insular cortex as the primary somatosensory area for cortical processing of cold sensation. Furthermore, it supports the role of SII and the cingulate cortex in mediating freeze-pain. Therefore, these results suggest different processing of cold, freeze-pain and touch in the human brain. (C) 2002 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.