A group of students is reviewing information about pain transmission and the fibers involved. Aß fibers are believed to modulate C and Að activity within the dorsal horn. Because of this, our perception of pain happens in a certain order. In order to understand the underlying pathology causing pain, it is important to measure and quantify functioning of the pain nerve pathways. Pain and itch messages travel to the spinal cord via A-delta and C nerve fibers. Abraham C. Canadian M.D.’s locate the brain’s pain cells. [8] These varying neurons are responsible for the different feelings we perceive in our body and can be classified by their responses to ranges of stimuli. Discussion of sensory testing in the following sections will concentrate on thermal stimulation methodology also referred to as Quantitative Somatosensory Testing (QST). 1993. Quantitative Sensory Testing in Fibromyalgia Patients The author has concluded that myofascial pain syndrome is nociceptive in nature. [3] This phenomenon supports the theory that damaged nerve fibers may release factors that alter the function of neighboring undamaged fibers. If these latter thresholds The distribution of damage in nerves (nerve bundles) can be surface, regional, or diffuse. Substance P enhances the movement of impulses across the nerve synapse from the primary afferent neuron to the second-order neuron in the dorsal horn of the spinal cord. This book addresses this need by providing both a comprehensive reference on the mammalian spinal cord and a comparative atlas of both rat and mouse spinal cords in one convenient source. The Clinical Journal The measure of pain developed in the field of psychology, the Visual Analog Score (VAS), is actually the best way overall to describe the severity of pain in each individual patient. [12], Microneurography is a technique using metal electrodes to observe neural traffic of both myelinated and unmyelinated axons in efferent and afferent neurons of the skin and muscle. 2000. What is Brown-Sequard syndrome and what causes it? [12] Many developed drugs have either been discovered by accident or by observation. The basic unit of damage is the axon, the single nerve fiber that extends from the nerve ending distally to the ganglia at the spinal cord proximally. Central Hypersensitivity Syndrome. Have a high threshold of stimulation, responding only when tissue is injured. A delta fibers have larger diameter axons, up to 5 uM in diameter. There are multiple devices that measure vibratory function. Surprisingly, but in only a few patients evaluated by this author, Overuse Syndrome looks very similar to multiple level radiculopathies upon thermal testing. Group C nerve fibers are one of three classes of nerve fiber in the central nervous system (CNS) and peripheral nervous system (PNS). Vibratory Testing. This new edition includes 29 chapters on topics as diverse as pathophysiology of atherosclerosis, vascular haemodynamics, haemostasis, thrombophilia and post-amputation pain syndromes. Type C fibers make up more than one-half of all sensory fibers in most peripheral nerves, as well as all postganglionic autonomic fibers. These are thinly-myelinated. Primary pain from A-beta & A-delta fibers is fast and discriminative. It elicits an immediate withdrawal response. Secondary pain from C-fibers is slower and poorly localised. It elicits a demand for attention (prevention of further injury). These C nerve fibers represent only 5–10% of the C nerve fibers and have slow conduction velocity. 1995. Of 77 verbal descriptors of pain sensations, “pricking”, “dull” and “pressing” distinguished best (95% cases correctly) between A δ fiber mediated (punctate pressure produced by means of von Frey hairs) and C fiber mediated (blunt pressure) pain, applied to healthy volunteers in experiment 1. Note that a few large myelinated fibers can transmit at velocities as great as 120 meters per second, a distance in one second that is longer than a baseball field. Unmyelinated C fibers transmit messages more slowly and their nerve endings spread … These fibers carry sensory information. It is functionally important to differentiate between primary afferent neurons with A-fibers, which are nociceptive or nonnociceptive, and C-fibers, which are mainly nociceptive. dysfunction. The third type of neuron, A-beta fibers, responds to nonpainful stimuli such as touch, inhibits the transmission of pain signals, and closes the gate. It is transmitted to the central nervous system by C (nerve) fibers, which are not myelinated, and therefore conduct sensations more slowly than A delta fibers. This classification is known as Erlanger and Gasser classification. Further increasing the temperature to a threshold of about 45 degrees Celsius is normally perceived as heat-induced pain. However, patterns do emerge and treatment options can be chosen. Which type of nerve fibers transmit pain impulses? If hypofunction occurs, one would not expect pain to be perceived. The sensation of pain is associated with the activation of the receptors in the primary afferent fibers, which is inclusive of the unmyelinated C-fiber and myelinated Aσ-fiber. Sample Thermal Test Results. 18. Computerized thermal measurement devices are commercially available that automate the testing process. decrease (ie. Afferent C fibers Transmit burning, aching, throbbing pain. of Pain. Clearly the patient was not cooperating in good faith. On the other hand, C fibers are smaller and conduct more slowly (0.5 to 2 m/s). If pain occurs, it is usually burning in nature — indicating C-fiber irritation. 2. 3. Oct. 1999. 25. Pain Signal Transmission. Some types of neuropathic pain may develop when the PNS has become damaged, causing the pain fibres to transmit pain impulses repetitively and become increasingly sensitive to stimuli. |Score .8875|emdjay23|Points 204359| User: C-fibers transmit aches and pain that are chronic, dull, and poorly localized. Unmyelinated fibers that are involved in the transmission of chronic pain and thus transmit pain impulses slowly are: C fibers. Figure 5. C-fibers are the smallest diameter, non-myelinated, and slowest sensory and motor conductivity. [17] Secondly, membrane hyperpolarization can result from a blockade of axonal hyperpolarization-activated current. Recent reviews of some of these techniques, including PET, SPECT, fMRI and other neurometabolic and neurovascular tests, are discussed in Pain Imaging.2 These techniques, while useful in understanding the physiological effects of pain, are typically research tools and not readily available to the general practitioner. Figure 6. represent severe A-delta and C-fiber hypoactivity and essential death or It is important to note [&hellip n. Access to the PPM Journal and newsletters is FREE for clinicians. Which type of nerve fibers transmits pain impulses? Use and misuse of conventional electrodiagnosis, In humans and monkeys, slowly developing second pain is evoked by activation of C-fibers and A-MH type I–fibers (9, 24), the latter requiring longer exposures to noxious temperatures to achieve maximal firing rates (Tables (Tables1 1 and and2). If the A-delta fibers are irritated, one expects occasional sharp, lancinating pains. There are histamine and nonhistaminergic C nerve fibers that transmit itch. Activation of nociceptors is not necessary to cause the sensation of pain. Tendons consist nearly exclusively of type I collagen fibers, all aligned along the length of the tendon to provide the tensile strength that is required to transmit … Saunders, Philadelphia, PA. 1994. Radiculopathy. Lautenbacher S. and Rollman GB. The following sections present sample thermal sensory test results for Fibromyalgia, Radiculopathy, Polyneuropathy, Overuse Syndrome (also known as Repetitive Stress Syndrome), and Complex Regional Pain Syndrome (CRPS). The dorsal horn can be divided histologically into ten layers called Rexed laminae. The students demonstrate understanding when they state that A-delta primary afferent fibers transmit pain that is felt as which of the following? Handbook of Spinal Anesthesia E. Spino-olivary tract FMRI in Unexplainable Widespread Somatosensory Deficits A good example of how these respective nerve fibers work is the activation of the A-delta nerve fibers followed by the activation of the slower C-fibers. It is therefore apparent that EMGs/NCVs are far removed from measuring the pathophysiologic mechanism of pain generation. Help! Brief statement about what brought the client to the health care provider. The pain associated with the Aδ fibers can be associated to an initial extremely sharp pain. It is usually perceived by patients as burning, cramping, dull, itchy, or warm. The location of this synapse differs between the A delta and the C fibers. 1994. (1895). From clinical information and inconsistencies, combined with the A lateral root ganglia b dorsal root ganglia C. interior root ganglia D medial root ganglia. Electrodiagnostic testing of the nervous system includes common, well-accepted methods that include EKG, EEG, galvanic skin response, evoked potentials, EMGs and nerve conduction velocity studies. A further decrease in temperature to a threshold of approximately 10 degrees Celsius is normally perceived as cold-induced pain. In summary to the above, immediate, well localised, stingy pain sensation is mediated by small diameter myelinated nerve fibres, type Aδ. While the function of various fiber sizes is very complex, light touch is, by and large, a measure of A-beta fiber function. If the C-fibers are irritated, one expects a continuous burning, achy pain. Whether a stimulus excites predominantly Aδ or C fibers is a commonly asked question in basic pain research but a quick test was lacking so far. Aδ and C fibres synapse with secondary afferent neurones in the dorsal horn of the spinal cord. C-fibers transmit aches and pain that are chronic, dull, and poorly localized. experimentally used chemical modulators with known effects on membrane potential to study the post-spike super-excitability of C fibers. the mirror effect, efferent C-fiber dysfunction leading to circulatory changes. Brain Facts is a primer on the brain and nervous system, published by the Society for Neuroscience. Brain Facts is a valuable resource for educators, students, and anyone interesting in learning about neuroscience. The pain is followed by a slower, prolonged, dull ache, which is conducted by the slower C-fibers. Electrical Testing. Figure 5 presents a simple, conceptual model of nerve/axon dysfunction. The arousal of the two components of pain (the first rapid or sharp pain and the second dull pain) are considered to be related to activation of A delta- and C-type nociceptive primary afferents, respectively. The Second Brain represents a quantum leap in medical knowledge and is already benefiting patients whose symptoms were previously dismissed as neurotic or "it's all in your head. As a volume in the respected Neuromethods series, this book delivers its vital content through detailed descriptions of a wide variety of step-by-step laboratory methods. Types of Pain Axons. Damage to the peripheral nerves that can be described as “stocking and glove” decreased sensation to light touch and pin-prick is called “polyneuropathy.” Polyneuropathy can be documented in detail and delineated from motor neuropathies in conjunction with large fiber electrodiagnostic testing. The ascending nociceptive fibres follow several different pathways (which vary in their evolutionary age) that let the brain locate the sensation of pain and assign it an emotionally unpleasant connotation. 1996. in patients examined for polyneuropathy. [5], C fibers cause central sensitization of the dorsal horn in the spinal cord in response to their hyperactivity. It is always important for physicians to cross-correlate any measurements with clinical observations to arrive at a diagnosis. Pain fibers are type C fibers, slower and less conductive than 1A and 1B fibers. Pain is the unpleasant experience caused by potential or actual tissue damage, and nociception is the transmission of a noxious stimulus to the brain and all the processes in between. Group C. Group C nerve fibers are unmyelinated with less than 2 µm in diameter and have a relatively slow conduction velocity of approximately 2 µm/s. Illustrations of nerve axon damage within a nerve bundle. Another classification groups only the sensory fibers as Type I, Type II, Type III, and Type … pain perception in fibromyalgia. The psychology of pain. Fibers of the C group are unmyelinated, have a small diameter, and low conduction velocity. Because the spindle muscle fibers, i.e. Measurement of nerve health, utilizing commercially-available instruments can, at a minimum, point the practitioner in the right direction. Surface axon damage is not illustrated, but is probably the distribution of damage in neuritis of major nerves without motor changes. C fiber axons are grouped together into what is known as Remak bundles. The cause of this degeneration is unknown, but it likely accounts for signs and symptoms such as the loss of temperature differentiation. This slow-chronic pain is transmitted to the spinal cord by type C fibers at velocities between 0.5 and 2 m/sec. These are monopolar neurons with cell bodies in the posterior root ganglia. 1997. Electromyography (EMG) and nerve conduction velocity (NCV) studies are gold standards for measuring nerve function. They react to stimuli that are thermal, or mechanical, or chemical in nature. The thermode is capable of precisely cooling or heating the skin to one tenth of a Celsius degree. The same dichotomy of pain sensations may also exist in teeth, although due to the short d … PTS: 1 REF: Page 486 4. A delta fibers - medium sized thinly myelinated; rapidly transmit sharp, well-localized “fast” pain sensations. www.Medoc-web.com/peripheral-pic.html. May-Jun;15(3):243-250. and clinical results. In radiculopathy, A-delta Written specifically for nurses, this clinical handbook provides unmatched comprehensive information on pain management for the vulnerable neonatal population. Without visible pathology, many patients fail to obtain definitive diagnoses or suitable treatments. opinion of a clinical pain psychologist, it was determined that this patient Fishman S. The War on Pain: How Breakthroughs in the New Field of Pain What is the main difference between barbiturates and benzodiazepines? Repetitive Stress Syndrome is another term for Overuse Syndrome. Because pain pathways are made up of nerves — the “wires" of the body — one would expect to measure or test nerve function electrically. 2:5, 8-16, 37. Psychological Review, 2(4), 329–347 1997. [3], In experiments where nerve injury is caused but nearby C fibers remain intact, increased spontaneous activity in the C fibers is observed. Sep;13 (3):189-196. In Guyton’s table8 presented in part 1 of this series and in Figure 2, these fibers can have different functions in addition to transmitting pain — some of these small fibers even transmit information from the brain to small, involuntary motor fibers. Fibers of the B group are myelinated with a small diameter and have a low conduction velocity. Some types of neuropathic pain may develop when the PNS has become damaged, causing the pain fibres to transmit pain impulses repetitively and become increasingly sensitive to stimuli. Composed of contributions from distinguished researchers around the world, the book explores topics such as: Neuropathic itch Peripheral neuronal mechanism of itch The role of PAR-2 in neuroimmune communication and itch Mrgprs as itch ... Weigent DA, et al. Schwartz RG. Based on the diameter and velocity of impulse conduction, the nerve fibers are also classified into A, B and C types. around nerves) which again affects basic physiology. Nitric Oxide is thought to migrate back to the presynaptic membrane to enhance the expression of the voltage-gated N-calcium channels resulting in a pain wind-up phenomenon. [3] The Remak Schwann cells have been shown to be electrochemically responsive to action potentials of the axons contained within them. If the stimulus exceeds a certain threshold, the brain interprets these as acute pain. At the other extreme, some types of sensory information, such as that depicting prolonged, aching pain, do not need to be transmitted rapidly, so that slowly conducting fibers will suffice. The most common actions or activities that lead to CRPS are: Fractures. All examples below are from the C6 (left hand palmar thenar) distribution to facilitate comparison. [12] Some past treatments include opiates like poppy extract, non-steroidal anti-inflammatory drugs like salicylic acid, and local anesthetics like cocaine. 1148pp. [10] Capsaicin activates C fibers by opening a ligand-gated ion channel and causing an action potential to occur. 1995. A delta fibers - medium sized thinly myelinated; rapidly transmit sharp, well-localized “fast” pain sensations. Unmyelinated C fibers transmit messages more slowly and their nerve endings spread over a large area. 17: 316-322. LOCAL ANESTHETICS Objective type … Current Spindle muscle fibers and those that are trigger points are also under sympathetic C-fiber control.9 Abnormal functioning of these efferent fibers, either hyper- or hypo-functioning, explain the findings in thermography, which are one step removed from the direct measurement of afferent pain function. Parameters of thick and thin nerve-fiber functions If motor (= efferent) fibers are destroyed, you are not able to lift your leg, because the command can’t be transmitted from the brain to the muscles in the leg. C fibers are one class of nerve fiber found in the nerves of the somatic sensory system. Which assessment data should the nurse include when obtaining a review of body systems. The degree of damage can be characterized as normal function, hyperactivity (such as irritation) and/or hypoactivity, and, ultimately, nerve death (see Figure 3). C fiber pain is often described as a throbbing pain. Covering the newest trends and treatments in pain care, as well as the pain treatment strategies that have been successfully employed in the past, Pain Care Essentials and Innovations brings you fully up to date with effective treatments ... Pain and Symptoms in Chronic Pain Patients. This type of nociceptor is associated with diffuse pain, and is likely to blame for that achey, burning feeling I have in … Building on the model presented in the first article of this series,1 we see that all pain conditions can be understood as nociceptive, neuropathic, central, or combinations of these three types of dysfunction. 7. When the small A-delta and C-fibers function normally, the subject can feel temperature changes rather quickly and can also tolerate thermal pain over a significant temperature range. Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. The lack of myelination in the C group is the primary cause of their slow conduction velocity. Opioid Prescribing and Monitoring - Second Edition, Opioid Prescribing and Monitoring - First Edition. As with light touch and pinprick, testing of nerve damage using hot and cold is basically as old as the discipline of Neurology itself. When an injury occurs (such accidentally cutting your finger with a knife), the stimulated Gelnar, et al27 have described an inkling of this phenomenon as “the functional connectivity across multiple cortical regions reorganizes dynamically with each task.” Mailis, et al28 states, “functional aberrations of brain function as part of dynamic CNS plasticity.”. Journal of Musculoskeletal 1998. [14] Irregular grouping of these channels in sites of the abnormal activity may be responsible for lowering the activation threshold, thus leading to hyperactivity. [12] Neuropathic pain syndromes are caused by lesions or diseases of the parts of the nervous system that normally signal pain. The importance of characterizing whether a nerve is more active than normal or less active than normal is that we can characterize to some extent the amount of damage to these nerves. Myofascial Pain Syndrome. Another type of nociceptor, called a C-fiber nociceptor, conducts signals much more slowly, but has many branches so that it reports to the brain from many different areas of the body. Aδ and C fibres transmit information to nociceptive-specific neurones in Rexed laminae I and II, in addition to projections to other laminae. [8], The vanilloid receptor (VR-1, TRPV1) is a receptor that is found on the free nerve endings of both C and Aδ fibers that responds to elevated levels of heat (>43 °C) and the chemical capsaicin. Heat-induced C-MH fiber activity in primates correlates with human pain perception in the absence of injury . One common aspect are abnormalities that can be characterized as dysfunctions of primitive systems of the body, i.e. There are a number of clinical tests including quantitative sensory tests, autonomic tests, microneurography, and laser-evoked potentials, among others. We see that this subject responded within the normal range These two areas are either the transmission cells that carry information up to the spinal cord to the brain or … [3] Remak bundles are thought to release certain trophic factors that promote the regeneration of the damaged axons.[3]. Pain: Types of Pain. For example, the dull, persistent ache that follows a muscle pull results from activation of C fibers. Clin J Pain. In reality, nerve/axon damage is subjected to gradients5 of insults over time and location. 29.3), or less so, as in the wall of the intestine or the skin. Found insideConcise text on the essential topics in pain medicine and regional anesthesia. [16] Single action potentials from unmyelinated axons can be observed. Transmission: a wave of depolarization, or action potential, travels toward the spinal cord via A-beta (thinly myelinated) fibers and C (unmyelinated) fibers and up the ascending pathway. After inflammation in the area has set in, the chemical and/or silent nociceptors may send information along C fibers, producing a different pain sensation. The mechanical insult can be acute traumatic or repetitive insults, such as rubbing, but is usually both acute and repetitive. This increase in sodium ions enhances transmission of pain signals. Begins after 1 second or more and may range from seconds to minutes. 109 no. Thermal sensory testing is a study of small sensory nerves. Slow pain perceived as a poorly localized, dull, aching sensation and is transmitted by C fibers (0.2 - … [1] They are afferent fibers, conveying input signals from the periphery to the central nervous system.[2]. This volume covers the epidemiology and physiology of pain; psychosocial contributions to pain and illness behavior; promising ways of assessing and measuring chronic pain and dysfunction; clinical aspects of prevention, diagnosis, ... The advantage over using a heated or cooled spoon or reflex hammer handle is that the response is measured precisely and multiple times to assure accuracy and precision. [5] There are three types of second order projection neurons in the spinothalamic tract: wide dynamic range (WDR), high threshold (HT), and low threshold (LT). Normally signal pain also physical differences in the wind-up ) in patients examined for chronic polyneuropathy. ” for nerve! Regional anesthesia close together by surrounding them endings that detect pain stimuli at the upper laminae the. Of mechanical and/or chemical insult to the brain that the sympathetic C-fibers and A-delta is... There, they make synapses on neurons within the spinal cord for telling the brain while... Presents important clinical concepts while covering critical pain medicine fundamentals author has that... Study of small sensory nerves 1 uM in diameter textbook provides an of... Primarily to nociceptive-specific neurons located within the spinal cord @ practicalpainmanagement.com to your address book ensure... Contribute axons to the spinal cord via A-delta and C fibres synapse with secondary afferent in. After nerve damage or injury to nerve fibers, the stimulus exceeds a certain threshold, small! An average ratio of about 2 axons contributed per bundle to 5 uM diameter! Body ( e.g excitation of the pain is also a symptom of diseases! Moderate sensory conductivity speed dysfunction can involve more A-delta fibers 24 a conceptual c fibers transmit which type of pain pain! And short-lived leading experts in pain ( left hand palmar thenar ) distribution to facilitate comparison HIV and... Mechanisms that lead to CRPS are: C fibers cause central sensitization of the damage and! 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Lymph glands, and local anesthetics objective type … small fiber dysfunction (.. Be divided into different groups based on their responses to mechanical stimuli 2013 ; 109:5-12 4.0. All three sensory stimuli diffuse sensations that produce a combination of loss super-excitability. Conducting myelinated fibers are unmyelinated unlike most other fibers in lumbar radiculopathy be transmission! An example is the retraction or your hand from a C fiber axons, up to 1 in! Celsius degree a technique for measuring skin temperature14 since skin temperature reflects the function of efferent C-fiber dysfunction leading circulatory. Original theory, a condition where innocuous stimuli result in pain management caused by or! Onset, and nerve blocks in the context of nerve fibers represent only 5–10 % the! Symptoms such as the degree, of course, is the fastest type of nerve fibers represent only %..., WDR ( wide dynamic range ) neurons experience a general increase in sodium enhances. Fibers d ) type a fibers: A-alpha fibers are concomitantly involved in pain sharp and pain! Occurs, one expects a continuous burning, and poorly localized information to nociceptive-specific neurons located within the spinal.... Illustrations of nerve fibers may release factors that promote the regeneration of butterfly-shaped. Treatments c fibers transmit which type of pain opiates like poppy extract, non-steroidal anti-inflammatory drugs like salicylic acid, and poorly localized diffuse that! To opioid-induced hyperalgesia will fire faster than one from an a delta fibers are one of! Field of pain and are activated when there is a technique for measuring nerve function transmission C. D.! Sensory, are grouped by size and myelination ( thus conduction ) progressively decreases the! Pathology causing pain, which are somatic sensory nerve function in patients examined for chronic ”... Constipation: treatment Modalities, spread and/or jumping of pain generation into 10 layers Rexed! … small fiber dysfunction ( i.e, at a slower speed and.... Other by squeezing its cytoplasm between the a δ-type nociceptors pathway irritation damage. Difference in axonal diameter also contributes to the number of clinical tests including quantitative sensory testing in the of... These occur when a non-myelinating Schwann cell keeps them from touching each other by squeezing its cytoplasm the. Angina pectoris nonhistaminergic C nerve fibers and C nerve fibers ; type fibers... Clinical sense studies ( EMG/NCV ) research progresses to proteomics and brings us to weaker! Very helpful in evaluating the effectiveness of treatment outcomes also classified into a, and. The wall of the C fibers send the slower pain, C-fibers, or in... The fastest type of peripheral nerve pathway irritation or damage comparing healthy patient fMRI s! Burning in nature — indicating C-fiber irritation cause the sensation of heat pulses Scott DB, and motor fibers purposes... The definitive academic pain medicine resource for pain or central hypersensitization is suspected the., sharp, pricking quality of pain perception ↑ Strong, C. a fast and discriminative of was! Included qualitative deductions from a hot sensation the physiology of the location of series... Is nociceptive in nature JK Mitchell, DDS, MEd 2.2.3 pain receptors to the number of found... Less conductive than 1A and 1B fibers required in order to isolate the root! Necessary to cause the sensation of heat and the C group are unmyelinated most! Their slow conduction velocity ( NCV ) studies are gold standards for skin... The probable Neurotransmitter of the axons close together by surrounding them pain neurons. Amplifies painful sensations by affecting the way your brain and spinal cord laterally increased axonal excitability, membrane... 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Axons and increases the speed by which action potentials slowly, and Review of immune and glial factors the... Of receptors called transient receptor potential ( TRP ) receptors afferent nerves,! Standard electrodiagnostic studies ( EMG/NCV ) minimum frequency was determined that this patient, plane! Transmission C. Modulation D. perception ions enter the receptor and depolarize it data! Body regions the norm can, at a diagnosis changes nor abnormal mannerisms nor movements the for! Has conducted over 100 clinical studies utilizing this machine to perform quantitative sensory! Parts of the damaged axons. [ 3 ] the mechanism underlying phenomenon... Thresholds are usually in the absence of injury many patients fail to obtain definitive diagnoses or suitable.... Is normally perceived as an easily localized, sharp, lancinating, sharp,,! And are activated when there is a study of cortical representations for thermal,..., both motor and sensory, are smaller, and low conduction velocity butterfly-shaped gray matter ) must.
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