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Tang VM, Ibrahim C, Rodak T, Goud R, Blumberger DM, Voineskos D, Le Foll B. Managing substance use in patients receiving therapeutic repetitive transcranial magnetic stimulation: A scoping review. Neurosci Biobehav Rev 2023; 155:105477. [PMID: 38007879 DOI: 10.1016/j.neubiorev.2023.105477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/16/2023] [Accepted: 11/18/2023] [Indexed: 11/28/2023]
Abstract
Repetitive Transcranial Magnetic Stimulation (rTMS) is an invaluable treatment option for neuropsychiatric disorders. Co-occurring recreational and nonmedical substance use can be common in those presenting for rTMS treatment, and it is unknown how it may affect the safety and efficacy of rTMS for the treatment of currently approved neuropsychiatric indications. This scoping review aimed to map the literature on humans receiving rTMS and had a history of any type of substance use. The search identified 274 articles providing information on inclusion/exclusion criteria, withdrawal criteria, safety protocols, type of rTMS and treatment parameters, adverse events and effect on primary outcomes that related to substance use. There are neurophysiological effects of substance use on cortical excitability, although the relevance to clinical rTMS practice is unknown. The current literature supports the safety and feasibility of delivering rTMS to those who have co-occurring neuropsychiatric disorder and substance use. However, specific details on how varying degrees of substance use alters the safety, efficacy, and mechanisms of rTMS remains poorly described.
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Affiliation(s)
- Victor M Tang
- Addictions Division, Centre for Addiction and Mental Health, Canada; Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; Institute of Mental Health Policy Research, Centre for Addiction and Mental Health, Canada.
| | - Christine Ibrahim
- Addictions Division, Centre for Addiction and Mental Health, Canada; Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Terri Rodak
- CAMH Mental Health Sciences Library, Department of Education, Centre for Addiction and Mental Health, Canada
| | - Rachel Goud
- Addictions Division, Centre for Addiction and Mental Health, Canada
| | - Daniel M Blumberger
- Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Canada
| | - Daphne Voineskos
- Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Canada; Poul Hansen Family Centre for Depression, Krembil Research Institute, Toronto Western Hospital, University Health Network, Canada
| | - Bernard Le Foll
- Addictions Division, Centre for Addiction and Mental Health, Canada; Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; Institute of Mental Health Policy Research, Centre for Addiction and Mental Health, Canada; CAMH Mental Health Sciences Library, Department of Education, Centre for Addiction and Mental Health, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Canada; Poul Hansen Family Centre for Depression, Krembil Research Institute, Toronto Western Hospital, University Health Network, Canada; Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Canada; Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Canada
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Vecchio D, Varrasi C, Virgilio E, Spagarino A, Naldi P, Cantello R. Cannabinoids in multiple sclerosis: A neurophysiological analysis. Acta Neurol Scand 2020; 142:333-338. [PMID: 32632918 DOI: 10.1111/ane.13313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/20/2020] [Accepted: 06/29/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To investigate the action of cannabinoids on spasticity and pain in secondary progressive multiple sclerosis, by means of neurophysiological indexes. MATERIAL AND METHODS We assessed 15 patients with progressive MS (11 females) using clinical scales for spasticity and pain, as well as neurophysiological variables (H/M ratio, cutaneous silent period or CSP). Testing occurred before (T0) and during (T1) a standard treatment with an oral spray containing delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). Neurophysiological measures at T0 were compared with those of 14 healthy controls of similar age and sex (HC). We then compared the patient results at the two time points (T1 vs T0). RESULTS At T0, neurophysiological variables did not differ significantly between patients and controls. At T1, spasticity and pain scores improved, as detected by the Modified Ashworth Scale or MAS (P = .001), 9-Hole Peg Test or 9HPT (P = .018), numeric rating scale for spasticity or NRS (P = .001), and visual analogue scale for pain or VAS (P = .005). At the same time, the CSP was significantly prolonged (P = .001). CONCLUSIONS The THC-CBD spray improved spasticity and pain in secondary progressive MS patients. The spray prolonged CSP duration, which appears a promising tool for assessing and monitoring the analgesic effects of THC-CBD in MS.
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Affiliation(s)
- Domizia Vecchio
- Neurology Unit Department of Translational Medicine University of Piemonte Orientale Novara Italy
| | - Claudia Varrasi
- Neurology Unit Department of Translational Medicine University of Piemonte Orientale Novara Italy
| | - Eleonora Virgilio
- Neurology Unit Department of Translational Medicine University of Piemonte Orientale Novara Italy
| | - Antonio Spagarino
- Neurology Unit Department of Translational Medicine University of Piemonte Orientale Novara Italy
| | - Paola Naldi
- Neurology Unit Department of Translational Medicine University of Piemonte Orientale Novara Italy
| | - Roberto Cantello
- Neurology Unit Department of Translational Medicine University of Piemonte Orientale Novara Italy
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Gündüz A, Aydın Ş, Kızıltan M. Cutaneous silent period: A literature review. NEUROL SCI NEUROPHYS 2020. [DOI: 10.4103/nsn.nsn_38_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kofler M, Leis A, Valls-Solé J. Cutaneous silent periods – Part 1: Update on physiological mechanisms. Clin Neurophysiol 2019; 130:588-603. [DOI: 10.1016/j.clinph.2019.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/28/2018] [Accepted: 01/08/2019] [Indexed: 12/14/2022]
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Cutaneous silent periods – Part 2: Update on pathophysiology and clinical utility. Clin Neurophysiol 2019; 130:604-615. [DOI: 10.1016/j.clinph.2019.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/28/2018] [Accepted: 01/08/2019] [Indexed: 02/08/2023]
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Aydın Ş, Kofler M, Bakuy Y, Gündüz A, Kızıltan ME. Effects of vibration on cutaneous silent period. Exp Brain Res 2019; 237:911-918. [PMID: 30659303 DOI: 10.1007/s00221-018-05463-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 12/21/2018] [Indexed: 12/14/2022]
Abstract
Suppression of an ongoing muscle contraction following noxious digital stimulation is called cutaneous silent period (CSP) which is under the influence of several physiological factors. In this study, we aimed to evaluate the influence of group Ia afferents on the cutaneous silent period (CSP) by applying 2-min vibration. CSP was obtained from abductor pollicis brevis muscle after stimulating index finger. The recordings were repeated three times-before, during and after vibration-which was applied over the tendon of flexor carpi radialis muscle. Onset latency, duration and magnitude of total CSP, inhibitory phases I1 and I2, and of the long-loop reflex were measured and compared. Suppression indices of CSP, I1 and I2 increased significantly during and after vibration, indicating significantly less exteroceptive EMG suppression outlasting the time of vibration. Vibration also caused mild shortening of I2 end latency (p = 0.048) and I2 duration (p = 0.019). Our findings indicate that vibration exerts a powerful influence on CSPs and causes reduction in the magnitude of exteroceptive EMG suppression during and after vibration. Although vibration is known to activate Ia afferents, we cannot exclude contribution of other afferents, e.g. mechanoreceptors, as well as pre- or postsynaptic inhibitory effects on ensuing interneurons, or enhanced vibration-related excitatory influence.
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Affiliation(s)
- Şenay Aydın
- Department of Neurology, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul, Turkey. .,Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Markus Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Yeliz Bakuy
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ayşegül Gündüz
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Meral E Kızıltan
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Cutaneous silent period evoked in human first dorsal interosseous muscle motor units by laser stimulation. J Electromyogr Kinesiol 2016; 31:104-110. [DOI: 10.1016/j.jelekin.2016.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 09/28/2016] [Accepted: 10/10/2016] [Indexed: 11/27/2022] Open
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Baek SH, Seok HY, Koo YS, Kim BJ. Lengthened Cutaneous Silent Period in Fibromyalgia Suggesting Central Sensitization as a Pathogenesis. PLoS One 2016; 11:e0149248. [PMID: 26871583 PMCID: PMC4752484 DOI: 10.1371/journal.pone.0149248] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 01/28/2016] [Indexed: 11/18/2022] Open
Abstract
The pathogenesis of fibromyalgia (FM) has not been clearly elucidated, but central sensitization, which plays an important role in the development of neuropathic pain, is considered to be the main mechanism. The cutaneous silent period (CSP), which is a spinal reflex mediated by A-delta cutaneous afferents, is useful for the evaluation of sensorimotor integration at the spinal and supraspinal levels. To understand the pathophysiology of FM, we compared CSP patterns between patients with FM and normal healthy subjects. Twenty-four patients with FM diagnosed in accordance with the 1990 American College of Rheumatology classification system and 24 age- and sex-matched healthy volunteers were recruited. The CSP was measured from the abductor pollicis brevis muscle. Demographic data, number of tender points, and visual analog scale and FM impact questionnaire scores were collected. The measured CSP and clinical parameters of the patient and control groups were compared. In addition, possible correlations between the CSP parameters and the other clinical characteristics were analyzed. Mean CSP latencies did not differ between patients (55.50 ± 10.97 ms) and healthy controls (60.23 ± 11.87 ms; p = 0.158), although the mean CSP duration was significantly longer in patients (73.75 ± 15.67 ms) than in controls (63.50 ± 14.05 ms; p = 0.021). CSP variables did not correlate with any clinical variables. The significantly longer CSP duration in FM patients suggests central dysregulation at the spinal and supraspinal levels, rather than peripheral small fiber dysfunction.
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Affiliation(s)
- Seol-Hee Baek
- Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Hung Youl Seok
- Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Yong Seo Koo
- Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
- * E-mail:
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Lopergolo D, Isak B, Gabriele M, Onesti E, Ceccanti M, Capua G, Fionda L, Biasiotta A, Di Stefano G, La Cesa S, Frasca V, Inghilleri M. Cutaneous silent period recordings in demyelinating and axonal polyneuropathies. Clin Neurophysiol 2014; 126:1780-9. [PMID: 25497713 DOI: 10.1016/j.clinph.2014.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 11/11/2014] [Accepted: 11/15/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate the cutaneous silent period (CSP), a spinal inhibitory reflex mainly mediated by A-delta fibres, in demyelinating and axonal polyneuropathy (PNP) and evaluate whether CSP parameters differ between patients with and without neuropathic pain. METHODS Eighty-four patients with demyelinating PNP, 178 patients with axonal PNP and 265 controls underwent clinical examination, DN4 questionnaire, standard nerve conduction study, motor-root stimulation and CSP recordings from abductor digiti minimi. We calculated the afferent conduction time of CSP (a-CSP time) with the formula: CSP latency-root motor evoked potential latency. RESULTS In the demyelinating PNP group the a-CSP time was significantly longer; in the axonal PNP group, CSP duration was shorter than the demyelinating group (p=0.010) and controls (p=0.001). CSP parameters were not different between patients with and without neuropathic pain. CONCLUSIONS The abnormality of a-CSP time in the demyelinating PNP group suggests the crucial role of A-delta fibres in the mechanism of CSP; the shorter CSP duration in the axonal PNP group supports the strong influence of the number of axons on this parameter. Our study suggests that neuropathic pain could be related to pathophysiological mechanisms differing from mere A-delta fibre loss. SIGNIFICANCE CSP evaluation is effective in detecting A-delta fibre dysfunction in axonal as well as demyelinating PNP.
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Affiliation(s)
- Diego Lopergolo
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Baris Isak
- Marmara University Hospital School of Medicine, Department of Neurology, Fevzi Cakmak Mah. Mimar Sinan Cad. No: 41, 34899 Ust Kaynarca/Pendik, Istanbul, Turkey; Department of Clinical Neurophysiology, Aarhus Universitets hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Maria Gabriele
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Emanuela Onesti
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Marco Ceccanti
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Gelsomina Capua
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Laura Fionda
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Antonella Biasiotta
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Giulia Di Stefano
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Silvia La Cesa
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Vittorio Frasca
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Maurizio Inghilleri
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy.
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Effects of a selective serotonin reuptake inhibitor escitalopram on the cutaneous silent period: A randomized controlled study in healthy volunteers. Neurosci Lett 2014; 566:17-20. [DOI: 10.1016/j.neulet.2014.02.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 02/13/2014] [Accepted: 02/15/2014] [Indexed: 12/14/2022]
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11
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Pujia F, Coppola G, Anastasio MG, Brienza M, Vestrini E, Valente GO, Parisi L, Serrao M, Pierelli F. Cutaneous silent period in hand muscles is lengthened by tramadol: Evidence for monoaminergic modulation? Neurosci Lett 2012; 528:78-82. [PMID: 22981885 DOI: 10.1016/j.neulet.2012.08.064] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 08/13/2012] [Indexed: 12/12/2022]
Abstract
The purpose of this study was to shed light on the neurochemical modulatory mechanisms of the noxious spinal inhibitory cutaneous silent period (CSP). We study the effects of 100mg of oral tramadol in 11 healthy volunteers. Tramadol has low affinity for opioid receptors and has the ability to inhibit serotonin and noradrenaline reuptake. We elicited CSPs in the first dorsal interosseus muscle and noxious withdrawal flexor reflexes (NWR) in the right biceps femoris muscle before, 30 min and each hour up to the 6th after tramadol. Subjective pain sensation was checked on an 11-point numerical scale. Tramadol increased duration of CSP, and reduced the NWR area under the curve maximally 2h after tramadol and paralleled the reduction of subjective pain perception. We suggest that the monoaminergic action of tramadol reinforces the activity of spinal inhibitory interneurons on α-motoneurons for the hand muscles.
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Affiliation(s)
- Francesco Pujia
- "Sapienza" University of Rome, Department of Medico-surgical Sciences and Biotechnologies, Neurology Section, Rome, Italy.
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Stetkarova I, Kofler M. Differential effect of baclofen on cortical and spinal inhibitory circuits. Clin Neurophysiol 2012; 124:339-45. [PMID: 22877625 DOI: 10.1016/j.clinph.2012.07.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 06/16/2012] [Accepted: 07/01/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The cutaneous silent period (SP) is a spinal inhibitory reflex, which suppresses activity in spinal motor nuclei. Transcranial magnetic stimulation (TMS) elicits a cortical SP, which represents GABA(B) receptor-mediated inhibition of cortical excitability. Baclofen as a strong GABA(B) agonist effectively reduces muscle hypertonia, however, it is not known whether intrathecal baclofen (ITB) may modulate spinal inhibitory circuits. METHODS We evaluated clinical and neurophysiological effects of ITB in ten patients with severe spasticity due to spinal cord injury (n = 9) and chronic progressive multiple sclerosis (n = 1). Neurophysiological assessment included H reflex and cutaneous and cortical SPs, before and 15, 30, 60, 90, 120, and 180 min after ITB bolus administration. RESULTS ITB suppressed soleus H reflex as early as 15 min after lumbar bolus injection; MAS scores declined after 1 h. Cortical SP end latency and duration increased progressively with a significant maximum 3h following ITB bolus, whereas cutaneous SP latency and duration did not change significantly. CONCLUSION The present findings suggest that baclofen does not affect the cutaneous SP, but prolongs the cortical SP. SIGNIFICANCE The spinal inhibitory circuitry of the cutaneous SP is not modulated by GABA(B) receptor-mediated activity, in contrast to the cortical inhibitory circuitry of the cortical SP, which is subject to powerful GABA(B) control.
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Affiliation(s)
- Ivana Stetkarova
- Department of Neurology, 3rd Medical Faculty, Charles University, Prague, Czech Republic.
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Toyosato A, Begum M, Sugiyama K, Someya G. Modulation of exteroceptive suppression periods in human jaw-closing muscles by subanaesthetic dose of propofol. J Oral Rehabil 2011; 38:79-85. [PMID: 21198772 DOI: 10.1111/j.1365-2842.2010.02150.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Exteroceptive suppression (ES) periods in human jaw-closing muscles can be conditioned by a wide range of somatosensory stimuli and cognitive states. The aim of this study was to examine the effects of subanaesthetic doses of midazolam, ketamine and propofol on the short latency (ES1) and long latency (ES2) reflex in the jaw-closing muscles. First, we tried to evaluate the various methodological criteria for ES recording. We then examined the effect of subanaesthetic doses of midazolam (0·035 mg kg(-1)), ketamine (0·30 mg kg(-1)) and propofol (0·35 mg kg(-1)) on these reflexes of recording left masseter and temporalis muscle. ES duration did not differ greatly in the present study, recorded with the correct adjustment of stimulating and recording conditions. None of the subanaesthetic doses of the agents influenced ES1, and no significant effects on ES2 were observed with midazolam and ketamine. However, significant inhibitory change was observed in ES2 with propofol. ES2 is thought to be mediated by afferents, which descend in the spinal trigeminal tract and connect with a polysynaptic chain of excitatory interneurones located in the lateral reticular formation. Our observations indicate that propofol is uniquely effective not only through involvement of the gamma-aminobutyric acid type A receptor, but also through a range of other effects.
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Affiliation(s)
- A Toyosato
- Department of Dental Anesthesiology, Kagoshima University of Medical and Dental Hospital, Kagoshima, Japan.
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Utility of the cutaneous silent period in the evaluation of carpal tunnel syndrome. Clin Neurophysiol 2010; 121:1584-1588. [DOI: 10.1016/j.clinph.2010.03.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 03/09/2010] [Accepted: 03/11/2010] [Indexed: 11/19/2022]
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Cutaneous silent period in human FDI motor units. Exp Brain Res 2010; 205:455-63. [DOI: 10.1007/s00221-010-2380-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 07/21/2010] [Indexed: 10/19/2022]
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Brown JM, Mokhtee D, Evangelista MS, Mackinnon SE. Scratch Collapse Test Localizes Osborne's Band as the Point of Maximal Nerve Compression in Cubital Tunnel Syndrome. Hand (N Y) 2010; 5:141-7. [PMID: 19774420 PMCID: PMC2880669 DOI: 10.1007/s11552-009-9225-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 08/31/2009] [Indexed: 10/20/2022]
Abstract
The objective of this study is to demonstrate the utility of the scratch collapse test (SCT) in localizing the point of maximal compression in cubital tunnel syndrome. From January 1, 2004 to December 1, 2005, 64 adult patients with cubital tunnel syndrome were evaluated by a single surgeon. Cubital tunnel syndrome was diagnosed based upon symptoms of numbness, tingling, and/or pain in the ulnar nerve distribution or by the presence of weakness or wasting of the ulnar-innervated intrinsic hand muscles. All diagnoses were confirmed with electrodiagnostic studies. As part of the physical examination, the SCT was performed along three subdivided segments in the region of the cubital tunnel. Results of the SCT were recorded and correlated with intraoperative findings. Of the 64 patients evaluated, 44 had a positive SCT that was either more profound or solely present a few centimeters distal to the medial epicondyle in the region of Osborne's band. All of these patients subsequently underwent anterior submuscular transposition and were found to have a tight compression point at Osborne's band corresponding to their preoperative SCT. This study suggests that the scratch collapse test may be a reliable physical examination technique for localizing the point of maximal nerve compression in patients with cubital tunnel syndrome. That point, in this series, corresponded with Osborne's band.
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Affiliation(s)
- Justin M. Brown
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8238, St. Louis, MO 63110 USA
- Department of Neurosurgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8057, St. Louis, MO 63110 USA
| | - David Mokhtee
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8238, St. Louis, MO 63110 USA
- Northwest Hand Specialists, Inc., P.S., 19930 Ballinger Way NE, Seattle, WA 98155 USA
| | - Maristella S. Evangelista
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8238, St. Louis, MO 63110 USA
- Aesthetic and Plastic Surgery Institute, University of California at Irvine, 200 Manchester Avenue, Suite 650, Orange, CA 92868 USA
| | - Susan E. Mackinnon
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8238, St. Louis, MO 63110 USA
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Khan SI, Burne JA. Inhibitory mechanisms following electrical stimulation of tendon and cutaneous afferents in the lower limb. Brain Res 2010; 1308:47-57. [DOI: 10.1016/j.brainres.2009.10.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 10/06/2009] [Accepted: 10/08/2009] [Indexed: 10/20/2022]
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Truini A, Padua L, Biasiotta A, Caliandro P, Pazzaglia C, Galeotti F, Inghilleri M, Cruccu G. Differential involvement of A-delta and A-beta fibres in neuropathic pain related to carpal tunnel syndrome. Pain 2009; 145:105-9. [DOI: 10.1016/j.pain.2009.05.023] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Revised: 04/21/2009] [Accepted: 05/22/2009] [Indexed: 11/30/2022]
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Cutaneous silent periods are not affected by the antihistaminic drug cetirizine. Clin Neurophysiol 2009; 120:1016-9. [DOI: 10.1016/j.clinph.2009.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 03/12/2009] [Accepted: 03/14/2009] [Indexed: 11/19/2022]
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Truini A, Galeotti F, Biasiotta A, Gabriele M, Inghilleri M, Petrucci MT, Cruccu G. Dissociation between cutaneous silent period and laser evoked potentials in assessing neuropathic pain. Muscle Nerve 2008; 39:369-73. [DOI: 10.1002/mus.21162] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Gilio F, Bettolo CM, Conte A, Iacovelli E, Frasca V, Serrao M, Giacomelli E, Gabriele M, Prencipe M, Inghilleri M. Influence of the corticospinal tract on the cutaneous silent period: a study in patients with pyramidal syndrome. Neurosci Lett 2008; 433:109-13. [PMID: 18242857 DOI: 10.1016/j.neulet.2007.12.055] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Revised: 12/17/2007] [Accepted: 12/26/2007] [Indexed: 02/08/2023]
Abstract
The cutaneous silent period (CSP) is a brief transient suppression of the voluntary muscle contraction that follows a noxious cutaneous nerve stimulation. In this study we investigated the influence of the corticospinal tract on this spinal inhibitory reflex. In patients with pyramidal syndrome and in a group of healthy subjects we delivered painful electrical finger stimulation during sustained contraction of the ipsilateral abductor digiti minimi muscle. The CSP latency and duration and the background electromyographic (EMG) activity were measured and compared between-groups. The compound motor action potential amplitude and F-wave latency were also measured after electrical stimulation of the ulnar nerve at the wrist. The CSP latency was significantly longer in patients than in healthy subjects. None of the other variables differed in patients and healthy subjects. Our findings suggest that corticospinal projections influence the CSP latency probably by modulating the balance of excitability in the underlying circuits.
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Affiliation(s)
- Francesca Gilio
- Department of Neurological Sciences, University of Rome Sapienza, Viale dell'Università 30, 00185 Rome, Italy
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Kofler M, Poustka K. Ipsi- and contralateral exteroceptive EMG modulation in uni- and bilaterally activated thenar muscles. Clin Neurophysiol 2005; 116:300-7. [PMID: 15661108 DOI: 10.1016/j.clinph.2004.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The cutaneous silent period (CSP) is a spinal inhibitory reflex mediated by A-delta fibers. The exact underlying neural pathway, however, is unknown. This study was undertaken to investigate whether the neural circuitry mediating CSPs is wired unilaterally or whether there is evidence of influence from or upon the contralateral side. METHODS Fifteen healthy subjects underwent bilateral CSP testing following unilateral nociceptive digit II stimulation. Surface electromyographic (EMG) recordings were obtained bilaterally from thenar muscles following unilateral recurrent nociceptive digit II stimulation while activating the ipsilateral or the contralateral or both thenar muscles against resistance. RESULTS Nociceptive digit II stimulation evoked consistent CSPs in ipsilateral thenar muscles during voluntary contraction, while there was no consistent influence on EMG activity in contralateral thenar muscles at rest. Furthermore, nociceptive digit II stimulation did neither consistently affect EMG activity in ipsilateral thenar muscles at rest nor in contralateral thenar muscles during voluntary contraction. Finally, there was no significant difference between any CSP parameters obtained during unilateral versus bilateral muscle contraction. Occasional late excitatory EMG activity in relaxed or contracted thenar muscles resembled startle reflexes, which seem to contribute to the post-inhibition EMG-rebound. CONCLUSIONS The present findings are consistent with unilateral wiring of the spinal circuitry mediating CSPs. SIGNIFICANCE The essential lack of a crossed inhibitory influence of nociceptive digit II stimulation underscores the utility of CSP testing in the assessment of the A-delta fiber system in healthy subjects and patients with various pathologies.
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Affiliation(s)
- Markus Kofler
- Department of Neurology, Hospital Hochzirl A-6170 Zirl, Austria.
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Kofler M, Poustka K. Interside comparison of cutaneous silent periods in thenar muscles of healthy male and female subjects. Clin Neurophysiol 2004; 115:2123-7. [PMID: 15294214 DOI: 10.1016/j.clinph.2004.04.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2004] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The cutaneous silent period (CSP) is a spinal inhibitory reflex mediated by A-delta fibers. To date, no data are available about normal interside differences. METHODS Twenty healthy subjects underwent comparison of CSPs in the dominant and non-dominant hand. Surface electromyographic (EMG) recordings were obtained from thenar muscles on either side following ipsilateral recurrent nociceptive digit II stimulation. RESULTS Group average CSP onset and end latency, CSP duration, and the magnitude of EMG suppression were not significantly different between both sides. Regression analysis revealed powerful correlations between individual CSP parameters of dominant and non-dominant hands. Calculated upper normal limits of maximum interside differences were 17% for CSP onset latency, 14% for CSP end latency, 22% for CSP duration, and 45% for the index of suppression. CSP parameters in right-handed subjects did not differ significantly from those in left-handed subjects. Female subjects tended to have shorter CSP onset latencies, longer CSP duration, and a smaller index of suppression, resulting in a larger overall suppression. CONCLUSIONS CSPs prove to be robust nociceptive cutaneomuscular reflexes with little side-to-side difference. SIGNIFICANCE The presented normative values of interside differences enable a more thorough comparison with patient data in various conditions.
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Affiliation(s)
- Markus Kofler
- Department of Neurology, Hospital Hochzirl, A-6170 Zirl, Austria.
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Romaniello A, Truini A, Galeotti F, De Lena C, Willer JC, Cruccu G. Cutaneous silent period in hand muscle is evoked by laser stimulation of the palm, but not the hand dorsum. Muscle Nerve 2004; 29:870-2. [PMID: 15170621 DOI: 10.1002/mus.20040] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Painful electrical stimulation of the fingers evokes an inhibitory response in hand muscles (cutaneous silent period, CSP). The aim of this study was to determine whether purely nociceptive thermal stimuli applied to the hand evoke a CSP. High-intensity laser pulses (205 +/- 44 mJ) were delivered to the dorsum and palm of the hand in five volunteers. Electromyographic signals were recorded from the ipsilateral first dorsal interosseous muscle. We then compared the laser-evoked CSP with the CSP induced by electrical stimulation. A clear laser CSP (latency 90 +/- 7 ms) was evoked in all subjects when laser pulses were applied to the palm of the hand, whereas no response was recorded after stimulation of the dorsum. Electrical stimulation of both the dorsum and the palm evoked a CSP (latency 65 +/- 5 ms), although the reflex threshold was significantly lower after stimulation of the palm. This study confirms that the CSP is a nociceptive response specific to limbs that grasp. In humans, palm nociceptors are probably more functionally effective than dorsal nociceptors in inducing the hand-muscle inhibition that interrupts hand prehension (so that a potentially noxious source is dropped) before proximal muscles withdraw the limb.
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Affiliation(s)
- A Romaniello
- Department of Neurological Sciences, University "La Sapienza," Viale Università 30, 00185 Rome, Italy
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25
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Kofler M. Influence of transcutaneous electrical nerve stimulation on cutaneous silent periods in humans. Neurosci Lett 2004; 360:69-72. [PMID: 15082181 DOI: 10.1016/j.neulet.2004.02.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2003] [Revised: 02/16/2004] [Accepted: 02/16/2004] [Indexed: 11/23/2022]
Abstract
The cutaneous silent period (CSP) is a spinal inhibitory reflex mediated by A-delta fibers. Ten healthy subjects underwent assessment of the effect of high-frequency transcutaneous electrical nerve stimulation (TENS) on the CSP. Surface electromyographic (EMG) recordings were obtained from thenar muscles following recurrent nociceptive digit II stimulation. Group average CSP duration was shortened relative to baseline recordings following 15 min of TENS. The amount of exteroceptive EMG inhibition was slightly increased due to a concomitant suppression of transcortical long-loop reflexes, which may be present within the CSP. Thus, TENS exerts an influence on both inhibitory and excitatory circuits involved in protective reflexes. These effects are likely mediated at the spinal segmental level through TENS-associated presynaptic inhibition of nociceptive A-delta fibers. The findings are in agreement with a known opiate-insensitive mechanism of TENS at the spinal level, and a previously reported insensitivity to fentanyl of CSPs.
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Affiliation(s)
- Markus Kofler
- Department of Neurology, Hospital Hochzirl, A-6170 Zirl, Austria.
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Cruccu G, Anand P, Attal N, Garcia-Larrea L, Haanpää M, Jørum E, Serra J, Jensen TS. EFNS guidelines on neuropathic pain assessment. Eur J Neurol 2004; 11:153-62. [PMID: 15009162 DOI: 10.1111/j.1468-1331.2004.00791.x] [Citation(s) in RCA: 385] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In September 2001, a Task Force was set up under the auspices of the European Federation of Neurological Societies with the aim of evaluating the existing evidence about the methods of assessing neuropathic pain and its treatments. This review led to the development of guidelines to be used in the management of patients with neuropathic pain. In the clinical setting a neurological examination that includes an accurate sensory examination is often sufficient to reach a diagnosis. Nerve conduction studies and somatosensory-evoked potentials, which do not assess small fibre function, may demonstrate and localize a peripheral or central nervous lesion. A quantitative assessment of the nociceptive pathways is provided by quantitative sensory testing and laser-evoked potentials. To evaluate treatment efficacy in a patient and in controlled trials, the simplest psychometric scales and quality of life measures are probably the best methods. A laboratory measure of pain that by-passes the subjective report, and thus cognitive influences, is a hopeful aim for the future.
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Affiliation(s)
- G Cruccu
- EFNS Panel on Neuropathic Pain Department of Neurological Sciences, La Sapienza University, Rome, Italy.
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Abstract
The cutaneous silent period (CSP) refers to the brief interruption in voluntary contraction that follows strong electrical stimulation of a cutaneous nerve. The CSP is a protective reflex that is mediated by spinal inhibitory circuits and is reinforced in part by parallel modulation of the motor cortex. This review summarizes current understanding of the afferents and circuits that are responsible for producing CSPs; the utility of the CSP for investigating peripheral and central nervous system disorders; and the relationship between the CSP, other cutaneous reflexes, and peripheral silent periods.
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Affiliation(s)
- Mary Kay Floeter
- EMG Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive, Building 10, Room 5C101, Bethesda, Maryland 20892, USA.
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