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Melo DLMD, Comerlato EA, Pinheiro DS, Manzano GM. Technical Aspects of Eliciting Trigeminocervical and Trigeminospinal Reflexes in Humans: A Scoping Review. J Clin Neurophysiol 2024; 41:379-387. [PMID: 38376940 DOI: 10.1097/wnp.0000000000001072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
SUMMARY This scoping review aims to summarize the technical strategies for obtaining trigeminocervical reflex (TCR) and trigeminospinal reflex (TSR) responses. Studies published on TCR or TSR elicitation in humans through electrical stimulation of trigeminal nerve branches were eligible for this scoping review. The data of interest included stimulation parameters, site of stimulation, recording parameters, and the feasibility of TCR and TSR elicitation, in healthy participants. Short-latency TCR responses were regularly obtained in both anterior and posterior neck muscles after electrical stimulation of the supraorbital and infraorbital nerves under voluntary muscle activation. However, without voluntary muscle activation, we found evidence of elicitation of short-latency TCR components only in the posterior neck muscles after supraorbital or infraorbital nerve stimulation. Long-latency TCR responses were regularly obtained in the anterior and posterior neck muscles in studies that evaluated this technique, regardless of the trigeminal branch stimulation or muscle activation status. Short-latency TSR components were not obtained in the included studies, whereas long-latency TSR responses were regularly recorded in proximal upper limb muscles. This scoping review revealed key heterogeneity in the techniques used for TCR and TSR elicitation. By summarizing all the methodological procedures used for TCR and TSR elicitation, this scoping review can guide researchers in defining optimized technical approaches for different research and clinical scenarios.
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Affiliation(s)
- Denise Lima Medeiros de Melo
- Department of Clinical Neurophysiology, SARAH Network of Rehabilitation Hospitals, Brasília, Federal District, Brazil; and
| | - Enio Alberto Comerlato
- Department of Clinical Neurophysiology, SARAH Network of Rehabilitation Hospitals, Brasília, Federal District, Brazil; and
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Bannister K, Smith RV, Wilkins P, Cummins TM. Towards optimising experimental quantification of persistent pain in Parkinson's disease using psychophysical testing. NPJ Parkinsons Dis 2021; 7:28. [PMID: 33731723 PMCID: PMC7969752 DOI: 10.1038/s41531-021-00173-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/19/2021] [Indexed: 02/07/2023] Open
Abstract
People with Parkinson's disease (PD) may live for multiple decades after diagnosis. Ensuring that effective healthcare provision is received across the range of symptoms experienced is vital to the individual's wellbeing and quality of life. As well as the hallmark motor symptoms, PD patients may also suffer from non-motor symptoms including persistent pain. This type of pain (lasting more than 3 months) is inconsistently described and poorly understood, resulting in limited treatment options. Evidence-based pain remedies are coming to the fore but therapeutic strategies that offer an improved analgesic profile remain an unmet clinical need. Since the ability to establish a link between the neurodegenerative changes that underlie PD and those that underlie maladaptive pain processing leading to persistent pain could illuminate mechanisms or risk factors of disease initiation, progression and maintenance, we evaluated the latest research literature seeking to identify causal factors underlying persistent pain in PD through experimental quantification. The majority of previous studies aimed to identify neurobiological alterations that could provide a biomarker for pain/pain phenotype, in PD cohorts. However heterogeneity of patient cohorts, result outcomes and methodology between human psychophysics studies overwhelmingly leads to inconclusive and equivocal evidence. Here we discuss refinement of pain-PD paradigms in order that future studies may enhance confidence in the validity of observed effect sizes while also aiding comparability through standardisation. Encouragingly, as the field moves towards cross-study comparison of data in order to more reliably reveal mechanisms underlying dysfunctional pain processing, the potential for better-targeted treatment and management is high.
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Affiliation(s)
- Kirsty Bannister
- Central Modulation of Pain, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Rory V Smith
- Central Modulation of Pain, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Patrick Wilkins
- Central Modulation of Pain, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Tatum M Cummins
- Central Modulation of Pain, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Synergistic antiallodynic and antihyperalgesic interaction between L-DOPA and celecoxib in parkinsonian rats is mediated by NO-cGMP-ATP-sensitive K + channel. Eur J Pharmacol 2020; 889:173537. [PMID: 32971091 DOI: 10.1016/j.ejphar.2020.173537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/28/2020] [Accepted: 09/03/2020] [Indexed: 11/22/2022]
Abstract
Pain is a usual and troublesome non-motor symptom of Parkinson's disease, with a prevalence of 29-82%. Therefore, it's vital to find pharmacological treatments for managing PD-associated pain symptoms, to improve patients' quality of life. For this reason, we tested the possible synergy between L-DOPA and celecoxib in decreasing allodynia and hyperalgesia induced by unilateral lesioning with 6-OHDA into the SNpc in rats. We also tested whether the antiallodynic and antihyperalgesic effect induced by combination of L-DOPA and celecoxib is mediated by the NO-cGMP-ATP-sensitive K+ channel pathway. Tactile allodynia and mechanical hyperalgesia were evaluated using von Frey filament. Isobolographic analyses were employed to define the nature of the drug interaction using a fixed dose ratio (0.5: 0.5). We found that acute and sub-acute (10-day) treatment with a single dose of L-DOPA (3-25 mg/kg, i. p.) or celecoxib (2.5-20 mg/kg, i. p.) induced a dose-dependent antiallodynic and antihyperalgesic effect in parkinsonian rats. Isobolographic analysis revealed that the ED50 values obtained by L-DOPA + celecoxib combination was significantly less than calculated additive values, indicating that co-administration of L-DOPA with celecoxib produces synergistic interactions in its antiallodynic and antihyperalgesic effect in animals with nigrostriatal lesions. Moreover, the antiallodynic and antihyperalgesic effects induced by L-DOPA + celecoxib combination were blocked by intrathecal pre-treatment with L-NAME, ODQ, and glibenclamide. Taken together, the data suggest that L-DOPA + celecoxib combination produces an antiallodynic and antihyperalgesic synergistic interaction at the systemic level, and these effects are mediated, at the central level, through activation of the NO-cGMP-ATP-sensitive K+ channel pathway.
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Grippe T, Cunha NSCD, BrandÃo PRDP, Fernandez RNM, Cardoso FEC. How can neurophysiological studies help with movement disorders characterization in clinical practice? A review. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:512-522. [PMID: 32901697 DOI: 10.1590/0004-282x20190195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 11/18/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Neurophysiological studies are ancillary tools to better understand the features and nature of movement disorders. Electromyography (EMG), together with electroencephalography (EEG) and accelerometer, can be used to evaluate a hypo and hyperkinetic spectrum of movements. Specific techniques can be applied to better characterize the phenomenology, help distinguish functional from organic origin and assess the most probable site of the movement generator in the nervous system. OBJECTIVE We intend to provide an update for clinicians on helpful neurophysiological tools to assess movement disorders in clinical practice. METHODS Non-systematic review of the literature published up to June 2019. RESULTS A diversity of protocols was found and described. These include EMG analyses to define dystonia, myoclonus, myokymia, myorhythmia, and painful legs moving toes pattern; EMG in combination with accelerometer to study tremor; and EEG-EMG to study myoclonus. Also, indirect measures of cortical and brainstem excitability help to describe and diagnose abnormal physiology in Parkinson's disease, atypical parkinsonism, dystonia, and myoclonus. CONCLUSION These studies can be helpful for the diagnosis and are usually underutilized in neurological practice.
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Affiliation(s)
- Talyta Grippe
- Centro Universitário de Brasília, Faculdade de Medicina, Brasília DF, Brazil.,Hospital de Base do Distrito Federal, Departamento de Neurologia, Brasília DF, Brazil
| | | | | | | | - Francisco Eduardo Costa Cardoso
- Universidade Federal de Minas Gerais, Departamento de Clínica Médica, Unidade de Distúrbios do Movimento, Belo Horizonte MG, Brazil
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Sung S, Vijiaratnam N, Chan DWC, Farrell M, Evans AH. Parkinson disease: A systemic review of pain sensitivities and its association with clinical pain and response to dopaminergic stimulation. J Neurol Sci 2018; 395:172-206. [PMID: 30401469 DOI: 10.1016/j.jns.2018.10.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/15/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
Abstract
Patients with Parkinson disease (PD) experience hyperalgesia on evoked pain sensitivity testing, although the relationship of this with persistent pain in PD is less certain. Studies examining this have generated contradictory findings. Further, the role of dopaminergic deficiency as an underlying substrate for hyperalgesia is controversial. We report the results of meta-analyses of the PD pain sensitivity literature in an attempt to answer these questions. We identified 429 records, of which ten articles compared pain sensitivity between PD patients that experienced clinical pain (PDP) to those who did not (PDNP), and twenty studies that examined the effect of dopaminergic medications on pain sensitivity in PD patients. PDP patients experienced a moderate increase in pain sensitivity, had more severe disease, required higher dosages of medication, and were more likely to be female when compared to those PDNP patients. PD patients also had reduced pain sensitivity when tested on dopaminergic medications compared to when they were not on medications. Overall, the results of this systematic review and meta-analysis supports the hypothesis that hyperalgesia contributes to clinical pain in PD, and that the underlying mechanism may be dopaminergically driven.
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Affiliation(s)
- Simon Sung
- Movement Disorders Service, Department of Neurology, the Royal Melbourne Hospital, Grattan St Parkville 3050, Australia; Department of Neurology, Sunshine Hospital, 176 Furlong Road, St Albans, VIC 3021, Australia
| | - Nirosen Vijiaratnam
- Department of Neurology, Sunshine Hospital, 176 Furlong Road, St Albans, VIC 3021, Australia
| | - Daniela Wan Chi Chan
- Department of Endocrinology, Barwon Health, Bellerine St, Geelong, VIC 3220, Australia
| | - Michael Farrell
- Department of Medical Imaging and Radiation Sciences, School of Biomedical Sciences, Faculty of Medicine, Nursing and Health Sciences, 10 Chancellors Walk, Clayton Campus, VIC 3800, Australia
| | - Andrew H Evans
- Movement Disorders Service, Department of Neurology, the Royal Melbourne Hospital, Grattan St Parkville 3050, Australia.
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Smith AT, Gorassini MA. Hyperexcitability of brain stem pathways in cerebral palsy. J Neurophysiol 2018; 120:1428-1437. [DOI: 10.1152/jn.00185.2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Individuals with cerebral palsy (CP) experience impairments in the control of head and neck movements, suggesting dysfunction in brain stem circuitry. To examine if brain stem circuitry is altered in CP, we compared reflexes evoked in the sternocleidomastoid (SCM) muscle by trigeminal nerve stimulation in adults with CP and in age/sex-matched controls. Increasing the intensity of trigeminal nerve stimulation produced progressive increases in the long-latency suppression of ongoing SCM electromyography in controls. In contrast, participants with CP showed progressively increased facilitation around the same reflex window, suggesting heightened excitability of brain stem pathways. We also examined if there was altered activation of cortico-brain stem pathways in response to prenatal injury of the brain. Motor-evoked potentials (MEPs) in the SCM that were conditioned by a prior trigeminal afferent stimulation were more facilitated in CP compared with controls, especially in ipsilateral MEPs that are likely mediated by corticoreticulospinal pathways. In some participants with CP, but not in controls, a combined trigeminal nerve and cortical stimulation near threshold intensities produced large, long-lasting responses in both the SCM and biceps brachii muscles. We propose that the enhanced excitatory responses evoked from trigeminal and cortical inputs in CP are produced by heightened excitability of brain stem circuits, resulting in the augmented activation of reticulospinal pathways. Enhanced activation of reticulospinal pathways in response to early injury of the corticospinal tract may provide a compensated activation of the spinal cord or, alternatively, contribute to impairments in the precise control of head and neck functions. NEW & NOTEWORTHY This is the first study to show that in adults with spastic cerebral palsy, activation of brain stem circuits by cortical and/or trigeminal afferents produces excitatory responses in anterior neck muscles compared with inhibitory responses in age/sex-matched controls. This may reflect a more excitable reticulospinal tract in response to early brain injury to provide a compensated activation of postural muscles. On the other hand, a hyperexcitable brain stem may contribute to impairments in the precise control of head and neck functions.
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Affiliation(s)
- A. T. Smith
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - M. A. Gorassini
- Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Sung S, Vijiaratnam N, Chan DWC, Farrell M, Evans AH. Pain sensitivity in Parkinson's disease: Systematic review and meta-analysis. Parkinsonism Relat Disord 2017; 48:17-27. [PMID: 29398491 DOI: 10.1016/j.parkreldis.2017.12.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/22/2017] [Accepted: 12/25/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Pain is a common and disabling non-motor symptom of Idiopathic Parkinson's disease (PD) but its underlying pathophysiological mechanisms are not well understood. There is evidence to suggest that altered pain sensitivity may contribute to the experience of pain in PD patients, but clinical studies investigating this have yielded inconsistent results. OBJECTIVES To examine whether pain thresholds are altered in PD patients compared to normal healthy controls (HC), via the use of systematic review and meta-analysis. DATA SOURCES A systematic search of the MEDLINE and EMBASE library from 1966 to April 2015. STUDY SELECTION Studies that compared pain thresholds in PD patients versus HC were included in the systematic review. Additionally, data comparing PD patients off dopaminergic medications (PDMoff) to HC off medications (HCMoff) were pooled for meta-analysis by pain modality. MAIN OUTCOMES Heat pain threshold, cold pain threshold, electrical pain threshold, nociceptive withdrawal reflex threshold, pressure pain threshold, and pain ratings. RESULTS 22 studies were reviewed, comprising of 616 PD and 451 HC. In the comparison of PDMoff versus HCMoff, a large majority of trials (15/19) found reduced pain thresholds (increased pain sensitivity) in PD patients. Meta-analysis of these trials revealed significantly reduced pain thresholds, of moderate to large effect size, in PD patients across all pain modalities. Results were much more heterogenous when PD patients on medications were compared with HC off medications, with most trials reporting no significant difference in pain thresholds between groups. No significant differences were found in pain thresholds for trials that compared PD patients on medications and HC on medications. CONCLUSION PD patients are more sensitive to noxious stimuli compared to HC when tested in the off medication state. This increase in pain sensitivity is observed across all modalities, but is not as apparent when PD patients are administered Levodopa, suggesting that dopamine deficient states may contribute to hyperalgesia. However, it remains to be seen whether or not increased pain sensitivity translates clinically into increased prevalence of pain. Similarly, it is unclear if dopaminergic medications influence pain sensitivity. Performing a meta-analysis on studies comparing pain thresholds in PD patients with and without pain, and on and off dopaminergic medications, may draw more definitive conclusions in this regard.
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Affiliation(s)
- Simon Sung
- Movement Disorders Service, Department of Neurology, The Royal Melbourne Hospital, Grattan, St Parkville, 3050, Australia; Department of Neurology, Sunshine Hospital, 176 Furlong Road, St Albans, VIC, 3021, Australia.
| | - Nirosen Vijiaratnam
- Department of Neurology, Sunshine Hospital, 176 Furlong Road, St Albans, VIC, 3021, Australia
| | - Daniela Wan Chi Chan
- Department of Endocrinology, Barwon Health, Bellerine St, Geelong, VIC, 3220, Australia
| | - Michael Farrell
- Department of Medical Imaging and Radiation Sciences, School of Biomedical Sciences, Faculty of Medicine, Nursing and Health Sciences, 10 Chancellors Walk, Clayton Campus, Victoria 3800, Australia
| | - Andrew H Evans
- Movement Disorders Service, Department of Neurology, The Royal Melbourne Hospital, Grattan, St Parkville, 3050, Australia
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Rana AQ, Qureshi D, Sabeh W, Mosabbir A, Rahman E, Sarfraz Z, Rana R. Pharmacological therapies for pain in Parkinson's disease - a review paper. Expert Rev Neurother 2017; 17:1209-1219. [PMID: 28949252 DOI: 10.1080/14737175.2017.1385393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) is a neurodegenerative movement disorder characterized by the loss of dopamine containing cells in the substantia nigra, with pain being one of the most common, yet frequently misunderstood symptoms. The prevalence of pain in PD populations ranges from 40-85% and is usually categorized under the following types: i) musculoskeletal pain ii) radicular and neuropathic pain iii) dystonia-related pain iv) akathitic pain and iv) central parkinsonian pain. Areas covered: The aim of this literature review was to document and present the common and uncommon pharmaceutical therapies that treat and/or alleviate these types of pain in PD. The PubMed database was searched with keywords: "Parkinson's disease", "Pain", and "Pharmacological Therapies". Research articles involving randomized, controlled trials were included as well as case studies and qualitative studies. Expert commentary: Given the increased prevalence of pain in PD populations, there is a need for a clear understanding of the types of pain treatments available and how they can be best combined to fit the specific needs of each patient.
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Affiliation(s)
- Abdul Qayyum Rana
- a Parkinson's Clinic of Eastern Toronto and Movement Disorders Center , Toronto , Canada
| | | | | | | | | | | | - Ruqqiyah Rana
- f University of Ontario Institute of Technology , Oshawa , Canada
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Zambito-Marsala S, Erro R, Bacchin R, Fornasier A, Fabris F, Lo Cascio C, Ferracci F, Morgante F, Tinazzi M. Abnormal nociceptive processing occurs centrally and not peripherally in pain-free Parkinson disease patients: A study with laser-evoked potentials. Parkinsonism Relat Disord 2017; 34:43-48. [DOI: 10.1016/j.parkreldis.2016.10.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/12/2016] [Accepted: 10/23/2016] [Indexed: 10/20/2022]
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Abnormalities of vestibular-evoked myogenic potentials in idiopathic Parkinson’s disease are associated with clinical evidence of brainstem involvement. Neurol Sci 2015; 36:995-1001. [DOI: 10.1007/s10072-014-2054-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 12/24/2014] [Indexed: 01/08/2023]
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Magnano I, Pes GM, Pilurzi G, Cabboi MP, Ginatempo F, Giaconi E, Tolu E, Achene A, Salis A, Rothwell JC, Conti M, Deriu F. Exploring brainstem function in multiple sclerosis by combining brainstem reflexes, evoked potentials, clinical and MRI investigations. Clin Neurophysiol 2014; 125:2286-2296. [DOI: 10.1016/j.clinph.2014.03.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 02/24/2014] [Accepted: 03/09/2014] [Indexed: 10/25/2022]
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Gündüz A, Uzun N, Örnek Nİ, Ünalan H, Karamehmetoğlu ŞS, Kızıltan ME. Trigemino-cervical reflex in spinal cord injury. Neurosci Lett 2014; 580:169-72. [PMID: 25128217 DOI: 10.1016/j.neulet.2014.08.006] [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: 04/26/2014] [Revised: 07/24/2014] [Accepted: 08/04/2014] [Indexed: 11/27/2022]
Abstract
Abnormal enhancement of polysynaptic brainstem reflexes has been previously reported in patients with spinal cord injury (SCI). We aimed to investigate trigemino-cervical reflex (TCR) in SCI since it may reflect alterations in the connections of trigeminal proprioceptive system and cervical motoneurons. Consecutive 14 patients with SCI and 16 healthy subjects were included in this study. All patients were in the chronic phase. TCR was recorded over sternocleidomastoid (SCM) and splenius capitis (SC) muscles by stimulation of infraorbital nerve. We measured onset latency, amplitudes and durations of responses and compared between groups. We obtained stable responses over both muscles after one sided stimulation in healthy volunteers whereas probability of TCR was decreased in patients over both SCM (78.6% vs. 100%, p=0.050) and SC (71.4% vs. 100%, p=0.022). The absence of TCR was related to use of oral baclofen (≥50mg/day). However, when present, responses of SCI group had higher amplitudes and were more persistent. We demonstrated that TCR probability was similar to healthy subjects in SCI patients who used no or low dose oral baclofen. But it had higher amplitudes and longer durations. It was not obtained in only two patients who used oral baclofen more than 50mg/day.
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Affiliation(s)
- Ayşegül Gündüz
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey.
| | - Nurten Uzun
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Nurettin İrem Örnek
- Department of Physical Therapy and Rehabilitation, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Ünalan
- Department of Physical Therapy and Rehabilitation, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Şafak Sahir Karamehmetoğlu
- Department of Physical Therapy and Rehabilitation, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Meral E Kızıltan
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
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Perrotta A, Bolla M, Serrao M, Paparatti M, Tassorelli C, Pierelli F, Sandrini G. Enhanced temporal pain processing in multiple system atrophy. Neurosci Lett 2013; 555:203-8. [DOI: 10.1016/j.neulet.2013.09.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 08/26/2013] [Accepted: 09/14/2013] [Indexed: 10/26/2022]
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Perrotta A, Serpino C, Cormio C, Serrao M, Sandrini G, Pierelli F, de Tommaso M. Abnormal spinal cord pain processing in Huntington’s disease. The role of the diffuse noxious inhibitory control. Clin Neurophysiol 2012; 123:1624-30. [DOI: 10.1016/j.clinph.2012.01.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 12/23/2011] [Accepted: 01/19/2012] [Indexed: 11/29/2022]
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Serrao M, Di Fabio R, Bartolo M, Perrotta A, Tassorelli C, Coppola G, Davassi C, Padua L, Sandrini G, Pierelli F. The contribution of trigemino-cervical reflexes in distinguishing progressive supranuclear palsy from multiple system atrophy. Clin Neurophysiol 2011; 122:1812-5. [DOI: 10.1016/j.clinph.2011.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 02/03/2011] [Accepted: 02/14/2011] [Indexed: 11/27/2022]
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Perrotta A, Sandrini G, Serrao M, Buscone S, Tassorelli C, Tinazzi M, Zangaglia R, Pacchetti C, Bartolo M, Pierelli F, Martignoni E. Facilitated temporal summation of pain at spinal level in Parkinson's disease. Mov Disord 2010; 26:442-8. [PMID: 21462260 DOI: 10.1002/mds.23458] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 08/15/2010] [Accepted: 09/03/2010] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Pain is one of the major nonmotor symptoms of Parkinson's disease. We hypothesized that Parkinson's disease patients could show an early diffuse abnormal processing of the nociceptive inputs also in the absence of clinical pain syndrome and that this could represent the physiopathological substrate to explain the high incidence of diffuse pain symptoms. MATERIALS AND METHODS We used the temporal summation threshold of the nociceptive withdrawal reflex and the related pain sensation to evaluate the facilitation in pain processing at spinal level. Fifteen (7 Women; 8 Men; mean age 63.0 ± 9.1) Parkinson's disease patients without clinical pain and 12 (6 Women, 6 Men; mean age 61.2 ± 4.2) healthy subjects were recruited. Parkinson's disease group has been subdivided into two subgroups, 7 early-stage Parkinson's disease patients with unilateral signs (Hoehn and Yahr stage 1) and 8 patients in a more advanced stage of the disease showing bilateral parkinsonian signs (Hoehn and Yahr stages 2 and 2.5), both "on" and "off" treatments with levodopa. RESULTS A significant facilitation in temporal summation of pain (reduced temporal summation threshold and increased painful sensation) was found in Parkinson's disease patients when compared with controls. This facilitation is more evident in Parkinson's disease with bilateral signs and on the side more affected in Parkinson's disease with unilateral signs. Levodopa administration failed to significantly modify the neurophysiological abnormalities; however, a slight improvement has been detected. CONCLUSIONS The increased gain in pain processing at spinal level in Parkinson's disease patients could be a consequence of the degenerative phenomena involving supraspinal projections implicated in the modulation of pain processing and could make Parkinson's disease patients more predisposed to develop a pain condition.
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Affiliation(s)
- Armando Perrotta
- Department of Neurology, IRCCS C. Mondino Institute of Neurology Foundation, University of Pavia, Pavia, Italy.
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Potvin S, Grignon S, Marchand S. Human evidence of a supra-spinal modulating role of dopamine on pain perception. Synapse 2009; 63:390-402. [DOI: 10.1002/syn.20616] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Greco R, Tassorelli C, Armentero MT, Sandrini G, Nappi G, Blandini F. Role of central dopaminergic circuitry in pain processing and nitroglycerin-induced hyperalgesia. Brain Res 2008; 1238:215-23. [PMID: 18761334 DOI: 10.1016/j.brainres.2008.08.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 07/31/2008] [Accepted: 08/01/2008] [Indexed: 01/12/2023]
Abstract
Experimental evidence shows that dopaminergic transmission within the basal ganglia is involved in the modulation of nociceptive information. Epidemiological studies show that in some disease states inherent pathophysiological mechanisms that involve degenerative changes (Parkinson's disease; PD) can also impact negatively on other unrelated functional systems (i.e. nociception). Delayed Fos expression in response to nitroglycerin (NTG) administration is a procedure used to identify the neuroanatomical substrates of the migraine condition. In this study, we investigated the influence of dopaminergic nigrostriatal denervation, obtained by intrastriatal injection of 6-hydroxydopamine (6-OHDA), on this response in Sprague-Dawley rats. We also explored the effects on the NTG-induced hyperalgesic response to painful stimuli (formalin and tail-flick tests). Nigrostriatal lesion prevented the neuronal activation typically induced by NTG in sub-cortical areas involved in pain perception, autonomic control and neuroendocrine functions, such as hypothalamic nuclei, periaqueductal grey, parabrachial nucleus and the medullary nuclei. In addition, 6-OHDA-induced lesion inhibited NTG-induced hyperalgesia. Our data show that integrity of central dopaminergic neurotransmission is required for the NTG-induced activation of sub-cortical areas involved in the expression of migraine symptoms, as well as for the hyperalgesic response to painful stimuli elicited by the drug.
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Affiliation(s)
- Rosaria Greco
- Interdepartmental Research Center for Parkinson's Disease, IRCCS Neurological Institute C Mondino, Pavia, Italy
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Bartolo M, Serrao M, Perrotta A, Tassorelli C, Sandrini G, Pierelli F. Lack of trigemino-cervical reflexes in progressive supranuclear palsy. Mov Disord 2008; 23:1475-9. [DOI: 10.1002/mds.22039] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Cole LJ, Farrell MJ, Gibson SJ, Egan GF. Age-related differences in pain sensitivity and regional brain activity evoked by noxious pressure. Neurobiol Aging 2008; 31:494-503. [PMID: 18513833 DOI: 10.1016/j.neurobiolaging.2008.04.012] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 04/15/2008] [Accepted: 04/21/2008] [Indexed: 10/22/2022]
Abstract
Compared with young adults, older people report more chronic pain complaints, and show reduced tolerance to experimental pain. Atrophy of brain parenchyma in normal ageing is well documented, with grey matter reduction occurring across many regions known to be involved in pain processing. However, the functional consequences of these changes, in particular their contribution toward age-related differences in pain perception and report, are yet to be elucidated. The present study investigated the effects of ageing on supraspinal pain processing by comparing regional brain responses to noxious pressure stimulation in 15 young (aged 26+/-3 years) and 15 older (aged 79+/-4 years) adults. Both groups showed significant pain-related activity in a common network of areas including the insula, cingulate, posterior parietal and somatosensory cortices. However, compared with older adults, young subjects showed significantly greater activity in the contralateral putamen and caudate, which could not be accounted for by increased age-associated shrinkage in these regions. The age-related difference in pain-evoked activity seen in the present study may reflect reduced functioning of striatal pain modulatory mechanisms with advancing age.
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Affiliation(s)
- Leonie J Cole
- Howard Florey Institute, University of Melbourne, Parkville, Victoria 3010, Australia.
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Tinazzi M, Del Vesco C, Defazio G, Fincati E, Smania N, Moretto G, Fiaschi A, Le Pera D, Valeriani M. Abnormal processing of the nociceptive input in Parkinson's disease: a study with CO2 laser evoked potentials. Pain 2007; 136:117-24. [PMID: 17765400 DOI: 10.1016/j.pain.2007.06.022] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Revised: 06/13/2007] [Accepted: 06/20/2007] [Indexed: 11/30/2022]
Abstract
Since a number of patients with Parkinson's Disease (PD) complain of painful sensations, we studied whether the central processing of nociceptive inputs is abnormal in PD. To test this hypothesis, we recorded scalp CO(2) laser evoked potentials (LEPs) to hand skin stimulation in 18 pain-free PD patients with unilateral bradykinetic-rigid syndrome (hemiparkinson) during the off state and in 18 healthy subjects. This technique allows us to explore non-invasively the functional status of some cerebral structures involved in nociceptive input processing. In both PD patients and control subjects, CO(2) laser stimulation gave rise to a main negative N2 potential followed by a positive P2 response at vertex peaking at a latency of about 200 and 300ms, respectively. These potentials are thought to originate from several brain structures devoted to nociceptive input processing, including the cingulate gyrus and insula. PD patients and normal subjects showed comparable N2 and P2 latencies, whereas the N2/P2 peak-to-peak amplitude was significantly lower in PD patients (regardless of the clinically affected body side) than in controls. LEPs were even recorded after acute L-dopa administration in 7 additional PD patients. L-dopa administration yielded no significant change in N2/P2 amplitude as compared to the off state. These results suggest an abnormal nociceptive input processing in pain-free PD patients which appears to be independent of clinical expression of parkinsonian motor signs and is not affected by dopaminergic stimulation.
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Affiliation(s)
- Michele Tinazzi
- Dipartimento di Scienze Neurologiche e della Visione, Sezione di Neurologia Riabilitativa, Università di Verona, Italy.
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Tassorelli C, Armentero MT, Greco R, Fancellu R, Sandrini G, Nappi G, Blandini F. Behavioral responses and Fos activation following painful stimuli in a rodent model of Parkinson's disease. Brain Res 2007; 1176:53-61. [PMID: 17884026 DOI: 10.1016/j.brainres.2007.08.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Revised: 08/06/2007] [Accepted: 08/07/2007] [Indexed: 11/21/2022]
Abstract
In Parkinson's disease (PD), the motor dysfunction caused by degeneration of the nigrostriatal pathway is often associated with alterations of pain perception. This is likely related to the role that the nigrostriatal system may play in the processing of noxious, somatosensory stimuli. To further address this issue, we used a rodent model of PD, based on the unilateral, intrastriatal injection of neurotoxin 6-hydroxydopamine (6-OHDA). We investigated the effects of the nigrostriatal lesion on behavioral responses to pain tests designed to explore different aspects of nociception, such as the formalin test and the tail flick test; we also explored modifications in the expression of Fos protein, a marker of neuronal activation, in supraspinal nuclei involved in the integration of pain perception and stress-related behavior. Rats bearing the nigrostriatal lesion showed complex alterations in pain perception, including hyperalgesic responses to the tonic, inflammatory pain elicited by formalin injection, but only when the stimulus was delivered ipsilaterally to the lesion. This phenomenon was associated with delayed responses to the phasic, thermal stimulus induced by the tail flick test. The hyperalgesic response to the formalin test was accompanied by reduced Fos expression in the paraventricular nucleus of the hypothalamus, which is part of a network (the medial pain system) that mediates motivational-affective aspects of pain. Our results confirm that a unilateral alteration of central dopaminergic transmission disrupts the neural mechanisms underlying proper integration of painful stimuli, particularly in the hemibody ipsilateral to the dopaminergic denervation.
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Affiliation(s)
- Cristina Tassorelli
- Laboratory of Pathophysiology of Integrative Autonomic Systems, Neurological Institute C Mondino, Pavia, Italy
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Crenna P, Carpinella I, Rabuffetti M, Calabrese E, Mazzoleni P, Nemni R, Ferrarin M. The association between impaired turning and normal straight walking in Parkinson's disease. Gait Posture 2007; 26:172-8. [PMID: 17532636 DOI: 10.1016/j.gaitpost.2007.04.010] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Accepted: 04/15/2007] [Indexed: 02/02/2023]
Abstract
Turning whilst walking was investigated by gait analysis in a group of Parkinson's Disease (PD) patients with mild clinical impairment and no significant abnormalities in stride parameters and kinematics of steady-state, linear walking. Comparison with age-matched controls demonstrated that patients approached turns with a slower step and completed turning with a greater number of steps. Moreover, the normal cranio-caudal sequence, whereby rotation of the head toward the intended direction of travel is followed by rotation of the trunk, was replaced by nearly simultaneous rotation of head and trunk and decreased relative head excursion after the second turning step. The evidence of abnormal inter-segmental coordination during turning in mildly affected, normally walking patients suggests that task-specific pathophysiological mechanisms, not necessary related to basic locomotor deficits, underlie disturbed directional changes in PD. Furthermore, turning-related neural systems may be more vulnerable to functional impairments associated with PD, as compared with linear walking. Hierarchically higher control levels involved in the turning ability may explain the observed unexpected association.
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Affiliation(s)
- P Crenna
- Istituto di Fisiologia Umana I, Università di Milano, LAMB P. & L. Mariani, Milan, Italy
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