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Gunduz A, Valls-Solé J, Serranová T, Coppola G, Kofler M, Jääskeläinen SK. The blink reflex and its modulation - Part 2: Pathophysiology and clinical utility. Clin Neurophysiol 2024; 160:75-94. [PMID: 38412746 DOI: 10.1016/j.clinph.2024.02.006] [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: 07/09/2023] [Revised: 12/30/2023] [Accepted: 02/06/2024] [Indexed: 02/29/2024]
Abstract
The blink reflex (BR) is integrated at the brainstem; however, it is modulated by inputs from various structures such as the striatum, globus pallidus, substantia nigra, and nucleus raphe magnus but also from afferent input from the peripheral nervous system. Therefore, it provides information about the pathophysiology of numerous peripheral and central nervous system disorders. The BR is a valuable tool for studying the integrity of the trigemino-facial system, the relevant brainstem nuclei, and circuits. At the same time, some neurophysiological techniques applying the BR may indicate abnormalities involving structures rostral to the brainstem that modulate or control the BR circuits. This is a state-of-the-art review of the clinical application of BR modulation; physiology is reviewed in part 1. In this review, we aim to present the role of the BR and techniques related to its modulation in understanding pathophysiological mechanisms of motor control and pain disorders, in which these techniques are diagnostically helpful. Furthermore, some BR techniques may have a predictive value or serve as a basis for follow-up evaluation. BR testing may benefit in the diagnosis of hemifacial spasm, dystonia, functional movement disorders, migraine, orofacial pain, and psychiatric disorders. Although the abnormalities in the integrity of the BR pathway itself may provide information about trigeminal or facial nerve disorders, alterations in BR excitability are found in several disease conditions. BR excitability studies are suitable for understanding the common pathophysiological mechanisms behind various clinical entities, elucidating alterations in top-down inhibitory systems, and allowing for follow-up and quantitation of many neurological syndromes.
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Affiliation(s)
- Aysegul Gunduz
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Neurology, Division of Neurophysiology, Istanbul, Turkey.
| | - Josep Valls-Solé
- IDIBAPS. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Villarroel 170 08024, Barcelona, Spain.
| | - Tereza Serranová
- Department of Neurology and Center of Clinical Neuroscience, Charles University, Prague 1st Faculty of Medicine and General University Hospital, Prague, Kateřinská 30, 12800 Prague 2, Czech Republic.
| | - Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino ICOT, via Franco Faggiana 1668 04100, Latina, Italy.
| | - Markus Kofler
- Department of Neurology, Hochzirl Hospital, A-6170 Zirl, Austria.
| | - Satu K Jääskeläinen
- Department of Clinical Neurophysiology, Division of Medical Imaging, Turku University Hospital and University of Turku, Postal Box 52, FIN 20521 Turku, Finland.
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Cho KR, Lee HS, Kim M, Park SK, Park K. Optimal method for reliable lateral spread response monitoring during microvascular decompression surgery for hemifacial spasm. Sci Rep 2023; 13:21672. [PMID: 38066203 PMCID: PMC10709590 DOI: 10.1038/s41598-023-49008-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
In this study, we propose an optimal method for monitoring the key electrophysiological sign, the Lateral Spread Response (LSR), during microvascular decompression (MVD) surgery for hemifacial spasm (HFS). Current monitoring methods and interpretations of LSR remain unclear, leading to potential misinterpretations and undesirable outcomes." We prospectively collected data from patients undergoing MVD for HFS, including basic demographics, clinical characteristics, and surgical outcomes. Stimulation intensity was escalated by 1 mA increments to identify the optimal range for effective LSR. We designated the threshold at which we can observe LSR as THR1 and THR2 for when LSR disappears, with high-intensity stimulation (30 mA) designated as THR30. Subsequently, we compared abnormal muscle responses (AMR) between the optimal range (between THR1 and THR2) and THR30. Additionally, we conducted an analysis to identify and assess factors associated with artifacts and their potential impact on clinical outcomes. As stimulation intensity increases, the onset latency to detect AMR was shortened. The first finding of the study was high intensity stimulation caused artifact that mimic the wave of LSR. Those artifacts were observed even after decompression thus interfere interpretation of disappearance of LSR. Analyzing the factors related to the artifact, we found the AMR detected at onset latency below 9.6 ms would be the lateral spreading artifact (LSA) rather than true LSR. To avoid false positive LSR from LSA, we should stepwise increase stimulation intensity and not to surpass the intensity that cause LSR onset latency below 10 ms.
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Affiliation(s)
- Kyung Rae Cho
- Department of Neurosurgery, Konkuk University Medical Center, 120, Neungdong-ro, Gwangjin-gu, 05029, Seoul, Republic of Korea
| | - Hyun-Seok Lee
- Department of Neurosurgery, Konkuk University Medical Center, 120, Neungdong-ro, Gwangjin-gu, 05029, Seoul, Republic of Korea
| | - Minsoo Kim
- Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, 25440, Republic of Korea
| | - Sang-Ku Park
- Department of Neurosurgery, Konkuk University Medical Center, 120, Neungdong-ro, Gwangjin-gu, 05029, Seoul, Republic of Korea.
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, 120, Neungdong-ro, Gwangjin-gu, 05029, Seoul, Republic of Korea.
- Department of Neurosurgery, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea.
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Jeon C, Kim M, Lee HS, Kong DS, Park K. Outcomes after Microvascular Decompression for Hemifacial Spasm without Definite Radiological Neurovascular Compression at the Root Exit Zone. Life (Basel) 2023; 13:2064. [PMID: 37895445 PMCID: PMC10608077 DOI: 10.3390/life13102064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/24/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023] Open
Abstract
The purpose of this study was to investigate the outcome of microvascular decompression (MVD) in patients with hemifacial spasm (HFS) who have no definite radiological neurovascular compression (NVC). Sixteen HFS patients without radiological NVC on preoperative MRI underwent MVD surgery. The symptoms were left-sided in fourteen (87.5%) and right-sided in two patients (12.5%). Intraoperatively, the most common vessel compressing the facial nerve was the AICA (8, 44.4%), followed by arterioles (5, 27.8%), veins (4, 22.2%), and the PICA (1, 5.6%). The most common compression site was the cisternal portion (13, 76.5%) of the facial nerve, followed by the REZ (4, 23.5%). One patient (6.3%) was found to have multiple NVC sites. Arachnoid type (7, 50%) was the most common compressive pattern, followed by perforator type (4, 28.6%), sandwich type (2, 14.3%), and loop type (1, 7.1%). A pure venous compression was seen in two patients, while a combined venous-arterial "sandwich" compression was detected in two patients. Symptom improvement was observed in all of the patients. Only one patient experienced recurrence after improvement. Based on our experience, MVD surgery can be effective for primary HFS patients with no definite radiological NVC. MVD can be considered if the patient shows typical HFS features, although NVC is not evident on MRI.
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Affiliation(s)
- Chiman Jeon
- Department of Neurosurgery, Korea University Ansan Hospital, Ansan 15355, Republic of Korea;
| | - Minsoo Kim
- Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, Republic of Korea;
| | - Hyun-Seok Lee
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea;
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea;
- Department of Neurosurgery, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
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Lee HS, Park K. Penetrating Offenders in Hemifacial Spasm: Surgical Tactics and Prognosis. Life (Basel) 2023; 13:2021. [PMID: 37895403 PMCID: PMC10608199 DOI: 10.3390/life13102021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/22/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: In cases of hemifacial spasm (HFS), there are various patterns related to the vascular compression of the facial nerve, including a very rare form that is seen when the offending vessel penetrates the facial nerve. However, there have been few reports in the literature regarding the associated surgical techniques and postoperative prognosis. (2) Methods: A retrospective review was conducted of 4755 patients who underwent microvascular decompression (MVD) surgery from April 1997 to June 2023. In total, 8 out of the 4755 patients (0.2%) exhibited a penetrating offending vessel; the medical and surgical records of these 8 patients were then analyzed. Surgery was then attempted to maximally decompress the penetrating offender. (3) Results: Seven out of the eight patients (87.5%) were spasm-free immediately after surgery, and one had only 10% residual spasm compared to their preoperative condition. That patient was also spasm-free one year later. Postoperative facial palsy occurred in one patient (12.5%) who was assessed as grade II in the House-Brackmann grading system. In another patient, the resection of a small facial nerve bundle did not result in facial palsy. There were no cases of hearing loss or other complications. (4) Conclusions: Decompressing the penetrating offender did not increase the incidence of facial palsy, and the prognosis for hemifacial spasms was good. Therefore, when a penetrating pattern was encountered during MVD surgery, decompression between the penetrating offender and the facial nerve may offer good results.
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Affiliation(s)
- Hyun-Seok Lee
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea;
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea;
- Department of Neurosurgery, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
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Jeon C, Jung NY, Kim M, Park K. Intraoperative Monitoring of the Facial Nerve during Microvascular Decompression for Hemifacial Spasm. Life (Basel) 2023; 13:1616. [PMID: 37511991 PMCID: PMC10381659 DOI: 10.3390/life13071616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 07/30/2023] Open
Abstract
This review article discusses the clinical significance of intraoperative neurophysiological monitoring (IONM), provides recommendations for monitoring protocols, and considers the interpretation of results in microvascular decompression (MVD) for hemifacial spasm (HFS). The lateral spread response (LSR) is an important monitoring parameter during MVD. It helps to identify the responsible blood vessel and confirms its thorough decompression from the facial nerve. The disappearance of the LSR during surgery is associated with favorable clinical outcomes. Standard and revised monitoring protocols and the confirmation of LSR persistence and disappearance are also discussed. The blink reflex and other facial nerve monitoring modalities, such as free-running electromyography, facial motor evoked potentials, F-waves, and the Z-L response, are further considered.
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Affiliation(s)
- Chiman Jeon
- Department of Neurosurgery, Korea University Ansan Hospital, Ansan 15355, Republic of Korea
| | - Na Young Jung
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Republic of Korea
| | - Minsoo Kim
- Department of Neurosurgery, Gangneung Asan Hospital, Gangneung 25440, Republic of Korea
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea
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Factors Related to Hemifacial Spasm Recurrence in Patients Undergoing Microvascular Decompression—A Systematic Review and Meta-Analysis. Brain Sci 2022; 12:brainsci12050583. [PMID: 35624968 PMCID: PMC9139130 DOI: 10.3390/brainsci12050583] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 12/10/2022] Open
Abstract
There is a lack of knowledge about the factors associated with the recurrence of hemifacial spam (HFS) following an initially successful microvascular decompression (MVD) surgery. The aim of the present study was to systematically review the pertinent literature and carry out a meta-analysis of factors linked to HFS recurrence in patients undergoing initially successful MVD treatment. An online literature search was launched on the PubMed/Medline and Scopus databases. The following data were collected: sex, age at surgery, affected side, reported improvement after surgery, presence of post-operatory facial weakness, symptom duration, offender vessels, and data obtained from intraoperative neurophysiological monitoring. Upon full-text review, eight articles were included, studying 1105 patients, of which 64 (5.7%) reported recurrence after MVD surgery for hemifacial spasm. There was a statistically significant increased incidence of HFS recurrence in patients with the persistence of lateral spread response (LSR after surgery (OR 9.44 (95% CI 1.69–52.58) p 0.01), while those patients experiencing a shorter disease duration before going to surgery were significantly less prone to experiencing disease recurrence (OR 0.11 (95% CI 0.03–0.46) p 0.002). The remaining examined factors did not result as significantly associated with the risk of recurrence. The funnel plots were largely symmetrical for each variable studied. Taken together, the results of our meta-analysis seem to suggest that short-term symptom duration is a protective factor against HFS recurrence after MVD surgery, while LSR persistence is a negative prognostic factor. Well-designed randomized controlled clinical trials with a long follow-up are expected to further explore therapeutic alternatives for HFS recurrence.
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Zhao ZJ, Zheng RZ, Wang XJ, Li TQ, Dong XH, Zhao CY, Li XY. Integrating Lipidomics and Transcriptomics Reveals the Crosstalk Between Oxidative Stress and Neuroinflammation in Central Nervous System Demyelination. Front Aging Neurosci 2022; 14:870957. [PMID: 35547618 PMCID: PMC9083465 DOI: 10.3389/fnagi.2022.870957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/01/2022] [Indexed: 11/23/2022] Open
Abstract
Multiple sclerosis (MS) is an incurable and progressive neurodegenerative disease that affects more than 2.5 million people worldwide and brings tremendous economic pressures to society. However, the pathophysiology of MS is still not fully elucidated, and there is no effective treatment. Demyelination is thought to be the primary pathophysiological alteration in MS, and our previous study found abnormal lipid metabolism in the demyelinated corpus callosum. Growing evidence indicates that central nervous system (CNS) demyelinating diseases never result from one independent factor, and the simultaneous participation of abnormal lipid metabolism, oxidative stress, and neuroinflammation could potentiate each other in the pathogenesis of MS. Therefore, a single omics analysis cannot provide a full description of any neurodegenerative disease. It has been demonstrated that oxidative stress and neuroinflammation are two reciprocal causative reasons for the progression of MS disease. However, the potential crosstalk between oxidative stress and neuroinflammation remains elusive so far. With an integrated analysis of targeted lipidomics and transcriptomics, our research presents the potential interaction between abnormalities of lipid metabolism, mitochondrial dysfunction, oxidative stress, and neuroinflammation in CNS demyelinating diseases. The findings of this paper may be used to identify possible targets for the therapy of CNS demyelinating diseases.
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Affiliation(s)
- Zhi-jie Zhao
- Department of Neurosurgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui-zhe Zheng
- Department of Neurosurgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiao-jing Wang
- Department of Neurosurgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tong-qi Li
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-hua Dong
- Department of Neurosurgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chang-yi Zhao
- Department of Neurosurgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Chang-yi Zhao,
| | - Xin-yuan Li
- Department of Neurosurgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Xin-yuan Li,
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Kim M, Cho KR, Park SK, Jeon C, Park K. Prognostic Value of Lateral Spread Response Recorded 1 Month After Microvascular Decompression for the Treatment of Hemifacial Spasm. Neurosurgery 2022; 91:159-166. [PMID: 35383685 DOI: 10.1227/neu.0000000000001960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/30/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The predictive value of intraoperative disappearance of the lateral spread response (LSR) during microvascular decompression surgery for hemifacial spasm treatment is unclear. Studies evaluating the clinical implications of the LSR recorded during the postoperative period are also limited. OBJECTIVE To analyze the LSR 1 month postoperatively and to evaluate its prognostic value until 1 year postsurgery. METHODS In total, 883 patients who underwent microvascular decompression between 2016 and 2018 were included. LSR was recorded preoperatively, intraoperatively before decompression, intraoperatively after decompression, and 1 month postoperatively. The outcomes were evaluated at 1 week, 1 month, and 1 year postoperatively. RESULTS The presence of preoperative and intraoperative LSR after decompression did not predict the postoperative outcome at 1 year. In 246 patients (27.9%), the postoperative LSR at 1 month was not identical to that recorded intraoperatively after decompression. Postoperative LSR at 1 month was associated with a worse outcome at 1 month (P < .0001) and 1 year (P = .0002) postoperatively. Patients with residual symptoms and a LSR 1 month postoperatively were more likely to show residual symptoms 1 year postoperatively, with a positive predictive value of 50.7%. CONCLUSION Unlike the intraoperative LSR, the LSR at 1 month postoperatively showed prognostic value in predicting 1-year postoperative outcomes and was useful for identifying patients with a high risk of unfavorable outcomes. Thus, confirming the presence of postoperative LSR is necessary.
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Affiliation(s)
- Minsoo Kim
- Department of Neurosurgery, Gangneung Asan Hospital, Gangneung, Republic of Korea.,Department of Neurosurgery, Samsung Medical Center, Seoul, Republic of Korea
| | - Kyung Rae Cho
- Department of Neurosurgery, Samsung Medical Center, Seoul, Republic of Korea.,Department of Neurosurgery, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Sang-Ku Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Chiman Jeon
- Department of Neurosurgery, Samsung Medical Center, Seoul, Republic of Korea
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul, Republic of Korea.,Department of Neurosurgery, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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