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Maestrini I, Viganò A, Di Stefano G, Toscano M, Di Piero V. Neurophysiological investigations in a case of primary paroxysmal hemicrania-tic syndrome. Neurol Sci 2024; 45:3917-3921. [PMID: 38523207 DOI: 10.1007/s10072-024-07470-3] [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: 12/20/2023] [Accepted: 03/13/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND The association between paroxysmal hemicrania (PH) and trigeminal neuralgia-the so-called PH-tic syndrome-has rarely been described. However, a correct diagnosis is crucial since both disorders require specific treatments. Little is known about pathophysiological mechanisms, and, to date, there are no electrophysiological studies in patients with PH-tic syndrome. CASE We describe the case of a 52-year-old man with a PH-tic syndrome successfully treated with an association of carbamazepine (1200 mg/day) and indomethacin (150 mg/die). Patient underwent trigeminal reflex testing, including blink and masseter inhibitory reflex, and laser-evoked potential (LEP) recording after supraorbital region stimulation in the affected and unaffected side. Both neurophysiological investigations resulted normal; LEPs failed to detect any latency asymmetry between both sides. CONCLUSIONS Neurophysiological findings demonstrate for the first time the integrity of somatosensory system in a primary PH-tic syndrome case. Central pathophysiological mechanisms and hypothalamic dysregulation may contribute to the development of this rare syndrome.
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Affiliation(s)
- Ilaria Maestrini
- Department of Systems Medicine, University Hospital of Rome "Tor Vergata", Rome, Italy.
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy.
| | - Alessandro Viganò
- Rehabilitation Neurology Unit, I.R.C.C.S. Fondazione Don Carlo Gnocchi, Via Alfonso Capecelatro 66, 20148, Milan, Italy
| | - Giulia Di Stefano
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Massimiliano Toscano
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
- Department of Neurology, Fatebenefratelli Hospital-Gemelli Isola, Rome, Italy
| | - Vittorio Di Piero
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
- University Consortium for Adaptive Disorders and Head Pain (UCADH), Pavia, Italy
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2
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Bologna M, Paparella G, Valls-Solé J, Hallett M, Berardelli A. Neural control of blinking. Clin Neurophysiol 2024; 161:59-68. [PMID: 38447495 DOI: 10.1016/j.clinph.2024.02.023] [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: 10/31/2023] [Revised: 02/01/2024] [Accepted: 02/07/2024] [Indexed: 03/08/2024]
Abstract
Blinking is a motor act characterized by the sequential closing and opening of the eyelids, which is achieved through the reciprocal activation of the orbicularis oculi and levator palpebrae superioris muscles. This stereotyped movement can be triggered reflexively, occur spontaneously, or voluntarily initiated. During each type of blinking, the neural control of the antagonistic interaction between the orbicularis oculi and levator palpebrae superioris muscles is governed by partially overlapping circuits distributed across cortical, subcortical, and brainstem structures. This paper provides a comprehensive overview of the anatomical and physiological foundations underlying the neural control of blinking. We describe the infra-nuclear apparatus, as well as the supra-nuclear control mechanisms, i.e., how cortical, subcortical, and brainstem structures regulate and coordinate the different types of blinking.
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Affiliation(s)
- Matteo Bologna
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy.
| | - Giulia Paparella
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
| | - Josep Valls-Solé
- Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona, Spain
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
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3
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Latorre A, Rocchi L, Paparella G, Manzo N, Bhatia KP, Rothwell JC. Changes in cerebellar output abnormally modulate cortical myoclonus sensorimotor hyperexcitability. Brain 2024; 147:1412-1422. [PMID: 37956080 PMCID: PMC10994547 DOI: 10.1093/brain/awad384] [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: 03/20/2023] [Revised: 10/07/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
Cortical myoclonus is produced by abnormal neuronal discharges within the sensorimotor cortex, as demonstrated by electrophysiology. Our hypothesis is that the loss of cerebellar inhibitory control over the motor cortex, via cerebello-thalamo-cortical connections, could induce the increased sensorimotor cortical excitability that eventually causes cortical myoclonus. To explore this hypothesis, in the present study we applied anodal transcranial direct current stimulation over the cerebellum of patients affected by cortical myoclonus and healthy controls and assessed its effect on sensorimotor cortex excitability. We expected that anodal cerebellar transcranial direct current stimulation would increase the inhibitory cerebellar drive to the motor cortex and therefore reduce the sensorimotor cortex hyperexcitability observed in cortical myoclonus. Ten patients affected by cortical myoclonus of various aetiology and 10 aged-matched healthy control subjects were included in the study. All participants underwent somatosensory evoked potentials, long-latency reflexes and short-interval intracortical inhibition recording at baseline and immediately after 20 min session of cerebellar anodal transcranial direct current stimulation. In patients, myoclonus was recorded by the means of surface EMG before and after the cerebellar stimulation. Anodal cerebellar transcranial direct current stimulation did not change the above variables in healthy controls, while it significantly increased the amplitude of somatosensory evoked potential cortical components, long-latency reflexes and decreased short-interval intracortical inhibition in patients; alongside, a trend towards worsening of the myoclonus after the cerebellar stimulation was observed. Interestingly, when dividing patients in those with and without giant somatosensory evoked potentials, the increment of the somatosensory evoked potential cortical components was observed mainly in those with giant potentials. Our data showed that anodal cerebellar transcranial direct current stimulation facilitates-and does not inhibit-sensorimotor cortex excitability in cortical myoclonus syndromes. This paradoxical response might be due to an abnormal homeostatic plasticity within the sensorimotor cortex, driven by dysfunctional cerebello-thalamo-cortical input to the motor cortex. We suggest that the cerebellum is implicated in the pathophysiology of cortical myoclonus and that these results could open the way to new forms of treatment or treatment targets.
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Affiliation(s)
- Anna Latorre
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari 09042, Italy
| | - Giulia Paparella
- Department of Neurology, IRCCS Neuromed, Pozzilli, IS 86077, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Italy
| | - Nicoletta Manzo
- Department of Neurology, IRCCS San Camillo Hospital, Venice 30126, Italy
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - John C Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
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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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Latorre A, Belvisi D, Rothwell JC, Bhatia KP, Rocchi L. Rethinking the neurophysiological concept of cortical myoclonus. Clin Neurophysiol 2023; 156:125-139. [PMID: 37948946 DOI: 10.1016/j.clinph.2023.10.007] [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: 01/28/2023] [Revised: 09/04/2023] [Accepted: 10/13/2023] [Indexed: 11/12/2023]
Abstract
Cortical myoclonus is thought to result from abnormal electrical discharges arising in the sensorimotor cortex. Given the ease of recording of cortical discharges, electrophysiological features of cortical myoclonus have been better characterized than those of subcortical forms, and electrophysiological criteria for cortical myoclonus have been proposed. These include the presence of giant somatosensory evoked potentials, enhanced long-latency reflexes, electroencephalographic discharges time-locked to individual myoclonic jerks and significant cortico-muscular connectivity. Other features that are assumed to support the cortical origin of myoclonus are short-duration electromyographic bursts, the presence of both positive and negative myoclonus and cranial-caudal progression of the jerks. While these criteria are widely used in clinical practice and research settings, their application can be difficult in practice and, as a result, they are fulfilled only by a minority of patients. In this review we reappraise the evidence that led to the definition of the electrophysiological criteria of cortical myoclonus, highlighting possible methodological incongruencies and misconceptions. We believe that, at present, the diagnostic accuracy of cortical myoclonus can be increased only by combining observations from multiple tests, according to their pathophysiological rationale; nevertheless, larger studies are needed to standardise the methods, to resolve methodological issues, to establish the diagnostic criteria sensitivity and specificity and to develop further methods that might be useful to clarify the pathophysiology of myoclonus.
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Affiliation(s)
- Anna Latorre
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London, London, United Kingdom.
| | - Daniele Belvisi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy
| | - John C Rothwell
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London, London, United Kingdom
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London, London, United Kingdom
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London, London, United Kingdom; Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Guidetti M, Maria Bianchi A, Parazzini M, Maiorana N, Bonato M, Ferrara R, Libelli G, Montemagno K, Ferrucci R, Priori A, Bocci T. Monopolar tDCS might affect brainstem reflexes: A computational and neurophysiological study. Clin Neurophysiol 2023; 155:44-54. [PMID: 37690391 DOI: 10.1016/j.clinph.2023.08.011] [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: 06/06/2023] [Revised: 08/04/2023] [Accepted: 08/12/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To assess whether monopolar multi-electrode transcranial direct current stimulation (tDCS) montages might selectively affect deep brain structures through computational predictions and neurophysiological assessment. METHODS Electric field distribution in deep brain structures (i.e., thalamus and midbrain) were estimated through computational models simulating tDCS with two monopolar and two monopolar multi-electrode montages. Monopolar multi-electrode tDCS was then applied to healthy subject, and effects on pontine and medullary circuitries was evaluated studying changes in blink reflex (BR) and masseter inhibitory reflex (MIR). RESULTS Computational results suggest that tDCS with monopolar multi-electrode montages might induce electric field intensities in deep brain structure comparable to those in grey matter, while neurophysiological results disclosed that BR and MIR were selectively modulated by tDCS only when cathode was placed over the right deltoid. CONCLUSIONS Multi-electrode tDCS (anodes over motor cortices, cathode over right deltoid) could induce significant electric fields in the thalamus and midbrain, and selectively affect brainstem neural circuits. SIGNIFICANCE Multi-electrode tDCS (anodes over motor cortices, cathode over right deltoid) might be further explored to affect brainstem activity, also in the context of non-invasive deep brain stimulation.
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Affiliation(s)
- Matteo Guidetti
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy; Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133 Milan, Italy
| | - Anna Maria Bianchi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133 Milan, Italy
| | - Marta Parazzini
- Institute of Electronics, Computer and Telecommunication Engineering (IEIIT), CNR, 20133 Milan, Italy
| | - Natale Maiorana
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy
| | - Marta Bonato
- Institute of Electronics, Computer and Telecommunication Engineering (IEIIT), CNR, 20133 Milan, Italy
| | - Rosanna Ferrara
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy
| | - Giorgia Libelli
- Neurology Unit, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Kora Montemagno
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy
| | - Roberta Ferrucci
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy; Clinical Neurology Unit, "Azienda Socio-Sanitaria Territoriale Santi Paolo E Carlo", Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy
| | - Alberto Priori
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy; Clinical Neurology Unit, "Azienda Socio-Sanitaria Territoriale Santi Paolo E Carlo", Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy
| | - Tommaso Bocci
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy; Clinical Neurology Unit, "Azienda Socio-Sanitaria Territoriale Santi Paolo E Carlo", Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy.
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Dhar D, Kamble N, Pal PK. Long Latency Reflexes in Clinical Neurology: A Systematic Review. Can J Neurol Sci 2023; 50:751-763. [PMID: 35801267 DOI: 10.1017/cjn.2022.270] [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] [Indexed: 11/05/2022]
Abstract
BACKGROUND Long latency reflexes (LLRs) are impaired in a wide array of clinical conditions. We aimed to illustrate the clinical applications and recent advances of LLR in various neurological disorders from a systematic review of published literature. METHODS We reviewed the literature using appropriately chosen MeSH terms on the database platforms of MEDLINE, Web of Sciences, and Google Scholar for all the articles from 1st January 1975 to 2nd February 2021 using the search terms "long loop reflex", "long latency reflex" and "C-reflex". The included articles were analyzed and reported using synthesis without meta-analysis (SWiM) guidelines. RESULTS Based on our selection criteria, 40 articles were selected for the systematic review. The various diseases included parkinsonian syndromes (11 studies, 217 patients), Huntington's disease (10 studies, 209 patients), myoclonus of varied etiologies (13 studies, 127 patients) including progressive myoclonic epilepsy (5 studies, 63 patients) and multiple sclerosis (6 studies, 200 patients). Patients with parkinsonian syndromes showed large amplitude LLR II response. Enlarged LLR II was also found in myoclonus of various etiologies. LLR II response was delayed or absent in Huntington's disease. Delayed LLR II response was present in multiple sclerosis. Among the other diseases, LLR response varied according to the location of cerebellar lesions while the results were equivocal in patients with essential tremor. CONCLUSIONS Abnormal LLR is observed in many neurological disorders. However, larger systematic studies are required in many neurological disorders in order to establish its role in diagnosis and management.
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Affiliation(s)
- Debjyoti Dhar
- Department of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Hosur Road, Bangalore 560029, Karnataka, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Hosur Road, Bangalore 560029, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Hosur Road, Bangalore 560029, Karnataka, India
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Effects of sagittal split osteotomy on brainstem reflexes. J Orofac Orthop 2023; 84:100-109. [PMID: 34570255 DOI: 10.1007/s00056-021-00350-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This prospective study was designed to assess whether patients with skeletal deformities show characteristic masseter inhibitory reflex (MIR) and blink reflex (BR) patterns. A secondary aim was to investigate whether these reflexes change following bilateral sagittal split osteotomy (BSSO). MATERIALS AND METHODS Fourteen consecutive patients who underwent single-jaw BSSO and 14 class I subjects who constituted the control group were enrolled into the study. MIR and BR, obtained by the stimulation of supraorbital (SBR) and mental nerves (MBR), were electrophysiologically recorded. Sensory impairment in the mental nerve distribution was clinically tested. Three evaluation periods were specified as immediately before (T0), 1 month (T1) and 6 months (T2) after surgery. RESULTS MIR early silent period duration was significantly shorter in the patients at T0 (p < 0.001). Sensory deficits developed on 23 sides after BSSO, of which, 17 recovered after 6 months. At T1, MBR was inelicitable bilaterally in 3 patients and unilaterally in 2 patients. These responses were still unrecordable bilaterally in 1 patient, and unilaterally in 4 patients at T2. MIR were unrecordable on 18 sides at T1 and recovered on 11 sides at T2. There were no parallels between the clinical sensory deficits and the abnormal results of the reflexes. CONCLUSIONS Shorter MIR in patients with dentofacial abnormalities may be a reflection of an adapted trigeminal reflex mechanism. Although MBR and MIR abnormalities do not develop parallel to the clinical sensory deficits, their course might provide insights into the disturbed trigeminal reflex pathways.
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Ito E, Sugita R, Saito R. Eyelid myokymia caused by a trigeminal schwannoma as determined by the trigeminal-evoked blink reflex. Clin Case Rep 2023; 11:e7086. [PMID: 36937635 PMCID: PMC10014513 DOI: 10.1002/ccr3.7086] [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: 01/17/2023] [Revised: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 03/17/2023] Open
Abstract
A 57-year-old man had trigeminal schwannoma in Meckel's cave with eyelid myokymia only. The evaluation of the trigeminal-evoked blink reflex was useful for confirming eyelid myokymia and contributed to surgical decision-making. In patients with persistent eyelid myokymia, neurophysiological and imaging evaluations may be useful for determining the underlying pathophysiology.
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Affiliation(s)
- Eiji Ito
- Department of NeurosurgeryNagoya University Graduate School of MedicineNagoyaJapan
| | - Ryotaro Sugita
- Department of NeurosurgeryGifu Prefectural Tajimi HospitalTajimiJapan
| | - Ryuta Saito
- Department of NeurosurgeryNagoya University Graduate School of MedicineNagoyaJapan
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Cosentino G, Maiorano E, Todisco M, Prunetti P, Antoniazzi E, Tammam G, Quartesan I, Lettieri S, De Icco R, Corsico AG, Benazzo M, Pisani A, Tassorelli C, Alfonsi E. Electrophysiological evidence of subclinical trigeminal dysfunction in patients with COVID-19 and smell impairment: A pilot study. Front Neurol 2022; 13:981888. [PMID: 36313508 PMCID: PMC9615421 DOI: 10.3389/fneur.2022.981888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background Smell and taste disturbances are among the most frequent neurological symptoms in patients with COVID-19. A concomitant impairment of the trigeminal nerve has been suggested in subjects with olfactory dysfunction, although it has not been confirmed with objective measurement techniques. In this study, we explored the trigeminal function and its correlations with clinical features in COVID-19 patients with impaired smell perception using electrophysiological testing. Methods We enrolled 16 consecutive patients with mild COVID-19 and smell impairment and 14 healthy controls (HCs). Olfactory and gustatory symptoms were assessed with self-reported questionnaires. Electrophysiological evaluation of the masseter inhibitory reflex (MIR) and blink reflex (BR) was carried out to test the trigeminal function and its connections within the brainstem. Results Masseter inhibitory reflex (MIR) analysis revealed higher latency of ipsilateral and contralateral early silent period in patients when compared with HCs. No significant differences between groups were detected as regards the duration of the early and late silent period. However, several patients showed a prolonged duration of the early silent period. BR evaluation disclosed only an increased amplitude of early components in patients. Conclusions Patients with COVID-19 and smell impairment show a subclinical trigeminal nerve impairment. Trigeminal alterations mainly involve the oligosynaptic pathway, as a result of either direct viral damage or secondary neuroinflammation of the peripheral trigeminal fibers, whereas the polysynaptic ponto-medullary circuits seem to be spared. The prolonged duration of the early silent period and the increased amplitude of early BR response might reflect a compensatory upregulation of the trigeminal function as a consequence of the olfactory dysfunction.
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Affiliation(s)
- Giuseppe Cosentino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- *Correspondence: Giuseppe Cosentino
| | - Eugenia Maiorano
- Department of Otolaryngology–Head and Neck Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Massimiliano Todisco
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Paolo Prunetti
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Elisa Antoniazzi
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Giulia Tammam
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Ilaria Quartesan
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Sara Lettieri
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Roberto De Icco
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Angelo Guido Corsico
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Pneumology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Marco Benazzo
- Department of Otolaryngology–Head and Neck Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Antonio Pisani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Movement Disorders Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Enrico Alfonsi
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Pavia, Italy
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11
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Leone C, Di Stefano G, Di Pietro G, Bloms-Funke P, Boesl I, Caspani O, Chapman SC, Finnerup NB, Garcia-Larrea L, Li T, Goetz M, Mouraux A, Pelz B, Pogatzki-Zahn E, Schilder A, Schnetter E, Schubart K, Tracey I, Troconiz IF, Van Niel H, Hernandez JMV, Vincent K, Vollert J, Wanigasekera V, Wittayer M, Phillips KG, Truini A, Treede RD. IMI2-PainCare-BioPain-RCT2 protocol: a randomized, double-blind, placebo-controlled, crossover, multicenter trial in healthy subjects to investigate the effects of lacosamide, pregabalin, and tapentadol on biomarkers of pain processing observed by non-invasive neurophysiological measurements of human spinal cord and brainstem activity. Trials 2022; 23:739. [PMID: 36064434 PMCID: PMC9442941 DOI: 10.1186/s13063-022-06431-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background IMI2-PainCare-BioPain-RCT2 is one of four similarly designed clinical studies aiming at profiling a set of functional biomarkers of drug effects on specific compartments of the nociceptive system that could serve to accelerate the future development of analgesics. IMI2-PainCare-BioPain-RCT2 will focus on human spinal cord and brainstem activity using biomarkers derived from non-invasive neurophysiological measurements. Methods This is a multisite, single-dose, double-blind, randomized, placebo-controlled, 4-period, 4-way crossover, pharmacodynamic (PD) and pharmacokinetic (PK) study in healthy subjects. Neurophysiological biomarkers of spinal and brainstem activity (the RIII flexion reflex, the N13 component of somatosensory evoked potentials (SEP) and the R2 component of the blink reflex) will be recorded before and at three distinct time points after administration of three medications known to act on the nociceptive system (lacosamide, pregabalin, tapentadol), and placebo, given as a single oral dose in separate study periods. Medication effects on neurophysiological measures will be assessed in a clinically relevant hyperalgesic condition (high-frequency electrical stimulation of the skin), and in a non-sensitized normal condition. Patient-reported outcome measures (pain ratings and predictive psychological traits) will also be collected; and blood samples will be taken for pharmacokinetic modelling. A sequentially rejective multiple testing approach will be used with overall alpha error of the primary analysis split between the two primary endpoints, namely the percentage amplitude changes of the RIII area and N13 amplitude under tapentadol. Remaining treatment arm effects on RIII, N13 and R2 recovery cycle are key secondary confirmatory analyses. Complex statistical analyses and PK-PD modelling are exploratory. Discussion The RIII component of the flexion reflex is a pure nociceptive spinal reflex widely used for investigating pain processing at the spinal level. It is sensitive to different experimental pain models and to the antinociceptive activity of drugs. The N13 is mediated by large myelinated non-nociceptive fibers and reflects segmental postsynaptic response of wide dynamic range dorsal horn neurons at the level of cervical spinal cord, and it could be therefore sensitive to the action of drugs specifically targeting the dorsal horn. The R2 reflex is mediated by large myelinated non-nociceptive fibers, its circuit consists of a polysynaptic chain lying in the reticular formation of the pons and medulla. The recovery cycle of R2 is widely used for assessing brainstem excitability. For these reasons, IMI2-PainCare-BioPain-RCT2 hypothesizes that spinal and brainstem neurophysiological measures can serve as biomarkers of target engagement of analgesic drugs for future Phase 1 clinical trials. Phase 2 and 3 clinical trials could also benefit from these tools for patient stratification. Trial registration This trial was registered on 02 February 2019 in EudraCT (2019-000755-14).
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Affiliation(s)
- Caterina Leone
- Department of Human Neuroscience, Sapienza University, Rome, Italy.
| | | | | | - Petra Bloms-Funke
- Translational Science & Intelligence, Grünenthal GmbH, Aachen, Germany
| | - Irmgard Boesl
- Clinical Science Development, Grünenthal GmbH, Aachen, Germany
| | - Ombretta Caspani
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sonya C Chapman
- Neuroscience Next Generation Therapeutics, Eli Lilly and Company, Lilly Innovation Center, Cambridge, MA, USA.,Eli Lilly and Company, Arlington Square, Bracknell, UK
| | - Nanna Brix Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Luis Garcia-Larrea
- Lyon Neurosciences Center Research Unit Inserm U 1028, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France
| | - Tom Li
- Teva Pharmaceutical Industries Ltd., Petah Tikva, Israel
| | | | - André Mouraux
- Institute of Neuroscience (IoNS), UCLouvain, Brussels, Belgium
| | | | - Esther Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Andreas Schilder
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Erik Schnetter
- University Computing Centre, University of Heidelberg, Heidelberg, Germany
| | | | - Irene Tracey
- Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Inaki F Troconiz
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain
| | - Hans Van Niel
- Mature Products Development, Grünenthal GmbH, Aachen, Germany
| | - Jose Miguel Vela Hernandez
- Welab Barcelona, Barcelona, Spain.,Drug Discovery & Preclinical Development, ESTEVE Pharmaceuticals, Barcelona, Spain
| | - Katy Vincent
- Nuffield Department of Women's and Reproductive Health (NDWRH), University of Oxford, Oxford, UK
| | - Jan Vollert
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany.,Pain Research, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Vishvarani Wanigasekera
- Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Matthias Wittayer
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Keith G Phillips
- Neuroscience Next Generation Therapeutics, Eli Lilly and Company, Lilly Innovation Center, Cambridge, MA, USA.,Eli Lilly and Company, Arlington Square, Bracknell, UK
| | - Andrea Truini
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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12
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De Stefano G, Leone C, Di Pietro G, Esposito N, Falco P, Galosi E, Litewczuk D, Mollica C, Truini A, Di Stefano G. Unravelling the role of unmyelinated nerve fibres in trigeminal neuralgia with concomitant continuous pain. Clin Neurophysiol 2022; 142:52-58. [DOI: 10.1016/j.clinph.2022.07.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/13/2022] [Accepted: 07/22/2022] [Indexed: 11/03/2022]
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13
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Hanada K, Yokoi K, Kashida N, Shimomura R, Murata D, Hirayama K. Midlateral medullary infarction presenting with isolated thermoanaesthesia: a case report. BMC Neurol 2022; 22:268. [PMID: 35854223 PMCID: PMC9295273 DOI: 10.1186/s12883-022-02796-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 07/13/2022] [Indexed: 11/21/2022] Open
Abstract
Background A small lateral medullary lesion could produce isolated impairment of temperature sensation without concomitant impaired pain sensation. However, only one such case has ever been reported, and there are no reports on subjective symptoms and detailed somatosensory testing. Case presentation Herein, we report the case of a 53-year-old female patient presenting with impaired temperature sensation on the left half of her body, from the neck down, following a small infarction of the right midlateral medulla. The chronological changes in the patient's introspection regarding impairment of thermoception and the results of detailed somatosensory tests, including thermal sense, are shown in this report. Conclusions Thorough somatosensory tests, personal descriptions of symptoms, and electrophysiological quantification of similar cases are needed to improve our understanding of the neurological separation of the sensations of pain and temperature at the medullary level.
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Affiliation(s)
- Keisuke Hanada
- Department of Rehabilitation, Suishokai Murata Hospital, Osaka City, Japan. .,Department of Rehabilitation, Kinsyukai Hanwa Memorial Hospital, 3-5-8, Minami-sumiyoshi, Sumiyoshi ward, Osaka, 558-0011, Japan. .,Department of Occupational Therapy, Graduate School of Rehabilitation Science, Osaka Metropolitan University, Habikino City, Osaka, Japan.
| | - Kayoko Yokoi
- Department of Occupational Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata City, Japan
| | - Natsuko Kashida
- Department of Rehabilitation, Suishokai Murata Hospital, Osaka City, Japan
| | - Ryota Shimomura
- Department of Rehabilitation, Suishokai Murata Hospital, Osaka City, Japan
| | - Daiki Murata
- Department of Neurosurgery, Suishokai Murata Hospital, Osaka City, Japan
| | - Kazumi Hirayama
- Department of Occupational Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata City, Japan
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14
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Rota E, Aguggia M, Immovilli P, Morelli N, Renosio D, Barbanera A. Change in the second exteroceptive suppression period of the temporalis muscle during erenumab treatment. Naunyn Schmiedebergs Arch Pharmacol 2022; 395:607-611. [PMID: 35179620 DOI: 10.1007/s00210-022-02216-4] [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: 09/21/2021] [Accepted: 01/28/2022] [Indexed: 11/25/2022]
Abstract
Comparative studies on the second exteroceptive suppression period (ES2) of the masseter or temporalis muscle in migraineurs and controls have provided conflicting results. As the interneurons responsible for ES2 are probably close to the trigeminal nucleus caudalis and receive afferents also from the anti-nociceptive system, the study of ES2 could provide information on neural circuits involved in migraine pathophysiology. The aim of this observational, pilot study was to assess whether erenumab treatment may affect the exteroceptive suppression reflex of the temporalis muscle activity in migraineurs. The exteroceptive suppression reflex of the temporalis muscle activity was previously studied in a small case series of three chronic female migraineurs and after 4 months of beneficial erenumab treatment, administered according to current clinical indications. There was a statistically significant decrease in ES2 latency (p-value 0.039) and duration (p-value 0.030) after treatment. The change observed in the temporalis ES2 during erenumab treatment indicates that ES2 may play some kind of role as a neurophysiological marker and that this monoclonal antibody can modulate the brainstem circuits involved in migraine pathophysiology, at least indirectly. Further studies are required to confirm this intriguing hypothesis.
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Affiliation(s)
- Eugenia Rota
- Neurology Unit, San Giacomo Hospital, ASLAL, Via E. Raggio 12, 15067, Novi Ligure, AL, Italy.
| | - Marco Aguggia
- Neurology Unit, Cardinal Massaia Hospital, ASLAT, Asti, Italy
| | - Paolo Immovilli
- Neurology Unit, Guglielmo da Saliceto Hospital, AUSL, Piacenza, PC, Italy
| | - Nicola Morelli
- Neurology Unit, Guglielmo da Saliceto Hospital, AUSL, Piacenza, PC, Italy
| | - Davide Renosio
- Neurology Unit, San Giacomo Hospital, ASLAL, Via E. Raggio 12, 15067, Novi Ligure, AL, Italy
| | - Andrea Barbanera
- Neurosurgery Unit, San Biagio e Arrigo Hospital, Alessandria, Italy
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15
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Fabbrini A, Guerra A, Giangrosso M, Manzo N, Leodori G, Pasqualetti P, Conte A, Di Lazzaro V, Berardelli A. Transcranial alternating current stimulation modulates cortical processing of somatosensory information in a frequency- and time-specific manner. Neuroimage 2022; 254:119119. [PMID: 35321858 DOI: 10.1016/j.neuroimage.2022.119119] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/16/2022] [Accepted: 03/19/2022] [Indexed: 10/18/2022] Open
Abstract
Neural oscillations can be modulated by non-invasive brain stimulation techniques, including transcranial alternating current stimulation (tACS). However, direct evidence of tACS effects at the cortical level in humans is still limited. In a tACS-electroencephalography co-registration setup, we investigated the ability of tACS to modulate cortical somatosensory information processing as assessed by somatosensory-evoked potentials (SEPs). To better elucidate the neural substrates of possible tACS effects we also recorded peripheral and spinal SEPs components, high-frequency oscillations (HFOs), and long-latency reflexes (LLRs). Finally, we studied whether changes were limited to the stimulation period or persisted thereafter. SEPs, HFOs, and LLRs were recorded during tACS applied at individual mu and beta frequencies and at the theta frequency over the primary somatosensory cortex (S1). Sham-tACS was used as a control condition. In a separate experiment, we assessed the time course of mu-tACS effects by recording SEPs before (T0), during (T1), and 1 min (T2) and 10 min (T3) after stimulation. Mu-tACS increased the amplitude of the N20 component of SEPs compared to both sham and theta-tACS. No differences were found between sham, beta-, and theta-tACS conditions. Also, peripheral and spinal SEPs, P25, HFOs, and LLRs did not change during tACS. Finally, mu-tACS-induced modulation of N20 amplitude specifically occurred during stimulation (T1) and vanished afterwards (i.e., at T2 and T3). Our findings suggest that TACS applied at the individual mu frequency is able to modulate early somatosensory information processing at the S1 level and the effect is limited to the stimulation period.
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Affiliation(s)
- Andrea Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome, 00185, Italy
| | - Andrea Guerra
- IRCCS Neuromed, Via Atinense 18, Pozzilli, IS 86077, Italy
| | - Margherita Giangrosso
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome, 00185, Italy
| | - Nicoletta Manzo
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome, 00185, Italy; IRCCS San Camillo Hospital, Via Alberoni 70, Venice 30126, Italy
| | - Giorgio Leodori
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome, 00185, Italy; IRCCS Neuromed, Via Atinense 18, Pozzilli, IS 86077, Italy
| | - Patrizio Pasqualetti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Viale dell'Università 30, Rome 00185, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome, 00185, Italy; IRCCS Neuromed, Via Atinense 18, Pozzilli, IS 86077, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, Via Álvaro Del Portillo 21, Rome 00128, Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome, 00185, Italy; IRCCS Neuromed, Via Atinense 18, Pozzilli, IS 86077, Italy.
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16
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Rothwell J, Antal A, Burke D, Carlsen A, Georgiev D, Jahanshahi M, Sternad D, Valls-Solé J, Ziemann U. Central nervous system physiology. Clin Neurophysiol 2021; 132:3043-3083. [PMID: 34717225 PMCID: PMC8863401 DOI: 10.1016/j.clinph.2021.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/13/2021] [Accepted: 09/20/2021] [Indexed: 12/15/2022]
Abstract
This is the second chapter of the series on the use of clinical neurophysiology for the study of movement disorders. It focusses on methods that can be used to probe neural circuits in brain and spinal cord. These include use of spinal and supraspinal reflexes to probe the integrity of transmission in specific pathways; transcranial methods of brain stimulation such as transcranial magnetic stimulation and transcranial direct current stimulation, which activate or modulate (respectively) the activity of populations of central neurones; EEG methods, both in conjunction with brain stimulation or with behavioural measures that record the activity of populations of central neurones; and pure behavioural measures that allow us to build conceptual models of motor control. The methods are discussed mainly in relation to work on healthy individuals. Later chapters will focus specifically on changes caused by pathology.
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Affiliation(s)
- John Rothwell
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, London, UK,Corresponding author at: Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK, (J. Rothwell)
| | - Andrea Antal
- Department of Neurology, University Medical Center Göttingen, Germany
| | - David Burke
- Department of Neurology, Royal Prince Alfred Hospital, University of Sydney, Sydney 2050, Australia
| | - Antony Carlsen
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Dejan Georgiev
- Department of Neurology, University Medical Centre Ljubljana, Slovenia
| | - Marjan Jahanshahi
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, London, UK
| | - Dagmar Sternad
- Departments of Biology, Electrical & Computer Engineering, and Physics, Northeastern University, Boston, MA 02115, USA
| | - Josep Valls-Solé
- Institut d’Investigació Biomèdica August Pi I Sunyer, Villarroel, 170, Barcelona, Spain
| | - Ulf Ziemann
- Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany
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17
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Ruiu E, Valls-Sole J. Excitatory and inhibitory responses to cervical root magnetic stimulation in healthy subjects. Clin Neurophysiol Pract 2021; 6:265-274. [PMID: 34825114 PMCID: PMC8604992 DOI: 10.1016/j.cnp.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/10/2021] [Accepted: 10/09/2021] [Indexed: 12/25/2022] Open
Abstract
We studied excitatory and inhibitory responses to cervical root magnetic stimulation. CRMS elicited direct and reflex responses in hand muscles. CRMS is painless and well tolerated and, therefore, applicable to clinical studies.
Objectives To characterize direct and reflex hand muscle responses to cervical root magnetic stimulation (CRMS) in healthy volunteers during sustained voluntary contraction. Methods In 18 healthy volunteers, we recorded from the first dorsal interosseous (FDI) muscle the responses to CRMS of progressively increasing intensity and level of muscle contraction. The compound muscle action potential (CMAP) and the silent period (SP) were compared to those obtained with plexus, midarm and wrist stimulation. Additionally, in a smaller number of subjects, we obtained the peristimulus time histogram (psth) of single motor unit firing in the FDI, examined the effects of vibration and recorded the modulation of sustained EMG activity in muscles of the lower limbs. Results Increasing CRMS intensity led to larger CMAP with no relevant changes in SP1 or SP2, except for lower amplitude of the burst interrupting the silent period (BISP). Increasing the level of muscle contraction led to reduced CMAP, shorter SP duration and increased BISP amplitude. The psth analysis showed the underlying changes in the motor unit firing frequency that corresponded to the changes seen in the CMAP and the SP with surface recordings. Progressively distal stimulation led to CMAPs of shorter latency and increased amplitude, SPs of longer latency and shorter duration, and a BISP of longer latency. Vibration led to reduction of the SP. CRMS induced SPs in muscles of the lower limb. Conclusions CRMS induces excitatory and inhibitory responses in hand muscles, fitting with the expected behavior of mixed nerve stimulation at very proximal sites. Significance Characterization of the effects of CRMS on hand muscles is of physiological and potentially clinical applicability, as it is a painless and reliable procedure.
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Affiliation(s)
- E Ruiu
- Unit of Clinical Neurology, Department of Clinical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - J Valls-Sole
- IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), Barcelona 08036, Spain
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18
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Spirin NN, Kiselev DV, Karpova MS. [Neuropathic pain syndromes in patients with multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:22-30. [PMID: 34387442 DOI: 10.17116/jnevro202112107222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Among the numerous pain syndromes (PS) of various localizations and types, observed in patients with multiple sclerosis (MS), the greatest attention of researchers is attracted by neuropathic PS. Neuropathic PS are often present already in the early stage of MS, significantly reduce the quality of life, hinder the social adaptation of patients, poorly respond to therapy. Central neuropathic PS, which pathogenesis is closely related with plaques in the central nervous system, are most common in patients with MS. Diagnostics of neuropathic PS in MS is based mainly on typical clinical symptoms; MRI and neurophysiological methods data are of secondary importance. This review focuses on modern concepts of three main neuropathic PS in MS: ongoing extremity pain, trigeminal neuralgia and Lhermitte's sign. Clinical symptoms of neuropathic PS, current ideas about their pathogenetic mechanisms, MRI and neurophysiological techniques data and the existing approaches to conservative therapy and surgical treatment based on randomized trials data are presented.
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Affiliation(s)
- N N Spirin
- Yaroslavl State Medical University, Yaroslavl, Russia
| | - D V Kiselev
- Yaroslavl State Medical University, Yaroslavl, Russia
| | - M S Karpova
- Yaroslavl State Medical University, Yaroslavl, Russia
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19
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Effects of Transcranial Ultrasound Stimulation on Trigeminal Blink Reflex Excitability. Brain Sci 2021; 11:brainsci11050645. [PMID: 34063492 PMCID: PMC8156436 DOI: 10.3390/brainsci11050645] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 01/01/2023] Open
Abstract
Recent evidence indicates that transcranial ultrasound stimulation (TUS) modulates sensorimotor cortex excitability. However, no study has assessed possible TUS effects on the excitability of deeper brain areas, such as the brainstem. In this study, we investigated whether TUS delivered on the substantia nigra, superior colliculus, and nucleus raphe magnus modulates the excitability of trigeminal blink reflex, a reliable neurophysiological technique to assess brainstem functions in humans. The recovery cycle of the trigeminal blink reflex (interstimulus intervals of 250 and 500 ms) was tested before (T0), and 3 (T1) and 30 min (T2) after TUS. The effects of substantia nigra-TUS, superior colliculus-TUS, nucleus raphe magnus-TUS and sham-TUS were assessed in separate and randomized sessions. In the superior colliculus-TUS session, the conditioned R2 area increased at T1 compared with T0, while T2 and T0 values did not differ. Results were independent of the interstimulus intervals tested and were not related to trigeminal blink reflex baseline (T0) excitability. Conversely, the conditioned R2 area was comparable at T0, T1, and T2 in the nucleus raphe magnus-TUS and substantia nigra-TUS sessions. Our findings demonstrate that the excitability of brainstem circuits, as evaluated by testing the recovery cycle of the trigeminal blink reflex, can be increased by TUS. This result may reflect the modulation of inhibitory interneurons within the superior colliculus.
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Çalıkuşu F, Gündüz A, Kızıltan M. The effect of vision on top.down modulation of hand blink reflex. NEUROL SCI NEUROPHYS 2021. [DOI: 10.4103/nsn.nsn_77_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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21
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Zhang B, Wang C, Shen C, Wang W. Responses to External Emotions or their Transitions at Central to Peripheral Nervous System Levels: A Methodological Contribution to Mental Health. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2020. [DOI: 10.2174/2666082216666200317143114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Responses to external emotional-stimuli or their transitions might help to
elucidate the scientific background and assist the clinical management of psychiatric problems, but
pure emotional-materials and their utilization at different levels of neurophysiological processing
are few.
Objective:
We aimed to describe the responses at central and peripheral levels in healthy volunteers
and psychiatric patients when facing external emotions and their transitions.
Methods:
Using pictures and sounds with pure emotions of Disgust, Erotica, Fear, Happiness, Neutral,
and Sadness or their transitions as stimuli, we have developed a series of non-invasive techniques,
i.e., the event-related potentials, functional magnetic resonance imaging, excitatory and
inhibitory brainstem reflexes, and polygraph, to assess different levels of neurophysiological responses
in different populations.
Results:
Sample outcomes on various conditions were specific and distinguishable at cortical to
peripheral levels in bipolar I and II disorder patients compared to healthy volunteers.
Conclusions:
Methodologically, designs with these pure emotions and their transitions are applicable,
and results per se are specifically interpretable in patients with emotion-related problems.
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Affiliation(s)
- Bingren Zhang
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Chu Wang
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Chanchan Shen
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Wei Wang
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
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22
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Di Stefano G, De Stefano G, Leone C, Cruccu G, Tardioli S, Cartocci G, Fiorelli M, Truini A, Caramia F. Concomitant continuous pain in patients with trigeminal neuralgia is associated with trigeminal nerve root atrophy. Cephalalgia 2020; 40:1502-1510. [DOI: 10.1177/0333102420949206] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Introduction Trigeminal neuralgia is an exemplary neuropathic pain condition characterized by paroxysmal electric-shock-like pain. However, up to 50% of patients also experiences concomitant continuous pain. In this neuroimaging study, we aimed to identify the specific anatomical features of trigeminal nerve root in patients with concomitant continuous pain. Methods We enrolled 73 patients with a definitive diagnosis of classical and idiopathic trigeminal neuralgia and 40 healthy participants. The diagnosis of trigeminal neuralgia was independently confirmed by two clinicians. Patients were grouped as patients with purely paroxysmal pain (45 patients) and patients also with concomitant continuous pain (28 patients). All participants underwent a structured clinical examination and a 3T MRI with sequences dedicated to the anatomical study of the trigeminal nerve root, including volumetric study. Images analysis was independently performed by two investigators, blinded to any clinical data. Results In most patients with concomitant continuous pain, this type of pain, described as burning, throbbing or aching, manifested at the disease onset. Demographic and clinical variables did not differ between the two groups of patients; the frequency of neurovascular compression and nerve dislocation were similar. Conversely, trigeminal nerve root atrophy was more severe in patients with concomitant continuous pain than in those with purely paroxysmal pain ( p = 0.006). Conclusions Our clinical and neuroimaging study found that in patients with trigeminal neuralgia, concomitant continuous pain was associated with trigeminal nerve root atrophy, therefore suggesting that this type of pain is likely related to axonal loss and abnormal activity in denervated trigeminal second-order neurons.
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Affiliation(s)
| | | | - Caterina Leone
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Giorgio Cruccu
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Stefano Tardioli
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Gaia Cartocci
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Marco Fiorelli
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Andrea Truini
- Department of Human Neuroscience, Sapienza University, Rome, Italy
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Does the network model fits neurophysiological abnormalities in blepharospasm? Neurol Sci 2020; 41:2067-2079. [DOI: 10.1007/s10072-020-04347-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
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Calabrò RS, Chillura A, Billeri L, Cannavò A, Buda A, Molonia F, Manuli A, Bramanti P, Naro A. Peri-Personal Space Tracing by Hand-Blink Reflex Modulation in Patients with Chronic Disorders of Consciousness. Sci Rep 2020; 10:1712. [PMID: 32015445 PMCID: PMC6997168 DOI: 10.1038/s41598-020-58625-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 01/17/2020] [Indexed: 12/14/2022] Open
Abstract
The assessment of awareness in patients with chronic Disorders of Consciousness (DoC), including Unresponsive Wakefulness Syndrome (UWS) and Minimally Conscious State (MCS), is challenging. The level of awareness impairment may depend on the degree of deterioration of the large-scale cortical-thalamo-cortical networks induced by brain injury. Electrophysiological approaches may shed light on awareness presence in patients with DoC by estimating cortical functions related to the cortical-thalamo-cortical networks including, for example, the cortico-subcortical processes generating motor responses to the perturbation of the peri-personal space (PPS). We measured the amplitude, latency, and duration of the hand-blink reflex (HBR) responses by recording electromyography (EMG) signals from both the orbicularis oculi muscles while electrically stimulating the median nerve at the wrist. Such a BR is thought to be mediated by a neural circuit at the brainstem level. Despite its defensive-response nature, HBR can be modulated by the distance between the stimulated hand and the face. This suggests a functional top-down control of HBR as reflected by HBR features changes (latency, amplitude, and magnitude). We therefore estimated HBR responses in a sample of patients with DoC (8 MCS and 12 UWS, compared to 15 healthy controls -HC) while performing a motor task targeting the PPS. This consisted of passive movements in which the hand of the subject was positioned at different distances from the participant's face. We aimed at demonstrating a residual top-down modulation of HBR properties, which could be useful to differentiate patients with DoC and, potentially, demonstrate awareness preservation. We found a decrease in latency, and an increase in duration and magnitude of HBR responses, which were all inversely related to the hand-to-face distance in HC and patients with MCS, but not in individuals with UWS. Our data suggest that only patients with MCS have preserved, residual, top-down modulation of the processes related to the PPS from higher-order cortical areas to sensory-motor integration network. Although the sample size was relatively small, being thus our data preliminary, HBR assessment seems a rapid, easy, and first-level tool to differentiate patients with MCS from those with UWS. We may also hypothesize that such a HBR modulation suggests awareness preservation.
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Affiliation(s)
| | | | - Luana Billeri
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | | | - Antonio Buda
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | | | | | | | - Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
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Differential Diagnosis of Chronic Neuropathic Orofacial Pain: Role of Clinical Neurophysiology. J Clin Neurophysiol 2020; 36:422-429. [PMID: 31688325 DOI: 10.1097/wnp.0000000000000583] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Orofacial pain syndromes encompass several clinically defined and classified entities. The focus here is on the role of clinical neurophysiologic and psychophysical tests in the diagnosis, differential diagnosis, and pathophysiological mechanisms of definite trigeminal neuropathic pain and other chronic orofacial pain conditions (excluding headache and temporomandibular disorders). The International Classification of Headache Disorders 2018 classifies these facial pain disorders under the heading Painful cranial neuropathies and other facial pains. In addition to unambiguous painful posttraumatic or postherpetic trigeminal neuropathies, burning mouth syndrome, persistent idiopathic facial and dental pain, and trigeminal neuralgia have also been identified with neurophysiologic and quantitative sensory testing to involve the nervous system. Despite normal clinical examination, these all include clusters of patients with evidence for either peripheral or central nervous system pathology compatible with the subclinical end of a continuum of trigeminal neuropathic pain conditions. Useful tests in the diagnostic process include electroneuromyography with specific needle, neurography techniques for the inferior alveolar and infraorbital nerves, brain stem reflex recordings (blink reflex with stimulation of the supraorbital, infraorbital, mental, and lingual nerves; jaw jerk; masseter silent period), evoked potential recordings, and quantitative sensory testing. Habituation of the blink reflex and evoked potential responses to repeated stimuli evaluate top-down inhibition, and navigated transcranial magnetic stimulation allows the mapping of reorganization within the motor cortex in chronic neuropathic pain. With systematic use of neurophysiologic and quantitative sensory testing, many of the current ambiguities in the diagnosis, classification, and understanding of chronic orofacial syndromes can be clarified for clinical practice and future research.
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Tataroğlu C, Deneri E, Tilek N, Çoban A. Long latency reflexes in patients with postural instability and ataxia. NEUROL SCI NEUROPHYS 2020. [DOI: 10.4103/nsn.nsn_44_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Electrophysiologic evaluation of facial nerve functions after oxaliplatin treatment. Cancer Chemother Pharmacol 2019; 84:513-520. [PMID: 30997533 DOI: 10.1007/s00280-019-03841-2] [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: 09/07/2018] [Accepted: 04/12/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE This study analyzes the effect of oxaliplatin treatment on the facial nerve. The facial nerve is the most commonly paralyzed cranial motor nerve because it advances through a long, curved bone canal. Electroneurography and blink reflex are the electrophysiological measurements used for evaluating facial nerve function. Oxaliplatin is a cytotoxic agent used in adjuvant or palliative systemic therapy for colorectal cancer treatment. METHODS This study was performed on 20 individuals who were at least 18 years old at Hacettepe University Ear Nose Throat Department, Audiology and Speech Disorders Unit, and Neurology Division EMG Laboratory as they received oxaliplatin treatment from Hacettepe University Oncology Hospital. Electroneurography and blink-reflex values were recorded and examined. The parameters taken during the second and fourth months were compared for this purpose. RESULTS This study shows that the prolongation of distal latencies of compound muscle action potential is statistically significant, the amplitudes showed no difference. The ENoG results were analyzed, the prolongation of latency measurements between pre-treatment and the fourth month after treatment were statistically significant. The blink-reflex results showed that comparison with the baseline values, the prolongation of latencies in R1 measurements between pre-treatment, the second month, and the fourth month were significant. CONCLUSIONS The facial nerve is affected asymptomatically by oxaliplatin treatment. During oxaliplatin treatment, the evaluation of facial nerve function could be beneficial for patients by improving their quality of life. Electroneurography and blink-reflex tests can be used in the early evaluations of different medicines to determine their neurotoxicity.
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Weise D, Pargac C, Pelz JO, Rumpf JJ, Fricke C, Classen J. Assessing blink reflex circuits by three different afferent routes in Parkinson’s disease. Clin Neurophysiol 2019; 130:582-587. [DOI: 10.1016/j.clinph.2018.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 12/04/2018] [Accepted: 12/16/2018] [Indexed: 10/27/2022]
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Prediction of Minimally Conscious State With Brain Stem Reflexes in Unconscious Patients After Traumatic Brain Injury. J Craniofac Surg 2019; 30:1942-1945. [PMID: 30908437 DOI: 10.1097/scs.0000000000005404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate the predictive power of the brain stem reflexes (BSRs) for minimally conscious state in unconscious patients after traumatic brain injury. MATERIALS AND METHODS A total of 120 patients with duration of unconsciousness were enrolled in this study. BSRs were recorded 14 days after Traumatic brain injury, and classified into 3 grades. Predictors including BSRs, age, sex, Glasgow Coma Scale (GCS), and cause of injury were also analyzed, respectively. The outcome was divided into 2 groups including unconscious group and minimally conscious state (MCS) group. RESULTS Seventy-two of 120 were minimally conscious and 48 of 120 were unconscious at 6 months from the onset of injury. The BSRs outmatched the predictive accuracy of the GCS for outcome (AUROC, 0.853; 95% confidence interval, 0.753-0.953; and AUROC, 0.655; 95% confidence interval, 0.512-0.799, respectively). BSRs grade (P < 0.001) and GCS (P < 0.05) were significantly associated with the outcome. The accuracy of the whole regression model for predicting unconscious and MCS was 91.7% and 79.2%, respectively. CONCLUSION The BSRs grade shows a significantly higher accuracy for prediction of MCS compared with the GCS. BSRs grade is a simple, yet reliable and stratification tool for early decision making.
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Di Stefano G, Maarbjerg S, Truini A. Trigeminal neuralgia secondary to multiple sclerosis: from the clinical picture to the treatment options. J Headache Pain 2019; 20:20. [PMID: 30782116 PMCID: PMC6734488 DOI: 10.1186/s10194-019-0969-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/06/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Trigeminal neuralgia is one of the most characteristic and difficult to treat neuropathic pain conditions in patients with multiple sclerosis. The present narrative review addresses the current evidence on diagnostic tests and treatment of trigeminal neuralgia secondary to multiple sclerosis. METHODS We searched for relevant papers within PubMed, EMBASE and the Cochrane Database of Systematic Reviews, taking into account publications up to December 2018. RESULTS Trigeminal neuralgia secondary to multiple sclerosis manifests with facial paroxysmal pain triggered by typical manoeuvres; neurophysiological investigations and MRI support the diagnosis, providing the definite evidence of trigeminal pathway damage. A dedicated MRI is required to identify pontine demyelinating plaques. In many patients with multiple sclerosis, neuroimaging and surgical evidence suggests that neurovascular compression might act in concert with the pontine plaque through a double-crush mechanism. Although no placebo-controlled trials have been conducted in these patients, according to expert opinion the first-line therapy for trigeminal neuralgia secondary to multiple sclerosis relies on sodium-channel blockers, i.e. carbamazepine and oxcarbazepine. The sedative and motor side effects of these drugs frequently warrant an early consideration for neurosurgery. Surgical procedures include Gasserian ganglion percutaneous techniques, gamma knife radiosurgery and microvascular decompression in the posterior fossa. CONCLUSIONS The relatively poor tolerability of the centrally-acting drugs carbamazepine and oxcarbazepine highlights the need to develop new selective and better-tolerated sodium-channel blockers. Prospective studies based on more advanced neuroimaging techniques should focus on how trigeminal anatomical abnormalities may be able to predict the efficacy of microvascular decompression.
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Affiliation(s)
- Giulia Di Stefano
- Department of Human Neurosciences, Sapienza University, Viale Università 30, 00185 Rome, Italy
| | - Stine Maarbjerg
- Danish Headache Center, Department of Neurology, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Andrea Truini
- Department of Human Neurosciences, Sapienza University, Viale Università 30, 00185 Rome, Italy
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Téllez MJ, Ulkatan S, Blitzer A, Sinclair CF. Unearthing a consistent bilateral R1 component of the laryngeal adductor reflex in awake humans. Laryngoscope 2018; 128:2581-2587. [PMID: 30194734 DOI: 10.1002/lary.27249] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Maria J. Téllez
- Department of Intraoperative Neurophysiology; New York New York U.S.A
| | - Sedat Ulkatan
- Department of Intraoperative Neurophysiology; New York New York U.S.A
| | - Andrew Blitzer
- New York Center for Voice and Swallowing Disorders; New York New York U.S.A
| | - Catherine F. Sinclair
- Department of Otolaryngology Head and Neck Surgery; Mount Sinai West Hospital; New York New York U.S.A
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Corrales NU, Ramírez JFN, Villegas SH. Swine welfare at slaughterhouses in Valle de Aburrá (Colombia). Vet Anim Sci 2018; 6:50-55. [PMID: 32734052 PMCID: PMC7386702 DOI: 10.1016/j.vas.2018.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 06/08/2018] [Accepted: 07/31/2018] [Indexed: 11/28/2022] Open
Abstract
The World Organization for Animal Health (OIE) makes recommendations related to the slaughter of animals for human consumption. Colombia has some regulations on animal welfare in slaughterhouses. This study assessed welfare of pigs in slaughterhouses in Valle de Aburrá, Colombia using measures from existing welfare protocols (Welfare Quality: Assessment protocol for pigs; Recommended Animal Handling Guidelines and Audit Guide for Cattle, Pig and Sheep). The objective was to determine the degree of compliance with some welfare protocols recommendation (Welfare Quality. Assessment protocol for pigs and Recommended Animal Handling Guidelines and Audit Guide for Cattle, Pig and Sheep) in regards to welfare of pigs in slaughterhouses in Valle de Aburrá, Colombia. A cross-sectional study was conducted using data from four slaughterhouses during 2017. Univariable analysis was performed, depending on the type of variable. Frequency distribution was assessed for descriptive variables, while quantity variables were assessed by central tendency and dispersion measures. It was found that electric prods are often used for moving pigs to lairage pens and to stunning area, the animals remain in lairage pens in too high stocking densities and also some signs related to inadequate loss of consciousness during stunning were shown. Some pigs were kept more than 10 h in lairage pens and some did not have access to water. Skin lesions occurred in 93.6% of the observed animals. It is concluded that the assessed slaughterhouses do not manage to keep animal welfare on a required level.
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Affiliation(s)
- Natalia Uribe Corrales
- Research Group Epidemiology and Biostatistics, Graduate School, Universidad CES, Medellín, Colombia
- Corresponding author.
| | - Juan F. Naranjo Ramírez
- Research Group INCA-CES, Faculty of Veterinary Medicine and Animal Science. Universidad CES, Medellín, Colombia
| | - Santiago Henao Villegas
- Research Group INCA-CES, Faculty of Veterinary Medicine and Animal Science. Universidad CES, Medellín, Colombia
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Pippi R, Spota A, Santoro M. Medicolegal Considerations Involving Iatrogenic Lingual Nerve Damage. J Oral Maxillofac Surg 2018; 76:1651.e1-1651.e13. [DOI: 10.1016/j.joms.2018.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 12/20/2022]
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Xu G, Zhou C, Liu S, Li W, Tang W. Electrophysiological characteristics of the frontal nerve in patients with herpetic ophthalmic neuralgia. Muscle Nerve 2018; 57:973-980. [PMID: 29314073 DOI: 10.1002/mus.26057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2017] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The aim of this study was to explore a method for obtaining sensory nerve action potentials (SNAPs) of the supratrochlear (STN) and supraorbital (SON) nerves and evaluate the function of affected nerves in patients with herpetic ophthalmic neuralgia (HON). METHODS Thirty healthy volunteers and 40 subjects with subacute HON participated in this study. RESULTS The amplitudes and sensory conduction velocities (SCVs) that predicted HON were identified. The corresponding cutoff values for the amplitudes ranged from 11.10 μV to 12.45 μV. The corresponding cutoff values for the SCVs ranged from 43.14 m/s to 44.64 m/s. SCVs were markedly lower on the affected side compared with healthy volunteers (P < 0.05), and the amplitudes of SNAPs on the affected side were decreased by 36% compared with healthy volunteers (P < 0.05). DISCUSSION SCVs of STN and SONs can be obtained with the 3-channel method and used to evaluate myelinated fibers in patients with HON. Muscle Nerve 57: 973-980, 2018.
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Affiliation(s)
- Gang Xu
- Department of Rehabilitation Medicine, Affiliated Tenth People's Hospital of Tongji University, Shanghai Tenth People's Hospital, 301 Middle Yanchang Road Shanghai, 200072, China
| | - Chaosheng Zhou
- Department of Rehabilitation Medicine, Affiliated Tenth People's Hospital of Tongji University, Shanghai Tenth People's Hospital, 301 Middle Yanchang Road Shanghai, 200072, China
| | - Shasha Liu
- Department of Rehabilitation Medicine, Affiliated Tenth People's Hospital of Tongji University, Shanghai Tenth People's Hospital, 301 Middle Yanchang Road Shanghai, 200072, China
| | - Wen Li
- Department of Rehabilitation Medicine, Affiliated Tenth People's Hospital of Tongji University, Shanghai Tenth People's Hospital, 301 Middle Yanchang Road Shanghai, 200072, China
| | - Weizhen Tang
- Department of Rehabilitation Medicine, Affiliated Tenth People's Hospital of Tongji University, Shanghai Tenth People's Hospital, 301 Middle Yanchang Road Shanghai, 200072, China
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Zhu Q, Wang J, Fan H, Ma G, Zhang B, Shen C, Wang W. Blink reflex under external emotional-stimuli in bipolar I and II disorders. Psychiatry Res 2018; 259:520-525. [PMID: 29156424 DOI: 10.1016/j.psychres.2017.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 11/02/2017] [Accepted: 11/04/2017] [Indexed: 11/17/2022]
Abstract
Bipolar disorder types I (BD I) and II (BD II) might present different cortico-brainstem circuit dysfunctions under external emotions, which might be reflected by the blink reflex. We therefore invited 32 BD I and 23 BD II patients, and 46 healthy volunteers to answer the Mood Disorder Questionnaire, the Hypomania Checklist-32, and the Plutchik - van Praag Depression inventory, and to undergo the blink reflex test under external emotions (emotional pictures plus sounds) of Disgust, Erotica, Fear, Happiness, and Sadness. Compared to healthy controls, BD I showed prolonged R2/R2' latencies under most emotions, and their PVP scores were negatively correlated with the areas under curve (AUCs) of R2 and R2' under Erotica; and BD II showed reduced R2/R2' AUCs under all emotions. Moreover, R2' AUCs under Disgust, Fear, and Happiness were significantly reduced in BD II than those in BD I. Our results have shown that, irrespective of patients' on-going affective states, the R2/R2' components were delayed in BD I but suppressed in BD II under most external emotions. Our study provides some hints to distinguish the two types of bipolar disorder, referring to the cortico-brainstem circuit dysfunctions under external emotions.
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Affiliation(s)
- Qisha Zhu
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Jiawei Wang
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Hongying Fan
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Guorong Ma
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Bingren Zhang
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Chanchan Shen
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Wei Wang
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China.
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Abstract
Neuropathic pain develops when the somatosensory nervous system is affected by a lesion or disease. Diagnostic tests aimed at assessing somatosensory afferent pathway damage are therefore useful for diagnosing neuropathic pain. Neuropathic pain manifests with a range of different symptoms such as ongoing burning pain, squeezing or pressure pain, paroxysmal electric shock-like sensations, stabbing pain, or mechanical dynamic allodynia. The various types of neuropathic pain are associated with different underlying nerve fiber abnormalities. This article summarizes the available methods of somatosensory afferent pathway assessment and discusses the potential pathophysiology underlying the most representative neuropathic pain types, i.e., ongoing burning pain, paroxysmal pain, and mechanical dynamic allodynia. FUNDING Pfizer, Italy.
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Affiliation(s)
- Andrea Truini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy.
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Electrophysiological Investigations in Orthostatic Myoclonus: Preliminary Findings. Can J Neurol Sci 2017; 45:100-103. [PMID: 29110740 DOI: 10.1017/cjn.2017.241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report the clinical and electrophysiological findings in seven patients with orthostatic myoclonus (OM) associated with gait initiation failure and falls. OM is one of the causes of unsteadiness of stance and gait, and it may develop as a symptom of neurodegenerative disorders. Both positive myoclonic bursts and negative myoclonus may be seen in electrophysiological recordings, and electrophysiological analysis suggests a subcortical origin for OM.
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Neurophysiological studies on atypical parkinsonian syndromes. Parkinsonism Relat Disord 2017; 42:12-21. [DOI: 10.1016/j.parkreldis.2017.06.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/14/2017] [Accepted: 06/24/2017] [Indexed: 01/31/2023]
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Jones MG, Andreou AP, McMahon SB, Spanswick D. Pharmacology of reflex blinks in the rat: a novel model for headache research. J Headache Pain 2016; 17:96. [PMID: 27770405 PMCID: PMC5074984 DOI: 10.1186/s10194-016-0686-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/29/2016] [Indexed: 11/10/2022] Open
Abstract
Background Migraineurs are highly sensitive to the nitric oxide donor glyceryl trinitrate which triggers attacks in many sufferers. In animal studies, glyceryl trinitrate increases neuronal activity in the trigeminovascular pathway and elevates neurotransmitter levels in the brainstem. Many migraineurs also display alterations in blink reflexes, known to involve brainstem circuits. We investigated the effect of GTN on evoked blinks in the anaesthetised rat to determine whether such reflexes may prove useful as the basis for a novel animal model to evaluate potential anti-migraine therapeutic agents. Method In anaesthetised rats the electromyogram associated with the reflex blink evoked by corneal airpuff was recorded. Rats were infused with glyceryl trinitrate, sumatriptan plus glyceryl trinitrate or vehicle control. Changes in the magnitude of the reflex blink-associated electromyogram following these treatments were measured. Results Glyceryl trinitrate potentiated the evoked reflex blink-associated EMG response from 2 h after infusion. That effect was abolished by simultaneous infusion of sumatriptan with glyceryl trinitrate. Conclusions These results show that simple skin surface measurements of evoked electromyographic activity in the rat can reliably detect the evoked blink reflex that can be potentiated by nitric oxide donors. This novel model may be an effective tool for evaluating putative anti-migraine therapeutic agents.
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Affiliation(s)
- M G Jones
- Neurorestoration Group, Wolfson Centre for Age-Related Disease, Kings College London, London, UK. .,Zenith NeuroTech, Wolfson Centre for Age-Related Disease, Kings College London, London, UK.
| | - A P Andreou
- Academic Headache Centre, Wolfson Centre for Age-Related Disease, Kings College London, London, UK.,London and Pain Management and Neuromodulation Centre, St Thomas's Hospital, London, UK
| | - S B McMahon
- Neurorestoration Group, Wolfson Centre for Age-Related Disease, Kings College London, London, UK
| | - D Spanswick
- Neurosolutions Ltd., University of Warwick, Coventry, UK
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Sleep bruxism is related to decreased inhibitory control of trigeminal motoneurons, but not with reticulobulbar system. Neurol Sci 2016; 38:75-81. [DOI: 10.1007/s10072-016-2711-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/06/2016] [Indexed: 12/23/2022]
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Diagnostic value of blink reflex in multisystem atrophy, progressive supranuclear palsy and Parkinson disease. Neurol Neurochir Pol 2016; 50:336-41. [PMID: 27591058 DOI: 10.1016/j.pjnns.2016.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/18/2016] [Accepted: 06/14/2016] [Indexed: 11/23/2022]
Abstract
UNLABELLED Abnormal blink reflex (BR) is a result of reticular brainstem pathways dysfunction and seems to be one of the features of brain degenerative disorders. The aim of the study was to estimate the diagnostic value of blink reflex in neurodegenerative diseases such as: multisystem atrophy (MSA), progressive supranuclear palsy (PSP) and Parkinson disease (PD). Material consisted of 99 patients with clinically probable MSA (51), PSP (28) and PD (20). MSA patients were divided into two subgroups, with dominant cerebellar (MSA-C) and parkinsonian signs (MSA-P). The mean age of patients was 64.9 years (47-79 years); males - 55.3%. Blink reflex was obtained in a typical way. RESULTS The significant differences in mean values of blink reflex latencies between PD and other subgroups (MSA-P, MSA-C, PSP) were found, but all of them were in normal range. In individual patients with PD and PSP (50% and 18%, respectively) delayed R2 latencies were recorded. CONCLUSIONS The most frequently abnormal blink reflexes, comparing the MSA, PSP and PD groups, were present in PD patients. We postulate that this may be explained by pathological influence of nigrostriatal pathway on the circuit linking the basal ganglia, cerebellum and brainstem.
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Suppa A, Bologna M, Conte A, Berardelli A, Fabbrini G. The effect of L-dopa in Parkinson’s disease as revealed by neurophysiological studies of motor and sensory functions. Expert Rev Neurother 2016; 17:181-192. [DOI: 10.1080/14737175.2016.1219251] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Antonio Suppa
- Department of Neurology and Psychiatry, Sapienza University of Rome and Neuromed Institute IRCCS, Pozzilli, Italy
| | - Matteo Bologna
- Department of Neurology and Psychiatry, Sapienza University of Rome and Neuromed Institute IRCCS, Pozzilli, Italy
| | - Antonella Conte
- Department of Neurology and Psychiatry, Sapienza University of Rome and Neuromed Institute IRCCS, Pozzilli, Italy
| | - Alfredo Berardelli
- Department of Neurology and Psychiatry, Sapienza University of Rome and Neuromed Institute IRCCS, Pozzilli, Italy
| | - Giovanni Fabbrini
- Department of Neurology and Psychiatry, Sapienza University of Rome and Neuromed Institute IRCCS, Pozzilli, Italy
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Fossataro C, Gindri P, Mezzanato T, Pia L, Garbarini F. Bodily ownership modulation in defensive responses: physiological evidence in brain-damaged patients with pathological embodiment of other's body parts. Sci Rep 2016; 6:27737. [PMID: 27292285 PMCID: PMC4904197 DOI: 10.1038/srep27737] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 05/23/2016] [Indexed: 11/27/2022] Open
Abstract
Do conscious beliefs about the body affect defensive mechanisms within the body? To answer this question we took advantage from a monothematic delusion of bodily ownership, in which brain-damaged patients misidentify alien limbs as their own. We investigated whether the delusional belief that an alien hand is their own hand modulates a subcortical defensive response, such as the hand-blink reflex. The blink, dramatically increases when the threated hand is inside the defensive peripersonal-space of the face. In our between-subjects design, including patients and controls, the threat was brought near the face either by the own hand or by another person’s hand. Our results show an ownership-dependent modulation of the defensive response. In controls, as well as in the patients’ intact-side, the response enhancement is significantly greater when the threat was brought near the face by the own than by the alien hand. Crucially, in the patients’ affected-side (where the pathological embodiment occurs), the alien (embodied) hand elicited a response enhancement comparable to that found when the threat is brought near the face by the real hand. These findings suggest the existence of a mutual interaction between our conscious beliefs about the body and the physiological mechanisms within the body.
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Affiliation(s)
- C Fossataro
- SAMBA - SpAtial, Motor &Bodily Awareness - Research Group, Psychology Department, University of Turin, Turin, Italy
| | - P Gindri
- SAMBA - SpAtial, Motor &Bodily Awareness - Research Group, Psychology Department, University of Turin, Turin, Italy.,San Camillo Hospital of Turin, Turin, Italy
| | - T Mezzanato
- Ausiliatrice - Don Gnocchi Hospital of Turin, Turin, Italy
| | - L Pia
- SAMBA - SpAtial, Motor &Bodily Awareness - Research Group, Psychology Department, University of Turin, Turin, Italy.,Neuroscience Institute of Turin (NIT), University of Turin, Italy
| | - F Garbarini
- SAMBA - SpAtial, Motor &Bodily Awareness - Research Group, Psychology Department, University of Turin, Turin, Italy.,San Camillo Hospital of Turin, Turin, Italy
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The blink reflex magnitude is continuously adjusted according to both current and predicted stimulus position with respect to the face. Cortex 2016; 81:168-75. [PMID: 27236372 PMCID: PMC4962765 DOI: 10.1016/j.cortex.2016.04.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 03/01/2016] [Accepted: 04/09/2016] [Indexed: 11/25/2022]
Abstract
The magnitude of the hand-blink reflex (HBR), a subcortical defensive reflex elicited by the electrical stimulation of the median nerve, is increased when the stimulated hand is close to the face (‘far–near effect’). This enhancement occurs through a cortico-bulbar facilitation of the polysynaptic medullary pathways subserving the reflex. Here, in two experiments, we investigated the temporal characteristics of this facilitation, and its adjustment during voluntary movement of the stimulated hand. Given that individuals navigate in a fast changing environment, one would expect the cortico-bulbar modulation of this response to adjust rapidly, and as a function of the predicted spatial position of external threats. We observed two main results. First, the HBR modulation occurs without a temporal delay between when the hand has reached the stimulation position and when the stimulus happens (Experiments 1 and 2). Second, the voluntary movement of the hand interacts with the ‘far–near effect’: stimuli delivered when the hand is far from the face elicit an enhanced HBR if the hand is being moved towards the face, whereas stimuli delivered when the hand is near the face elicit an enhanced HBR regardless of the direction of the hand movement (Experiment 2). These results indicate that the top-down modulation of this subcortical defensive reflex occurs continuously, and takes into account both the current and the predicted position of potential threats with respect to the body. The continuous control of the excitability of subcortical reflex circuits ensures appropriate adjustment of defensive responses in a rapidly-changing sensory environment.
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Erturk O, Korkmaz B, Alev G, Demirbilek V, Kiziltan M. Startle and blink reflex in high functioning autism. Neurophysiol Clin 2016; 46:189-92. [PMID: 26997128 DOI: 10.1016/j.neucli.2016.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 02/10/2016] [Accepted: 02/10/2016] [Indexed: 10/22/2022] Open
Abstract
An important clinical feature of autism is the presence of atypical responses to sensory stimuli. In this study, we investigated if high functioning autistic patients had abnormalities in the blink reflex and the startle reaction to auditory or somatosensory stimuli. Fourteen patients aged between 7 and 16 years were included in the study. We found a longer latency of the blink reflex, an increased duration and amplitude of the auditory startle reaction and a lower presence rate of the somatosensorial startle reaction in autistic patients. To better define the sensorial characteristics of the disease could improve the therapeutic management of children with autism spectrum disorder.
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Affiliation(s)
- Ozdem Erturk
- Department of neurology, Cerrahpasa faculty of medicine, Istanbul university, 34098 KMPasa, Fatih, Istanbul, Turkey.
| | - Baris Korkmaz
- Department of neurology, Cerrahpasa faculty of medicine, Istanbul university, 34098 KMPasa, Fatih, Istanbul, Turkey
| | - Gulce Alev
- Institute of health sciences, speech and language therapy, Anadolu university, Eskisehir, Turkey
| | - Veysi Demirbilek
- Department of neurology, Cerrahpasa faculty of medicine, Istanbul university, 34098 KMPasa, Fatih, Istanbul, Turkey
| | - Meral Kiziltan
- Department of neurology, Cerrahpasa faculty of medicine, Istanbul university, 34098 KMPasa, Fatih, Istanbul, Turkey
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Terlouw C, Bourguet C, Deiss V. Consciousness, unconsciousness and death in the context of slaughter. Part II. Evaluation methods. Meat Sci 2016; 118:147-56. [PMID: 27086068 DOI: 10.1016/j.meatsci.2016.03.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 03/04/2016] [Accepted: 03/09/2016] [Indexed: 01/23/2023]
Abstract
This second review describes indicators of consciousness and unconsciousness that can be used in the abattoir. These indicators evaluate different aspects of cerebral functioning, but only indirectly. It is therefore necessary to monitor several indicators. Animals are considered unconscious if signs of consciousness are absent, and signs of unconsciousness are present. Given that the unconscious state may be reversible it is further necessary to monitor these indicators until the end of bleeding. The techniques used to diagnose brain death in humans cannot be used in the slaughterhouse. Under field conditions, at the end of bleeding, the absence of breathing and of brainstem reflexes and the adequacy of the exsanguination are verified. If these three aspects are confirmed, in the context of the slaughterhouse and at this stage of the slaughter process the loss of vital functions is irreversible and the animal can be considered dead.
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Affiliation(s)
- Claudia Terlouw
- INRA, UMR1213 Herbivores, 63122 Saint-Genès-Champanelle, France; Clermont University, VetAgro Sup, UMR1213 Herbivores, BP 10448, 63000 Clermont-Ferrand, France.
| | | | - Véronique Deiss
- INRA, UMR1213 Herbivores, 63122 Saint-Genès-Champanelle, France; Clermont University, VetAgro Sup, UMR1213 Herbivores, BP 10448, 63000 Clermont-Ferrand, France
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Mohammadian F, Noroozian M, Nafissi S, Fatehi F. Blink Reflex May Help Discriminate Alzheimer Disease From Vascular Dementia. J Clin Neurophysiol 2015; 32:505-11. [PMID: 26629759 DOI: 10.1097/wnp.0000000000000214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Dementia has several different etiologies, and vascular dementia (VaD) is considered the second leading cause of dementia after Alzheimer disease (AD). Various studies used blink reflex in different spectrum of neurological diseases as a complementary diagnostic test. We performed blink test in AD, VaD, and mixed dementia to investigate different usefulness of blink reflex in differentiating these types of dementia. METHODS Blink reflex was performed for patients with AD (n = 18), VaD (n = 17), mixed dementia (n = 19), and normal subjects (n = 20). The absolute latency of R1, R2, and contralateral R2 (R2c) was determined and then compared with normal values. We used ROC curve to determine the screening cut-off value for R2 and R2c to discriminate dementia with vascular component and AD. RESULTS The mean age ± SD of patients was 71.61 ± 8.23, 66.71 ± 11.48, 75.26 ± 8.32, and 66.60 ± 3.91 years in 4 groups of AD, VaD, mixed dementia, and normal, respectively. R2 and R2c were recorded in fewer number of subjects with VaD or mixed dementia than AD and normal subjects. For mean R2 latency higher than 45 milliseconds, the sensitivity and specificity were 42% and 100%, respectively, and for latency higher than 45 milliseconds, the sensitivity and specificity were 72% and 89%, respectively. CONCLUSIONS R2 and R2c components of blink reflex could specifically discriminate between Alzheimer and dementia with vascular component. The interruption of descending corticoreticular pathways by small infarcts could explain it.
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Affiliation(s)
- Fatemeh Mohammadian
- *Department of Neurology, Shariati Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; †Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran; and ‡Iranian Center of Neurological Research, Department of Neurology, Shariati Hospital, School of medicine, Tehran University of Medical Sciences, Tehran, Iran
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Pilurzi G, Mercante B, Ginatempo F, Follesa P, Tolu E, Deriu F. Transcutaneous trigeminal nerve stimulation induces a long-term depression-like plasticity of the human blink reflex. Exp Brain Res 2015; 234:453-61. [PMID: 26514812 DOI: 10.1007/s00221-015-4477-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/15/2015] [Indexed: 01/17/2023]
Abstract
The beneficial effects of trigeminal nerve stimulation (TNS) on several neurological disorders are increasingly acknowledged. Hypothesized mechanisms include the modulation of excitability in networks involved by the disease, and its main site of action has been recently reported at brain stem level. Aim of this work was to test whether acute TNS modulates brain stem plasticity using the blink reflex (BR) as a model. The BR was recorded from 20 healthy volunteers before and after 20 min of cyclic transcutaneous TNS delivered bilaterally to the infraorbital nerve. Eleven subjects underwent sham-TNS administration and were compared to the real-TNS group. In 12 subjects, effects of unilateral TNS were tested. The areas of the R1 and R2 components of the BR were recorded before and after 0 (T0), 15 (T15), 30 (T30), and 45 (T45) min from TNS. In three subjects, T60 and T90 time points were also evaluated. Ipsi- and contralateral R2 areas were significantly suppressed after bilateral real-TNS at T15 (p = 0.013), T30 (p = 0.002), and T45 (p = 0.001), while R1 response appeared unaffected. The TNS-induced inhibitory effect on R2 responses lasted up to 60 min. Real- and sham-TNS protocols produced significantly different effects (p = 0.005), with sham-TNS being ineffective at any time point tested. Bilateral TNS was more effective (p = 0.009) than unilateral TNS. Acute TNS induced a bilateral long-lasting inhibition of the R2 component of the BR, which resembles a long-term depression-like effect, providing evidence of brain stem plasticity produced by transcutaneous TNS. These findings add new insight into mechanisms of TNS neuromodulation and into physiopathology of those neurological disorders where clinical benefits of TNS are recognized.
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Affiliation(s)
- Giovanna Pilurzi
- Neurological Clinic, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 10, 07100, Sassari, Italy.
| | - Beniamina Mercante
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, 07100, Sassari, Italy.
| | - Francesca Ginatempo
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, 07100, Sassari, Italy.
| | - Paolo Follesa
- Department of Life and Environmental Sciences, University of Cagliari, Cittadella Universitaria Monserrato, 09042, Monserrato, Italy.
| | - Eusebio Tolu
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, 07100, Sassari, Italy.
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, 07100, Sassari, Italy.
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Evidence of brainstem dysfunction in patients with familial dysautonomia and carriers of the IKBKAP mutation. Clin Neurophysiol 2015; 127:1748-1749. [PMID: 26525363 DOI: 10.1016/j.clinph.2015.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 08/25/2015] [Accepted: 08/31/2015] [Indexed: 11/20/2022]
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Abstract
PURPOSE The auditory blink reflex (ABR) is a teleceptive reflex consisting of an early brief muscle contraction of the orbicularis oculi in response to sound stimuli. Constriction of the orbicularis oculi in response to auditory stimulation is accepted as a part of the startle reaction. The blink reflex and ABR might share a final common pathway, consisting of facial nerve nuclei and the facial nerve and may have common premotor neurons. METHODS In this study, the authors evaluated the value of the ABR in patients with peripheral facial palsy (PFP), cross-checking the results with commonly used blink reflex changes. RESULTS In total, 83 subjects with PFP and 34 age-matched healthy volunteers were included. Auditory blink reflex was elicited in all control subjects and in 36 PFP cases on the paralytic sides (43.3%), whereas it was asymmetric in 30.1% of the patients. Auditory blink reflex positivity was significantly lower in PFP cases with increasing severity. Blink reflex results were largely correlated with ABR positivity. CONCLUSIONS Auditory blink reflex is a useful readily elicited and sensitive test in PFP cases, providing parallel results to blink reflex and being affected by disease severity.
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