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Shaikh AG, Jinnah HA. Interdisciplinary insights into tremor in dystonia: Navigating clinical controversies, definitional challenges, and pathophysiological complexities. Parkinsonism Relat Disord 2024; 122:106068. [PMID: 38548571 DOI: 10.1016/j.parkreldis.2024.106068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 05/05/2024]
Abstract
This review delves into the historical evolution and ongoing controversy surrounding the relationship between tremor and dystonia. The Dystonia Consensus Panel and the International Parkinson's and Movement Disorders Society's Tremor Taskforce have attempted to define these entities, but the complexity arises when patients have a combination of both dystonia and tremor. The term "dystonic tremor" has sparked diverse interpretations, with debates over its clinical features and the need for more objectively defined characteristics. Logistic regression analyses in a large cohort of dystonia patients identified determinants such as body region affected by dystonia, dystonia severity, age, and recruitment site, with unexpected associations emphasizing the subjectivity in detecting and classifying tremor. The study further discovered diverse prevalence of "dystonic tremor" based on different definitions, revealing substantial variability among investigators. The recently convened Dystonia-Tremor panel aimed to address these challenges by proposing a more uniform nomenclature, emphasizing precise and descriptive terms. Despite the complexity, instrumented measures, such as electromyography, temporal discrimination threshold, blink reflex, and trajectory shape analysis, seem to be useful in distinguishing between tremor and dystonia. The pathophysiology debate centers around the involvement of the cerebello-thalamo-cortical and basal ganglia-thalamo-cortical circuits. Evidence supports the role of both circuits in driving the pathophysiology of dystonic tremor, challenging the notion of a clear dichotomy. The review concludes by emphasizing the need for a nuanced understanding, highlighting the intricate interplay between tremor and dystonia, and the potential of instrumental measures in advancing diagnostic accuracy.
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Affiliation(s)
- Aasef G Shaikh
- University Hospitals and Cleveland VA Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| | - H A Jinnah
- Department of Neurology, Emory University, Atlanta, Georgia, USA
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Rostás R, Fekete I, Horváth L, Fekete K. Blink Reflex Examination in Patients with Amyotrophic Lateral Sclerosis Compared to Diseases Affecting the Peripheral Nervous System and Healthy Controls. Brain Sci 2023; 13:1384. [PMID: 37891753 PMCID: PMC10605916 DOI: 10.3390/brainsci13101384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal form of neuromuscular disease. The aim of this study was to assess changes in the blink reflex (BR) parameters as a valid and easy-to-use tool in ALS patients. We assessed the BR test in patients with a definitive diagnosis of ALS, healthy volunteers, and patients with diseases affecting the peripheral nervous system. The BR was studied in 29 patients who met the Awaji criteria. Latencies were compared with our healthy controls (N = 50) and other diseases of the peripheral nervous system (N = 61). The ALS Functional Rating Scale-Revised (ALSFRS-R) was used to evaluate functional status. Significantly prolonged R2i and R2c latencies were found in the ALS group compared with the healthy control group (p < 0.001). The latencies of R1, R2i, R2c were all increased in the bulbar subtype compared to the limb-onset subtype (p < 0.05). According to our results, BR examination might be a promising tool to monitor the course of the disease or serve as a prognostic biomarker in patients with ALS, but it should be assessed in further studies. The abnormalities detected through BR might help perform earlier interventions in ALS patients and might be useful in other diseases affecting the peripheral nervous system.
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Affiliation(s)
- Róbert Rostás
- Division of Radiology and Imaging Science, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Nagyerdei krt 98, 4032 Debrecen, Hungary
- Department of Neurology, Faculty of Medicine, University of Debrecen, Móricz Zsigmond krt 22, 4032 Debrecen, Hungary; (I.F.); (K.F.)
| | - István Fekete
- Department of Neurology, Faculty of Medicine, University of Debrecen, Móricz Zsigmond krt 22, 4032 Debrecen, Hungary; (I.F.); (K.F.)
| | - László Horváth
- Department of Pharmaceutical Surveillance and Economy, Faculty of Pharmacy, University of Debrecen, Nagyerdei krt 98, 4032 Debrecen, Hungary;
| | - Klára Fekete
- Department of Neurology, Faculty of Medicine, University of Debrecen, Móricz Zsigmond krt 22, 4032 Debrecen, Hungary; (I.F.); (K.F.)
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Crnošija L, Adamec I, Krbot Skorić M, Habek M. How to explore and explain autonomic changes in multiple sclerosis. Neurophysiol Clin 2023; 53:102854. [PMID: 36966707 DOI: 10.1016/j.neucli.2023.102854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/29/2023] Open
Abstract
Autonomic dysfunction (AD) in people with MS (pwMS) is a frequent finding. This narrative review will present an overview of central neural mechanisms involved in the control of cardiovascular and thermoregulatory systems, and methods of autonomic nervous system testing will be discussed thereafter. Since the need for standardization of autonomic nervous system (ANS) testing, we will focus on the standard battery of tests (blood pressure and heart rate response to Valsalva maneuver and head-up tilt, and heart rate response to deep breathing test plus one of the tests for sudomotor function), which can detect ANS pathology in the majority of pwMS. The review will briefly discuss the other types of AD in pwMS and the use of appropriate tests. While performing ANS testing in pwMS one has to consider the multiple sclerosis phenotypes, disease duration, and its activity, the degree of clinical disability of patients included in the study, and the disease-modifying therapies taken, as these factors may have a great influence on the results of ANS testing. In other words, detailed patient characteristics presentation and patient stratification are beneficial when reporting results of ANS testing in pwMS.
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Margaritella N, Mendozzi L, Garegnani M, Gilardi E, Nemni R, Pugnetti L. Sympathetic skin response in multiple sclerosis: a meta-analysis of case-control studies. Neurol Sci 2018; 39:45-52. [PMID: 28963666 PMCID: PMC5772132 DOI: 10.1007/s10072-017-3111-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 09/05/2017] [Indexed: 11/24/2022]
Abstract
The usefulness of sympathetic skin responses (SSR) in multiple sclerosis (MS) has been advocated by several studies in the last 20 years; however, due to a great heterogeneity of findings, a comprehensive meta-analysis of case-control studies is in order to pinpoint consistencies and investigate the causes of discrepancies. We searched MEDLINE, EMBASE and Cochrane databases for case-control studies comparing SSR absence frequency and latency between patients with MS and healthy controls. Thirteen eligible studies including 415 MS patients and 331 healthy controls were identified. The pooled analysis showed that SSR can be always obtained in healthy controls while 34% of patients had absent SSRs in at least one limb (95% CI 22-47%; p < 0.0001) but with considerable heterogeneity across studies (I 2 = 90.3%). Patients' age explained 22% of the overall variability and positive correlations were found with Expanded Disability Status Scale and disease duration. The pooled mean difference of SSR latency showed a significant increase in patients on both upper (193 ms; 95% CI 120-270 ms) and lower (350 ms; 95% CI 190-510 ms) extremities. We tested the discriminatory value of SSR latency thresholds defined as the 95% confidence interval (CI) upper bound of the healthy controls, and validated the results on a new dataset. The lower limb threshold of 1.964 s produces the best results in terms of sensitivity 0.86, specificity 0.67, positive predicted value 0.75 and negative predicted value 0.80. Despite a considerable heterogeneity of findings, there is evidence that SSR is a useful tool in MS.
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Affiliation(s)
- Nicolò Margaritella
- Laboratory of Clinical Neurophysiology, Scientific Institute (IRCCS) S. Maria Nascente, don C. Gnocchi Foundation, via Capecelatro 66, 20148, Milan, Italy
| | - Laura Mendozzi
- Multiple Sclerosis Rehabilitation Unit, Scientific Institute (IRCCS) S. Maria Nascente, don C. Gnocchi Foundation, Milan, Italy
| | - Massimo Garegnani
- Laboratory of Clinical Neurophysiology, Scientific Institute (IRCCS) S. Maria Nascente, don C. Gnocchi Foundation, via Capecelatro 66, 20148, Milan, Italy
| | - Elisabetta Gilardi
- Laboratory of Clinical Neurophysiology, Scientific Institute (IRCCS) S. Maria Nascente, don C. Gnocchi Foundation, via Capecelatro 66, 20148, Milan, Italy
| | - Raffaello Nemni
- Neurological Rehabilitation Unit, Scientific Institute (IRCCS) S. Maria Nascente, don C. Gnocchi Foundation, Milan, Italy
| | - Luigi Pugnetti
- Laboratory of Clinical Neurophysiology, Scientific Institute (IRCCS) S. Maria Nascente, don C. Gnocchi Foundation, via Capecelatro 66, 20148, Milan, Italy.
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Biasiotta A, D'Arcangelo D, Passarelli F, Nicodemi EM, Facchiano A. Ion channels expression and function are strongly modified in solid tumors and vascular malformations. J Transl Med 2016; 14:285. [PMID: 27716384 PMCID: PMC5050926 DOI: 10.1186/s12967-016-1038-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/21/2016] [Indexed: 12/21/2022] Open
Abstract
Background Several cellular functions relate to ion-channels activity. Physiologically relevant chains of events leading to angiogenesis, cell cycle and different forms of cell death, require transmembrane voltage control. We hypothesized that the unordered angiogenesis occurring in solid cancers and vascular malformations might associate, at least in part, to ion-transport alteration. Methods The expression level of several ion-channels was analyzed in human solid tumor biopsies. Expression of 90 genes coding for ion-channels related proteins was investigated within the Oncomine database, in 25 independent patients-datasets referring to five histologically-different solid tumors (namely, bladder cancer, glioblastoma, melanoma, breast invasive-ductal cancer, lung carcinoma), in a total of 3673 patients (674 control-samples and 2999 cancer-samples). Furthermore, the ion-channel activity was directly assessed by measuring in vivo the electrical sympathetic skin responses (SSR) on the skin of 14 patients affected by the flat port-wine stains vascular malformation, i.e., a non-tumor vascular malformation clinical model. Results Several ion-channels showed significantly increased expression in tumors (p < 0.0005); nine genes (namely, CACNA1D, FXYD3, FXYD5, HTR3A, KCNE3, KCNE4, KCNN4, CLIC1, TRPM3) showed such significant modification in at least half of datasets investigated for each cancer type. Moreover, in vivo analyses in flat port-wine stains patients showed a significantly reduced SSR in the affected skin as compared to the contralateral healthy skin (p < 0.05), in both latency and amplitude measurements. Conclusions All together these data identify ion-channel genes showing significantly modified expression in different tumors and cancer-vessels, and indicate a relevant electrophysiological alteration in human vascular malformations. Such data suggest a possible role and a potential diagnostic application of the ion–electron transport in vascular disorders underlying tumor neo-angiogenesis and vascular malformations.
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Affiliation(s)
| | - Daniela D'Arcangelo
- Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Fondazione Luigi Maria Monti, via Monti di Creta 104, 00167, Rome, Italy
| | - Francesca Passarelli
- Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Fondazione Luigi Maria Monti, via Monti di Creta 104, 00167, Rome, Italy
| | - Ezio Maria Nicodemi
- Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Fondazione Luigi Maria Monti, via Monti di Creta 104, 00167, Rome, Italy.
| | - Antonio Facchiano
- Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Fondazione Luigi Maria Monti, via Monti di Creta 104, 00167, Rome, Italy.
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Magnano I, Pes GM, Pilurzi G, Cabboi MP, Ginatempo F, Giaconi E, Tolu E, Achene A, Salis A, Rothwell JC, Conti M, Deriu F. Exploring brainstem function in multiple sclerosis by combining brainstem reflexes, evoked potentials, clinical and MRI investigations. Clin Neurophysiol 2014; 125:2286-2296. [DOI: 10.1016/j.clinph.2014.03.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 02/24/2014] [Accepted: 03/09/2014] [Indexed: 10/25/2022]
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Brooks JBB, Jardim MR, Papais-Alvarenga RM, Fragoso YD. There is still a role for the blink reflex in the diagnosis and follow-up of multiple sclerosis. Clin Neurophysiol 2014; 126:743-7. [PMID: 25193750 DOI: 10.1016/j.clinph.2014.06.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 06/15/2014] [Accepted: 06/30/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The evolution of the diagnostic criteria for multiple sclerosis (MS) has essentially evolved to clinical manifestations and magnetic resonance imaging. Inexpensive, quick to apply, non-invasive, quantitative and reliable neurophysiological tests are rare in daily practice and absent in clinical trials. METHOD The blink reflex was assessed in 50 patients with remitting-relapsing MS (RRMS) and 100 matched controls. RESULTS Patients with RRMS had abnormalities in the blink reflex waves in relation to controls. If only RRMS patients were considered, these abnormalities were more pronounced in patients with longer disease duration, higher disability and for those with clinical or image lesions in the brainstem. CONCLUSION Neurophysiological tests, such as the blink reflex, can be used for helping the diagnosis and follow-up of patients with RRMS, since the reflex can identify dissemination in time and in space in a clear and quantitative manner. SIGNIFICANCE Potential good methods for diagnosis and follow-up of MS should be considered for clinical trials and daily practice.
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Affiliation(s)
- Joseph Bruno Bidin Brooks
- Department of Neurology, Universidade Metropolitana de Santos, SP, Brazil; Postgraduate Program in Neurology, Universidade Federal do Estado do Rio de Janeiro, RJ, Brazil
| | - Marcia Rodrigues Jardim
- Postgraduate Program in Neurology, Universidade Federal do Estado do Rio de Janeiro, RJ, Brazil
| | | | - Yara Dadalti Fragoso
- Department of Neurology, Universidade Metropolitana de Santos, SP, Brazil; Postgraduate Program in Neurology, Universidade Federal do Estado do Rio de Janeiro, RJ, Brazil.
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Abnormal control of orbicularis oculi reflex excitability in multiple sclerosis. PLoS One 2014; 9:e103897. [PMID: 25083902 PMCID: PMC4118978 DOI: 10.1371/journal.pone.0103897] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 07/07/2014] [Indexed: 11/20/2022] Open
Abstract
Brain lesions in patients with multiple sclerosis may lead to abnormal excitability of brainstem reflex circuits because of impairment of descending control pathways. We hypothesized that such abnormality should show in the analysis of blink reflex responses in the form of asymmetries in response size. The study was done in 20 patients with relapsing-remitting multiple sclerosis and 12 matched healthy subjects. We identified first patients with latency abnormalities (AbLat). Then, we analyzed response size by calculating the R2c/R2 ratio to stimulation of either side and the mean area of the R2 responses obtained in the same side. Patients with significantly larger response size with respect to healthy subjects in at least one side were considered to have abnormal response excitability (AbEx). We also examined the blink reflex excitability recovery (BRER) and prepulse inhibition (BRIP) of either side in search for additional indices of asymmetry in response excitability. Neurophysiological data were correlated with MRI-determined brain lesion-load and volume. Eight patients were identified as AbLat (median Expanded Disability Status Scale–EDSS = 2.75) and 7 of them had ponto-medullary lesions. Nine patients were identified as AbEx (EDSS = 1.5) and only 2 of them, who also were AbLat, had ponto-medullary lesions. In AbEx patients, the abnormalities in response size were confined to one side, with a similar tendency in most variables (significantly asymmetric R1 amplitude, BRER index and BRIP percentage). AbEx patients had asymmetric distribution of hemispheral lesions, in contrast with the symmetric pattern observed in AbLat. The brainstem lesion load was significantly lower in AbEx than in AbLat patients (p = 0.04). Asymmetric abnormalities in blink reflex response excitability in patients with multiple sclerosis are associated with lesser disability and lower tissue loss than abnormalities in response latency. Testing response excitability could provide a reliable neurophysiological index of dysfunction in early stages of multiple sclerosis.
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Degirmenci E, Erdogan C, Bir LS. Correlation between blink reflex abnormalities and magnetic resonance imaging findings in patients with multiple sclerosis. Acta Neurol Belg 2013; 113:265-9. [PMID: 23358960 DOI: 10.1007/s13760-012-0175-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 12/28/2012] [Indexed: 11/26/2022]
Abstract
This study investigates the correlation between brain magnetic resonance imaging findings and blink reflex abnormalities in patients with relapsing remitting multiple sclerosis. Twenty-six patients and 17 healthy subjects were included in this study. Blink reflex test (BRT) results were obtained using right and left stimulations; thus, 52 BRT results were recorded for the patient group, and 34 BRT results were recorded for the control group. The magnetic resonance imaging (MRI) findings were classified based on the existence of brainstem lesions (hyperintense lesion on T2 weighted (W) and fast fluid-attenuated inversion recovery MRI or contrast-enhancing lesion on T1W MRI). Correlation analysis was performed for the BRT and MRI findings. The percentage of individuals with abnormal BRT results (including R1 latency, ipsilateral R2 latency, and contralateral R2 latency) was significantly higher in the patient group as compared to the control group (p values: 0.015, 0.001, and 0.002, respectively). Correlation analysis revealed significant correlations between contralateral R2 latency abnormalities and brainstem lesions (p value: 0.011). Our results showed significant correlation correlations between contralateral R2 latency abnormalities and brainstem lesions and these results may be explained the effects of multiple demyelinating lesions of the brain stem of patients with relapsing remitting multiple sclerosis.
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Affiliation(s)
- Eylem Degirmenci
- Neurology Department, Faculty of Medicine, Pamukkale University, 90-20020, Denizli, Turkey.
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Electromyographic evaluation of blink reflex as a tool for early diagnosis of neurological dysfunction in patients of hypothyroidism. Ann Neurosci 2013; 20:95-8. [PMID: 25206024 PMCID: PMC4117124 DOI: 10.5214/ans.0972.7531.200304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 03/05/2013] [Accepted: 05/10/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Neurological dysfunction is an important consequence of hypothyroidism. Some of the neurologic manifestations of hypothyroidism include somnolence, lethargy, impaired memory and concentration, depression and entrapment neuropathy. Rarer but reversible neurological manifestations include cerebellar ataxia, psychosis, dementia and myxedema coma. PURPOSE The aim of the present study was to evaluate the usefulness of the blink reflex as a method for obtaining an early diagnosis of central nervous system dysfunction in hypothyroid patients who do not have signs or symptoms of nervous system dysfunction. METHODS Forty-eight patients with mean age 40 (± 11), with newly diagnosed primary hypothyroidism and 20 healthy control subjects were included in the study. The patients were divided into subclinical and overt hypothyroidism. Patients with normal T3/T4 with elevated TSH were considered subclinical hypothyroids. For blink reflex testing, subjects lay supine on a bed in a warm room with eyes gently closed. Recordings were performed with an EMG machine (Nihon Kohdeni'Neuropack), with a filter setting of 20 Hz to 10 kHz, using an analysis time of 50 ms. Recordings were performed with surface recording electrodes (Dantec 13K60, Copenhagen, Denmark). RESULTS Second ipsilateral response (R2I) and second contralateral response (R2C) latencies in hypothyroidism were prolonged relative to controls, and the differences were statistically significant (P<0.001 and P<0.001, respectively). Latency of Rl, R2I, and R2C did not correlate linearly free T3, free T4, or TSH values in the hypothyroid group. CONCLUSION The finding of abnormal blink reflex responses in hypothyroid individuals raises the notion that they may be useful in detecting early changes and in the follow-up of the patients with the disorder.
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Sternberg Z. Autonomic dysfunction: A unifying multiple sclerosis theory, linking chronic cerebrospinal venous insufficiency, vitamin D3, and Epstein-Barr virus. Autoimmun Rev 2012; 12:250-9. [DOI: 10.1016/j.autrev.2012.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 04/22/2012] [Indexed: 12/18/2022]
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Sympathetic skin response (SSR) in multiple sclerosis and clinically isolated syndrome: A case-control study. Neurophysiol Clin 2011; 41:161-71. [DOI: 10.1016/j.neucli.2011.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 05/10/2011] [Accepted: 08/15/2011] [Indexed: 11/18/2022] Open
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Lensch E, Jost WH. Autonomic disorders in multiple sclerosis. Autoimmune Dis 2011; 2011:803841. [PMID: 21603189 PMCID: PMC3096149 DOI: 10.4061/2011/803841] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Accepted: 02/24/2011] [Indexed: 11/20/2022] Open
Abstract
Multiple sclerosis is an inflammatory disease leading to disseminated lesions of the central nervous system resulting in both somatomotor and autonomic disturbances. These involve the central centers of the autonomic nervous system, as well as the automatic control and pathway systems. All autonomic functions may be disordered individually or in combined form. There is no other disease with a clinical picture so multifaceted. Besides cardiovascular dysfunctions disorders of bladder and rectum have become apparent. Somatomotor and autonomic disturbances occur with similar frequency; however the focused exam often heavily favors somatomotor symptoms. Autonomic disturbances should primarily be taken into account on history taking and clinical examination. Individual diagnosis and treatment is a secondary feature. Impairments of the autonomic nervous systems in multiple sclerosis are frequently overlooked.
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Affiliation(s)
- E. Lensch
- Department of Neurology, Deutsche Klinik für Diagnostik, Aukammallee 33, 65191 Wiesbaden, Germany
| | - W. H. Jost
- Department of Neurology, Deutsche Klinik für Diagnostik, Aukammallee 33, 65191 Wiesbaden, Germany
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Mikropoulos EH, Papathanasiou AA, Hadjigeorgiou G, Tsironi E, Papadimitriou A. Supratentorial multiple sclerosis lesions affect the blink reflex test. Open Neurol J 2010; 4:92-9. [PMID: 21347209 PMCID: PMC3043265 DOI: 10.2174/1874205x01004010092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 06/01/2010] [Accepted: 07/17/2010] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The Blink Reflex Test (BRT) is a neurophysiological examination used for evaluation of brainstem reflex circuits. MRI is the most precise modality for evaluation of MS lesion anatomy. Our study objective was to investigate how the functional results of the neurophysiological BRT relate to the anatomy of MS lesions in routine MRI studies. METHODS 65 MS patients underwent the BRT within 2 months of a brain MRI showing demyelinating lesions. RESULTS The overall sensitivity of the BRT was 90.8%, while in patients with at least one brainstem lesion and no brainstem lesions it was 91.4% and 90%, respectively. DISCUSSION The presence of brainstem lesions does not significantly affect BRT sensitivity. This points to the influence of supratentorial MS lesions on the BRT. Gender, age, disease duration, type of MS, acuteness of an MS event and whether MS diagnosis was recent or not were not variables affecting the results.
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Affiliation(s)
- Efthimios H Mikropoulos
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Thessaly, P.O. Box 1400, Mezourlo Hill, Larissa, Greece
| | - Afroditi A Papathanasiou
- Department of Biomathematics, Faculty of Medicine, School of Health Sciences, University of Thessaly, P.O. Box 1400, Mezourlo Hill, Larissa, Greece
| | - Georgios Hadjigeorgiou
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Thessaly, P.O. Box 1400, Mezourlo Hill, Larissa, Greece
| | - Evangelia Tsironi
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Thessaly, P.O. Box 1400, Mezourlo Hill, Larissa, Greece
| | - Alex Papadimitriou
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Thessaly, P.O. Box 1400, Mezourlo Hill, Larissa, Greece
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Fjeldstad C, Frederiksen C, Fjeldstad AS, Bemben M, Pardo G. Arterial Compliance in Multiple Sclerosis: A Pilot Study. Angiology 2009; 61:31-6. [DOI: 10.1177/0003319709334120] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A reduction in arterial compliance in patients with autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosus has been previously reported. It is caused by the effect that systemic inflammation has on the cardiovascular system. Multiple sclerosis (MS), an immune-mediated disease that exclusively affects the central nervous system (CNS), has a significant inflammatory component that is limited to that compartment. The potential effects of its inflammatory mediators in the cardiovascular system are largely unknown. Purpose: To examine large (C1) and small arterial compliance (C2) in patients with MS and compare them with healthy age-matched controls. To also determine whether any differences in C1 and C2 indices between participants diagnosed with relapsing remitting MS (RR-MS), secondary progressive MS (SP-MS), and controls exist. Methods: A total of 26 men and women between the ages of 18 and 64 diagnosed with MS and 25 healthy controls volunteered for this study. Arterial compliance was measured by using pulse contour analysis (PCA), which records and analyzes the blood pressure waveform data from the Arterial Pulse Wave Sensors. Results: Significant differences in C1 and C2 were found between young RR-MS and healthy young controls (P < .05), with the MS group showing lower arterial C1 and C2 compliance. No significant differences (P > .05) were seen for C1 or C2 values between older RR-MS, SP-MS, and healthy controls. Conclusion: Arterial compliance is significantly compromised in young individuals with MS, compared with age-matched controls, but not for older individuals, suggesting a systemic effect of an inflammatory process that predominantly affects the CNS.
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Affiliation(s)
- Cecilie Fjeldstad
- MS Center of Oklahoma, Mercy NeuroScience Institute, Oklahoma City, Oklahoma,
| | | | - Anette S. Fjeldstad
- Department of Medicine, Division of Geriatrics, University of Utah and GRECC, Utah
| | - Michael Bemben
- Department of Health and Exercise Science, University of Oklahoma, Norman, Oklahoma
| | - Gabriel Pardo
- MS Center of Oklahoma, Mercy NeuroScience Institute, Oklahoma City, Oklahoma
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Saari A, Tolonen U, Pääkkö E, Suominen K, Pyhtinen J, Sotaniemi KA, Jauhiainen J, Myllylä VV. Sympathetic skin responses in multiple sclerosis. Acta Neurol Scand 2008; 118:226-31. [PMID: 18355393 DOI: 10.1111/j.1600-0404.2008.01003.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study assessed the sympathetic skin responses (SSRs) and their correlation with brain lesion volumes in patients with multiple sclerosis (MS). MATERIALS AND METHODS The SSRs were measured in 27 patients with MS and 27 healthy controls. The volumes of the proton density-weighted MS lesions in the brain were measured using MRI. RESULTS The SSRs were abnormal in 52% of the patients with MS, but absent only in clinically severe MS. The total lesion volume in the whole brain correlated significantly with both the severity of MS expressed by the EDSS score (P < 0.001) and the decreased SSR amplitudes in the feet (P < 0.01). Focal lesion volumes in the temporal lobe (P < 0.01), in the pons (P < 0.01) and in the cerebellum (P < 0.01) were also separately associated with abnormal SSR reflexes. CONCLUSIONS Sudomotor regulation failure in MS is associated with certain focal MS lesions.
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Affiliation(s)
- A Saari
- Department of Neurology, Oulu University Hospital, Oulu, Finland.
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18
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Difficulties in the diagnosis of autonomic dysfunction in multiple sclerosis. Clin Auton Res 2007; 17:375-7. [DOI: 10.1007/s10286-007-0443-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Accepted: 08/22/2007] [Indexed: 10/22/2022]
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Nazliel B, Arikan Z, Irkeç C, Karakiliç H. SSR abnormalities in chronic alcoholics. Addict Behav 2007; 32:1290-4. [PMID: 16971049 DOI: 10.1016/j.addbeh.2006.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Revised: 07/16/2006] [Accepted: 08/11/2006] [Indexed: 10/24/2022]
Abstract
We performed sympathetic skin response (SSR) studies on 29 male patients diagnosed as chronic alcoholics according to DSM-IV criteria. The average age was 43 years and the mean duration of alcohol abuse was 21 years, with all patients having a history of alcohol abuse for a minimum of 4 years. None of the patients had any symptoms and/nor signs related to autonomic nervous system dysfunction and all demonstrated normal nerve conduction velocities. Hand and foot latencies in alcoholics were prolonged relative to controls and the difference was statistically significant: reflected by p values of 0.02 and 0.004, respectively. Forty-four percent of patients demonstrated abnormal results. The unilateral prolongation of the lower extremity latency was the most commonly found abnormality (24%). Finding abnormal SSR in this patient population has made us aware that SSR has the potential to detect subclinical autonomic nervous system dysfunction even in patients who do not have autonomic complaints or neuropathy and to provide information about a part of the peripheral nervous system small unmyelinated C fibers that can not be assessed by currently performed techniques used in clinical EMG laboratories or by physical examination.
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Affiliation(s)
- B Nazliel
- Faculty of Medicine, Department of Neurology, Gazi University, Ankara-Turkey.
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Nazliel B, Arikan Z, Irkeç C, Karakiliç H. Blink Reflex Abnormalities in Chronic Alcoholics. Eur Neurol 2004; 52:82-6. [PMID: 15273428 DOI: 10.1159/000079935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2003] [Accepted: 04/06/2004] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of the present study was to evaluate the efficacy of blink reflex as a method for obtaining early diagnosis of cranial nerve involvement in alcoholic patients. MATERIALS AND METHODS The study was conducted on 30 male alcoholics with a mean age of 43 years. They had histories of alcohol abuse for at least 6 years (mean: 25). At the time of recording, they had undergone detoxification treatment for a mean of 27 days. RESULTS R1 (early response), R2Y (second ipsilateral response), and R2C (second contralateral response) latencies in alcoholics were prolonged relative to controls and the differences were statistically significant (p < 0.02, p < 0.001, p < 0.001, respectively). According to the defined criteria, 40% of the patients had abnormal responses, and the most common abnormality was the unilateral prolongation of R1 (13%). CONCLUSION Finding abnormal blink reflex responses in alcoholic patients has suggested that blink reflex testing is a useful method for the evaluation of subclinical cranial nerve involvement in alcoholic patients. Blink reflex testing may be useful in detecting early changes and in the follow-up of alcoholic disorder.
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Affiliation(s)
- B Nazliel
- Department of Neurology-Psychiatry, Faculty of Medicine, Gazi University, Ankara, Turkey.
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