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Arslan BT, Görkem Özyurt M, İşak B, Cecen S, Türker KS. Single motor unit estimation of the cutaneous silent period in ALS. Clin Neurophysiol 2024; 157:110-119. [PMID: 38096766 DOI: 10.1016/j.clinph.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/08/2023] [Accepted: 11/16/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE Recent evidence indicated that amyotrophic lateral sclerosis (ALS) also impairs spinal circuits, including those mediating cutaneous silent period (CSP). However, most studies utilised surface electromyography (sEMG), which needs more resolution to pinpoint changes at the single motoneuron level. We aimed to investigate CSP properties using single motor unit discharges in ALS. METHODS In mild and severe ALS patients and controls, CSP was recorded in the first dorsal interosseus and analysed using the discharge rate method, which accurately shows the inhibitory postsynaptic potentials (IPSPs) profile. RESULTS Our findings confirmed that the CSP latency was prolonged only in severe ALS patients. Moreover, the CSP duration was similar in each group, but late-stage ALS patients tend to have a longer CSP duration. The discharge rate method revealed a significantly longer duration (up to 150 ms) than the duration detected using sEMG. Strikingly, the motoneuron discharge rate - IPSP duration inverse relationship is lost in ALS patients, indicating a possible impairment in the motoneuron integrative properties. CONCLUSIONS Our data support previous findings of prolonged latency, presented input-output modifications of motoneurons, and revealed the entire course of the CSP, representing a much stronger inhibitory event than previously thought. SIGNIFICANCE Motoneuron integrative property modification assessed by CSP could be a new biomarker for ALS.
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Affiliation(s)
| | - M Görkem Özyurt
- Department of Neuromuscular Diseases, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Barış İşak
- Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Serpil Cecen
- Health Science University, Hamidiye Medical Faculty, Istanbul, Turkey
| | - Kemal S Türker
- Istanbul Gelisim University, Faculty of Dentistry, Physiology, Istanbul, Turkey.
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Castro J, Swash M, de Carvalho M. The cutaneous silent period as a measure of upper motor neuron dysfunction in amyotrophic lateral sclerosis. Neurophysiol Clin 2023; 53:102843. [PMID: 36716610 DOI: 10.1016/j.neucli.2022.102843] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/17/2022] [Accepted: 12/17/2022] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES We investigated the cutaneous silent period (CutSP) as a measure of upper motor neuron (UMN) dysfunction in amyotrophic lateral sclerosis. METHODS The onset latency, duration, and amount of EMG suppression of the CutSP were compared with clinical UMN signs in 24 patients with amyotrophic lateral sclerosis (ALS). UMN signs were quantified using a clinical index and transcranial magnetic stimulation (TMS). Central motor conduction time (CMCT), cortical motor threshold and motor evoked potential amplitudes were assessed as measures of UMN dysfunction. CutSP was studied in abductor digit minimi (ADM) and tibialis anterior (TA) EMG recordings following stimulation of the 5th finger and sural nerves respectively. Non-parametric tests and binomial logistic regression were applied to evaluate the data. RESULTS CutSP onset latency was increased in ALS patients, compared to healthy controls, both for ADM and TA muscles. In limbs with clinical UMN signs or abnormal TMS findings, the CutSP onset latency was particularly increased. There was a significant positive correlation between CutSP onset latency and the UMN score in both upper and lower limbs. In TA muscles there was also a negative correlation between CutSP onset latency and EMG suppression. The logistic regression model based on CutSP parameters correctly classified more than 70% of the cases regarding the presence of clinical signs of UMN lesion, in both upper and lower limbs. The results were not significant for TMS. CONCLUSION We conclude that upper limb CutSP changes associates with UMN lesion in ALS. This neurophysiological measurement merits further investigation in ALS.
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Affiliation(s)
- José Castro
- Instituto de Fisiologia, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Department of Neurosciences and Mental Health, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal.
| | - Michael Swash
- Instituto de Fisiologia, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Departments of Neurology and Neuroscience, Barts and the London School of Medicine, Queen Mary University of London, United Kingdom
| | - Mamede de Carvalho
- Instituto de Fisiologia, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Department of Neurosciences and Mental Health, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
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Luigetti M, Di Paolantonio A, Guglielmino V, Romano A. Cutaneous silent period in ATTRv carriers: a possible early marker of nerve damage? Neurol Sci 2022; 43:6979-82. [PMID: 35943637 DOI: 10.1007/s10072-022-06317-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/02/2022] [Indexed: 02/03/2023]
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Boček V, Krbec M, Vaško P, Brabec K, Pavlíková M, Štětkářová I. Alteration of cortical but not spinal inhibitory circuits in idiopathic scoliosis. J Spinal Cord Med 2022; 45:186-193. [PMID: 32202478 PMCID: PMC8986185 DOI: 10.1080/10790268.2020.1739893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Background: The pathogenesis of adolescent idiopathic scoliosis (AIS), including the role of brain and spinal inhibitory circuits, is still poorly elucidated. The aim of this study was to identify which central inhibitory mechanisms are involved in the pathogenesis of AIS.Design: A prospective neurophysiological study, using a battery of neurophysiological tests, such as cutaneous (CuSP) and cortical (CoSP) silent periods, motor evoked potentials (MEP) and paired-pulse transcranial magnetic stimulation (ppTMS).Settings: Neurophysiological laboratory.Participants: Sixteen patients with AIS (14 females, median age 14.4) and healthy controls.Outcome measures: MEPs were obtained after transcranial magnetic stimulation (TMS) and recorded from the abductor pollicis muscle (APB). ppTMS was obtained at interval ratios (ISI) of 1, 2, 3, 6, 10, 15 and 20 ms. The cortical silent period (CoSP) was recorded from the APB. The cutaneous silent period (CuSP) was measured after painful stimuli delivered to the thumb while the subjects maintained voluntary contraction of the intrinsic hand muscles. The data were analyzed and compared with those from healthy subjects.Results: The CoSP duration was significantly prolonged in AIS patients. A significantly higher amplitude of ppTMS for ISI was found in all AIS patients, without remarkable left-right side differences. No significant difference in MEP latency or amplitude nor in the CuSP duration was obtained.Conclusion: Our observation demonstrates evidence of central nervous system involvement in adolescent idiopathic scoliosis (AIS). Lower intracortical inhibition, higher motor cortex excitability, and preserved spinal inhibitory circuits are the main findings of this study. A possible explanation of these changes could be attributed to impaired sensorimotor integration predominantly at the cortical level.
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Affiliation(s)
- Václav Boček
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic,Correspondence to: Václav Boček, Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Ruska 87, 100 00Prague 10, Czech Republic.
| | - Martin Krbec
- Department of Orthopedics and Traumatology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Peter Vaško
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Karel Brabec
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic,Department of Orthopedics and Traumatology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Markéta Pavlíková
- Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University, Prague, Czech Republic
| | - Ivana Štětkářová
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
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Yusifov M, Alpaydin Baslo S, Tekin B, Erdogan M, Ozturk O, Atakli D. Metabolic syndrome and anthropometric indices in CTS hands: an electrophysiological study. Neurol Sci 2022; 43:1375-1384. [PMID: 34245382 DOI: 10.1007/s10072-021-05430-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/19/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION This study aims to evaluate the effect of metabolic syndrome (MetS) and anthropometric indices on carpal tunnel syndrome (CTS). METHODS Forty-three healthy controls and 41 CTS patients were enrolled. Complaints of patients were assessed by Boston Questionnaire (BQ). MetS components were investigated. Wrist circumference, wrist depth, wrist width, palm width, and palm length were measured. Routine nerve conduction studies of median and ulnar nerves as well as the "sensitive" comparison tests were performed. Cutaneous silent period (CuSP) was studied by stimulating both second and fifth digital nerves while recording over thenar muscles. RESULTS The vast majority of the participants were female and right-handed. CTS was bilateral in 61% of patients. Data of 109 hands were analyzed. MetS was more frequent in CTS patients. BQ scores were not related to MetS. Waist circumference, serum TG, and fasting glucose levels were higher in CTS patients. CTS hands with MetS had lower median CMAP amplitudes and increased sensory thresholds. Sensory thresholds were increased with both median and ulnar nerve stimulations suggesting a wider spread of peripheral nerve excitability changes in MetS presence. CuSPs were recorded from all 109 hands. CuSP latencies and durations were similar between controls and CTS patients. Wrist ratio was the only anthropometric index that was a statistically significant predictor for CTS development. CONCLUSION MetS was more prevalent in CTS patients. Some clinical and electrophysiological features (mainly sensory thresholds) may worsen in presence of MetS, but not the wrist ratio.
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Affiliation(s)
- Mahir Yusifov
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic, and Neurosurgical Diseases, University of Health Sciences, Zuhuratbaba mah, Dr. Tevfik Sağlam cad. No: 25/2, 34147, Bakırköy, Istanbul, Turkey
| | - Sezin Alpaydin Baslo
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic, and Neurosurgical Diseases, University of Health Sciences, Zuhuratbaba mah, Dr. Tevfik Sağlam cad. No: 25/2, 34147, Bakırköy, Istanbul, Turkey.
| | - Betül Tekin
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic, and Neurosurgical Diseases, University of Health Sciences, Zuhuratbaba mah, Dr. Tevfik Sağlam cad. No: 25/2, 34147, Bakırköy, Istanbul, Turkey
| | - Mucahid Erdogan
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic, and Neurosurgical Diseases, University of Health Sciences, Zuhuratbaba mah, Dr. Tevfik Sağlam cad. No: 25/2, 34147, Bakırköy, Istanbul, Turkey
| | - Oya Ozturk
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic, and Neurosurgical Diseases, University of Health Sciences, Zuhuratbaba mah, Dr. Tevfik Sağlam cad. No: 25/2, 34147, Bakırköy, Istanbul, Turkey
| | - Dilek Atakli
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic, and Neurosurgical Diseases, University of Health Sciences, Zuhuratbaba mah, Dr. Tevfik Sağlam cad. No: 25/2, 34147, Bakırköy, Istanbul, Turkey
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Abdulhadi IG, Al-Mahdawi AM, Hamdan FB. Electrophysiological findings in patients with restless legs syndrome. Sleep Med 2021; 87:151-157. [PMID: 34610569 DOI: 10.1016/j.sleep.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/02/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Restless legs syndrome (RLS) manifests as an urge to move the body to relieve the discomfortable sensations, primarily when resting, sitting, laying down, or sleeping. Diagnosis of RLS relies on clinical criteria, and the immobilization test was the only instrumental tool with equivocal results. OBJECTIVES To assess different electrophysiological findings in patients with RLS, and compare the diagnostic values of these parameters in the diagnosis of RLS. METHODS 30 patients with primary RLS and 30 controls who were matched for age and gender were studied. Participant's demographics, laboratory findings, and electrophysiological test, namely nerve conduction studies (NCS), cutaneous silent period (CSP), H reflex and sympathetic skin response (SSR), F-wave latency, amplitude, F-wave duration (FWD), and the ratio between FWD and duration of the corresponding compound muscle action potential (FWD/CMAPD) were analyzed. RESULTS None of the patients showed altered NCS data. FWD of upper (12.37 ± 2.77 ms) and lower limb (21.71 ± 5.24 ms) were significantly longer in patients. Also, FWD/CMAP duration of the upper (1.03 ± 0.2) and lower limb (2.02 ± 0.55) was longer in patients. Likewise, they exhibited delayed CSP latency from TA (110.62 ± 13.73 ms) and APB (77.35 ± 12.16 ms) whereas the CSP duration from TA and APB was decreased (37.36 ± 11.59 ms; 42.55 ± 7.97 ms, respectively). The SSR latency was not different, and right-sided H reflex amplitude (5.07 ± 3.98 mV) and H/M ratio (0.65 ± 1.81) were significantly increased in the patient group. CONCLUSION The data suggest that there may be a dysfunction of the inhibitory/excitatory circuits at a spinal level; and no pathology in the peripheral nerves. The unilateral difference of H reflex amplitude and H/M ratio may suggest asymmetrical central inhibitory dysfunction. Further prospective studies with larger cohorts are now needed to evaluate the pathophysiology of RLS with different neurophysiological assessment tools.
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Affiliation(s)
| | | | - Farqad Bader Hamdan
- Department of Physiology, College of Medicine, Al-Nahrain University, Baghdad, Iraq.
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Isak B, Tankisi H, Pugdahl K, Ventzel L, Finnerup NB, Fuglsang-Frederiksen A. Neurophysiologic assessment of small fibre damage in chemotherapy-induced peripheral neuropathy. Clin Neurophysiol 2021; 132:1947-56. [PMID: 34034962 DOI: 10.1016/j.clinph.2021.02.406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 02/16/2021] [Accepted: 02/28/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE In patients with chemotherapy-induced peripheral neuropathy (CIPN), demonstration of small fibre (SF) damage is important to understand chronic late effects. METHODS Thirty patients having complaints compatible with possible CIPN following treatment with oxaliplatin or docetaxel were compared with 27 healthy subjects. All subjects were evaluated with quantitative sensory testing (QST) assessing SF function and laser evoked potentials (LEP). In addition, SF-damage was assessed using cutaneous silent periods evoked with electrical (El-CSP) and laser (Ls-CSP) stimuli. RESULTS For LEP, N2P2 amplitudes were significantly smaller in patients than controls in both upper (P = 0.007) and lower extremities (P = 0.002), and the N1 amplitude in upper extremities of patients were significantly smaller than in controls (P = 0.001). SF-QST, LEP, Ls-CSP, and El-CSP were abnormal in 10 (33.3%), 16 (53.3%), 19 (63.3%), and 24 (80%) of CIPN patients, respectively. CONCLUSIONS In patients with possible CIPN, El-CSP and Ls-CSP were more often abnormal than LEP and QST. This is probably because El-CSP and Ls-CSP inform mainly about peripheral nociceptive fibres, while LEP and QST inform about peripheral and central nociceptive pathways together. SIGNIFICANCE LEP and QST are established methods to detect SF-damage. El- and Ls-CSP might help clinicians in diagnosing SF-damage.
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Castro J, Swash M, de Carvalho M. The cutaneous silent period in motor neuron disease. Clin Neurophysiol 2020; 132:660-665. [PMID: 33358125 DOI: 10.1016/j.clinph.2020.10.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/07/2020] [Accepted: 10/27/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the cutaneous silent period (CSP) by measuring its onset latency, duration and amount signal suppression in patients with motor neuron disease (MND) grouped according to the intensity of upper motor neuron involvement (UMN), and to test the effect of contralateral hand contraction. METHODS Painful stimulation was applied at the V finger, and contraction recorded from the abductor digiti minimi (ADM) muscle (baseline condition). Afterwards, CSP was studied during strong contralateral ADM contraction (test condition). 10-15 consecutive traces were recorded for each condition, signals were rectified, averaged, and analyzed offline. RESULTS 46 patients were investigated, 15 with progressive muscular atrophy (PMA), 16 with typical amyotrophic lateral sclerosis (ALS), 15 with primary lateral sclerosis/predominant UMN-ALS (PLS+UMN-ALS), and 28 controls. In the baseline condition, all MND groups showed delayed onset latencies (p = 0.001). There was no significant difference in the CSP duration. Suppression was lower in the PLS + UMN-ALS group (p = 0.004). In the control group, contralateral contraction did not change CSP, but onset latency shortened significantly in the PMA group. CONCLUSIONS CSP onset latency is delayed in all investigated groups of MND, including in PMA, indicating subclinical UMN involvement. Changes in CSP can indicate UMN lesion in MND. SIGNIFICANCE CSP should be explored to identify UMN involvement in MND.
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Affiliation(s)
- José Castro
- Instituto de Fisiologia, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Department of Neurosciences and Mental Health, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Michael Swash
- Instituto de Fisiologia, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Departments of Neurology and Neuroscience, Barts and the London School of Medicine, Queen Mary University of London, United Kingdom
| | - Mamede de Carvalho
- Instituto de Fisiologia, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Department of Neurosciences and Mental Health, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
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Gunduz A, Kofler M, Aktan Suzgun M, Tutuncu M, Karaali-Savrun F, Uzun N, E Kızıltan M. Cutaneous silent period in patients with spinal muscular atrophy type 2 and type 3. Neurophysiol Clin 2020; 50:353-359. [PMID: 32951956 DOI: 10.1016/j.neucli.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine cutaneous silent periods (CSPs) in spinal muscular atrophy (SMA) type 2 and type 3 patients. METHODS Fourteen patients with SMA and 14 healthy subjects were included. CSPs were recorded from thenar muscles after painful stimulation of the index finger during slight thumb abduction. CSP parameters (including onset latency, duration, index of suppression, long-loop reflex, and post-inhibitory rebound activity) were measured. All parameters were compared between SMA patients and healthy subjects using the Mann-Whitney U test. We then correlated CSP parameters to Hammersmith Functional Motor Scale Expanded (HFMSE) scores in SMA patients by Spearman-rho testing. RESULTS No CSP parameter except E3% (i.e., the post-inhibitory rebound activity relative to pre-stimulus baseline) differed significantly between SMA patients and healthy subjects. E3% was significantly smaller in patients than healthy individuals. HFMSE scores of SMA patients correlated negatively with CSP duration and positively with E3%. DISCUSSION Smaller E3%, correlating with longer CSP duration, in SMA patients with more severe clinical findings and therefore more marked motoneuron loss suggests that the E3 component following the CSP is directly affected by motoneuron loss.
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Affiliation(s)
- Aysegul Gunduz
- Istanbul University- Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, Turkey.
| | - Markus Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Merve Aktan Suzgun
- Istanbul University- Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, Turkey
| | - Melih Tutuncu
- Istanbul University- Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, Turkey
| | - Feray Karaali-Savrun
- Istanbul University- Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, Turkey
| | - Nurten Uzun
- Istanbul University- Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, Turkey
| | - Meral E Kızıltan
- Istanbul University- Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, Turkey
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Gündüz A, Ayas S, Kofler M, Aydın Ş, Kızıltan ME. Modulation of the excitatory phase following the cutaneous silent period by vibration. Neurol Sci 2020; 42:633-637. [PMID: 32648049 DOI: 10.1007/s10072-020-04557-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The post-inhibition excitatory phase (E3) of the cutaneous silent period (CSP) is attributed to the resynchronization of motoneuron activity following the inhibitory period but there is also evidence that a somatosensory startle reflex may contribute to this phase. We hypothesized that the startle reflex component contained in E3 will decrease during vibration. METHODS Sixteen healthy individuals were included in the study. CSP was recorded from slightly contracted right thenar muscles after painful index finger stimulation, before, during, and immediately after vibration. The values of the percentage change of E3 relative to pre-stimulus baseline (E3%) were compared before, during, and after vibration for each individual. RESULTS There was a reduction in E3% during vibration and the values returned to normal immediately after vibration (153.1 ± 43.5%, 115.2 ± 30.2%, 154.9 ± 68.2%, respectively; p = 0.030). DISCUSSION E3 is reduced during vibration in healthy individuals, presumably due to suppression of a reflex component, which is superimposed upon the known resynchronization of motoneurons.
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Affiliation(s)
- Ayşegül Gündüz
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Selahattin Ayas
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Markus Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Şenay Aydın
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Meral Erdemir Kızıltan
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Tekatas A, Tekatas DD, Solmaz V, Karaca T, Pamuk ON. Small fiber neuropathy and related factors in patients with systemic lupus erythematosus; the results of cutaneous silent period and skin biopsy. Adv Rheumatol 2020; 60:31. [PMID: 32503623 DOI: 10.1186/s42358-020-00133-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 05/27/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Evaluating small nerve fibers in patients with systemic lupus erythematosus (SLE) using cutaneous silent period (CSP) and skin biopsy and assesssing the relationship between clinical signs, autoantibodies and neuropathic pain score. OBJECTIVE - METHODS Fifty one SLE patients and 46 healthy volunteers were included in this study. Nerve conduction studies and CSP were performed both on upper and lower limbs in subjects. Skin biopsy was performed and the number of epidermal nerve density and IL-6 staining were evaluated. RESULTS In SLE patients, CSP latencies were significantly prolonged both in lower and upper limbs and lower and upper extremity CSP durations were significantly shorter when compared to controls (p < 0.001). The number of epidermal nerve was significantly lower in SLE patients when compared to healthy controls (p < 0.001). CONCLUSION We detected marked small nerve fiber damage in both lower and upper limbs in SLE patients using CSP. Decreased epidermal nerve density also supports this finding.
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Affiliation(s)
- Aslan Tekatas
- Department of Neurology, Medikent Hospital, Kırklareli, Turkey
| | | | - Volkan Solmaz
- Department of Neurology, Memorial Hizmet hospital, 34100, İstanbul, Turkey.
| | - Turan Karaca
- Department of Histology, Trakya University Medical Faculty, Edirne, Turkey
| | - Omer Nuri Pamuk
- Department of Internal Medicine, Division of Rheumatology, Trakya University Medical Faculty, Edirne, Turkey
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Kenis-Coskun O, Giray E, Gunduz OH, Akyuz G. The effect of vitamin D replacement on spinal inhibitory pathways in women with chronic widespread pain. J Steroid Biochem Mol Biol 2020; 196:105488. [PMID: 31589918 DOI: 10.1016/j.jsbmb.2019.105488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/05/2019] [Accepted: 09/30/2019] [Indexed: 12/11/2022]
Abstract
Vitamin D replacement helps in pain reduction in patients with chronic widespread pain (CWP). But the current literature lack studies that investigate its mechanism. Cutaneous silent period (CSP) is the electrophysiologic analog of the spinal inhibitory pathways and an objective method to document their involvement. This study aims to show if vitamin D replacement has an effect on the spinal inhibitory pathways through CSP parameters. Female patients who have CWP with vitamin D deficiency were included. Patients received an 8-week replacement therapy of vitamin D. Patients' pain were evaluated using the visual analog scale (VAS) and Leeds assessment of neuropathic symptoms and signs pain scale (LANSS). Quality of life with Nottingham Health Profile (NHP) and CSP parameters were also recorded before and after treatment. A total of 51 patients were included in the final analyses. The mean age of the patients was 44.3 ± 12.7 (minimum 18-maximum 65). Mean symptom duration was 13.1 ± 6.7 (minimum3-maximum 24) months. Patients' mean BMI was 21.6 ± 3.9 (minimum 18.0 maximum 29.1). Patients' median VAS and LANSS scores decreased significantly (p < 0.01) and NHP scores improved significantly in all subsets (p < 0.01). Vitamin D replacement did not significantly change CSP latency and duration (p = 0.06 and p = 0.12).Vitamin D replacement does not seem to work via modifying the spinal inhibitory pathways that are involved in the formation of the cutaneous silent period. This is the first study to objectively investigate the effect of vitamin D replacement on central sensitization mechanisms.
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Affiliation(s)
- Ozge Kenis-Coskun
- Marmara University Medical Faculty Physical Medicine and Rehabilitation Department, Turkey.
| | - Esra Giray
- Marmara University Medical Faculty Physical Medicine and Rehabilitation Department, Turkey
| | - Osman Hakan Gunduz
- Marmara University Medical Faculty Physical Medicine and Rehabilitation Department, Turkey
| | - Gulseren Akyuz
- Marmara University Medical Faculty Physical Medicine and Rehabilitation Department, Turkey
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Stokic DS, Kofler M, Stetkarova I, Leis AA. Exteroceptive suppression of voluntary activity in thenar muscles by cutaneous stimulation: How many trials should be averaged? Clin Neurol Neurosurg 2019; 184:105452. [PMID: 31377674 DOI: 10.1016/j.clineuro.2019.105452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/19/2019] [Accepted: 07/21/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine a minimum number of trials that preserve input-output (I-O) properties of duration and magnitude of exteroceptive EMG suppression (eEMGs). PATIENTS AND METHODS eEMGs was recorded in 16 healthy subjects from thenar muscles following index finger stimulation at 2.5, 5, 10, and 20 times sensory threshold (xST). Individual trials were rectified and incrementally averaged in blocks of 5, 10, 20, 30, 40, 50, and 60. To determine if the block size affects I-O properties, the goodness of curve fit parameter R2 for each block was compared to R2 of the global function across all blocks combined. RESULTS eEMGs was found in all subjects at 10xST and 20xST (100%, respectively) but less often at 5xST (63-75%) and 2.5xST (25-56%). A quadratic function best described both duration and magnitude of eEMGs. The quadratic R2 did not significantly differ between any individual block function (5-60) and the global function (eEMGs duration 0.647-0.704 vs 0.679; magnitude 0.525-0.602 vs 0.560, respectively). CONCLUSIONS Averaging 5 trials consistently shows eEMGs at and above 10xST. I-O properties of eEMGs do not differ whether 5 or up to 60 trials are averaged. Clinical studies of eEMGs in thenar muscles are possible with as few as 5 trials averaged.
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Fava E, Kofler M, Saltuari L. Reversible cutaneous silent period abnormalities in vitamin B12 deficiency: A case report. Clin Neurophysiol Pract 2019; 4:128-132. [PMID: 31249907 PMCID: PMC6586985 DOI: 10.1016/j.cnp.2019.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/29/2019] [Accepted: 05/15/2019] [Indexed: 11/30/2022] Open
Abstract
Polyneuropathy is a frequent neurological manifestation of B12 hypovitaminosis. Thin-myelinated A-delta fibers may be affected in B12 hypovitaminosis. CSP testing is a useful diagnostic tool for A-delta fiber function in B12 deficiency.
Objectives Vitamin B12 deficiency is common in adult and elderly patients and is often underdiagnosed because of its polymorphous manifestations. Neurological symptoms of this condition include subacute combined degeneration and polyneuropathy, with possible affection of thin-myelinated A-delta fibers. Cutaneous silent periods (CSPs) may serve to test small-diameter fiber function non-invasively, using routine electrodiagnostic equipment, but to the best of our knowledge have not been studied so far in vitamin B12 deficiency. Methods We report a 49-year-old male patient suffering from B12 hypovitaminosis due to autoantibodies against gastric parietal cells, who underwent neurophysiological investigation to confirm clinically suspected polyneuropathy during the first month of intramuscular vitamin B12 supplementation. We performed standard electroneurography, needle electromyography in tibialis anterior muscle, quantitative sensory testing, and cutaneous silent periods six months after symptom onset and repeated the electrodiagnostic study 21 months later, after intramuscular vitamin B12 supplementation. Results Standard electroneurography demonstrated axonal sensory polyneuropathy. Needle electromyography (EMG) in tibialis anterior muscle was unremarkable. Cutaneous silent periods in tibialis anterior muscle after noxious electrical sural nerve stimulation were delayed, with incomplete EMG suppression concurring with dysfunction of thin-myelinated A-delta fibers. Quantitative sensory testing revealed altered cold and warm perception thresholds in both upper limbs, but normal values in both lower limbs. A follow-up electrodiagnostic study after 21 months intramuscular vitamin B12 supplementation revealed improvement of all neurophysiological findings, including normalization of cutaneous silent periods. Conclusions Thin-myelinated A-delta fibers may be affected in B12 hypovitaminosis and may show recovery after intramuscular vitamin B12 supplementation. CSP may serve to diagnose small fiber affection in this medical condition and to monitor their recovery after vitamin supplementation. Significance CSP testing represents a useful, non-invasive, rapidly available diagnostic and follow-up tool in vitamin B12 deficiency.
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Affiliation(s)
- Elena Fava
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Markus Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
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15
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Aydın Ş, Kofler M, Bakuy Y, Gündüz A, Kızıltan ME. Effects of vibration on cutaneous silent period. Exp Brain Res 2019; 237:911-918. [PMID: 30659303 DOI: 10.1007/s00221-018-05463-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 12/21/2018] [Indexed: 12/14/2022]
Abstract
Suppression of an ongoing muscle contraction following noxious digital stimulation is called cutaneous silent period (CSP) which is under the influence of several physiological factors. In this study, we aimed to evaluate the influence of group Ia afferents on the cutaneous silent period (CSP) by applying 2-min vibration. CSP was obtained from abductor pollicis brevis muscle after stimulating index finger. The recordings were repeated three times-before, during and after vibration-which was applied over the tendon of flexor carpi radialis muscle. Onset latency, duration and magnitude of total CSP, inhibitory phases I1 and I2, and of the long-loop reflex were measured and compared. Suppression indices of CSP, I1 and I2 increased significantly during and after vibration, indicating significantly less exteroceptive EMG suppression outlasting the time of vibration. Vibration also caused mild shortening of I2 end latency (p = 0.048) and I2 duration (p = 0.019). Our findings indicate that vibration exerts a powerful influence on CSPs and causes reduction in the magnitude of exteroceptive EMG suppression during and after vibration. Although vibration is known to activate Ia afferents, we cannot exclude contribution of other afferents, e.g. mechanoreceptors, as well as pre- or postsynaptic inhibitory effects on ensuing interneurons, or enhanced vibration-related excitatory influence.
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Affiliation(s)
- Şenay Aydın
- Department of Neurology, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul, Turkey. .,Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Markus Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Yeliz Bakuy
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ayşegül Gündüz
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Meral E Kızıltan
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Abstract
OBJECTIVE Brachial plexus injuries are usually severe and involve the entire brachial plexus, sometimes occurring with root avulsions. Imaging and electrodiagnostic studies are an essential part of the lesion evaluation; however, the results sometimes show a discrepancy. The cutaneous silent period (SP) is a spinal inhibitory reflex mediated by small-diameter A-delta nociceptive fibers. The aim of the study was to determine if cutaneous SP testing may serve as a useful aid in evaluation of brachial plexus injury and/or in the diagnosis of root avulsion. METHODS In 19 patients with traumatic brachial plexus injury (15 males, age 18-62 years) we performed a clinical examination, CT myelography and neurophysiological testing. A needle EMG was obtained from muscles supplied by C5-T1 myotomes. Cutaneous SP was recorded after painful stimuli were delivered to the thumb (C6 dermatome), middle (C7) and little (C8) fingers while subjects maintained voluntary contraction of intrinsic hand muscles. RESULTS Electrodiagnostic and imaging studies confirmed root avulsion (partial or total) maximally involving C5, C6 roots in 12 patients, whereas only in 4 of them the cutaneous SP was partially absent. In the remaining subjects, the cutaneous SP was preserved. CONCLUSION In brachial plexopathy even with plurisegmental root avulsion, the cutaneous SP was mostly preserved. This method cannot be recommended as a reliable test for diagnosis of single root avulsion; however, it can provide a quick physiological confirmation of functional afferent A-delta fibers through damaged roots and/or trunks. The clinicians may add this test to the diagnosis of spinal cord dysfunction.
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Affiliation(s)
- Peter Vasko
- Department of Neurology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vaclav Bocek
- Department of Neurology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Libor Mencl
- Department of Neurosurgery, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pavel Haninec
- Department of Neurosurgery, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ivana Stetkarova
- Department of Neurology, Third Faculty of Medicine, Charles University, Prague, Czech Republic,Correspondence to: Ivana Stetkarova, Head of Department of Neurology, Third Faculty of Medicine, Charles University of Prague, Ruska 87, Prague 10, Czech Republic, 100 00.
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Sonkaya AR, Şenol MG, Demir S, Özdağ FM. The investigation into the cutaneous silent period in patients with essential tremor pre-treatment and post-treatment. Acta Neurol Belg 2016; 116:583-588. [PMID: 26668015 DOI: 10.1007/s13760-015-0580-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 11/30/2015] [Indexed: 11/29/2022]
Abstract
Although essential tremor (ET) is the most common movement disorder, little is known regarding its pathophysiology. Cutaneous silent period (CSP) is a spinal inhibitory reflex that causes suppression of the voluntary muscle contraction that is induced by strong electrical stimulation of the cutaneous nerves. Clinical interest in the CSP stems from its potential usefulness for evaluating segment and components of sensory nerves that are not well assessed by standard electrodiagnostic methods. The aim of this study was to investigate CSP in patients with ET before and after treatment. A total of 30 patients (12 females + 18 males), having ET diagnosis and propranolol treatment initiated, were studied with technique of CSP. Patient group's pre-treatment latency average is found 84.45 ± 18.63, average CSP duration 42.37 ± 11.82, and CSP final latency average 127.10 ± 19.13. According to post-treatment CSP analysis, it is seen that patients' average latency values are found 83.14 ± 20.92 and it is determined that there is no significant statistical difference compared to pre-treatment latency values (p > 0.05). Post-treatment average CSP duration is found 36.64 ± 13.38, and it is seen that there is a significant statistical shortening compared to pre-treatment durations (p < 0.05). Patients' post-treatment CSP final latency averages are found 123.17 ± 13.67, and it is determined that there is no significant statistical difference compared to pre-treatment latency values (p > 0.05). The main finding of this study is that in ET the CSP is prolonged and that treatment with propranolol shortens the CSP and brings it closer to normal values. A small dose of propranolol has the effect of shortening pathologically prolonged CSP in a subset of ET patients (women and without family history), making further investigations with this method interesting. From this point of view in our study, patients with ET treatment give an idea of the effectiveness of propranolol. In recent years, a technique of CSP is interested in the field of electrophysiology and shows the effect of ET that given other pharmacological treatment and also it can be considered a quantitative measure to compare them. The usefulness of CSP should be supported by further studies with more patients.
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Affiliation(s)
- Ali Riza Sonkaya
- Department of Neurology, Erzurum Mareşal Çakmak Military Hospital, Erzurum, Turkey.
| | - Mehmet Güney Şenol
- Department of Neurology, GATA Haydarpaşa Training Hospital, Istanbul, Turkey
| | - Serkan Demir
- Department of Neurology, GATA Haydarpaşa Training Hospital, Istanbul, Turkey
| | - Fatih Mehmet Özdağ
- Department of Neurology, GATA Haydarpaşa Training Hospital, Istanbul, Turkey
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Cogez J, Etard O, Derache N, Defer G. Cutaneous and Mixed Nerve Silent Period Recordings in Symptomatic Paroxysmal Kinesigenic Dyskinesia. Open Neurol J 2016; 10:9-14. [PMID: 27330574 PMCID: PMC4891988 DOI: 10.2174/1874205x01610010009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/01/2014] [Accepted: 12/11/2014] [Indexed: 11/22/2022] Open
Abstract
Objective: The underlying neurophysiologic mechanism responsible for secondary paroxysmal kinesigenic
dyskinesia (PKD) is still unclear. Here, we study the pathogenesis of PKD in two patients with a
demyelinating lesion in the spinal cord. Methods: Electromyogram recordings from affected arms of
two patients with spinal cord lesions presenting PKD were compared with our laboratory standards.
The cutaneous silent period (CuSP), mixed nerve silent period (MnSP) and coincidence period (CiP), defined
as the common period between the CuSP and MnSP, were recorded. Results: A large decrease in the MnSP and disappearance
of the CiP were observed in our patients, which was secondary to simultaneous extinction of the third portion of the MnSP,
while the CuSP was normal. The MnSP and CiP were normal after recovery. Conclusions: Our results demonstrate that the third portion
of the MnSP and the CuSP do not correspond to the same physiologic process.
These findings suggest that PKD patients have abnormal spinal interneuron integration.
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Affiliation(s)
- Julien Cogez
- CHU de Caen, Service de Neurologie, CHU de Caen, Caen, F-14000, France
| | - Olivier Etard
- CHU de Caen, Service D'explorations Fonctionnelles du Systeme Nerveux, Caen, F-14000, France; Université de Caen Basse-Normandie, UFR de Médecine, Caen, F-14000, France
| | - Nathalie Derache
- CHU de Caen, Service de Neurologie, CHU de Caen, Caen, F-14000, France; INSERM, INSERM U923, CHU de Caen, Caen, F-14000, France
| | - Gilles Defer
- CHU de Caen, Service de Neurologie, CHU de Caen, Caen, F-14000, France
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Lopergolo D, Isak B, Gabriele M, Onesti E, Ceccanti M, Capua G, Fionda L, Biasiotta A, Di Stefano G, La Cesa S, Frasca V, Inghilleri M. Cutaneous silent period recordings in demyelinating and axonal polyneuropathies. Clin Neurophysiol 2014; 126:1780-9. [PMID: 25497713 DOI: 10.1016/j.clinph.2014.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 11/11/2014] [Accepted: 11/15/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate the cutaneous silent period (CSP), a spinal inhibitory reflex mainly mediated by A-delta fibres, in demyelinating and axonal polyneuropathy (PNP) and evaluate whether CSP parameters differ between patients with and without neuropathic pain. METHODS Eighty-four patients with demyelinating PNP, 178 patients with axonal PNP and 265 controls underwent clinical examination, DN4 questionnaire, standard nerve conduction study, motor-root stimulation and CSP recordings from abductor digiti minimi. We calculated the afferent conduction time of CSP (a-CSP time) with the formula: CSP latency-root motor evoked potential latency. RESULTS In the demyelinating PNP group the a-CSP time was significantly longer; in the axonal PNP group, CSP duration was shorter than the demyelinating group (p=0.010) and controls (p=0.001). CSP parameters were not different between patients with and without neuropathic pain. CONCLUSIONS The abnormality of a-CSP time in the demyelinating PNP group suggests the crucial role of A-delta fibres in the mechanism of CSP; the shorter CSP duration in the axonal PNP group supports the strong influence of the number of axons on this parameter. Our study suggests that neuropathic pain could be related to pathophysiological mechanisms differing from mere A-delta fibre loss. SIGNIFICANCE CSP evaluation is effective in detecting A-delta fibre dysfunction in axonal as well as demyelinating PNP.
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Affiliation(s)
- Diego Lopergolo
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Baris Isak
- Marmara University Hospital School of Medicine, Department of Neurology, Fevzi Cakmak Mah. Mimar Sinan Cad. No: 41, 34899 Ust Kaynarca/Pendik, Istanbul, Turkey; Department of Clinical Neurophysiology, Aarhus Universitets hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Maria Gabriele
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Emanuela Onesti
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Marco Ceccanti
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Gelsomina Capua
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Laura Fionda
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Antonella Biasiotta
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Giulia Di Stefano
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Silvia La Cesa
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Vittorio Frasca
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Maurizio Inghilleri
- Department of Neurology and Psychiatry, University "Sapienza", Viale dell'Università 30, 00185 Rome, Italy.
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Kofler M, Valls-Solé J, Vasko P, Boček V, Štetkárová I. Influence of limb temperature on cutaneous silent periods. Clin Neurophysiol 2014; 125:1826-33. [PMID: 24555925 DOI: 10.1016/j.clinph.2014.01.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 01/16/2014] [Accepted: 01/26/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The cutaneous silent period (CSP) is a spinal inhibitory reflex mediated by small-diameter afferents (A-delta fibers) and large-diameter efferents (alpha motoneurons). The effect of limb temperature on CSPs has so far not been assessed. METHODS In 27 healthy volunteers (11 males; age 22-58 years) we recorded median nerve motor and sensory action potentials, median nerve F-wave and CSPs induced by noxious digit II stimulation in thenar muscles in a baseline condition at room temperature, and after randomly submersing the forearm in 42 °C warm or 15 °C cold water for 20 min each. RESULTS In cold limbs, distal and proximal motor and sensory latencies as well as F-wave latencies were prolonged. Motor and sensory nerve conduction velocities were reduced. Compound motor and sensory nerve action potential amplitudes did not differ significantly from baseline. CSP onset and end latencies were more delayed than distal and proximal median nerve motor and sensory latencies, whereas CSP duration was not affected. In warm limbs, opposite but smaller changes were seen in nerve conduction studies and CSPs. CONCLUSION The observed CSP shift "en bloc" towards longer latencies without affecting CSP duration during limb cooling concurs with slower conduction velocity in both afferent and efferent fibers. Disparate conduction slowing in afferents and efferents, however, suggests that nociceptive EMG suppression is mediated by fibers of different size in the afferent than in the efferent arm, indirectly supporting the contribution of A-delta fibers as the main afferent input. SIGNIFICANCE Limb temperature should be taken into account when testing CSPs in the clinical setting, as different limb temperatures affect CSP latencies more than large-diameter fiber conduction function.
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Affiliation(s)
- Markus Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria.
| | | | - Peter Vasko
- Department of Neurology, Charles University, Third Faculty of Medicine, Prague, Czech Republic
| | - Václav Boček
- Department of Neurology, Charles University, Third Faculty of Medicine, Prague, Czech Republic
| | - Ivana Štetkárová
- Department of Neurology, Charles University, Third Faculty of Medicine, Prague, Czech Republic
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