Melih TÜTÜNCÜ, Hikmat ABBASZADE, Ayşegül GÜNDÜZ, Meral E. KIZILTAN

Servikal ve Jeneralize Distonide Periferik Sessiz Periyot

Amaç: Distoni, sürekli veya aralıklı kas kasılmalarının anormal duruşlara veya tekrarlayan hareketlere neden olduğuistemsiz bir hareket bozukluğudur. Distoni sadece bir motor sistem hastalığı değildir. Patofizyolojisinde, anormalsensorimotor entegrasyon yaygın olarak kabul edilmektedir. Diğer bir patofizyolojik açıklama, inhibitör yolaklardakianormalliklerdir. Bu çalışmanın amacı, kutanöz stimülasyonu (CuSP) veya miks sinir stimülasyonunu (MnSP) takibensessiz period (SP) kaydederek distonide, omurilikteki inhibitör yolakların durumunu araştırmaktır. Yöntemler: Çalışmaya 23 distonili hasta dahil edildi. Ayrıca kontrol grubu olarak 19 sağlıklı denek mevcuttu. Yaş gruplararasında benzerdi. (p = 0.092). CuSP ve MnSP, sırasıyla abdüktör pollicis brevis ve median sinir aracılığıyla kaydedildi.Bulgular: CuSP'nin başlangıç latansı, süresi ve supresyon indeksi ile ilgili olarak, distoni hastaları ile sağlıklı bireylerarasında fark yoktu. MnSP'nin başlangıç ve bitiş latansları ayrıca süreleri, hastalar ve sağlıklı bireyler arasında farklıdeğildi. Segmental ve jeneralize distonili hastaların karşılaştırılması, jeneralize distoni hastalarında I2 supresyonindeksinin düşük olduğunu gösterdi (100.0'a karşı 86.7 ± 21.4%; F = 4.252, 0.035). Tartışma: Jeneralize distonili hastalarda CuSP sırasında daha az supresyon görülürken, servikal distonili hastalardasağlıklı deneklere benzerdi. Sonuçlarımız, spinal inhibitör devrelerin, sadece ilgili segmentin klinik tutulumu varsa dahaaz aktif olduğunu.

Peripheral Silent Period In Cervical and Generalized Dystonia

Objective: Dystonia is a movement disorder described by continuous or alternating muscle contractions causing unusual postures or insistent motions. Abnormal sensorimotor integration and abnormalities in inhibitory pathways are thought to have a role in pathogenesis. This paper aims to research the state of inhibitory pathways in the spinal cord in dystonia through documenting a silent period (SP) through cutaneous stimulation (CuSP) or mixed nerve stimulation (MnSP).Methods: 23 patients with dystonia were included in the study. Also, 19 healthy subjects were included in the study as a control group. Ages were similar between two groups. (p=0.092). CuSP and MnSP are recorded through abductor pollicis brevis and median nerve at the wrist respectively. Results: Onset latency, time, and suppression index of CuSP were equivalent between two groups. Moreover, the initiation and terminate latencies of MnSP, also duration, were similar between these two groups. I2 suppression index was lower in generalized dystonia patients compared to patients with cervical dystonia (100.0 vs 86.7±21.4%; F=4.252, 0.035). Conclusions: The most striking result to emerge from the data is that there was lower suppression during CuSP in generalized dystonia patients. Our results suggest that spinal inhibitory circuits are less active if only there is clinical involvement of the relevant segment.

PDF

___

1. Sanger TD. Chen D, Fehlings DL, Hallett M, et al. Definition and classification of hyperkinetic movements in childhood. Movement Disorders 2010; 25: 1538–49.
2. Sitburana O, Chen Wu LJ, Sheffield JK, Davidson A, Jankovic J. Motor overflow and mirror dystonia Parkinsonism and Related Disorders 2009; 15: 758– 61.
3. Gündüz A, Aydın Ş, Kızıltan ME. Cutaneous silent period: A literature review. Neurological Sciences and Neurophysiology 2020; 37: 101–9.
4. Kofler M, Leis AA, Valls-Solé J. Cutaneous silent periods – Part 2: Update on pathophysiology and clinical utility. Clinical Neurophysiology 2019; 130: 604–15.
5. Wang Y, Guo S, Xu L, et al. Tremor Caused by Dandy-Walker Syndrome Concomitant with Syringomyelia: Case Report and Review of the Literature Review. World Neurosurgery 2020; 136: 301–4.
6. Cohodarevic T, Mailis A, Montanera W, Abnormalities S. Syringomyelia: Pain, Sensory Abnormalities, and Neuroimaging. 2000; 1: 54–66.
7. Mulroy E, Balint B, Latorre A, et al. Syringomyelia Associated Dystonia: Case Series, Literature Review, and Novel Insights. Movement Disorders Clinical Practice 2019; 6: 387–92.
8. Raj VS. Lofton L. Rehabilitation and treatment of spinal cord tumors. Journal of Spinal Cord Medicine 2013; 36: 4–11.
9. Kofler M, Leis AA. Valls-Solé J. Cutaneous silent periods – Part 1: Update on physiological mechanisms. Clinical Neurophysiology 2019; 130: 588–603.
10. Han JK, Oh K, Kim BJ, et al. Cutaneous silent period in patients with restless leg syndrome. Clinical Neurophysiology 2007; 118: 1705–10.
11. Congiu P, Fantini ML, Milioli G, et al. F-Wave duration as a specific and sensitive tool for the diagnosis of restless legs syndrome/willis-ekbom disease. Journal of Clinical Sleep Medicine 2017; 13: 369–75.
12. 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 Neurologica Belgica 2016; 116: 583–8.
13. Stetkarova I, Kofler M. Majerova V. Cutaneous silent periods in multiple system atrophy. Biomedical Papers 2015; 159: 327–32.
14. Pullman SL, Ford B, Elibol B, et al. Cutaneous electromyographic silent period findings in brachial dystonia. Neurology 1996; 46: 503–8.
15. Bocek V, Stetkarova I, Fecikova A, et al. Pallidal stimulation in dystonia affects cortical but not spinal inhibitory mechanisms. Journal of the Neurological Sciences 2016; 369: 19–26.
16. Fahn S. Concept and classification of dystonia. Advances in neurology 1988; 50: 1–8.
17. Quartarone A. Hallett M. Emerging concepts in the physiological basis of dystonia. Movement Disorders 2013; 28: 958–67.
18. Kiziltan ME, Gunduz A, Apaydin H, Ertan S, Kiziltan G,. Auditory startle reflex and startle reflex to somatosensory inputs in generalized dystonia. Clinical Neurophysiology 2015; 126: 1740–5.
19. Koelman JH, Speelman JD, Hilgevoord AA, Bour LJ, Ongerboer de Visser BW. Dopa-responsive dystonia and normalization of soleus H-reflex test results with treatment Neurology. 1995; 45: 281-5.
20. Panizza M, Lelli S, Nilsson J, Hallett M. H-reflex recovery curve and reciprocal inhibition of H-reflex in different kinds of dystonia. Neurology 1990; 40: 824–8.
21. Leis AA. Conduction abnormalities detected by silent period testing. Electroencephalography and Clinical Neurophysiology/ Evoked Potentials 1994; 93: 444–9.
22. Leis AA, Ross MA, Emori T, Matsue Y, Saito T. The silent period produced by electrical stimulation of mixed peripheral nerves. Muscle & Nerve 1991; 14: 1202–8.