1
|
Cunha NSC, Grippe T, Boechat-Barros R, Fernandez RNM, Brandão PRP, Chen R, Cardoso F. Evaluation of the Cutaneous Silent Period in a Healthy Brazilian Population. J Clin Neurophysiol 2023; 40:541-546. [PMID: 35349508 DOI: 10.1097/wnp.0000000000000921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To establish cutaneous silent period (CSP) normative values and investigate the variables that may influence them. METHODS We tested 41 healthy subjects. All subjects underwent nerve conduction studies, and we evaluated the CSP in both arms. RESULTS Four subjects did not have CSP and were excluded. The analyses were performed in the healthy group composed of 23 women and 14 men, with a mean age of 35 (range, 19-64) years. The CSP median duration was 23.2 milliseconds (ms), with 2 to 98th percentile at 11.3 and 48.7 ms. The median onset latency was 87.9 (range, 72.9-109) ms, and the median end latency was 112 (range, 93.8-138) ms. The CSP onset latency positively correlated with height, whereas CSP end latency and duration were weakly but significantly associated with age. Some measurements of ulnar nerve conduction study also correlated with CSP measures. The interrater coefficients for the primary measures of onset and end latency demonstrates the reproducibility of the method. CONCLUSIONS The CSP with the fifth digit stimulation and recording from the abductor digiti minimi muscle is a valid diagnostic tool that can be used in clinical practice.
Collapse
Affiliation(s)
- Natalia S C Cunha
- Department of Medical Sciences, Universidade de Brasília Brasília, Brazil
- Department of Child Neurology, Hospital da Criança de Brasília José de Alencar Brasília, Brazil
| | - Talyta Grippe
- Department of Neurophysiology, Instituto Hospital de Base do Distrito Federal Brasília, Brazil
- Krembil Research Institute, Toronto, Canada
- Movement Disorders Unit, Internal Medicine Department, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | | | - Rubens N M Fernandez
- Department of Child Neurology, Hospital da Criança de Brasília José de Alencar Brasília, Brazil
- Department of Neurophysiology, Instituto Hospital de Base do Distrito Federal Brasília, Brazil
| | - Pedro Renato P Brandão
- Neuroscience and Behavior Lab, Universidade de Brasília Brasilia, Brazil; and
- Neurology Unit, Hospital Sírio-Libanês Brasilia, Brazil
| | | | - Francisco Cardoso
- Movement Disorders Unit, Internal Medicine Department, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| |
Collapse
|
2
|
Cutaneous silent period in ATTRv carriers: a possible early marker of nerve damage? Neurol Sci 2022; 43:6979-6982. [PMID: 35943637 DOI: 10.1007/s10072-022-06317-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/02/2022] [Indexed: 02/03/2023]
|
3
|
Cambieri C, Libonati L, Moret F, Tartaglia G, Garibaldi M, Chimenti C, Inghilleri M, Ceccanti M. The Silent Period for Small Fiber Sensory Neuropathy Assessment in a Mixed Cohort of Transthyretin-Mediated Amyloidosis. Biomedicines 2022; 10:biomedicines10092073. [PMID: 36140174 PMCID: PMC9495326 DOI: 10.3390/biomedicines10092073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/20/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Transthyretin-mediated amyloidosis (ATTR) is a rare multisystemic disease involving the peripheral nervous system and heart. Autonomic and small fiber involvement is one of the hallmarks of ATTR, and many tools have been proposed to assess this aspect. Aim: The aim of this study was to investigate cutaneous and mixed nerve silent periods (CSP and MnSP) as instruments for small fiber assessment. Methods: A total of 21 ATTR patients, 20 healthy controls, and 18 asymptomatic carriers underwent a sensory conduction study from the right sural and non-dominant ulnar nerves. A motor conduction study from the right deep peroneal and non-dominant ulnar nerves, with their F waves, CSPs, and MnSPs, was performed. Results: The amplitudes of the sural and ulnar sensory nerves and of the peroneal and ulnar motor nerves were reduced in ATTR patients compared to the other groups. F waves from the ulnar and peroneal nerves showed no differences between the three groups. The CSP and MnSP latency, but not amplitude, were increased in both the ulnar and peroneal nerves of ATTR patients. Conclusions: ATTR patients showed axonal involvement of large sensory and motor nerve fibers and demyelinating features of small sensory fibers.
Collapse
Affiliation(s)
- Chiara Cambieri
- Center for Rare Neuromuscular Diseases, Department of Human Neuroscience, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy
| | - Laura Libonati
- Center for Rare Neuromuscular Diseases, Department of Human Neuroscience, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy
| | - Federica Moret
- Center for Rare Neuromuscular Diseases, Department of Human Neuroscience, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy
| | - Giorgio Tartaglia
- Center for Rare Neuromuscular Diseases, Department of Human Neuroscience, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy
| | - Matteo Garibaldi
- Neuromuscular and Rare Disease Center, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Cristina Chimenti
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Sapienza University, 00185 Rome, Italy
- Cellular and Molecular Cardiology Lab, IRCCS Lazzaro Spallanzani, 00149 Rome, Italy
| | - Maurizio Inghilleri
- Center for Rare Neuromuscular Diseases, Department of Human Neuroscience, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy
| | - Marco Ceccanti
- Center for Rare Neuromuscular Diseases, Department of Human Neuroscience, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy
- Correspondence:
| |
Collapse
|
4
|
Neves ELDA, Silva JRS. Recording cutaneous silent period parameters in hereditary and acquired neuropathies. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:831-836. [PMID: 36252592 PMCID: PMC9703883 DOI: 10.1055/s-0042-1755229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background Cutaneous silent period (CSP) is the interruption in muscle activity after painful stimulation of a sensory nerve.
Objective The aim of the present study is to assess CSP changes in patients with polyneuropathy (PNP).
Methods The present study was carried out to assess CSP in individuals with diabetes (DM) and Charcot-Marie-Tooth (CMT) disease. The sample comprised 24 individuals with DM, 10 individuals with CMT1 disease, and 10 individuals with CMT2 disease. The control group (CG) consisted of 59 individuals.
Results The mean latencies recorded for the upper limbs in the CG were 79.2 milliseconds (onset latency), 69.3 milliseconds (50% reduction latency), 112.2 milliseconds (end latency), and 33.1 milliseconds (CSP duration). On the other hand, the mean latencies recorded for the lower limbs were 99.0 milliseconds (onset latency), 85.0 milliseconds (50% reduction latency), 136.9 milliseconds (end latency), and 38.2 milliseconds (CSP duration). The mean latencies recorded for the CG were significantly lower than the ones recorded for other groups, both in the upper and lower limbs.
Conclusions Cutaneous silent period values recorded for the CG in the present study were close to the ones reported in studies available in the literature. Abnormal CSP parameters were observed in the group of individuals with PNP. The end latency in the lower limbs helped differentiating the demyelinating subgroup from the axonal one.
Collapse
Affiliation(s)
- Eduardo Luis de A. Neves
- Universidade Federal de Sergipe, Programa de Pós-Gradução em Ciências da Saúde, Aracaju SE, Brazil
| | - José Rodrigo S. Silva
- Universidade Federal de Sergipe, Departamento de Estatística e Ciências Atuariais, Aracaju SE, Brazil
| |
Collapse
|
5
|
Mondelli M, Aretini A. Cutaneous silent period in ulnar neuropathy at the elbow. Muscle Nerve 2021; 65:225-232. [PMID: 34724221 DOI: 10.1002/mus.27452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION/AIMS The cutaneous silent period (CSP) reflects the function of A-delta sensory fibers. There are few studies on CSP in nerve entrapment syndromes. This study aims to evaluate the neurophysiological abnormalities of small-diameter sensory fibers in ulnar neuropathy at the elbow (UNE) by means of CSP. METHODS We consecutively evaluated UNE patients at one electrodiagnostic laboratory. The CSP was obtained upon stimulating the fifth (D5) and third digits, recording from the first dorsal interosseous (FDI) and abductor pollicis brevis (APB) muscles. RESULTS We enrolled 37 UNE patients (mean age 55.4 ± 11.2 y) and 30 controls (mean age 51.2 ± 11.1 y). The combinations of the D5-APB and D5-FDI mean onset latencies of CSP were significantly more prolonged in patients (83.7 ± 6.8 and 84.5 ± 8 ms, respectively) than in controls (78.2 ± 8.1 and 79.4 ± 7.6 ms, respectively). The D5-FDI duration of CSP was shorter in patients (52.2 ± 8.3 ms) than in controls (55.8 ± 7 ms). The mean of the onset latencies of D5-FDI and D5-APB was related to the clinical severity (P = .013 and .0025, respectively). D5-APB and D5-FDI onset latencies were more prolonged and the duration was shorter in the UNE group with absent ulnar sensory nerve action potentials (SNAPs) and axonal motor damage than in patients with preserved SNAPs and with demyelinating damage. DISCUSSION CSP was able to demonstrate abnormalities of small-diameter myelinated sensory fibers. This damage was directly related to UNE severity and to axonal damage of motor fibers. Absence of a sensory large-diameter fiber response did not exclude preserved residual small fiber conduction.
Collapse
Affiliation(s)
- Mauro Mondelli
- EMG Service, Local Health Unit Toscana Sud Est, Siena, Italy
| | | |
Collapse
|
6
|
Gündüz A, Aydın Ş, Kızıltan M. Cutaneous silent period: A literature review. NEUROL SCI NEUROPHYS 2020. [DOI: 10.4103/nsn.nsn_38_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
7
|
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] [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.
Collapse
|
8
|
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] [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.
Collapse
Affiliation(s)
- Elena Fava
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Markus Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | | |
Collapse
|
9
|
Kofler M, Leis A, Valls-Solé J. Cutaneous silent periods – Part 1: Update on physiological mechanisms. Clin Neurophysiol 2019; 130:588-603. [DOI: 10.1016/j.clinph.2019.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/28/2018] [Accepted: 01/08/2019] [Indexed: 12/14/2022]
|
10
|
Cutaneous silent periods – Part 2: Update on pathophysiology and clinical utility. Clin Neurophysiol 2019; 130:604-615. [DOI: 10.1016/j.clinph.2019.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/28/2018] [Accepted: 01/08/2019] [Indexed: 02/08/2023]
|
11
|
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] [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.
Collapse
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
| |
Collapse
|
12
|
The utility of electrodiagnostic tests for the assessment of medically unexplained weakness and sensory deficit. Clin Neurophysiol Pract 2016; 1:2-8. [PMID: 30214953 PMCID: PMC6123842 DOI: 10.1016/j.cnp.2016.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 02/10/2016] [Indexed: 12/14/2022] Open
Abstract
Medically unexplained symptoms (MUS) are challenge for electrodiagnostic testing. Weakness and sensory deficit can be manifestations of psychogenic disorders. This is a review of electrodiagnostic methods used for the assessment of MUS.
Patients with suspected medically unexplained symptoms or psychogenic disorders are frequently requested to undergo an EMG exam. However, the suspected diagnosis is not always told to the electromyography practitioner, who must be able to recognize such a condition to avoid false positive diagnosis without dismissing the possibility to uncover any true dysfunction. There are many clinical manoeuvers to assess the consistency of the patients’ reported weakness or sensory deficit. The electrodiagnostic practitioner should be aware of those clinical tricks and interpret the electrodiagnostic findings in the clinical context. There are many electrodiagnostic tests that the practitioner can use for the assessment of motor and sensory functions but these tests have also important drawbacks and limitations. Only after a good clinical evaluation would the practitioner be able to give his/her opinion on the clinical relevance of the electrodiagnostic findings. Here we review some of the tests that can help the practitioner to define the electrophysiological characteristics of a suspected functional disorder presenting with weakness or sensory deficit.
Collapse
|
13
|
Denislic M, Tiric-Campara M, Resić H, Al-Hashel JY, Zorec R, Gojak R, Ravnik J. A neurophysiological study of large- and small-diameter nerve fibers in the hands of hemodialysis patients. Int Urol Nephrol 2015; 47:1879-87. [DOI: 10.1007/s11255-015-1117-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/18/2015] [Indexed: 10/23/2022]
|
14
|
Mota IA, Fernandes JB, Cardoso MN, Sala-Blanch X, Kofler M, Valls-Solé J. Temporal profile of the effects of regional anesthesia on the cutaneous reflexes of foot muscles. Exp Brain Res 2015; 233:2587-96. [PMID: 26025613 DOI: 10.1007/s00221-015-4329-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 05/14/2015] [Indexed: 12/23/2022]
Abstract
We analyzed the effects of an anesthetic sciatic nerve block on the cutaneomuscular reflex (cMR) and the cutaneous silent period (cSP) of foot muscles, in order to investigate further the type of fibers involved in their generation. In 14 neurologically normal patients with indication for surgical treatment of hallux valgus, we recorded from the extensor digitorum brevis muscle the reflex responses elicited by high-intensity electrical stimulation of the big toe at various time periods, ranging from 0 to 20 min, after ultrasound-guided sciatic nerve popliteal anesthetic block. The first effect was a delay in cSP onset latency, with no changes in end latency. The cMR remained unaltered up to when subjects were no longer able to maintain the contraction. The effects of local anesthetics on peripheral nerves allow for recognition of the different types of fibers contributing to the cMR and the cSP in muscles of the lower limb.
Collapse
Affiliation(s)
- Isabella A Mota
- Hospital Universitario Lauro Wanderley, João Pessoa, Paraiba, Brazil
| | | | | | | | | | | |
Collapse
|