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Latorre A, Belvisi D, Rothwell JC, Bhatia KP, Rocchi L. Rethinking the neurophysiological concept of cortical myoclonus. Clin Neurophysiol 2023; 156:125-139. [PMID: 37948946 DOI: 10.1016/j.clinph.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 09/04/2023] [Accepted: 10/13/2023] [Indexed: 11/12/2023]
Abstract
Cortical myoclonus is thought to result from abnormal electrical discharges arising in the sensorimotor cortex. Given the ease of recording of cortical discharges, electrophysiological features of cortical myoclonus have been better characterized than those of subcortical forms, and electrophysiological criteria for cortical myoclonus have been proposed. These include the presence of giant somatosensory evoked potentials, enhanced long-latency reflexes, electroencephalographic discharges time-locked to individual myoclonic jerks and significant cortico-muscular connectivity. Other features that are assumed to support the cortical origin of myoclonus are short-duration electromyographic bursts, the presence of both positive and negative myoclonus and cranial-caudal progression of the jerks. While these criteria are widely used in clinical practice and research settings, their application can be difficult in practice and, as a result, they are fulfilled only by a minority of patients. In this review we reappraise the evidence that led to the definition of the electrophysiological criteria of cortical myoclonus, highlighting possible methodological incongruencies and misconceptions. We believe that, at present, the diagnostic accuracy of cortical myoclonus can be increased only by combining observations from multiple tests, according to their pathophysiological rationale; nevertheless, larger studies are needed to standardise the methods, to resolve methodological issues, to establish the diagnostic criteria sensitivity and specificity and to develop further methods that might be useful to clarify the pathophysiology of myoclonus.
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Affiliation(s)
- Anna Latorre
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London, London, United Kingdom.
| | - Daniele Belvisi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy
| | - John C Rothwell
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London, London, United Kingdom
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London, London, United Kingdom
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London, London, United Kingdom; Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Wang L, Wang S, Zhang S, Dou Z, Guo T. Effectiveness and Electrophysiological Mechanisms of Focal Vibration on Upper Limb Motor Dysfunction in Patients with Subacute Stroke: A Randomized Controlled Trial. Brain Res 2023; 1809:148353. [PMID: 36990135 DOI: 10.1016/j.brainres.2023.148353] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023]
Abstract
Upper limb motor dysfunction is a common complication after stroke, which has a negative impact on the daily life of patients. Focal vibration (FV) has been used to improve upper limb motor function in acute and chronic stroke patients, but its application in subacute stroke patients has not been extensively explored. Therefore, the purpose of this study was to explore the therapeutic effect of FV on upper limb motor function in subacute stroke patients and its underlying electrophysiological mechanism. Twenty-nine patients were enrolled and randomized into two groups: control group and vibration group. The control group were treated with conventional therapy including passive and active physical activity training, standing and sitting balance exercises, muscle strength training, hand extension and grasping exercises. The vibration group were given conventional rehabilitation and vibration therapy. A deep muscle stimulator (DMS) with a frequency of 60 Hz and an amplitude of 6 mm was used to provide vibration stimulation, which was sequentially applied along the biceps muscle to the flexor radialis of the affected limb for 10 minutes, once a day, and 6 times a week. Both groups received treatments for 4 consecutive weeks. In the vibration group, the motor evoked potential (MEP) latency and the somatosensory evoked potential (SEP) latency were significantly shortened (P<0.05) immediately after vibration and 30 minutes after vibration; the SEP amplitude and MEP amplitude were significantly increased (P<0.05) immediately after vibration and 30 minutes after vibration. The MEP latency (P=0.001) and SEP N20 latency (P=0.001) were shortened, and the MEP amplitude (P=0.011) and SEP N20 amplitude (P=0.017) were significantly increased after 4 weeks in the vibration group. After 4 consecutive weeks, the vibration group showed significant improvements in Modified Ashworth Scale (MAS) (P=0.037), Brunnstrom stage for upper extremity (BS-UE) (P=0.020), Fugl-Meyer assessment for upper extremity (FMA-UE) (P=0.029), Modified Barthel Index (MBI) (P=0.024), and SEP N20 (P=0.046) compared to the control group. The Brunnstrom stage for hand (BS-H) (P=0.451) did not show significant differences between the two groups. This study showed that FV was effective in improving upper limb motor function in subacute stroke patients. The underlying mechanism of FV may be that it enhances the efficacy of sensory pathways and induces plastic changes in the sensorimotor cortex.
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3
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Significance and clinical suggestions for the somatosensory evoked potentials increased in amplitude revealed by a large sample of neurological patients. Neurol Sci 2022; 43:5553-5562. [DOI: 10.1007/s10072-022-06236-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
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4
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Chen R, Berardelli A, Bhattacharya A, Bologna M, Chen KHS, Fasano A, Helmich RC, Hutchison WD, Kamble N, Kühn AA, Macerollo A, Neumann WJ, Pal PK, Paparella G, Suppa A, Udupa K. Clinical neurophysiology of Parkinson's disease and parkinsonism. Clin Neurophysiol Pract 2022; 7:201-227. [PMID: 35899019 PMCID: PMC9309229 DOI: 10.1016/j.cnp.2022.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 06/11/2022] [Accepted: 06/22/2022] [Indexed: 01/01/2023] Open
Abstract
This review is part of the series on the clinical neurophysiology of movement disorders and focuses on Parkinson’s disease and parkinsonism. The pathophysiology of cardinal parkinsonian motor symptoms and myoclonus are reviewed. The recordings from microelectrode and deep brain stimulation electrodes are reported in detail.
This review is part of the series on the clinical neurophysiology of movement disorders. It focuses on Parkinson’s disease and parkinsonism. The topics covered include the pathophysiology of tremor, rigidity and bradykinesia, balance and gait disturbance and myoclonus in Parkinson’s disease. The use of electroencephalography, electromyography, long latency reflexes, cutaneous silent period, studies of cortical excitability with single and paired transcranial magnetic stimulation, studies of plasticity, intraoperative microelectrode recordings and recording of local field potentials from deep brain stimulation, and electrocorticography are also reviewed. In addition to advancing knowledge of pathophysiology, neurophysiological studies can be useful in refining the diagnosis, localization of surgical targets, and help to develop novel therapies for Parkinson’s disease.
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Affiliation(s)
- Robert Chen
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Italy.,IRCCS Neuromed Pozzilli (IS), Italy
| | - Amitabh Bhattacharya
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Italy.,IRCCS Neuromed Pozzilli (IS), Italy
| | - Kai-Hsiang Stanley Chen
- Department of Neurology, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Alfonso Fasano
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Rick C Helmich
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology and Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - William D Hutchison
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Departments of Surgery and Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Andrea A Kühn
- Department of Neurology, Movement Disorder and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Germany
| | - Antonella Macerollo
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom.,The Walton Centre NHS Foundation Trust for Neurology and Neurosurgery, Liverpool, United Kingdom
| | - Wolf-Julian Neumann
- Department of Neurology, Movement Disorder and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Germany
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | | | - Antonio Suppa
- Department of Human Neurosciences, Sapienza University of Rome, Italy.,IRCCS Neuromed Pozzilli (IS), Italy
| | - Kaviraja Udupa
- Department of Neurophysiology National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
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5
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Cavaliere S, Lori S, Bastianelli M, Cossu C, Gabbanini S, Dani C, Bertini G. Unilateral Transient Enhanced SEP during Integrated Multiparameter Neurophysiological Monitoring in a Newborn with Symptomatic Seizure. Pediatr Rep 2022; 14:254-261. [PMID: 35736655 PMCID: PMC9230835 DOI: 10.3390/pediatric14020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/05/2022] [Accepted: 05/24/2022] [Indexed: 02/01/2023] Open
Abstract
During Integrated Multiparametric Neurophysiological Monitoring (IMNA), a newborn with suspected hypoxia at birth and microhaemorrhagic and ischaemic lesions presented some clonic-tonic episodes with specific EEG patterns characterized by rolandic and temporal spikes and the appearance of a unilateral enhanced Somatosensory Evoked Potential (SEP) (10.45 µv). Since the literature does not seem to describe cases of giant SEP in newborns, in this case report, we will discuss the hypotheses underlying this potential. It could be assumed that the ischaemic and haemorrhagic lesions presented by the newborn may have developed as a result of neurotransmitter balance failure. This may be the origin of the EEG picture, which, consequently, could have triggered a potential with high amplitude.
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Affiliation(s)
- Sara Cavaliere
- Department of Neurosciences, Psychology, Drug Research and Children’s Health, University of Florence, 50134 Florence, Italy; (S.C.); (C.D.)
| | - Silvia Lori
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, 50134 Florence, Italy; (S.L.); (M.B.); (C.C.); (S.G.)
| | - Maria Bastianelli
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, 50134 Florence, Italy; (S.L.); (M.B.); (C.C.); (S.G.)
| | - Cesarina Cossu
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, 50134 Florence, Italy; (S.L.); (M.B.); (C.C.); (S.G.)
| | - Simonetta Gabbanini
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, 50134 Florence, Italy; (S.L.); (M.B.); (C.C.); (S.G.)
| | - Carlo Dani
- Department of Neurosciences, Psychology, Drug Research and Children’s Health, University of Florence, 50134 Florence, Italy; (S.C.); (C.D.)
| | - Giovanna Bertini
- Department of Neurosciences, Psychology, Drug Research and Children’s Health, University of Florence, 50134 Florence, Italy; (S.C.); (C.D.)
- Correspondence:
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King G, Veros KM, MacLaren DAA, Leigh MPK, Spernyak JA, Clark SD. Human wildtype tau expression in cholinergic pedunculopontine tegmental neurons is sufficient to produce PSP-like behavioural deficits and neuropathology. Eur J Neurosci 2021; 54:7688-7709. [PMID: 34668254 DOI: 10.1111/ejn.15496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/30/2021] [Accepted: 10/12/2021] [Indexed: 11/30/2022]
Abstract
Progressive Supranuclear Palsy (PSP) is the most common atypical parkinsonism and exhibits hallmark symptomology including motor function impairment and dysexecutive dementia. In contrast to Parkinson's disease, the underlying pathology displays aggregation of the protein tau, which is also seen in disorders such as Alzheimer's disease. Currently, there are no pharmacological treatments for PSP, and drug discovery efforts are hindered by the lack of an animal model specific to PSP. Based on previous results and clinical pathology, it was hypothesized that viral deposition of tau in cholinergic neurons within the hindbrain would produce a tauopathy along neural connections to produce PSP-like symptomology and pathology. By using a combination of ChAT-CRE rats and CRE-dependent AAV vectors, wildtype human tau (the PSP-relevant 1N4R isoform; hTau) was expressed in hindbrain cholinergic neurons. Compared to control subjects (GFP), rats with tau expression displayed deficits in a variety of behavioural paradigms: acoustic startle reflex, marble burying, horizontal ladder and hindlimb motor reflex. Postmortem, the hTau rats had significantly reduced number of cholinergic pedunculopontine tegmentum and dopaminergic substantia nigra neurons, as well as abnormal tau deposits. This preclinical model has multiple points of convergence with the clinical features of PSP, some of which distinguish between PSP and Parkinson's disease.
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Affiliation(s)
- Gabriella King
- Department of Pharmacology and Toxicology, University at Buffalo, Buffalo, New York, USA
| | - Kaliana M Veros
- Department of Pharmacology and Toxicology, University at Buffalo, Buffalo, New York, USA
| | | | | | - Joseph A Spernyak
- Department of Cell Stress Biology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Stewart D Clark
- Department of Pharmacology and Toxicology, University at Buffalo, Buffalo, New York, USA
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7
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Dubbioso R, Provitera V, Vitale F, Stancanelli A, Borreca I, Caporaso G, De Michele G, De Rosa A, Picillo M, Barone P, Iodice R, Manganelli F, De Michele G, Santoro L, Nolano M. Cutaneous sensory and autonomic denervation in progressive supranuclear palsy. Neuropathol Appl Neurobiol 2021; 47:653-663. [PMID: 33421177 DOI: 10.1111/nan.12692] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/17/2020] [Accepted: 12/28/2020] [Indexed: 12/13/2022]
Abstract
AIM Progressive Supranuclear Palsy (PSP) is a progressive neurodegenerative tauopathy characterised by motor, behavioural and cognitive dysfunction. While in the last decade, sensory and autonomic disturbances as well as peripheral nerve involvement are well-recognised in Parkinson's Disease (PD), little is known in this regard for PSP. Herein, we aim to assess peripheral sensory and autonomic nerve involvement in PSP and to characterise possible differences in morpho-functional pattern compared to PD patients. METHODS We studied 27 PSP and 33 PD patients without electrophysiological signs of neuropathy, and 33 healthy controls (HC). In addition to motor impairment, evaluated by means of UPDRS-III and the PSP rating scale, all patients underwent clinical, functional and morphological assessment of sensory-autonomic nerves through dedicated questionnaires, sympathetic skin response, dynamic sweat test and skin biopsies. The analysis of cutaneous sensory and autonomic innervation was performed using indirect immunofluorescence and confocal microscopy. RESULTS PSP patients displayed a length-dependent loss of sensory and autonomic nerve fibres associated with functional impairment compared to HC and, overall, a more severe picture than in PD patients. The disease severity correlated with the loss of intraepidermal nerve fibre density in the leg of PSP patients (p < 0.05). CONCLUSION We demonstrated a length-dependent small fibre pathology in PSP, more severe compared to PD, and paralleling disease severity. Our findings suggest the morphological and functional study of cutaneous nerves as possible biomarkers to monitor disease progression and response to new treatments.
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Affiliation(s)
- Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Vincenzo Provitera
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Neurology of Telese, Terme Institute, Italy
| | - Floriana Vitale
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Annamaria Stancanelli
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Neurology of Telese, Terme Institute, Italy
| | - Ilaria Borreca
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Neurology of Telese, Terme Institute, Italy
| | - Giuseppe Caporaso
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Neurology of Telese, Terme Institute, Italy
| | - Giovanna De Michele
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Anna De Rosa
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Marina Picillo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Baronissi, SA, Italy
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Baronissi, SA, Italy
| | - Rosa Iodice
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Fiore Manganelli
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Giuseppe De Michele
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Lucio Santoro
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Maria Nolano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy.,Istituti Clinici Scientifici Maugeri IRCCS, Department of Neurology of Telese, Terme Institute, Italy
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8
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Horlings CGC, Kofler M, Hotter A, Reiter E, Wanschitz JV, Löscher WN. The clinical meaning of giant somatosensory evoked potentials of the median nerve. Clin Neurophysiol 2020; 131:1495-1496. [PMID: 32388474 DOI: 10.1016/j.clinph.2020.03.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 11/16/2022]
Affiliation(s)
| | - Markus Kofler
- Department of Neurology, Medical University Innsbruck, Austria; Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Anna Hotter
- Department of Neurology, Medical University Innsbruck, Austria
| | - Eva Reiter
- Department of Neurology, Medical University Innsbruck, Austria
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Large Amplitude Cortical Evoked Potentials in Nonepileptic Patients. Reviving an Old Neurophysiologic Tool to Help Detect CNS Pathology. J Clin Neurophysiol 2017; 34:84-91. [DOI: 10.1097/wnp.0000000000000326] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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10
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Frascarelli F, Di Rosa G, Bisozzi E, Castelli E, Santilli V. Neurophysiological changes induced by the botulinum toxin type A injection in children with cerebral palsy. Eur J Paediatr Neurol 2011; 15:59-64. [PMID: 20493744 DOI: 10.1016/j.ejpn.2010.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 04/07/2010] [Accepted: 04/10/2010] [Indexed: 10/19/2022]
Abstract
In the last few years botulinum toxin type A (BTX-A) has been widely used in the management of spasticity in children with cerebral palsy in order to reduce hypertonicity and improve functional outcomes enhancing motor skill development. The botulinum toxin injection seems to interact with intrafusal and extrafusal fibers producing a reduction of hypertone both through synaptic blockade and inhibition of stretch reflex loop and these changes may influence not only the spinal cord but also the central nervous system (CNS). The purpose of our study was to determine the neurophysiological changes induced by the BTX-A through an evaluation of cortical somatosensory Evoked Potential (SEP) and Soleus H wave, that is the index of excitability of stretch reflex loop. Eighteen children with Cerebral Palsy (CP), aged between 5 and 12, were recruited at Children's Hospital "Bambino Gesù" of Rome. All children were evaluated with appropriate clinical scales before and 1 month after the BTX-A injection. Neurophysiological measurements were performed before, and 1 month after botulinum toxin injection through lower limb SEPs, M-wave and Soleus H wave recording. After the injection the results showed a statistically significant improvement both of clinical scales and the neurophysiological variables. These findings suggest that spasticity itself can be considered as a factor affecting the cortical SEPs. And even though it seems that BTX-A does not have any direct central effect on sensory pathways we suppose an indirect mechanism on modulation of afferent fibers Ia due to the modification induced by BTX-A to central loop reflex.
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Affiliation(s)
- Flaminia Frascarelli
- Pediatric Neuro-Rehabilitation Division, Children's Hospital Bambino Gesù IRCCS, Via Torre di Palidoro, Passoscuro (Fiumicino), Rome 00050, Italy.
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11
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128-Channel somatosensory evoked potentials in the differential diagnosis of parkinsonian disorders. Parkinsonism Relat Disord 2009; 15:564-71. [DOI: 10.1016/j.parkreldis.2009.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 02/09/2009] [Accepted: 02/12/2009] [Indexed: 11/21/2022]
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12
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Schorl M. Giant somatosensory evoked potentials as indicator of nonconvulsive status epilepticus. Clin Neurophysiol 2008; 119:726-728. [DOI: 10.1016/j.clinph.2007.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2007] [Revised: 10/25/2007] [Accepted: 11/05/2007] [Indexed: 10/22/2022]
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13
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Multichannel recording of median nerve somatosensory evoked potentials. Neurophysiol Clin 2008; 38:9-21. [DOI: 10.1016/j.neucli.2007.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 05/07/2007] [Accepted: 08/23/2007] [Indexed: 11/21/2022] Open
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14
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Laterality of auditory startle responses in humans. Clin Neurophysiol 2008; 119:309-14. [DOI: 10.1016/j.clinph.2007.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2007] [Revised: 10/30/2007] [Accepted: 11/11/2007] [Indexed: 11/23/2022]
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15
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16
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Abstract
Parkinsonism or dystonia are associated with myoclonus in several extrapyramidal diseases. Although the latter symptom is not always prominent, stimulus-sensitive, distal, or focal reflex myoclonus is frequently observed. This review will consider the clinical and electrophysiological features of myoclonus in Parkinson's disease, multiple system atrophy, corticobasal degeneration, progressive supranuclear palsy, Huntington's disease, dentatorubral-pallidoluysian atrophy, Lewy body dementia, and myoclonus with dystonia. The evidence of a long-latency reflex response, the presence of giant somatosensory evoked potentials, and the demonstration of a back-averaged premyoclonus focal cortical EEG activity often lead to classify myoclonus as a cortical phenomenon. However, a subcortical origin cannot always be ruled out.
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Affiliation(s)
- L Defebvre
- Department of Neurology and Movement Disorders, EA2683, IFR114, Lille University Medical Centre, Hôpital Roger-Salengro, 59037 Lille cedex, France.
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17
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Tomita Y, Fukuda C, Kato Y, Maegaki Y, Shiota S, Amisaki T. Topographic MN-SSEPs (N18, N20 and N30) might characterize underlying CNS involvements in representative types of cerebral palsy. Brain Dev 2006; 28:653-9. [PMID: 16766152 DOI: 10.1016/j.braindev.2006.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2005] [Revised: 04/28/2006] [Accepted: 05/01/2006] [Indexed: 10/24/2022]
Abstract
This study is aimed at constructing the neurophysiological basis for determining the characteristic features of cerebral motor disturbance in representative cerebral palsy (CP) types using topographical S-SEPs technology. Median-nerve stimulated S-SEPs (MN-SSEPs) were examined for 23 patients with four representative types of cerebral palsy: 6 athetotic (including 3 patients due to hypoxic-ischemic encephalopathy (HIE) and 3 to kernicterus), 7 hemiplegic, 5 diplegic and 5 tetraplegic types, and 13 normal controls. In HIE group of athetotic CP, frontal N30 specifically showed severe amplitude reduction or abolishment. In hemiplegic CP, both N20 and N30 on the affected cerebral side tended either to disappear or to be normally evoked at the same time, and their mean amplitudes declined severely. In diplegic CP, the amplitudes of subcortical N18 and parietal N20 were not small but significantly enlarged. N30 amplitude stayed within normal. The reason for this unexpected enlargement of N18 and N20 is unclear, but may be partly due to premature birth which caused abnormally abundant dendritic spine due to absence from perinatal normal spine elimination in the brainstem. In several quadriplegic patients, both N20 and N30 disappeared. The mean amplitude of N30 severely decreased. In conclusion, topographical results of N18, N20 and N30 may basically suggest the underlying involvement of nervous structures in CP according to their representative type.
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Affiliation(s)
- Yutaka Tomita
- Department of Pathological Science and Technology, Faculty of Medicine, Tottori University, Yonago, Japan.
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18
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Stetkárová I, Stejskal L, Kofler M. Tumors localized near the central sulcus may cause increased somatosensory evoked potentials. Clin Neurophysiol 2006; 117:1359-66. [PMID: 16677857 DOI: 10.1016/j.clinph.2006.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2005] [Revised: 02/21/2006] [Accepted: 03/08/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Median nerve somatosensory evoked potentials (SEPs) may be altered in patients with cerebral tumors. In rare cases cortical responses may be increased, but the significance of this finding remains unclear. METHODS We investigated 3 patients in whom an epileptic seizure was the only neurological symptom of a cerebral tumor located near the central sulcus. We studied median nerve SEPs, motor evoked potentials in abductor digiti minimi muscle, and long-loop reflexes in abductor pollicis brevis muscle bilaterally. Two patients also underwent intraoperative neurophysiological monitoring. RESULTS All 3 patients presented with enlarged cortical SEPs on the side of the brain tumor. The responses increased further post-operatively, and the enhancement persisted in follow-up examinations up to 6 months after surgical tumor extirpation. Intraoperative monitoring documented a substantial increase of the enlarged potential N20-P22 during tumor removal in one patient, who also presented with an exaggerated long-loop reflex on the tumor side. Transcranial magnetic stimulation revealed unremarkable motor evoked potentials in all 3 patients. CONCLUSIONS Distinct mechanisms must be considered in order to explain both immediate and long-term changes of neuronal excitability leading to increased cortical SEPs. SIGNIFICANCE Hyperexcitability of cortical neurons or insufficient cortical inhibitory mechanisms may be responsible for increased SEPs, which may serve as an epileptic marker in patients suffering from a tumor near the central sulcus.
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Affiliation(s)
- Ivana Stetkárová
- Department of Neurology, Na Homolce Hospital, Prague, Czech Republic
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19
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Kofler M, Müller J, Valls-Solé J. Chapter 19 Auditory startle responses as a probe of brainstem function in healthy subjects and patients with movement disorders. SUPPLEMENTS TO CLINICAL NEUROPHYSIOLOGY 2006; 58:232-48. [PMID: 16623335 DOI: 10.1016/s1567-424x(09)70072-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Markus Kofler
- Department of Neurology, Hospital HochZirl, A-6170 Zirl, Austria.
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20
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Rampello L, Buttà V, Raffaele R, Vecchio I, Battaglia G, Cormaci G, Alvano A. Progressive supranuclear palsy: A systematic review. Neurobiol Dis 2005; 20:179-86. [PMID: 16242626 DOI: 10.1016/j.nbd.2005.03.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2004] [Revised: 01/21/2005] [Accepted: 03/18/2005] [Indexed: 11/25/2022] Open
Abstract
The progressive supranuclear palsy (PSP) is a rapidly progressing degenerative disease belonging to the family of tauophaties, characterized by the involvement of both cortical and subcortical structures. Although the pathogenesis of PSP is still uncertain, genetic, biochemical, and immunohistochemical studies have been performed and are reviewed here. Genetic factors, oxidative damage, neurotoxins, and environmental factors contribute to tau deposition in the cerebral areas involved in PSP. Symptoms originate from the ensuing dysfunction of dopaminergic, GABAergic, cholinergic, and noradrenergic pathways. Recent advances in neuroradiological and instrumental examinations facilitate the diagnosis and have gained new insights into the pathophysiology of PSP, although the primary cause of the disease is unknown and disease-modifying drugs are not yet available.
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Affiliation(s)
- L Rampello
- Department of Neurosciences, University of Catania, Azienda Policlinico-Neurologia, via S. Sofia, 78, 95125 Catania, Italy.
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Halliday GM, Macdonald V, Henderson JM. A comparison of degeneration in motor thalamus and cortex between progressive supranuclear palsy and Parkinson's disease. ACTA ACUST UNITED AC 2005; 128:2272-80. [PMID: 16014651 DOI: 10.1093/brain/awh596] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Changes in motor cortical activation are associated with the major symptoms observed in both Parkinson's disease and progressive supranuclear palsy (PSP). While research has concentrated on basal ganglia abnormalities as central to these cortical changes, several studies in both disorders have shown pathology in the thalamus and motor cortices. In particular, we recently reported an 88% loss of corticocortical projection neurones in the pre-supplementary motor (pre-SMA) cortex in Parkinson's disease. Further analysis of the degree of neuronal loss and pathology in motor cortices and their thalamocortical relays in Parkinson's disease and PSP is warranted. Six cases with PSP, nine cases with Parkinson's disease and nine controls were selected from a prospectively studied brain donor cohort. alpha-Synuclein, ubiquitin and tau immunohistochemistry were used to identify pathological lesions. Unbiased stereological methods were used to analyse atrophy and neuronal loss in the motor thalamus [ventral anterior, ventrolateral anterior and ventrolateral posterior (VLp) nuclei] and motor cortices (primary motor, dorsolateral premotor and pre-SMA cortices). Analysis of variance and post hoc testing was used to determine differences between groups. In Parkinson's disease, the motor thalamus and motor cortices (apart from the pre-SMA) were preserved containing only rare alpha-synuclein-positive and ubiquitin-positive Lewy bodies. In contrast, patients with PSP had significant atrophy and neuronal loss in VLp (22 and 30%, respectively), pre-SMA (21 and 51%, respectively) and primary motor cortices (33 and 54%, respectively). In the primary motor cortex of PSP cases, neuronal loss was confined to inhibitory interneurones, whereas in the pre-SMA both interneurones (reduced by 26%) and corticocortical projection neurones (reduced by 82%) were affected. Tau-positive neurofibrillary and glial tangles were observed throughout the motor thalamus and motor cortices in PSP. These non-dopaminergic lesions in motor circuits are likely to contribute to the pathogenesis of both PSP and Parkinson's disease. The selective involvement of the VLp and primary motor cortex in PSP implicates these cerebellothalamocortical pathways as differentiating this disease, possibly contributing to the early falls.
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Affiliation(s)
- Glenda M Halliday
- Prince of Wales Medical Research Institute and University of New South Wales, Sydney, Australia.
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Grummich P, Nimsky C, Fahlbusch R, Ganslandt O. Observation of unaveraged giant MEG activity from language areas during speech tasks in patients harboring brain lesions very close to essential language areas: expression of brain plasticity in language processing networks? Neurosci Lett 2005; 380:143-8. [PMID: 15854767 DOI: 10.1016/j.neulet.2005.01.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2004] [Revised: 01/08/2005] [Accepted: 01/11/2005] [Indexed: 11/26/2022]
Abstract
We describe a series of 12 patients who suffered from lesions adjacent to the classic Broca and Wernicke areas and were examined by magnetoencephalography (MEG) for presurgical language localization while performing a protocol of different language tasks. In these patients very large MEG activity of up to 5pT was observed, which was located not only in the adjacent language processing brain areas but also in more distant areas, which are part of the language processing neuronal network. The high amplitude and the focal spatial extent of this activity allowed MEG source localization from the unaveraged data. In nine patients sources of this high amplitude activity were even found in the homologous language areas on the contralateral, the nondominant side of the brain. The physiological interrelationship of these large MEG changes needs to be investigated in more detail in further studies especially in the context of possible mechanisms for brain plasticity to overcome inhibitory activity of the impaired language area.
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Affiliation(s)
- Peter Grummich
- Biomagnetism Group, University of Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany.
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Kühn AA, Grosse P, Holtz K, Brown P, Meyer BU, Kupsch A. Patterns of abnormal motor cortex excitability in atypical parkinsonian syndromes. Clin Neurophysiol 2004; 115:1786-95. [PMID: 15261857 DOI: 10.1016/j.clinph.2004.03.020] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2004] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal-ganglionic degeneration (CBGD) are all clinically characterized by an akinetic-rigid syndrome together with a variety of additional signs. We hypothesised that these atypical parkinsonian syndromes (APS) will show distinctive patterns in their motor output upon transcranial magnetic stimulation (TMS) due to their different underlying anatomico-functional deficits. METHODS We performed single and paired-pulse TMS and assessed inhibitory and excitatory response parameters from the first dorsal interosseus muscles in 13 patients with MSA, 18 with PSP, 13 with CBGD, 15 patients with Parkinson's disease and 17 healthy subjects. RESULTS PSP and MSA patients had significantly enlarged response amplitudes at rest, reduced intracortical inhibition (ICI) and prolonged ipsi- and contralateral silent periods, whereas CBGD patients showed significantly increased motor thresholds, smaller response amplitudes at rest, shortened contralateral silent period, reduced transcallosal inhibition and a reduced ICI. In 22% of APS patients ipsilateral motor responses occurred in upper limb muscles irrespective of the underlying disease. CONCLUSIONS Our results indicate that motor cortex disinhibition is predominant in patients with PSP and MSA. In CBGD more severe neuronal cell loss in the motor cortex itself may lead to hypoexcitability of corticospinal and transcallosal pathways.
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Affiliation(s)
- A A Kühn
- Department of Neurology, Charité, Humboldt University Berlin, 13353 Berlin, Augustenburger Platz 1, Germany.
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Kofler M, Müller J, Seppi K, Wenning GK. Exaggerated auditory startle responses in multiple system atrophy: a comparative study of parkinson and cerebellar subtypes. Clin Neurophysiol 2003; 114:541-7. [PMID: 12705434 DOI: 10.1016/s1388-2457(02)00390-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Auditory startle responses (ASRs) have recently been reported to be exaggerated in cranial and peripheral nerve supplied muscles of patients with multiple system atrophy (MSA). ASRs displayed increased probability, amplitude and duration, shorter onset latency, and reduced habituation in comparison with healthy subjects. In order to investigate whether certain ASR features may differentiate MSA subtypes, the authors studied ASRs in 21 MSA patients (olivopontocerebellar type, MSA-C: n = 8, striatonigral type, MSA-P: n = 13), and 17 age-matched normal controls. METHODS ASRs were elicited by binaural high-intensity auditory stimuli which differed randomly in tonal frequency and intensity (250 Hz, 90 db; 500 Hz, 105 db; 750 Hz, 105 db; 1000 Hz, 110 db normal hearing level), presented through tubal insert phones. Reflex electromyographic activity was simultaneously recorded with surface electrodes from masseter, orbicularis oculi, sternocleidomastoid, biceps brachii, abductor pollicis brevis, rectus femoris, tibialis anterior, and soleus muscles. RESULTS Eighteen MSA patients (86%) had exaggerated ASRs as compared to normal subjects. At group level, indices of ASR disinhibition including increased ASR probability (in extremity muscles), shortened onset latency, and enlarged response magnitude were significantly more marked in MSA-P as compared to MSA-C patients. ASR probability showed habituation in normal subjects, less in MSA-P. and none in MSA-C patients. Three MSA-patients had no ASRs except in orbicularis oculi muscle. CONCLUSIONS Although absent ASRs may occur in some MSA patients, most of them exhibit exaggerated ASRs. This finding may reflect disinhibition of lower brainstem nuclei due to the degenerative disorder. ASRs were significantly more disinhibited in MSA-P versus MSA-C. suggesting involvement of different neural structures in the two MSA-subtypes.
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Affiliation(s)
- Markus Kofler
- Department of Neurology, Hospital Hochzirl, Anna-Dengel-Haus, A-6170 Zirl, Austria.
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Abstract
This review provides an update on progressive supranuclear palsy (PSP, or Steele-Richardson-Olszewski disease), an adult-onset neurodegenerative disorder characterised by early postural instability, which leads to falls, and a vertical supranuclear-gaze palsy. Recent epidemiological studies have shown that the disorder is more common than previously recognised, that it is commonly misdiagnosed, and that it may present to a wide range of hospital specialists. The diagnosis of PSP hinges on clinical acumen. Attempts to identify a suitable biomarker in the CSF or a specific and sensitive imaging or neurophysiological technique have so far failed to have a significant effect on the diagnostic process. Better understanding of the molecular pathology of PSP has highlighted the importance of tau-protein accumulation and tau-genotype susceptibility in its pathogenesis. No drug treatment significantly and consistently benefits patients, and novel therapies are urgently required.
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Affiliation(s)
- David J Burn
- University of Newcastle upon Tyne, Newcastle upon Tyne, UK.
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Miwa H, Mizuno Y. Enlargements of somatosensory-evoked potentials in progressive supranuclear palsy. Acta Neurol Scand 2002; 106:209-12. [PMID: 12225316 DOI: 10.1034/j.1600-0404.2002.01223.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the usefulness of the somatosensory-evoked potential (SEP) in differentiating progressive supranuclear palsy (PSP) from other movement disorders. MATERIALS AND METHODS The median nerve SEPs were studied in patients with PSP, Parkinson's disease and essential tremor, and in healthy controls. RESULTS The amplitudes of the median nerve SEPs were enlarged only in patients with PSP. In four of the 10 patients with PSP, giant SEPs were elicited either unilaterally or bilaterally. CONCLUSIONS The enlargement of the SEP in PSP may be useful for early differentiation of PSP, and this enlargement suggest a disease-specific dysfunction in the sensory processing mechanism of PSP which distinguishes it from other movement disorders.
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Affiliation(s)
- H Miwa
- Department of Neurology, Juntendo University School of Medicine, Tokyo Japan.
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Schauer R, Singer M, Saltuari L, Kofler M. Suppression of cortical myoclonus by levetiracetam. Mov Disord 2002; 17:411-5. [PMID: 11921136 DOI: 10.1002/mds.10027] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
A 16-year-old boy suffered severely disabling posthypoxic myoclonus. Neurophysiological investigation showed cortical but not reticular reflex myoclonus. Add-on therapy with levetiracetam significantly improved the patient's clinical condition, suppressed cortical myoclonus-associated spikes, and enabled further neurorehabilitation.
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Affiliation(s)
- Robert Schauer
- Department of Neurology, Hospital Hochzirl, Zirl, Austria
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Abstract
The auditory startle reaction is considered a brainstem reflex in response to an unexpected loud stimulus. It may be abnormal in various neurological conditions. However, the influence of gender on physiological characteristics of auditory startle responses (ASRs) in humans has to date been studied only in orbicularis oculi muscle. We investigated 54 healthy adult subjects (27 males, 27 females). ASRs were elicited by binaural high-intensity auditory stimuli which differed randomly in tonal frequency and intensity (250 Hz-90 db; 500 Hz-105 dB; 750 Hz-110 db, 1000 Hz-110 dB nHL), presented through tubal insert phones. Reflex electromyographic activity was simultaneously recorded with surface electrodes from masseter, orbicularis oculi, sternocleidomastoid, biceps brachii, abductor pollicis brevis, rectus femoris, tibialis anterior, and soleus muscles. ASR probability was significantly lower, and ASR area under the curve was significantly smaller, in men versus women. Median onset latencies did not differ significantly, but tended to be shorter in the lower extremities of men despite greater body height. Habituation, measured as a reduction in response probability with repeated stimulation, was significant in all muscles except orbicularis oculi in both men and women. Our data provide evidence for a significant influence of gender on ASR characteristics. The observed differences are likely due to gender-specific variations of central processing in the brainstem centers involved in ASR generation, and should be taken into account when testing ASRs in health and disease.
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Affiliation(s)
- M Kofler
- Departments of Neurology, Hospital Hochzirl, A-6170 Zirl, Austria.
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Kofler M, Müller J, Reggiani L, Valls-Solé J. Influence of age on auditory startle responses in humans. Neurosci Lett 2001; 307:65-8. [PMID: 11427301 DOI: 10.1016/s0304-3940(01)01908-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The auditory startle reaction is considered a brainstem reflex in response to an unexpected loud stimulus. We investigated the influence of age on auditory startle responses (ASRs) in 54 adult healthy subjects separated in three age groups (below 30; 30 to 50; above 50 years). ASRs were elicited by auditory stimuli randomly presented through tubal insert phones. Reflex electromyographic activity was simultaneously recorded from eight facial, neck, and extremity muscles. ASR probability was lower in extremity muscles of younger versus older subjects, but did not differ among age groups in facial and neck muscles. Median ASR latencies were significantly shorter in all muscles of younger versus older subjects. Our data provide evidence of a significant influence of age on ASRs. The observed differences are likely due to age-specific variations of central processing in the brainstem centers involved in ASR generation.
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Affiliation(s)
- M Kofler
- Department of Neurology, Hospital Hochzirl, A-6170, Zirl, Austria.
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