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Thurner M, Valls-Solé J, Pucks-Faes E, Versace V, Kofler M. P-40 Prepulse effects on blink reflex excitability – A study of brainstem modulation of sensory information flow. Clin Neurophysiol 2023. [DOI: 10.1016/j.clinph.2023.02.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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Versace V, Campostrini S, Sebastianelli L, Saltuari L, Valls-Solé J, Kofler M. Influence of posture on blink reflex prepulse inhibition induced by somatosensory inputs from upper and lower limbs. Gait Posture 2019; 73:120-125. [PMID: 31323620 DOI: 10.1016/j.gaitpost.2019.07.194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 03/26/2019] [Revised: 06/17/2019] [Accepted: 07/10/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Prepulse inhibition (PPI) is a neurophysiological phenomenon whereby a weak stimulus modulates the reflex response to a subsequent strong stimulus. Its physiological purpose is to avoid interruption of sensory processing by subsequent disturbing stimuli at the subcortical level, thereby preventing undesired motor reactions. An important hub in the PPI circuit is the pedunculopontine nucleus, which is also involved in the control of posture and sleep/wakefulness. OBJECTIVE To study the effect of posture (supine versus standing) on PPI, induced by somatosensory prepulses to either upper or lower limb. PPI was measured as the percentage inhibition of the blink reflex response to electrical supraorbital nerve (SON) stimulation. METHODS Sixteen healthy volunteers underwent bilateral blink reflex recordings following SON stimulation either alone (baseline) or preceded by an electrical prepulse to the median nerve (MN) or sural nerve (SN), both in supine and standing. Stimulus intensity was 8 times sensory threshold for SON, and 2 times sensory threshold for MN and SN, respectively. Eight stimuli were applied in each condition. RESULTS Baseline blink reflex parameters did not differ significantly between the two postures. Prepulse stimulation to MN and SN caused significant inhibition of R2. In supine but not in standing, R2 was significantly more inhibited by MN than by SN prepulses. In standing, SN stimulation caused significantly more inhibition of R2 than in supine, while the inhibition caused by MN prepulses did not differ significantly between postures. SIGNIFICANCE PPI induced by lower limb afferent input may contribute to postural control while standing.
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Affiliation(s)
- V Versace
- Department of Neurorehabilitation, Hospital of Vipiteno/Sterzing, Vipiteno, Sterzing, Italy; Reasearch Unit for Neurorehabilitation of South Tyrol, Bolzano, Bozen, Italy.
| | - S Campostrini
- Department of Neurorehabilitation, Hospital of Vipiteno/Sterzing, Vipiteno, Sterzing, Italy; Reasearch Unit for Neurorehabilitation of South Tyrol, Bolzano, Bozen, Italy
| | - L Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno/Sterzing, Vipiteno, Sterzing, Italy; Reasearch Unit for Neurorehabilitation of South Tyrol, Bolzano, Bozen, Italy
| | - L Saltuari
- Reasearch Unit for Neurorehabilitation of South Tyrol, Bolzano, Bozen, Italy; Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - J Valls-Solé
- EMG and Motor Control Unit, Department of Neurology, Hospital Clínic, Barcelona, Spain; IDIBAPS (Institut d'Investigació August Pi i Sunyer), Facultat de Medicina, University of Barcelona, Barcelona, Spain
| | - M Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
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Versace V, Campostrini S, Sebastianelli L, Saltuari L, Valls-Solé J, Kofler M. P14 Influence of posture on blink reflex prepulse inhibition induced by somatosensory inputs from upper and lower limbs. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2019.04.668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Versace V, Campostrini S, Sebastianelli L, Saltuari L, Valls-Solé J, Kofler M. P15 Modulation of blink reflex by self-stimulation in peripersonal space. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2019.04.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Garcia-Rill E, Saper CB, Rye DB, Kofler M, Nonnekes J, Lozano A, Valls-Solé J, Hallett M. Focus on the pedunculopontine nucleus. Consensus review from the May 2018 brainstem society meeting in Washington, DC, USA. Clin Neurophysiol 2019; 130:925-940. [PMID: 30981899 PMCID: PMC7365492 DOI: 10.1016/j.clinph.2019.03.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/15/2019] [Accepted: 03/22/2019] [Indexed: 12/12/2022]
Abstract
The pedunculopontine nucleus (PPN) is located in the mesopontine tegmentum and is best delimited by a group of large cholinergic neurons adjacent to the decussation of the superior cerebellar peduncle. This part of the brain, populated by many other neuronal groups, is a crossroads for many important functions. Good evidence relates the PPN to control of reflex reactions, sleep-wake cycles, posture and gait. However, the precise role of the PPN in all these functions has been controversial and there still are uncertainties in the functional anatomy and physiology of the nucleus. It is difficult to grasp the extent of the influence of the PPN, not only because of its varied functions and projections, but also because of the controversies arising from them. One controversy is its relationship to the mesencephalic locomotor region (MLR). In this regard, the PPN has become a new target for deep brain stimulation (DBS) for the treatment of parkinsonian gait disorders, including freezing of gait. This review is intended to indicate what is currently known, shed some light on the controversies that have arisen, and to provide a framework for future research.
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Affiliation(s)
- E Garcia-Rill
- Center for Translational Neuroscience, Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - C B Saper
- Department of Neurology, Division of Sleep Medicine and Program in Neuroscience, Harvard Medical School, Boston, MA, USA
| | - David B Rye
- Department of Neurology, Division of Sleep Medicine and Program in Neuroscience, Harvard Medical School, Boston, MA, USA
| | - M Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - J Nonnekes
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, the Netherlands
| | - A Lozano
- Division of Neurosurgery, University of Toronto and Krembil Neuroscience Centre, University Health Network, Toronto, Canada
| | - J Valls-Solé
- Neurology Department, Hospital Clínic, University of Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), Barcelona, Spain
| | - M Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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Castellote JM, Valls-Solé J. Temporal relationship between perceptual and physiological events triggered by nociceptive heat stimuli. Sci Rep 2019; 9:3264. [PMID: 30824733 PMCID: PMC6397156 DOI: 10.1038/s41598-019-39509-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 12/18/2018] [Indexed: 12/20/2022] Open
Abstract
A combined assessment tool for the perceptual-motor aspects of pain processing will be valuable to clinicians. Fifteen healthy subjects were exposed to contact-heat stimulation (Pathway, Medoc, Israel) to assess perception through a simple task (motor response or conscious appraisal of the time the stimulus was felt) or with a dual task (both responses). The outcome measure was the temporal relationship between contact heat evoked potentials (CHEPS), reaction time (RT) and conscious awareness (AW). There were different temporal profiles for CHEPs, RT and AW to changes in stimulus intensity, AW being the least affected. Performing the dual task led to a significantly more pronounced effect on RT than on AW, while CHEPS were not influenced by task performance. Our results support the dissociation between physiological, behavioral and cognitive events elicited by nociceptive stimuli. The time of conscious appraisal of stimulus occurrence is a complementary information to other responses such as evoked potentials or behavioral tasks. The combined assessment of physiological and behavioral aspects of pain processing may provide clinicians with information on the different paths followed by nociceptive afferent inputs in the central nervous system.
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Affiliation(s)
- J M Castellote
- National School of Occupational Medicine, Carlos III Institute of Health and CIBERNED, Madrid, Spain. .,Department of Physical Medicine and Rehabilitation, School of Medicine, Complutense University of Madrid, Madrid, Spain.
| | - J Valls-Solé
- EMG and Motor Control Section, Neurology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
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Luis L, Costa J, Muñoz E, de Carvalho M, Carmona S, Schneider E, Gordon CR, Valls-Solé J. Vestibulo-ocular reflex dynamics with head-impulses discriminates spinocerebellar ataxias types 1, 2 and 3 and Friedreich ataxia. J Vestib Res 2018; 26:327-34. [PMID: 27392837 DOI: 10.3233/ves-160579] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Although the diagnosis of inherited ataxias is ultimately genetic, this usually means an extensive and expensive process. This justifies the search for distinct clinical signs that may potentially help orient molecular diagnosis. METHODS We explored the vestibulo-ocular reflex (VOR) with the video Head Impulse Test in patients diagnosed with spinocerebellar ataxia (SCA) type 3 (n = 15), type 1 (n = 4) and type 2 (n = 4), Friedreich's ataxia (FA) (n = 9) and healthy controls (n = 40). We estimated the latency, regression (VORr) and instantaneous VOR gain at 40, 60 and 80 ms (VOR40, VOR60 and VOR80), and determined the latency, peak-velocity and occurrence rate of catch-up saccades triggered with head-impulses. RESULTS VOR latency was higher in FA (p < 0.001) and SCA3 (p = 0.02) as compared to controls, discriminating FA from other ataxic patients with an overall diagnostic accuracy of 88%. VORr, VOR40 and VOR60 were significantly lower in FA and SCA3 (p < 0.01). VOR80 was only significantly lower than controls in SCA3 (p < 0.01), discriminating these from other ataxic patients with an overall diagnostic accuracy of 78%. Covert saccades were only triggered in SCA3 but with low occurrence rate and peak velocity (11.1 ± 28.5% and 77.50 ± 15.30°/s) whereas overt saccades were present in all groups. VORr gain showed a negative correlation with disease severity evaluated with SARA (Spearman r = -0.46, p = 0.01). CONCLUSIONS vHIT provides phenotypic information that differentiates these autosomal ataxias and can serve as a strategy to orient genetic diagnosis. A correlation between VOR and SARA raises the possibility of using VOR gain as a neurophysiologic biomarker for disease severity.
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Affiliation(s)
- L Luis
- Clinical Translational Physiology Unit, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Department of Surgical Specialties and Anesthesia, Otolaryngology Unit, Hospital de Cascais, Portugal.,Institute of Health Sciences, Portuguese Catholic University, Lisbon, Portugal
| | - J Costa
- Clinical Translational Physiology Unit, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Department of Neurology, EMG and Motor Control Unit, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Spain
| | - E Muñoz
- Department of Neurology, EMG and Motor Control Unit, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Spain
| | - M de Carvalho
- Clinical Translational Physiology Unit, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - S Carmona
- Department of Neuro-otology and Pain and Headache, Instituto de Neurociencias de Buenos Aires INEBA, Buenos Aires, Argentina
| | - E Schneider
- Institute of Medical Technology, Brandenburg University of Technology Cottbus - Senftenberg, Germany
| | - C R Gordon
- Department of Neurology, Meir Medical Center, Kfar Saba, Tel Aviv University, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Valls-Solé
- Department of Neurology, EMG and Motor Control Unit, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Spain
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Casanova-Molla J, Valls-Solé J. Reply. Muscle Nerve 2017; 56:E178. [DOI: 10.1002/mus.23351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 08/03/2017] [Accepted: 08/12/2017] [Indexed: 11/09/2022]
Affiliation(s)
| | - J. Valls-Solé
- Neurology Department; Hospital Clinic; Barcelona Spain
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Fernàndez-Lobera M, Arca R, Valls-Solé J. The effect of voluntary contraction on the direction of the wrist movement induced by focal tms. Brain Stimul 2017. [DOI: 10.1016/j.brs.2017.01.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Banea O, Casanova-Molla J, Morales M, Cabib C, Arca R, Brum M, Valls-Solé J. ID 323 – Shortening of the cutaneous silent period duration in tibialis anterior after fatiguing eccentric exercise. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.11.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Leon L, Cabib C, Cordoso M, Motta I, Valls-Solé J. An excitatory reflex between R1 and R2 responses of the blink reflex to supraorbital nerve stimuli. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Brum M, Cabid C, Arca R, Banea O, Casanova- Molla J, Valls-Solé J. ID 317 – On the clinical value of measuring the increase in duration of the motor evoked potential with contraction-induced facilitation. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.11.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Banea O, Casanova-Molla J, Morales M, Cabib C, Arca R, Brum M, Valls-Solé J. ID 396 – On the relationship between inter saccadic interval and object velocity in a reaching movement task. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.11.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Castellote J, Valls-Solé J. Modulation of force and velocity for accurate tasks by a startle. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Luis L, Lehnen N, Muñoz E, de Carvalho M, Schneider E, Valls-Solé J, Costa J. Anticompensatory quick eye movements after head impulses: A peripheral vestibular sign in spontaneous nystagmus. J Vestib Res 2016; 25:267-71. [PMID: 26890428 DOI: 10.3233/ves-160566] [Citation(s) in RCA: 8] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Differentiating central from peripheral origins of spontaneous nystagmus (SN) is challenging. Looking for a simple sign of peripheral disease with the video Head Impulsive Test we noticed anti-compensatory eye movements (AQEM) in patients with peripheral etiologies of spontaneous nystagmus (SN). Here we assess the diagnostic accuracy of AQEM in differentiating peripheral from central vestibular disorders. METHODS We recorded the eye movements in response to horizontal head impulses in a group of 43 consecutive patients with acute vestibular syndrome (12 with central, 31 with peripheral disorders), 5 patients after acute vestibular neurectomy (positive controls) and 39 healthy subjects (negative controls). AQEM were defined as quick eye movements (peak velocity above 50°/s) in the direction of the head movement. RESULTS All patients with peripheral disorders and positive controls had AQEM (latency 231 ± 53 ms, amplitude 3.4 ± 1.4°, velocity 166 ± 55°/s) when their head was moved to the opposite side of the lesion. Central patients did not have AQEM. AQEM occurrence rate was higher in peripheral patients with contralesional (74 ± 4%, mean ± SD) in comparison to ipsilesional (1 ± 4%) impulses (p< 0.001). Overall diagnostic accuracy for differentiating central from peripheral patients was 96% (95% CI for AUC ROC curve: 0.90 to 1.0) for VOR gain and 100% (95% CI: 1.0 to 1.0) for AQEM occurrence rate. CONCLUSIONS These results suggest that AQEM are a sign of vestibular imbalance in a peripheral deficit. In addition to VOR gain they should be added to the evaluation of the head impulse test.
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Affiliation(s)
- L Luis
- Health Sciences Institute, Portuguese Catholic University, Lisbon, Portugal.,Translational Clinical Physiology Unit, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Portugal.,Otolaryngology Unit, Hospital de Cascais, Cascais, Portugal
| | - N Lehnen
- German Center for Vertigo and Balance Disorders, Munich University Hospital, Germany.,Department of Neurology, Munich University Hospital, Germany
| | - E Muñoz
- EMG and Motor Control Unit, Neurology Department, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Spain
| | - M de Carvalho
- Translational Clinical Physiology Unit, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Portugal
| | - E Schneider
- German Center for Vertigo and Balance Disorders, Munich University Hospital, Germany.,Institute for Clinical Neurosciences, Munich University Hospital, Germany.,Institute of Medical Technology, Brandenburg University of Technology, Cottbus-Senftenberg, Germany
| | - J Valls-Solé
- EMG and Motor Control Unit, Neurology Department, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Spain
| | - J Costa
- Translational Clinical Physiology Unit, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Portugal.,EMG and Motor Control Unit, Neurology Department, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Spain
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Cabib C, Morales M, Cipullo F, Valls-Solé J. Modifying excitability of trigemino-facial reflex circuits with transcranial direct current stimulation. Brain Stimul 2015. [DOI: 10.1016/j.brs.2015.01.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Castellote JM, Valls-Solé J. The StartReact effect in tasks requiring end-point accuracy. Clin Neurophysiol 2015; 126:1879-85. [PMID: 25754260 DOI: 10.1016/j.clinph.2015.01.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 06/23/2014] [Revised: 01/26/2015] [Accepted: 01/28/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Fast and accurate movements are often performed in response to a sensory signal. In reaction time tasks, execution of open loop movements is speeded up when a startling auditory stimulus (SAS) is applied together with the imperative signal (IS). In this study, we examined the effects of a SAS on the performance of a task that demands accuracy. METHODS Nine subjects were asked to move a monitored pen to a target point located in a table at a fixed angular distance of 30 degrees from a start point. The target was a spot of three possible diameters: 5, 10, and 20mm. Finger force for pen holding, pen tip pressure against the table and kinematic variables of the forearm movement were measured for three conditions: control, SAS delivered at IS (SAS-IS trials) and SAS delivered during movement execution (SAS-MOV trials). RESULTS Two movement phases could be identified in the movement trajectory and force profile. The first phase, ballistic, was significantly shortened in SAS-MOV trials, with earlier and larger peak velocity and peak force with respect to control trials. The second phase, slow approach to target, was longer in SAS-IS trials but not in SAS-MOV trials. Accuracy was maintained throughout all conditions and stimulation modes. CONCLUSIONS A SAS speeds up only the first (ballistic) part of the movement in an accuracy task. Slower target approach compensates for the accelerated initial movement. No changes in the last part of the movement are seen when a SAS is delivered after movement onset. SIGNIFICANCE The StartReact effect is restricted to the onset of a complex movement, when muscles are activated in a ballistic mode, without feedback.
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Affiliation(s)
- J M Castellote
- National School of Occupational Medicine, Carlos III Institute of Health, Madrid, Spain; Department of Physical Medicine and Rehabilitation, School of Medicine, Complutense University of Madrid, Madrid, Spain.
| | - J Valls-Solé
- Unidad de EMG y Control Motor, Servei de Neurologia, Hospital Clínico, Universidad de Barcelona, Barcelona, Spain
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Granovsky Y, Anand P, Nakae A, Nascimento O, Smith B, Valls-Solé J, Yarnitsky D. P144: Contact heat evoked potentials (CHEPs) in healthy subjects – no laterality effect. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50284-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Araujo Mota I, Sala-Blanch X, Fernandes J, Neves Cardoso M, Valls-Solé J. P852: Temporal profile of the effects of regional anesthesia on the cutaneous silent period of foot muscles. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50882-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cabib C, Llufriu S, Martinez-Heras E, Saiz A, Valls-Solé J. O41: Mirror movements in multiple sclerosis. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50146-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Neves Cardoso M, Krarup C, Valls-Solé J. P847: Signs of motoneuronal hyperexcitability with reinnervation after peripheral nerve lesions. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50877-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Leote J, Valls-Solé J. P784: Characterization of the action potential derived from anodal stimulation in orthodromic sensory nerve conduction studies. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50823-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Melia U, Vallverdú M, Clariá F, Valls-Solé J, Caminal P. Auditory and Nociceptive Stimuli Responses in the Electroencephalogram. A Non-linear Measures and Time-frequency Representation Based Analysis. Methods Inf Med 2014; 54:209-14. [PMID: 24816506 DOI: 10.3414/me13-02-0044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/22/2013] [Accepted: 03/30/2014] [Indexed: 11/09/2022]
Abstract
INTRODUCTION This article is part of the Focus Theme of Methods of Information in Medicine on "Biosignal Interpretation: Advanced Methods for Neural Signals and Images". OBJECTIVES An efficient way to investigate the neural basis of nociceptive responses is the analysis of the event-related brain potentials (ERPs). The main objective of this work was to study how adaptation and fatigue affect the ERPs to stimuli of different modalities, by characterizing the responses to infrequent and frequent stimulation in different recording periods. METHODS In this work, series of averaged EEG epochs recorded after thermal, electrical and auditory stimulation were analyzed with time-frequency representation and non-linear measures as spectral entropy and auto-mutual information function. The study was performed by considering the traditional EEG frequency bands. RESULTS The defined measures presented a statistical significance p-value < 0.01 and accuracy higher than 60% by differentiating windows of response to infrequent (I) and frequent (F) stimuli between the start and end of the EEG recording. CONCLUSIONS These measures permitted to observe some aspects of the subject's adaptation and the nociceptive response.
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Affiliation(s)
| | - M Vallverdú
- Dr. Montserrat Vallverdú, Dept. ESAII, Universitat Politècnica de Catalunya, Carrer Pau Gargallo 5, 08028 Barcelona, Spain, E-mail:
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Groppa S, Oliviero A, Eisen A, Quartarone A, Cohen LG, Mall V, Kaelin-Lang A, Mima T, Rossi S, Thickbroom GW, Rossini PM, Ziemann U, Valls-Solé J, Siebner HR. A practical guide to diagnostic transcranial magnetic stimulation: report of an IFCN committee. Clin Neurophysiol 2012; 123:858-82. [PMID: 22349304 DOI: 10.1016/j.clinph.2012.01.010] [Citation(s) in RCA: 775] [Impact Index Per Article: 64.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 01/16/2012] [Accepted: 01/22/2012] [Indexed: 11/29/2022]
Abstract
Transcranial magnetic stimulation (TMS) is an established neurophysiological tool to examine the integrity of the fast-conducting corticomotor pathways in a wide range of diseases associated with motor dysfunction. This includes but is not limited to patients with multiple sclerosis, amyotrophic lateral sclerosis, stroke, movement disorders, disorders affecting the spinal cord, facial and other cranial nerves. These guidelines cover practical aspects of TMS in a clinical setting. We first discuss the technical and physiological aspects of TMS that are relevant for the diagnostic use of TMS. We then lay out the general principles that apply to a standardized clinical examination of the fast-conducting corticomotor pathways with single-pulse TMS. This is followed by a detailed description of how to examine corticomotor conduction to the hand, leg, trunk and facial muscles in patients. Additional sections cover safety issues, the triple stimulation technique, and neuropediatric aspects of TMS.
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Affiliation(s)
- S Groppa
- Department of Neurology, Christian Albrechts University, Kiel, Germany
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Castellote J, Valls-Solé J, Casanova-Molla J, Selvi A. 2. The StartReact effect in tasks requiring a precise endpoint. Clin Neurophysiol 2012. [DOI: 10.1016/j.clinph.2011.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Leon L, Casanova-Molla J, Valls-Solé J. 8. The blink reflex to median nerve stimuli in brainstem disorders. Clin Neurophysiol 2012. [DOI: 10.1016/j.clinph.2011.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Selvi A, Costa J, Valls-Solé J. 11. The effects of the StartReact paradigm in homonymous contralateral muscles. Clin Neurophysiol 2012. [DOI: 10.1016/j.clinph.2011.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Casanova-Molla J, Verger J, Castillo-Hernández C, Valls-Solé J. 223 DYNAMIC THERMOTEST TO EVALUATE CHANGES IN THERMOALGESIC THRESHOLDS IN PATIENTS WITH NEUROPATHIC PAIN. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/s1754-3207(10)70228-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Costa J, Guzmán J, Valldeoriola F, Rumiá J, Tolosa E, Casanova-Molla J, Valls-Solé J. P17.18 Modulation of the soleus H reflex by electrical subcortical stimuli in humans. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60485-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Castellote J, Queralt A, Valls-Solé J. P22.11 The motor programme for landing is unaffected by a startle. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60572-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Albanese A, Asmus F, Bhatia K, Elia AE, Elibol B, Filippini G, Gasser T, Krauss JK, Nardocci N, Newton A, Valls-Solé J. Response to letter by Dr Neil Murray. Eur J Neurol 2011. [DOI: 10.1111/j.1468-1331.2010.03346.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Albanese A, Asmus F, Bhatia KP, Elia AE, Elibol B, Filippini G, Gasser T, Krauss JK, Nardocci N, Newton A, Valls-Solé J. EFNS guidelines on diagnosis and treatment of primary dystonias. Eur J Neurol 2011; 18:5-18. [PMID: 20482602 DOI: 10.1111/j.1468-1331.2010.03042.x] [Citation(s) in RCA: 258] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES to provide a revised version of earlier guidelines published in 2006. BACKGROUND primary dystonias are chronic and often disabling conditions with a widespread spectrum mainly in young people. DIAGNOSIS primary dystonias are classified as pure dystonia, dystonia plus or paroxysmal dystonia syndromes. Assessment should be performed using a validated rating scale for dystonia. Genetic testing may be performed after establishing the clinical diagnosis. DYT1 testing is recommended for patients with primary dystonia with limb onset before age 30, and in those with an affected relative with early-onset dystonia. DYT6 testing is recommended in early-onset or familial cases with cranio-cervical dystonia or after exclusion of DYT1. Individuals with early-onset myoclonus should be tested for mutations in the DYT11 gene. If direct sequencing of the DYT11 gene is negative, additional gene dosage is required to improve the proportion of mutations detected. A levodopa trial is warranted in every patient with early-onset primary dystonia without an alternative diagnosis. In patients with idiopathic dystonia, neurophysiological tests can help with describing the pathophysiological mechanisms underlying the disorder. TREATMENT botulinum toxin (BoNT) type A is the first-line treatment for primary cranial (excluding oromandibular) or cervical dystonia; it is also effective on writing dystonia. BoNT/B is not inferior to BoNT/A in cervical dystonia. Pallidal deep brain stimulation (DBS) is considered a good option, particularly for primary generalized or cervical dystonia, after medication or BoNT have failed. DBS is less effective in secondary dystonia. This treatment requires a specialized expertise and a multidisciplinary team.
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Affiliation(s)
- A Albanese
- Istituto Neurologico Carlo Besta, Milan, Italy Università Cattolica del Sacro Cuore, Milan, Italy.
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Lauria G, Hsieh ST, Johansson O, Kennedy WR, Leger JM, Mellgren SI, Nolano M, Merkies ISJ, Polydefkis M, Smith AG, Sommer C, Valls-Solé J. European Federation of Neurological Societies/Peripheral Nerve Society Guideline on the use of skin biopsy in the diagnosis of small fiber neuropathy. Report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society. Eur J Neurol 2011; 17:903-12, e44-9. [PMID: 20642627 DOI: 10.1111/j.1468-1331.2010.03023.x] [Citation(s) in RCA: 525] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Revision of the guidelines on the use of skin biopsy in the diagnosis of peripheral neuropathy, published in 2005, has become appropriate owing to publication of more relevant articles. Most of the new studies focused on small fiber neuropathy (SFN), a subtype of neuropathy for which the diagnosis was first developed through skin biopsy examination. This revision focuses on the use of this technique to diagnose SFN. METHODS Task force members searched the Medline database from 2005, the year of the publication of the first EFNS guideline, to June 30th, 2009. All pertinent articles were rated according to the EFNS and PNS guidance. After a consensus meeting, the task force members created a manuscript that was subsequently revised by two experts (JML and JVS) in the field of peripheral neuropathy and clinical neurophysiology, who were not previously involved in the use of skin biopsy. RESULTS AND CONCLUSIONS Distal leg skin biopsy with quantification of the linear density of intraepidermal nerve fibers (IENF), using generally agreed upon counting rules, is a reliable and efficient technique to assess the diagnosis of SFN (Recommendation Level A). Normative reference values are available for bright-field immunohistochemistry (Recommendation Level A) but not yet for confocal immunofluorescence or the blister technique. The morphometric analysis of IENF density, either performed with bright-field or immunofluorescence microscopy, should always refer to normative values matched for age (Recommendation Level A). Newly established laboratories should undergo adequate training in a well-established skin biopsy laboratory and provide their own stratified for age and gender normative values, intra- and interobserver reliability, and interlaboratory agreement. Quality control of the procedure at all levels is mandatory (Good Practice Point). Procedures to quantify subepidermal nerve fibers and autonomic innervated structures, including erector pili muscles, and skin vessels, are under development but need to be confirmed by further studies. Sweat gland innervation can be examined using an unbiased stereologic technique recently proposed (Recommendation Level B). A reduced IENF density is associated with the risk of developing neuropathic pain (Recommendation Level B), but it does not correlate with its intensity. Serial skin biopsies might be useful for detecting early changes of IENF density, which predict the progression of neuropathy, and to assess degeneration and regeneration of IENF (Recommendation Level C). However, further studies are warranted to confirm its potential usefulness as an outcome measure in clinical practice and research. Skin biopsy has not so far been useful for identifying the etiology of SFN. Finally, we emphasize that 3-mm skin biopsy at the ankle is a safe procedure based on the experience of 10 laboratories reporting absence of serious side effects in approximately 35,000 biopsies and a mere 0.19% incidence of non-serious side effects in about 15 years of practice (Good Practice Point).
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Affiliation(s)
- G Lauria
- Neuromuscular Diseases Unit, IRCCS Foundation, 'Carlo Besta' Neurological Institute, Milan, Italy.
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Lladó A, Fortea J, Ojea T, Bosch B, Sanz P, Valls-Solé J, Clarimon J, Molinuevo JL, Sánchez-Valle R. A novel PSEN1 mutation (K239N) associated with Alzheimer’s disease with wide range age of onset and slow progression. Eur J Neurol 2010; 17:994-6. [DOI: 10.1111/j.1468-1331.2010.02949.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Benito Penalva J, Opisso E, Medina J, Corrons M, Kumru H, Vidal J, Valls-Solé J. H reflex modulation by transcranial magnetic stimulation in spinal cord injury subjects after gait training with electromechanical systems. Spinal Cord 2009; 48:400-6. [DOI: 10.1038/sc.2009.151] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Sala Blanch X, López AM, Carazo J, Hadzic A, Carrera A, Pomés J, Valls-Solé J. Intraneural injection during nerve stimulator-guided sciatic nerve block at the popliteal fossa. Br J Anaesth 2009; 102:855-61. [PMID: 19420006 DOI: 10.1093/bja/aep097] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Exact location of the needle tip during nerve stimulation-guided peripheral nerve blocks is unknown. Using high-frequency ultrasound imaging, we tested the hypothesis that intraneural injection is common with nerve stimulator-guided sciatic nerve (SN) block in popliteal fossa. METHODS Forty-two patients scheduled for hallux valgus repair were studied. Sciatic block at the popliteal fossa was accomplished using nerve stimulation. When a motor response was elicited at <0.5 mA (2 Hz, 0.1 ms), 40 ml of local anaesthetic (LA) was injected. Using ultrasound (Titan, Sonosite, 5-10 MHz), the diameters and area of the SN were measured before and after the injection. The presence of nerve swelling and proximal or distal diffusion of LA were also assessed. Intraneural injection was defined as nerve area (NA) increase of > OR =15% and one or more additional ultrasonographic markers (nerve swelling, proximal-distal diffusion within epineural tissue). Clinical neurological evaluation was performed 1 week after the block. RESULTS Post-injection NA increase > OR =15% was seen in 32 (76%) patients [0.54 (SD 0.19) cm(-2) vs 0.76 (0.24) cm(-2); P<0.05]. Nerve swelling with fascicular separation was observed in 37 (88%) patients; proximal and distal diffusion of LA were present in six (14%) and 14 (38%) patients, respectively. Intraneural injection criteria were met in 28 (66%) patients. Greater NA increase was present in patients with fast block onset [61 (45) vs 25 (33)%; (Dif 35% 95% CI 61-9%); P<0.05]. No patient developed neurological complications. CONCLUSIONS Intraneural (subepineural) injection is a common occurrence after nerve stimulator-guided SN block at the popliteal fossa, yet it may not inevitably lead to neurological complications.
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Affiliation(s)
- X Sala Blanch
- Department of Anesthesiology, Hospital Clinic, Universitat de Barcelona, C/Villarroel 170, Barcelona 08036, Spain.
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Abstract
The cutaneous silent period (CSP) is a spinal inhibitory reflex mediated by Adelta fibres. The postinhibitory rebound of electromyographic (EMG) activity following the CSP has been mainly attributed to resynchronization of motoneurons, but the possibility of startle reflex activity contributing to the EMG burst has also been suggested. Several types of reflexes may be suppressed by a preceding weak stimulus--a phenomenon called prepulse inhibition (PPI). Our aim was to study whether PPI would diminish the EMG rebound, thereby providing further evidence for excitatory reflex activity contained within the postinhibitory EMG rebound following the CSP. Ten healthy subjects underwent CSP testing following noxious digit II stimulation in two conditions, with and without a prepulse applied to digit III. Rectified surface EMG recordings were obtained from right orbicularis oculi, sternocleidomastoid and thenar muscles of the dominant hand during thumb abduction with 25% of maximum force. The area of the EMG rebound and the EMG reflex responses in orbicularis oculi and sternocleidomastoid were significantly smaller in recordings where a prepulse stimulus was applied 100 ms before the stimulus as compared to control responses without prepulse. CSP onset and end latency, CSP duration, and the degree of EMG suppression were not influenced. Prepulses significantly reduced subjective discomfort as based on visual analog scale scores. Inhibition of the EMG rebound by prepulse stimulation supports the hypothesis that the excitatory EMG activity following the CSP contains not only resynchronization of motoneuronal firing, but also an excitatory reflex component. The most probable type of reflex seems to be a somatosensory startle reflex, a defence reaction which is generated in structures located in the caudal brainstem following an unexpected intense stimulus. Reduction of the discomfort associated with high-intensity electrical fingertip stimulation by a prepulse without affecting CSP parameters underlines the utility of PPI in the context of CSP testing.
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Affiliation(s)
- H Kumru
- Department of Neurology, Instituto Guttmann, Hospital de Neurorehabilitació, Camí de Can Ruti S/N, Badalona, Spain
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Kumru H, Vidal J, Kofler M, Benito J, Garcia A, Valls-Solé J. Exaggerated auditory startle responses in patients with spinal cord injury. J Neurol 2008; 255:703-9. [DOI: 10.1007/s00415-008-0780-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Revised: 10/03/2007] [Accepted: 10/16/2007] [Indexed: 11/29/2022]
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Schestatsky P, Kumru H, Valls-Solé J, Valldeoriola F, Marti MJ, Tolosa E, Chaves ML. Neurophysiologic study of central pain in patients with Parkinson disease. Neurology 2007; 69:2162-9. [PMID: 18056580 DOI: 10.1212/01.wnl.0000295669.12443.d3] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Patients with Parkinson disease (PD) may present with various types of pain. In some instances, no cause can be identified and pain is considered a primary disorder (primary central pain [PCP]). We hypothesized that PCP in patients with PD (PD-PCP) may be due to a dysfunction of pain pathways or the processing of pain inputs in the CNS. METHODS We carried out a psychophysical and neurophysiologic study in 9 patients with PD-PCP, 9 patients with PD without pain (PD-NoP), and 9 healthy control subjects. We assessed the clinical characteristics of pain, performed quantitative sensory testing with thermal probes, and recorded laser-evoked potentials (LEPs) and laser-induced sudomotor skin responses (1-SSRs) in "off" and "on" conditions. RESULTS In "off" condition, patients with PD-PCP had lower heat pain and laser pinprick thresholds, higher LEP amplitudes, and less habituation of the l-SSR in comparison with PD-NoP patients and control subjects. Abnormalities were more marked in the most affected side. In "on" condition, psychophysical and neurophysiologic differences disappeared or were significantly attenuated. CONCLUSION Conduction along peripheral and central pain pathways is normal in patients with Parkinson disease with or without primary central pain. However, apart from signs of hyperalgesia, our patients exhibited lack of habituation of sympathetic sudomotor responses to repetitive pain stimuli, suggesting an abnormal control of the effects of pain inputs on autonomic centers. Abnormalities were attenuated by l-dopa, suggesting that the dysfunction may occur in dopamine-dependent centers regulating both autonomic function and inhibitory modulation of pain inputs.
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Affiliation(s)
- P Schestatsky
- Medical Sciences Post-Graduation Course, UFRGS School of Medicine, Porto Alegre, Brazil
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Alvarez S, Marchetti P, Valls-Solé J. P05. Startle reactions to somatosensory inputs. Different response pattern to stimuli of upper and lower limbs. Clin Neurophysiol 2007. [DOI: 10.1016/j.clinph.2007.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Schestatsky P, Valls-Solé J, Kumru H, Carbó EL, Marti M, Valldeoriola F, Tolosa E, Chaves M. P07. Localized brainstem dysfunction in patients with Parkinson’s disease and central pain. Clin Neurophysiol 2007. [DOI: 10.1016/j.clinph.2007.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Veciana M, Valls-Solé J, Schestatsky P, Montero J, Casado V. Abnormal sudomotor skin responses to temperature and pain stimuli in syringomyelia. J Neurol 2007; 254:638-45. [PMID: 17420928 DOI: 10.1007/s00415-006-0422-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Revised: 08/04/2006] [Accepted: 09/11/2006] [Indexed: 10/23/2022]
Abstract
Thermoalgesic sensory deficits in patients with syringomyelia may escape objective documentation with conventional electrophysiological techniques. We examined six patients with radiologically proven centrospinal cavities and patchy thermoalgesic sensory deficits by recording the evoked potentials and the sympathetic sudomotor skin responses (SSR) to laser stimuli. While electrical stimuli to the affected areas induced evoked potentials and SSRs of normal latency and amplitude, CO2 laser stimulation induced absent or abnormally reduced evoked potentials. Also, warmth and heat pain stimulation with a Peltier thermode induced absent or abnormal SSRs when applied over the affected areas but well defined SSRs when applied to the corresponding contralateral areas. Our results reveal the utility of recording the SSR to pain and temperature stimuli over specific body sites to demonstrate impairment of pain and temperature pathways in patients with syringomyelia. Comparison of electrical versus laser and temperature induced SSRs is an objective means to evaluate the selective thermoalgesic sensory deficit in these patients.
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Affiliation(s)
- M Veciana
- Dept. of Neurology, Hospital de St Boi, Barcelona, Spain
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Lladó A, León L, Valls-Solé J, Mena P, Callejas MA, Peri JM. Changes in the sympathetic skin response after thoracoscopic sympathectomy in patients with primary palmar hyperhidrosis. Clin Neurophysiol 2005; 116:1348-54. [PMID: 15978496 DOI: 10.1016/j.clinph.2005.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2004] [Revised: 01/13/2005] [Accepted: 02/10/2005] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate whether thoracic sympathectomy induced any change in the pattern of abnormalities or in the waveform of the sudomotor skin response (SSR) in patients with primary palmar hyperhidrosis (PPH). METHODS We recorded the SSR to median nerve electrical stimuli before and after bilateral thoracoscopic sympathectomy in 27 patients with PPH. We analyzed the changes in amplitude, type of waveform and pattern of abnormality. RESULTS All patients reported symptomatic improvement. The amplitude of the SSR decreased significantly in patients examined within 1 year after surgery, but was not different in patients examined after 1 year. The number of abnormally enhanced responses reduced after surgery, but there was no significant change in the number of patients with enhanced excitability recovery or with double-peak responses to single stimuli. There was a significant increase in the number of SSRs with a predominantly negative waveform after surgery. CONCLUSIONS The persistence of SSR abnormalities after surgery suggests that the central nervous system dysfunction is not modified by sympathectomy. The change of the waveform to predominantly negative type after surgery could be the consequence of the decrease in the production of sweating. SIGNIFICANCE Our results show the effects of sympathectomy on the SSR and on its abnormal patterns in patients with PPH.
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Affiliation(s)
- A Lladó
- Neurology Department, Hospital Clínic, University of Barcelona, Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona, Spain
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Mascia MM, Valls-Solé J, Martí MJ, Salazar G. Sensorimotor integration in patients with parkinsonian type multisystem atrophy. J Neurol 2005; 252:473-81. [PMID: 15726255 DOI: 10.1007/s00415-005-0678-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2004] [Revised: 09/08/2004] [Accepted: 10/05/2004] [Indexed: 10/25/2022]
Abstract
Sensorimotor integration is an essential feature of the central nervous system that contributes to the accurate performance of motor tasks. Some patients with multiple system atrophy with parkinsonian features (MSAp) exhibit clinical signs compatible with an abnormal central nervous system excitability to somatosensory inputs, such as action myoclonus or enhanced cutaneo-muscular reflexes. To investigate further the site where such dysfunction in sensorimotor integration takes place, we examined the inhibitory effects of a cutaneous afferent volley at two different levels of the motor system in 10 MSAp patients and in 10 age-matched healthy volunteers. Electrical digital nerve stimuli were given as the conditioning stimulus for the motor evoked potentials (MEP) elicited by transcranial magnetic stimulation in hand muscles, and for the blink reflex responses obtained in the orbicularis oculi muscles by supraorbital nerve stimulation. Intervals for the conditioning were 20 to 50 ms for the MEP and 90 to 110 ms for the blink reflex. The MEP was significantly inhibited in test trials in healthy volunteers, reaching a mean of 32% of the baseline values at the ISI of 35 ms. Significant inhibition occurred also in the blink reflex, in which the R2 response was a mean of 12% of baseline values at the ISI of 100 ms. The inhibitory effects were abnormally reduced in 8 patients on the MEP, and in 7 patients on the blink reflex. There were significant group differences between patients and control subjects in the size of the conditioned MEP and blink reflex. These results suggest that sensorimotor integration is abnormal in patients with MSAp in at least two central nervous system sites: the sensorimotor cortex, and the brainstem reticular formation.
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Affiliation(s)
- M M Mascia
- Unitat d'EMG. Servei de Neurologia, Hospital Clínic, Villarroel,170, Barcelona 08036, Spain.
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Valls-Solé J. [Function and dysfunction of the startle reaction in humans]. Rev Neurol 2004; 39:946-55. [PMID: 15573313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
INTRODUCTION AND DEVELOPMENT The startle reaction is one of the fastest movements of human beings in response to a sensory stimulus. It is likely that the central nervous system uses the circuits of the SR for the execution of a ballistic movement. Evidence in favour of the participation of the startle reaction circuits in the execution of a ballistic movement has been gathered by combining the presentation of startle reaction-inducing stimuli with the imperative signal in a reaction time task experiment. In this situation, in which subjects are highly prepared for movement execution, the reaction becomes accelerated but the movement pattern is not modified. On top of that, acceleration is limited to the movement per se, and it does not involve the subjective perception of the movement. Impairment of the central control of the startle reaction may lead to excess or reduction of the response. One of the examples of excessive response is hyperekplexia, in which patients cannot avoid having a startle reaction to unexpected stimuli. Reduced startle reaction occurs in parkinsonism and, specially, in progressive supranuclear palsy. CONCLUSIONS One of the best known mechanisms of control of the startle reaction is prepulse inhibition. This phenomenon is likely the consequence of sensory signal processing at the brainstem level. The role of the prepulse inhibition is to avoid disruption of the sensory processing by the interference of another input. Prepulse inhibition is abnormally reduced in patients with parkinsonism, as an expression of the abnormal control of brainstem circuits by the basal ganglia. It has been also found abnormal in patients with Huntington's disease and in some patients with dystonia.
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Affiliation(s)
- J Valls-Solé
- Unidad de Electromiografía, Servicio de Neurología, Hospital Clínic, Barcelona, Spain.
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Valls-Solé J, Muñoz JE, Valldeoriola F. Abnormalities of prepulse inhibition do not depend on blink reflex excitability: a study in Parkinson's disease and Huntington's disease. Clin Neurophysiol 2004; 115:1527-36. [PMID: 15203054 DOI: 10.1016/j.clinph.2004.02.014] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2004] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Prepulse inhibition of the blink reflex is a robust phenomenon with an interesting physiology and a large potential for clinical applicability. In the study presented here we investigated whether the blink reflex inhibition by a prepulse (BRIP) is influenced by the blink reflex excitability recovery (BRER). METHODS The study was undertaken in 20 patients with Parkinson's disease (PD), 20 patients with Huntington's disease (HD) and 20 healthy volunteers. BRER was determined by measuring the size of the response to a test supraorbital nerve stimulus as a percentage of the response to a conditioning stimulus at inter-stimuli intervals of 100-1000 ms. BRIP was determined as the percentage reduction induced in the response to a supraorbital nerve stimulus by either a low intensity auditory click or a weak third finger somatosensory stimulus, applied with a leading interval of 50-110 ms. RESULTS There was a negative correlation between the percentage BRER and the percentage BRIP (Pearson's correlation coefficient of -0.37). BRER was enhanced in 14 PD patients (70%) and 6 HD patients (30%), while it was depressed in 10 HD patients (50%). BRIP was significantly reduced in 15 PD patients (75%) and 16 HD patients (80%). No significant correlation was found between abnormally enhanced BRER and abnormally reduced BRIP in all patients as a group (chi(2)=2.4;P=0.11). A weak correlation was found in PD patients (P=0.019) and no correlation was observed in HD patients (P=0.8). CONCLUSIONS Our results indicate that an abnormally reduced BRIP was not always accompanied by an abnormally enhanced BRER in patients with HD. The two tests likely assess specific and distinct brainstem functions, and provide different types of information. While BRIP may be the result of a widespread integrative processing of sensory stimuli, BRER likely reflects the excitability of a chain of brainstem inter-neurons. SIGNIFICANCE BRER and BRIP provide independent information on the state of functionally separate circuits that converge on trigemino-facial brainstem inter-neurons.
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Affiliation(s)
- J Valls-Solé
- Unitat d'EMG, Servei de Neurologia, Institut d'Investigació Biomèdica August Pi i Sunyer, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, Barcelona 08017, Spain.
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Abstract
The execution of a ballistic movement within a reaction time task paradigm is significantly speeded up when an unexpected startling auditory stimulus (SAS) is delivered together with the imperative signal. Using Libet's clock, we investigated whether acceleration involves also the subjective appraisal of the time of task execution. In trials containing the SAS, reaction time shortened to 68.7% of control values. However, subjective judgment of task execution remained a similar time with respect to the imperative signal as in control trials. The dissociation between task execution and its subjective perception indicates the existence of separate circuits for action execution and action awareness.
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Affiliation(s)
- M T Sanegre
- Unitat d'EMG, Servei de Neurologia, Hospital Clínic, Departament de Medicina, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), Barcelona, Spain
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50
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Abstract
In preparation for performing task specific ballistic movements, subjects may choose among different possibilities for setting up their motor apparatus, ranging from quiet resting to different types of muscle activation. In the study presented here, we investigated whether differences in the motor set modify either the reaction time or the kinematic characteristics of the movement. Subjects wearing surface EMG recording electrodes in the wrist extensor (WE) and wrist flexor (WF) muscles were requested to react to the presentation of a visual stimulus by performing a ballistic wrist extension movement of an amplitude of about 50 degrees in the following experimental conditions: resting quietly, which was considered as the control condition (CC); isometric contraction (IC), in which subjects were required to activate WE and WF muscles isometrically; rapid oscillations (RO), in which subjects were requested to make a fast oscillatory wrist movement; and slow oscillations (SO), in which subjects were maintaining a slow oscillatory motion of the wrist. To constrain the movement to the wrist joint and limit the action of postural muscles, the subject's forearm and hand were attached to joined non-resistive metallic platforms, allowing for free non-frictional displacement. In the EMG recordings, we measured the size of the EMG bursts in agonist and antagonist muscles, and the inter-burst intervals. In movement recordings, we measured movement onset latency and the velocity profile. Movement onset was delayed in SO with respect to all other conditions. Conversely, peak velocity was larger in all test conditions in comparison to CC. There were no differences in the size of the first EMG burst of the agonist muscle, but significant changes occurred in the subsequent bursts recorded in the agonist and antagonist muscles. Our study indicates that the motor program used to execute a ballistic voluntary movement is influenced by the conditions of the motor system. The configuration of the motor set should be specifically considered in the search for improving the speed of the reaction and the kinematics of ballistic movements.
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Affiliation(s)
- J M Castellote
- Facultad de Ciencias de la Actividad Física y el Deporte, Universidad de Valencia, Valencia, Spain
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