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Gündüz A, Aliş C, Kızıltan ME. Blink reflex excitability in patients with Hemifacial spasm exhibiting different abnormal discharge patterns: from early isolated discharges to later grouped bursts or tonic spasms. Acta Neurol Belg 2024; 124:495-501. [PMID: 38296894 DOI: 10.1007/s13760-023-02445-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 11/27/2023] [Indexed: 02/02/2024]
Abstract
OBJECTIVE We studied blink reflex (BR) and BR excitability recovery (BRER) in patients with hemifacial spasm (HFS) exhibiting different abnormal discharge patterns. We hypothesized that patients with groups of clonic or tonic burst activities appear later in the disease course and may have more excitability of the BR circuit at the brainstem compared to patients with isolated twitchings, which occur earlier. METHODS We included 124 patients with botulinum toxin-naive HFS (mean age 50.6 ± 13.3 years) and 40 healthy subjects. We performed surface polymyography on facial muscles in patients and classified them according to the abnormal discharge pattern: isolated discharges, grouped bursts forming random sequences, tonic spasms, and a combination of these activities. Then, we recorded BR and BRER at 200, 600, and 1000 ms interstimulus intervals. We compared disease duration, R1 and R2 latencies, R2 area-under-the-curve (AUC), and BRER% (i) between healthy subjects and patients and (ii) among groups of patients with different abnormal discharge patterns. RESULTS There were isolated discharges in 28 patients, grouped bursts forming random sequences in 42, and continuous muscle activity with tonic spasms in one. The remaining patients had combinations. Mean R1 and R2 latencies were significantly longer, and mean R2 AUC was significantly higher on the symptomatic side of patients compared to healthy subjects. The mean BRER was enhanced on both sides in patients than in healthy subjects (p < 0.001). However, it was similar among patient groups with different abnormal discharge patterns (p > 0.05). The mean disease duration in patients with isolated discharges was shorter (3.3 ± 2.0 years) than those with grouped bursts or tonic spasms (p = 0.002; Kruskal-Wallis test). CONCLUSION Our study observed that excitability at the brainstem was similar in HFS patients with different abnormal discharge patterns, suggesting that the difference in discharge patterns in HFS may be due to a reason other than the difference in BR excitability.
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Affiliation(s)
- Ayşegül Gündüz
- Cerrahpasa Faculty of Medicine, Department of Neurology, Istanbul University-Cerrahpasa, Istanbul, Türkiye.
| | - Ceren Aliş
- Cerrahpasa Faculty of Medicine, Department of Neurology, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Meral E Kızıltan
- Cerrahpasa Faculty of Medicine, Department of Neurology, Istanbul University-Cerrahpasa, Istanbul, Türkiye
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Gündüz A, Çetinkaya Tezer D, Türk BG, E Kızıltan M. Segmental Reflex, Long Latency Reflex, and Mixed Nerve Silent Period in Dystonia. Can J Neurol Sci 2023:1-5. [PMID: 37955243 DOI: 10.1017/cjn.2023.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
We hypothesized that "long latency reflexes" (LLRs), associated segmental reflex (SR), and mixed nerve silent periods (MnSPs) recorded on the distal upper extremity muscles would behave differently in patients with cervical dystonia and focal hand dystonia. We enrolled patients with cervical dystonia, generalized dystonia, focal hand dystonia, and healthy individuals. We recorded SR, LLRs, and MnSPs. The mean amplitude of SR on the affected side of focal hand dystonia was significantly lower (p = 0.010). The parameters related to LLRs and MnSPs were not different between groups. We suggest, using SR, LLRs, and MnSPs, we could not show an electrophysiological signature specific to dystonia.
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Affiliation(s)
- Ayşegül Gündüz
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurology, Istanbul, Turkey
| | - Damla Çetinkaya Tezer
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurology, Istanbul, Turkey
| | - Bengi Gül Türk
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurology, Istanbul, Turkey
| | - Meral E Kızıltan
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurology, Istanbul, Turkey
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Akıncı T, Gündüz A, Özkara Ç, Kızıltan ME. The Thalamic and Intracortical Inhibitory Function of Somatosensory System Is Unchanged in Mesial Temporal Lobe Epilepsy With Hippocampal Sclerosis. J Clin Neurophysiol 2023; 40:45-52. [PMID: 33675312 DOI: 10.1097/wnp.0000000000000839] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE In mesial temporal lobe epilepsy with hippocampal sclerosis, there is parietal atrophy and cognitive involvement in related domains. In this context, we hypothesized that inhibitory input into somatosensory cortex and thalamus may be increased in these patients, which could improve after epilepsy surgery. Thus, we analyzed the inhibitory function of somatosensory system by studying surround inhibition (SI) and recovery function of somatosensory evoked potentials in patients with mesial temporal lobe epilepsy with hippocampal sclerosis. METHODS Nine patients with unoperated mesial temporal lobe epilepsy with hippocampal sclerosis, 10 patients who underwent epilepsy surgery, and 12 healthy subjects were included. For SI of somatosensory evoked potentials, we recorded somatosensory evoked potentials after stimulating median or ulnar nerve at wrist separately and after median and ulnar nerves simultaneously and calculated SI% in all participants. For recovery function of somatosensory evoked potentials, paired stimulation of median nerve at 40- and 100-millisecond intervals was performed. We compared the findings among groups. As a secondary analysis, we determined the outliers in the patient group and analyzed the relation to the clinical findings. RESULTS The mean SI% or recovery function was similar among three groups. However, there were five patients with SI loss on normal side in the patient group, which was related to the antiseizure drugs. CONCLUSIONS In contrast to our hypothesis, both intracortical (SI) and thalamic/striatal (recovery function) inhibitory modulation of the somatosensory cortex was not altered in mesial temporal lobe epilepsy with hippocampal sclerosis and did not differ in surgical and nonsurgical groups.
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Affiliation(s)
- Tuba Akıncı
- Department of Neurology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa (I.U.C), Istanbul, Turkey
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Tanrıverdi U, Gündüz A, Hatice Kumru, Kızıltan ME. Cutaneous silent period modulation by tooth clenching, tonic and phasic limb movements in healthy subjects. Exp Brain Res 2022; 240:2783-2789. [DOI: 10.1007/s00221-022-06455-y] [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] [Received: 06/24/2022] [Accepted: 08/29/2022] [Indexed: 11/29/2022]
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Ertaş Fİ, Aygun D, Benbir Senel G, Gündüz A, Karadeniz D, E Kızıltan M. Contribution of brainstem circuits in pathophysiology of NREM-sleep parasomnias. Neurosci Lett 2021; 760:136075. [PMID: 34153369 DOI: 10.1016/j.neulet.2021.136075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/22/2021] [Accepted: 06/16/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We aimed to investigate the brainstem circuits to reveal if there was any abnormality in these circuits in clinically diagnosed patients with NREM parasomnias during wakefulness. METHODS Twelve patients with NREM-sleep parasomnia diagnosed according to ICSD-3 criteria and a control group of 16 healthy subjects were enrolled into our study. We analyzed the auditory startle reflex (ASR), blink reflex (BR), prepulse inhibition (PPI) of BR and recovery excitability of BR. RESULTS There was a trend for longer responses from orbicularis oculi and sternocleidomastoid muscles after auditory stimulation in the patients compared to those in the healthy subjects. The recovery percentages at 200 ms and 300 ms showed a borderline significance in the patients. No significant difference was found in the R2-PPI between the patients and healthy subjects. CONCLUSIONS Our results suggest a mildly enhanced ASR and relatively early facilitation of BR excitability in patients with NREM-sleep parasomnia during daytime. Although our findings suggest involvement of brainstem networks in NREM-sleep parasomnia during wakefulness, it would be better to study these networks at night and during daytime to see if there is any contribution.
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Affiliation(s)
- F İnci Ertaş
- Istanbul University- Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, Turkey
| | - Demet Aygun
- Istanbul University- Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, Turkey
| | - Gülçin Benbir Senel
- Istanbul University- Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, Turkey
| | - Ayşegül Gündüz
- Istanbul University- Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, Turkey.
| | - Derya Karadeniz
- Istanbul University- Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, Turkey
| | - Meral E Kızıltan
- Istanbul University- Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, Turkey
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Asan F, Gündüz A, E Kızıltan M. Prepulse inhibition and recovery of trigemino-cervical reflex in patients with cervical dystonia. Neurophysiol Clin 2020; 50:361-366. [PMID: 33036866 DOI: 10.1016/j.neucli.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/05/2020] [Accepted: 09/06/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We aimed to analyze the prepulse inhibition (PPI) and recovery rate (R) of the trigeminocervical reflex (TCR) in patients with cervical dystonia (CD). METHODS We enrolled 15 patients with CD and 16 healthy subjects. TCR was recorded over splenius capitis after infraorbital nerve stimulation. For TCR-PPI, we applied a prepulse stimulus to the left second finger 100 ms prior to the test stimulus and the percentage of change of response to test stimulus was calculated. For TCR-R, we applied paired infraorbital stimuli at interstimulus interval (ISIs) of 300 ms and the percentage of change of the second compared to the first response was calculated. RESULTS TCR-PPI and TCR-R values were higher (less inhibition and greater recovery) on both sides in the patient group compared to healthy subjects. There was high correlation between TCR-PPI and TCR-R on both sides in patients with dystonia (p < 0.005). We did not find any significant relationship between TCR-R or TCR-PPI and side of dystonic posture. CONCLUSIONS We showed disturbed modulation of TCR in CD patients. In CD, a general inhibition of the inhibitory pathways and facilitation of the excitatory pathways occur. Although TCR was recorded directly on the affected muscles in CD, symmetric abnormal TCR findings in CD suggest that these findings are probably secondary to altered function of higher order centers rather than being directly related to the pathophysiological process.
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Affiliation(s)
- Furkan Asan
- Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Neurology, Turkey.
| | - Ayşegül Gündüz
- Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Neurology, Turkey
| | - Meral E Kızıltan
- Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Neurology, Turkey
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Gunduz A, Kofler M, Aktan Suzgun M, Tutuncu M, Karaali-Savrun F, Uzun N, E Kızıltan M. Cutaneous silent period in patients with spinal muscular atrophy type 2 and type 3. Neurophysiol Clin 2020; 50:353-359. [PMID: 32951956 DOI: 10.1016/j.neucli.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine cutaneous silent periods (CSPs) in spinal muscular atrophy (SMA) type 2 and type 3 patients. METHODS Fourteen patients with SMA and 14 healthy subjects were included. CSPs were recorded from thenar muscles after painful stimulation of the index finger during slight thumb abduction. CSP parameters (including onset latency, duration, index of suppression, long-loop reflex, and post-inhibitory rebound activity) were measured. All parameters were compared between SMA patients and healthy subjects using the Mann-Whitney U test. We then correlated CSP parameters to Hammersmith Functional Motor Scale Expanded (HFMSE) scores in SMA patients by Spearman-rho testing. RESULTS No CSP parameter except E3% (i.e., the post-inhibitory rebound activity relative to pre-stimulus baseline) differed significantly between SMA patients and healthy subjects. E3% was significantly smaller in patients than healthy individuals. HFMSE scores of SMA patients correlated negatively with CSP duration and positively with E3%. DISCUSSION Smaller E3%, correlating with longer CSP duration, in SMA patients with more severe clinical findings and therefore more marked motoneuron loss suggests that the E3 component following the CSP is directly affected by motoneuron loss.
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Affiliation(s)
- Aysegul Gunduz
- Istanbul University- Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, Turkey.
| | - Markus Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Merve Aktan Suzgun
- Istanbul University- Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, Turkey
| | - Melih Tutuncu
- Istanbul University- Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, Turkey
| | - Feray Karaali-Savrun
- Istanbul University- Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, Turkey
| | - Nurten Uzun
- Istanbul University- Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, Turkey
| | - Meral E Kızıltan
- Istanbul University- Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, Turkey
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Aktuglu Zeybek C, Gunduz A, Enver EO, Tezen D, Kiykim E, Kızıltan ME. Movement disorders in the early-diagnosed cerebrotendinous xanthomatosis: An electrophysiological study. Parkinsonism Relat Disord 2020; 80:12-14. [PMID: 32927342 DOI: 10.1016/j.parkreldis.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 08/22/2020] [Accepted: 09/03/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Cigdem Aktuglu Zeybek
- Istanbul University- Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Pediatrics, Department of Pediatric Nutrition and Metabolism, Istanbul, Turkey
| | - Aysegul Gunduz
- Istanbul University- Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, Turkey.
| | - Ece Oge Enver
- Istanbul University- Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Pediatrics, Department of Pediatric Nutrition and Metabolism, Istanbul, Turkey
| | - Didem Tezen
- Istanbul University- Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, Turkey
| | - Ertugrul Kiykim
- Istanbul University- Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Pediatrics, Department of Pediatric Nutrition and Metabolism, Istanbul, Turkey
| | - Meral E Kızıltan
- Istanbul University- Cerrahpaşa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, Turkey
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Ayas S, Kızıltan ME, Karaali-Savrun F, Gündüz A. Modulation of the Somatosensory Blink Reflex in the Peripersonal Space Is Defective in Episodic Migraine. Pain Med 2020; 21:1663-1667. [PMID: 31958117 DOI: 10.1093/pm/pnz328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE In migraine, there is an altered behavior of patients during the attack and an altered connectivity in the cortical structures modulating and encoding the sensation and pain. Thus, we hypothesized that the extent of the peripersonal space (PPS) and the responses in the PPS may change during a migraine attack. For this reason, we analyzed the modulation of somatosensory blink reflex (SBR) in the PPS during episodic migraine. DESIGN Cross-sectional assessment of modulation of SBR in patients with migraine. SETTING Headache outpatient clinic of a tertiary referral center. SUBJECTS We included 22 patients with episodic migraine, of whom 13 individuals were in the interictal period and nine were experiencing a headache episode. We also included 14 healthy individuals. The three groups were similar in age and gender. METHODS SBR was recorded when the participants were sitting with their forearm in the extrapersonal space and also when their hands were in the PPS surrounding the face. Latency, amplitude, and area under the curve (AUC) were measured and compared. RESULTS The amplitude and AUC of the SBR were significantly higher in patients during the attack compared with healthy subjects. The magnitude of the SBR was increased in the PPS in healthy subjects, whereas the increase was not significant in patients during the attack or in the interictal period. CONCLUSIONS We think that the modulation in the PPS is defective in patients with migraine both during the acute attack and in the interictal phase, suggesting diminished top-down modulation of the SBR.
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Affiliation(s)
- Selahattin Ayas
- Department of Neurology, Cerrahpasa Medical Faculty, IUC, Istanbul, Turkey
| | - Meral E Kızıltan
- Department of Neurology, Cerrahpasa Medical Faculty, IUC, Istanbul, Turkey
| | | | - Ayşegül Gündüz
- Department of Neurology, Cerrahpasa Medical Faculty, IUC, Istanbul, Turkey
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Ser MH, Tekgül Ş, Gündüz A, Kızıltan ME, Kızıltan G, Başak AN. Ataxia telangiectasia like disorder: Another dopa-responsive disorder look-alike? Parkinsonism Relat Disord 2020; 74:22-24. [PMID: 32289520 DOI: 10.1016/j.parkreldis.2020.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/10/2020] [Accepted: 03/20/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Merve Hazal Ser
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Neurology, Turkey
| | - Şeyma Tekgül
- Koç University, School of Medicine, Molecular Biology and Genetics- KUTTAM, Suna and Inan Kıraç Foundation Neurodegeneration Research Laboratory, Turkey
| | - Ayşegül Gündüz
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Neurology, Turkey.
| | - Meral E Kızıltan
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Neurology, Turkey
| | - Güneş Kızıltan
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Neurology, Turkey
| | - A Nazlı Başak
- Koç University, School of Medicine, Molecular Biology and Genetics- KUTTAM, Suna and Inan Kıraç Foundation Neurodegeneration Research Laboratory, Turkey
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E Kızıltan M, Gündüz A. Late component of trigemino-cervical reflex: changes according to age and gender. Neurol Sci 2020; 41:1759-1764. [PMID: 32006124 DOI: 10.1007/s10072-020-04242-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Trigemino-cervical reflex (TCR) is a protective reflex which is elicited by the stimulation of any branch of the trigeminal nerve. After infraorbital stimulation, an early and late components have been described. The aim of this study was to find out whether there are age- or gender-related changes in the long-latency (RII) component of TCR. METHOD We included consecutive 53 healthy subjects (20 men, 37.7%) who had normal neurological examination. The mean age was 45.1 ± 14.3 years (age range 18-75 years). TCR was recorded simultaneously from bilateral sternocleidomastoid (SCM) and splenius capitis (SC) muscles with surface electrodes after stimulating right or left infraorbital branch of the trigeminal nerve, separately. We compared latency, amplitude, and duration according to gender and age. RESULTS The amplitudes of SC responses were significantly higher in women compared to men. The duration of SCM response was significantly longer in subjects above the age of 50 years compared to younger patients. The latency of the SC response was significantly delayed above the age of 40 years. CONCLUSION There are age- and gender-related changes in TCRs probably due to changes in the motoneurons of the SC and SCM muscles.
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Affiliation(s)
- Meral E Kızıltan
- Department of Neurology, Cerrahpaşa School of Medicine, IUC, Istanbul, Turkey
| | - Ayşegül Gündüz
- Department of Neurology, Cerrahpaşa School of Medicine, IUC, Istanbul, Turkey.
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E Kızıltan M, Dogan C, Ayas S, Valls-Sole J, Gunduz A. Changes in brainstem excitatory and inhibitory pathways in dry eye syndrome. Neurosci Lett 2019; 718:134726. [PMID: 31884018 DOI: 10.1016/j.neulet.2019.134726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/22/2019] [Accepted: 12/25/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND We hypothesized that there may be changes in sensory integration pathways in patients with dry eye. To confront this issue, we analyzed blink reflex (BR), prepulse modulation (PPM) of BR, and excitability recovery of BR to paired stimuli in 17 experimental subjects with dry eye syndrome. METHOD We included 17 experimental subjects, 8 with primary and 9 with secondary, dry eye syndrome. We also examined a control group of 14 age and gender matched control subjects. After clinical evaluation, we recorded BR, PPM of BR (at 50 and 100 ms intervals) and BR percentage recovery to paired stimulation (at 300 and 500 ms intervals). RESULTS None of the patients had any spasm activity. Experimental subjects had significantly larger R2 and R2c AUCs, significantly greater excitability recovery at 300 ms interval and significantly reduced R2 and R2c prepulse inhibition, in comparison to control subjects. Experimental subjects with primary dry eye syndrome had higher number of spontaneous blinks than experimental subjects with secondary dry eye syndrome (54.0 ± 10.3 for primary dry eye and 43.5 ± 13.3 secondary dry eye). CONCLUSION Our results are compatible with increased excitability and abnormalities in sensorimotor integration in blink reflex circuits of patients with dry eye. This suggests the development of adaptive changes in brainstem synaptic activity, aimed at facilitation of blinking in the context of increased sensory input from corneal irritation.
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Affiliation(s)
- Meral E Kızıltan
- Department of Neurology, Cerrahpasa Medical Faculty, I.U.C, Istanbul, Turkey
| | - Cezmi Dogan
- Department of Ophtalmology, Cerrahpasa Medical Faculty, I.U.C, Istanbul, Turkey
| | - Selahattin Ayas
- Department of Neurology, Cerrahpasa Medical Faculty, I.U.C, Istanbul, Turkey
| | - Josep Valls-Sole
- IDIBAPS (Institut d'Investigació August Pi i Sunyer), Barcelona, Spain
| | - Aysegul Gunduz
- Department of Neurology, Cerrahpasa Medical Faculty, I.U.C, Istanbul, Turkey.
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Akıncı Y, Asan F, Sohtaoğlu M, Tütüncü M, Uygunoğlu U, Saip S, Gündüz A, Kızıltan ME. Brainstem reflexes in neuro-Behçet disease. Neurophysiol Clin 2019; 49:381-384. [PMID: 31727406 DOI: 10.1016/j.neucli.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 11/29/2022] Open
Abstract
We hypothesized that brainstem responses may allow detection of functional brainstem changes in patients with neuro-Behçet Disease (NBD). Thus, we recorded electrically-induced blink reflex (eBR), auditory blink reflex (aBR) and electrically-induced masseter inhibitory reflex (eMIR) in 16patients with NBD. However, these neurophysiological tests proved to have a poor overall sensitivity compared to neuroimaging for the diagnosis of brainstem lesions. They also showed low sensitivity for the differential diagnosis of focal pontine lesion versus diffuse brainstem disease in NBD.
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Affiliation(s)
- Yasemin Akıncı
- Istanbul University-Cerrahpasa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, 34098, Turkey
| | - Furkan Asan
- Istanbul University-Cerrahpasa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, 34098, Turkey
| | - Melis Sohtaoğlu
- Istanbul University-Cerrahpasa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, 34098, Turkey
| | - Melih Tütüncü
- Istanbul University-Cerrahpasa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, 34098, Turkey
| | - Uğur Uygunoğlu
- Istanbul University-Cerrahpasa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, 34098, Turkey
| | - Sabahattin Saip
- Istanbul University-Cerrahpasa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, 34098, Turkey
| | - Ayşegül Gündüz
- Istanbul University-Cerrahpasa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, 34098, Turkey.
| | - Meral E Kızıltan
- Istanbul University-Cerrahpasa, Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, 34098, Turkey
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Affiliation(s)
- Meral E. Kızıltan
- Department of Neurology, Cerrahpasa Medical Faculty, I.U.C., Istanbul, Turkey
| | - S. Naz Yeni
- Department of Neurology, Cerrahpasa Medical Faculty, I.U.C., Istanbul, Turkey
| | - Ceren Aliş
- Department of Neurology, Cerrahpasa Medical Faculty, I.U.C., Istanbul, Turkey
| | - Ayşegül Gündüz
- Department of Neurology, Cerrahpasa Medical Faculty, I.U.C., Istanbul, Turkey
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Gündüz A, Koçak S, Gez S, Kızıltan ME. Fear leads to a deficit of prepulse inhibition of blink reflex in healthy humans. Neurol Sci 2019; 40:2581-2586. [PMID: 31350658 DOI: 10.1007/s10072-019-04028-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 07/18/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We aimed to analyze whether or not fear conditioning exerts an effect on prepulse inhibition (PPI) of blink reflex (BR). To create fear conditioning, we used fearful faces. Since fearful faces lead to a specific set of fear conditioning, we hypothesized PPI of BR would change under the observation of fearful faces. METHOD We included 17 healthy subjects with a mean age of 30.8 ± 6.9 years and seven healthy subjects with a mean age of 57.7 ± 7.3 years between January 2018 and June 2018 and recorded PPI of BR. The recordings were done before observation of any image, during observation of images, and immediately after observation of images. Observation of images included observation of fearful faces for 30 s and a neutral image of a white screen for 30 s (in a randomized order). RESULTS There was a R2-PPI deficit during observation of fearful faces in each group whereas R2-PPI fully developed at other time points. R1 amplitude and R2 magnitude were lower during observation of any image compared with baseline and post-observation time points. CONCLUSION In conclusion, a deficit of R2-PPI develops during observation of fearful faces in humans which is probably related to activation of the amygdala.
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Affiliation(s)
- Ayşegül Gündüz
- Department of Neurology, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
| | - Selen Koçak
- Department of Neurology, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Sedat Gez
- Department of Neurology, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Meral E Kızıltan
- Department of Neurology, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Aydın Ş, Kofler M, Bakuy Y, Gündüz A, Kızıltan ME. Effects of vibration on cutaneous silent period. Exp Brain Res 2019; 237:911-918. [PMID: 30659303 DOI: 10.1007/s00221-018-05463-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 12/21/2018] [Indexed: 12/14/2022]
Abstract
Suppression of an ongoing muscle contraction following noxious digital stimulation is called cutaneous silent period (CSP) which is under the influence of several physiological factors. In this study, we aimed to evaluate the influence of group Ia afferents on the cutaneous silent period (CSP) by applying 2-min vibration. CSP was obtained from abductor pollicis brevis muscle after stimulating index finger. The recordings were repeated three times-before, during and after vibration-which was applied over the tendon of flexor carpi radialis muscle. Onset latency, duration and magnitude of total CSP, inhibitory phases I1 and I2, and of the long-loop reflex were measured and compared. Suppression indices of CSP, I1 and I2 increased significantly during and after vibration, indicating significantly less exteroceptive EMG suppression outlasting the time of vibration. Vibration also caused mild shortening of I2 end latency (p = 0.048) and I2 duration (p = 0.019). Our findings indicate that vibration exerts a powerful influence on CSPs and causes reduction in the magnitude of exteroceptive EMG suppression during and after vibration. Although vibration is known to activate Ia afferents, we cannot exclude contribution of other afferents, e.g. mechanoreceptors, as well as pre- or postsynaptic inhibitory effects on ensuing interneurons, or enhanced vibration-related excitatory influence.
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Affiliation(s)
- Şenay Aydın
- Department of Neurology, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul, Turkey. .,Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Markus Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Yeliz Bakuy
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ayşegül Gündüz
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Meral E Kızıltan
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Türk BG, Gündüz A, Metin S, Metin B, Karadeniz D, Kızıltan ME. Comparisons of Akathisia and Restless Legs Syndrome: An Electrophysiologic Study. tnd 2018. [DOI: 10.4274/tnd.92679] [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: 12/01/2022] Open
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E Kızıltan M, Bekdik Şirinocak P, Akıncı T, Cerrahoğlu Şirin T, Arkalı BN, Candan F, Gündüz A. Prepulse modulation and recovery of trigemino-cervical reflex in normal subjects. Neurol Sci 2018; 40:305-310. [PMID: 30397817 DOI: 10.1007/s10072-018-3624-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 10/25/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE In this study, we analyzed the inhibitory control on the trigemino-cervical reflex (TCR), and whether or not prepulse modulation (PPM) has an effect on TCR. Thus, we studied the PPM of TCR. We hypothesized that TCR would presumably be under the modulatory effect after the prepulse stimulus similar to blink reflex (BR). We also studied the recovery of TCR which was previously shown. METHODS We included 13 healthy individuals. All subjects underwent recordings of TCR, TCR-PPM, and recovery of TCR. For TCR-PPM, a subthreshold stimulus to second finger 50 or 100 ms before the test stimulus was applied. For recovery of TCR, two stimuli at the infraorbital nerve were applied at 300, 500, and 800 ms interstimulus intervals (ISIs). RESULTS There was an inhibition of bilateral late responses of TCR at the ISIs of both 50 ms and 100 ms. There was no change of latencies. Full recovery of TCR did not develop even at the ISI 800 ms. DISCUSSION We have provided an evidence for the TCR-PPM in healthy subjects for the first time in this study. The prepulse inhibition is attributed to the functions of the pedunculopontine tegmental nucleus. Our study provides a strong indication that there are connections between pedunculopontine tegmental nucleus and trigemino-cervical circuit, which produces TCR.
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Affiliation(s)
- Meral E Kızıltan
- Department of Neurology, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Pınar Bekdik Şirinocak
- Department of Neurology, Kocaeli Derince Education and Research Hospital, Istanbul, Turkey
| | - Tuba Akıncı
- Department of Neurology, Beylikdüzü State Hospital, Istanbul, Turkey
| | - Tuba Cerrahoğlu Şirin
- Department of Neurology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Burcu Nuran Arkalı
- Department of Neurology, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Fatma Candan
- Department of Neurology, Goztepe Education and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ayşegül Gündüz
- Department of Neurology, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
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Kızıltan ME, Leba LK, Gündüz A, Pazarcı N, Özkara Ç, Yeni N. Does Valproic Acid/Na Valproate Suppress Auditory Startle Reflex in Patients With Epilepsy? Clin EEG Neurosci 2018; 49:407-413. [PMID: 29262725 DOI: 10.1177/1550059417747155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Auditory startle response (ASR) was normal in juvenile myoclonic epilepsy whereas it was suppressed in progressive myoclonic epilepsy. However, both groups were using valproic acid/Na valproate (VPA) in different doses. Therefore, we aimed to analyze whether VPA has an impact on ASR in a cohort of epilepsy. For this purpose, we included patients with epilepsy and analyzed ASR in patients who were using VPA. PATIENTS AND METHOD We included 51 consecutive patients who had epilepsy and were using VPA between January 2014 and January 2016. Two control groups of 37 epilepsy patients using other antiepileptic drugs (AEDs) and of 25 healthy subjects were also constituted. All participants underwent investigations of ASR and startle response to somatosensory inputs (SSS) under similar conditions. RESULTS An analysis of patients using VPA, not using VPA and healthy subjects revealed significantly longer latency and lower probability of orbicularis oculi (O.oc) and sternocleidomastoid responses after auditory stimulation, decreased total ASR probability and longer latency of O.oc response after somatosensory stimulation in patient groups compared with healthy subjects. Multivariate analysis showed type of AED had a role in the generation of abnormalities. VPA, carbamazepine, and multiple AED use caused suppression of ASR. Total ASR probability was decreased or O.oc latency got longer with longer duration of VPA use whereas serum VPA level at the time of investigation did not correlate with total ASR probability. DISCUSSION Both ASR and SSS are suppressed by the effect of VPA, especially in patients using for a long period and in patients using other AEDs with VPA. Given the fact that VPA leads to long-standing synaptic changes of dopaminergic transmission, abnormalities of this network may be the more likely cause.
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Affiliation(s)
- Meral E Kızıltan
- 1 Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Leyla Köse Leba
- 1 Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayşegül Gündüz
- 1 Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Nevin Pazarcı
- 1 Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Çiğdem Özkara
- 1 Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Naz Yeni
- 1 Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
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Gündüz A, Uygunoğlu U, Uluduz D, Saip S, Siva A, Göksan B, Kızıltan ME. Reduced inhibition in brainstem circuits in classical trigeminal neuralgia. Eur J Pain 2018; 23:142-149. [PMID: 30055103 DOI: 10.1002/ejp.1293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE We hypothesized that prepulse modulation (PPM) would be altered in trigeminal neuralgia (TN) if suprasegmental inhibitory network involvement was present and tested our hypothesis in a group of patients with classical TN. METHODS The study enrolled nine consecutive patients with classical TN and 14 healthy subjects. Diagnosis and classification followed the International Classification of Headache Disorders-third edition (beta version). The blink reflex (BR) and BR-PPM were recorded. Ipsilateral recordings were made after stimulating each trigeminal nerve in the patient group whereas right-sided recordings were performed after stimulating the right trigeminal nerve in the healthy subjects. A conditioning electrical stimulus was applied to the ipsilateral median nerve at interstimulus intervals (ISIs) of 50 and 100 ms before the test stimulus to the supraorbital nerve. RESULTS The unconditioned BR recordings were similar in all groups. In the healthy subjects, the prepulse stimulus resulted in a reduced R2 magnitude (p = 0.000, Friedman's test) and longer R2 latency (p = 0.008, Friedman's test) at ISIs of 50 and 100 ms in comparison with unconditioned recordings. The R2 latency differed significantly between the unconditioned recordings and the ISI of 100 ms. In the patients with TN, no significant change was observed on either the symptomatic or asymptomatic sides. CONCLUSIONS There is a bilateral prepulse inhibition deficit in TN, even on the asymptomatic side. Our findings provide electrophysiological evidence for suprasegmental changes and loss of filtering activity at the brainstem in level TN.
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Affiliation(s)
- A Gündüz
- Department of Neurology, Cerrahpasa Medical School, Istanbul University, Turkey
| | - U Uygunoğlu
- Department of Neurology, Cerrahpasa Medical School, Istanbul University, Turkey
| | - D Uluduz
- Department of Neurology, Cerrahpasa Medical School, Istanbul University, Turkey
| | - S Saip
- Department of Neurology, Cerrahpasa Medical School, Istanbul University, Turkey
| | - A Siva
- Department of Neurology, Cerrahpasa Medical School, Istanbul University, Turkey
| | - B Göksan
- Department of Neurology, Cerrahpasa Medical School, Istanbul University, Turkey
| | - M E Kızıltan
- Department of Neurology, Cerrahpasa Medical School, Istanbul University, Turkey
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Öztürk O, Gündüz A, E. Kızıltan M. Cortical modulation of brainstem circuits is abnormal in cervical dystonia. Neurosci Lett 2018; 677:84-87. [DOI: 10.1016/j.neulet.2018.04.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 11/29/2022]
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E Kızıltan M, Öztürk O, Gündüz A. Differential modulation of prepulse inhibition of the blink reflex in peripersonal versus extrapersonal space. Neurophysiol Clin 2018; 48:181-185. [PMID: 29631777 DOI: 10.1016/j.neucli.2018.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 03/10/2018] [Accepted: 03/13/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Threatening stimuli encountered in peripersonal space (PPS) are processed differently from those encountered in extrapersonal space (EPS). This phenomenon is attributed to tonic top-down modulation. We hypothesized that prepulse inhibition (PPI) of a reflex, which has a protective function, may change according to whether the conditioning stimulus appears in PPS or EPS. We aimed to compare the strength of the PPI according to whether stimulation was delivered in PPS or EPS. METHODS The study included 23 healthy subjects with a mean age of 36.8±9.1years. Recordings of blink reflex (BR) after supraorbital stimulation (so-BR) were performed. Recordings of BR after prepulse stimulation to the median nerve 100ms prior to the supraorbital stimulation were acquired with the ipsilateral hand 50-60cm from the face (EPS) and approximately 3-4cm from the face (PPS). Changes of response magnitudes were compared between PPS and EPS conditions. RESULTS R2 area-under-the curve of so-BR was reduced after prepulse stimulation of median nerve in all subjects while the hand was in EPS. Although the R2 magnitude was also decreased after prepulse stimulation while the hand was in PPS, the percentage of reduction with the hand in PPS was significantly smaller compared to that with the hand in EPS. CONCLUSION Reduction in R2 magnitude after prepulse stimulation 100ms prior to test pulse is recognized (PPI). Although PPI was observed under both conditions, PPI of so-BR was attenuated when the stimulus was presented in the PPS. Therefore, our study provides evidence for modulation of PPI of so-BR in PPS and may suggest top-down modulation of the neural circuitry underlying PPI.
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Affiliation(s)
- Meral E Kızıltan
- Department of Neurology, Cerrahpaşa School of Medicine, Istanbul University, 34098 Istanbul, Turkey
| | - Oya Öztürk
- Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Department of Neurology, Istanbul, Turkey
| | - Ayşegül Gündüz
- Department of Neurology, Cerrahpaşa School of Medicine, Istanbul University, 34098 Istanbul, Turkey.
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Gündüz A, Uzun N, Karaali-Savrun F, Kızıltan ME. Reorganization of sensorimotor gating after peripheral facial palsy starts at brainstem. Neurol Res 2018; 40:541-548. [DOI: 10.1080/01616412.2018.1453102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Ayşegül Gündüz
- Department of Neurology, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Nurten Uzun
- Department of Neurology, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Feray Karaali-Savrun
- Department of Neurology, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Meral E. Kızıltan
- Department of Neurology, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
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Kızıltan ME, Gündüz A. The influence of the site of conditioning sensory stimuli on prepulse modulation of the blink reflex. Neurophysiol Clin 2017; 48:187-189. [PMID: 29254836 DOI: 10.1016/j.neucli.2017.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 11/22/2017] [Accepted: 11/23/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Meral E Kızıltan
- Department of Neurology, Cerrahpaşa School of Medicine, Istanbul University, Kocamustafapaşa Cd. No: 53 Cerrahpaşa 34098 Fatih/İstanbul, Turkey.
| | - Ayşegül Gündüz
- Department of Neurology, Cerrahpaşa School of Medicine, Istanbul University, Kocamustafapaşa Cd. No: 53 Cerrahpaşa 34098 Fatih/İstanbul, Turkey
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Gökdemir S, Gündüz A, Özkara Ç, Kızıltan ME. Fear-conditioned alterations of motor cortex excitability: The role of amygdala. Neurosci Lett 2017; 662:346-350. [PMID: 29097251 DOI: 10.1016/j.neulet.2017.10.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 10/25/2017] [Accepted: 10/28/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVE We hypothesized that fear-conditioning may increase motor cortical excitability in preparation for response to fear. We tested our hypothesis in healthy subjects and in the second step, to determine the role of amygdala in alterations of motor cortex excitability, we included a group of patients who previously underwent unilateral amygdalo-hippocampectomy for temporal lobe epilepsy. PATIENTS AND METHODS In the first step, we included 16 healthy volunteers. In the second step, 14 patients who previously underwent unilateral amygdalo-hippocampectomy for temporal lobe epilepsy and who were seizure-free were included in the study. Motor evoked potentials (MEPs) recorded over right hand were recorded twice before and after the observation of fearful faces (fear-conditioning). Auditory startle response (ASR) was also recorded. RESULTS Comparisons of before and after fear-conditioning MEP parameters within the healthy subjects group showed MEP amplitude was higher after fear-conditioning (p=0.019). Same comparison in patients with unilateral amygdalo-hippocampectomy demonstrated shorter MEP latency (p=0.036) and higher MEP amplitudes after fear-conditioning (p=0.046). CSPs did not show any change after this paradigm in both groups. Comparisons of ASR findings before and after fear-conditioning demonstrated enhanced responses after fear-conditioning in both healthy subjects and in patients with unilateral amygdalo-hippocampectomy. For MEPs or ASRs, there was a similar enhancement in patients with left- or right-sided operation. CONCLUSIONS Fear-potentiation of both corticospinal and reticulospinal pathways occurs in healthy humans and bilateral potentiation of ASR and potentiation of MEPs are maintained even after resection of unilateral amygdala regardless of its side.
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Affiliation(s)
- Selim Gökdemir
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, 34098 K.M.Pasa, Istanbul, Turkey
| | - Ayşegül Gündüz
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, 34098 K.M.Pasa, Istanbul, Turkey.
| | - Çiğdem Özkara
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, 34098 K.M.Pasa, Istanbul, Turkey
| | - Meral E Kızıltan
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, 34098 K.M.Pasa, Istanbul, Turkey
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Abstract
Cortical reflex myoclonus is a typical feature of progressive myoclonic epilepsy (PME) in which it is accompanied by other types of mostly drug-resistant seizures and progressive neurological signs. Although PME is characterized by cortical hyperexcitability, studies have demonstrated atrophy and degenerative changes in the brainstem in various types of PME. Thus, we have questioned whether any stimuli may trigger a hyperactive response of brainstem reticular formation in PME and investigated the startle reflex in individuals with PME. We recorded the auditory startle response (ASR) and the startle response to somatosensory inputs (SSS) in patients with PME, and compared the results with healthy volunteers and patients with other types of drug-resistant epilepsy. All patients were using antiepileptic drugs (AEDs), 12 were on multiple AEDs. The probability of ASR was significantly lower and mean onset latency was longer in patients with PME compared with other groups. SSS responses over all muscles were low in both the PME and drug-resistant epilepsy groups; however, the differences were not statistically significant. The presence of a response over the biceps brachii muscle was zero in the PME group and showed a borderline difference compared with the other groups. Decreased probability and prolonged latencies of ASR in PME indicate inhibition of reflex circuit. A trend for decreased responses of SSS suggests hypoactive SSS in both PME and other epilepsy groups. Hypoactive ASR in PME and hypoactive SSS in both PME and other epilepsies may be attributed to the degeneration of pontine reticular nuclei in PME and functional inhibition by AEDs in both disorders.
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Affiliation(s)
- Meral E Kızıltan
- 1 Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayşegül Gündüz
- 1 Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Tülin Coşkun
- 1 Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Şakir Delil
- 1 Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Nevin Pazarcı
- 1 Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Çiğdem Özkara
- 1 Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Naz Yeni
- 1 Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
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Korkmaz B, Benbir Şenel G, Kızıltan ME, Karadeniz D. Demonstration of sympathetic dysfunction in patients with obstructive sleep apnea syndrome by measuring sympathetic skin responses from the neck. Sleep Med 2016; 25:13-15. [PMID: 27823705 DOI: 10.1016/j.sleep.2016.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/06/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We aimed to study the sympathetic sudomotor responses via the sympathetic skin responses (SSR) from bilateral hands and right and left sides of the neck in patients with obstructive sleep apnea syndrome (OSAS). METHODS A total of 31 patients with OSAS diagnosed by whole-night polysomnography and 18 healthy volunteers were consecutively enrolled into this prospective study. RESULTS The SSRs from hands were not obtained in two patients with OSAS (6.4%) and in one volunteer (5.5%); the attainability of SSRs from hands was similar between patients and healthy controls (p = 0.698). The SSRs from neck were not obtained in 22 patients with OSAS (70.9%), but only in two healthy volunteers (11.1%, p <0.001). The mean amplitudes of SSRs from both right and left sides of neck were significantly lower in patients with OSAS than those in controls (p <0.001). After effective treatment of OSAS, the SSRs from hands were obtained in all patients (100% vs 93.6% before treatment, p = 0.560). The attainability of SSRs from bilateral sides of the neck was significantly improved after treatment (80%) in compared to before treatment (29.1%, p <0.001). The amplitudes of SSRs obtained from the neck were also significantly increased after treatment (p <0.004). CONCLUSIONS Our results show that there is sympathetic dysfunction in OSAS, which could be demonstrated by sudomotor response abnormalities from neck area and reversed following effective treatment of OSAS. SSR studies from the neck area may therefore be accepted as an easy and effective method for demonstrating the sympathetic dysfunction in OSAS and for monitoring the efficacy of OSAS treatment.
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Affiliation(s)
- Bektaş Korkmaz
- Department of Neurology, Sleep and Disorders Unit, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey.
| | - Gülçin Benbir Şenel
- Department of Neurology, Sleep and Disorders Unit, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Meral E Kızıltan
- Department of Neurology, Sleep and Disorders Unit, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Derya Karadeniz
- Department of Neurology, Sleep and Disorders Unit, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
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Öztürk O, Gündüz A, Kızıltan ME. Deficient median nerve prepulse inhibition of the blink reflex in cervical dystonia. Clin Neurophysiol 2016; 127:3524-3528. [PMID: 27815976 DOI: 10.1016/j.clinph.2016.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 08/31/2016] [Accepted: 09/07/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We analyzed prepulse inhibition (PPI) of the blink reflex (BR) in patients with cervical dystonia (CD) to examine the sensory modulation of the motor system. METHODS This study enrolled 22 consecutive patients with idiopathic CD and 25 age- and gender-matched healthy subjects. Prepulse inhibition of the BR was recorded after stimulating the median nerve at the wrist using an electrical stimulus twice at a perception threshold 100ms before a test stimulus to the supraorbital nerve. RESULTS The R2 area and amplitude were significantly reduced and the R2 latency delayed after the conditioned stimulus in patients with CD. The R1 latency and amplitude did not differ between trials in patients with CD. In healthy subjects, the R1 amplitude was higher, whereas the R2 latency was delayed and the R2 amplitude and area were reduced after the conditioned stimulus. However, there was significantly less R2 and R2c area suppression in patients compared with healthy subjects. ANOVA showed that reduction of R2 area after conditioned stimulus (F=6.620, p=0.003) and percentage change of R2 area (F=5.217, p=0.009) were lower in patients with and without sensory tricks compared with healthy subjects, whereas the reduction in PPI was pronounced in patients without a sensory trick compared with healthy subjects. CONCLUSIONS Patients with CD show significantly less prepulse R2 inhibition than healthy subjects, but this occurred without R1 facilitation. The absence of a sensory trick leads to the more pronounced reduction of PPI. SIGNIFICANCE The modulatory effects of sensory inputs are lost in patients with CD without sensory tricks.
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Affiliation(s)
- Oya Öztürk
- Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Department of Neurology, Turkey
| | - Ayşegül Gündüz
- Department of Neurology, Cerrahpaşa School of Medicine, Istanbul University, Turkey.
| | - Meral E Kızıltan
- Department of Neurology, Cerrahpaşa School of Medicine, Istanbul University, Turkey
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Abstract
Intramuscular injections are likely the most common cause of sciatic nerve injury in developing countries. Less common causes include piriformis syndrome, primary tumors of the sciatic nerve, metastatic tumors invading or compressing the nerve, endometriosis, vascular malformations, and prolonged immobilization or positioning. While the most reliable diagnostic and prognostic methods include nerve conduction studies and electromyography, magnetic resonance imaging has been suggested as an alternative method of determining type of lesion, establishing location, and investigating level of nerve involvement. A case of sciatic neuropathy that developed after intramuscular injection, with patient in prolonged lithotomy position and under sedation, is described.
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Affiliation(s)
- Ayşe Altıntaş
- Department of Neurology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Ayşegül Gündüz
- Department of Neurology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey.
| | - Fatih Kantarcı
- Department of Radiology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Gökçen Gözübatık Çelik
- Department of Neurology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Naci Koçer
- Department of Radiology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Meral E Kızıltan
- Department of Neurology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
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Sohtaoğlu M, E Kızıltan M, Gündüz A, Bozluolçay M. Startle responses after different stimulus modalities differ in stroke. Neurophysiol Clin 2016; 46:193-9. [PMID: 26917356 DOI: 10.1016/j.neucli.2015.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 10/27/2015] [Accepted: 12/29/2015] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The auditory startle reaction (ASR) and startle reflex to somatosensory inputs (SSS) are stereotypical responses to sudden and unexpected stimuli, which are generated in the caudal brainstem reticular formation. Changes of ASR are relatively well known in stroke. Here, we aimed to investigate central pathways of SSS and plasticity changes of SSS circuits in different stages and localizations of stroke, by comparing with ASR. METHODS We prospectively included 39 patients with stroke between June 2009 and June 2013, and 23 age and gender-matched healthy subjects. ASR and SSS were recorded over orbicularis oculi, sternocleidomastoid, biceps brachii (BB), and abductor policis brevis muscles (APB) using surface electrodes. RESULTS There were supratentorial and infratentorial lesions in both acute and chronic stages. Overall, ASR probability was similar between groups (P=0.981). However, ASR probability was increased for BB and APB recordings on symptomatic sides of stroke patients with high amplitudes and long durations, most prominently on symptomatic sides of pontine strokes. Latencies and presence rates of SSS did not differ between any subgroups of stroke and healthy subjects. CONCLUSION ASR is facilitated in arm and hand muscles on symptomatic sides of stroke patients, whereas SSS did not show any significant changes according to stroke.
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Affiliation(s)
- Melis Sohtaoğlu
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, 34098 K.M. Pasa, Istanbul, Turkey
| | - Meral E Kızıltan
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, 34098 K.M. Pasa, Istanbul, Turkey
| | - Ayşegül Gündüz
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, 34098 K.M. Pasa, Istanbul, Turkey.
| | - Melda Bozluolçay
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, 34098 K.M. Pasa, Istanbul, Turkey
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Kandemir M, Gündüz A, Uzun N, Yeni SN, Kızıltan ME. Enhanced blink reflex recovery in juvenile myoclonic epilepsy. Neurosci Lett 2015; 609:7-10. [DOI: 10.1016/j.neulet.2015.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 07/30/2015] [Accepted: 10/08/2015] [Indexed: 10/22/2022]
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Gündüz A, Uzun N, Örnek Nİ, Ünalan H, Karamehmetoğlu ŞS, Kızıltan ME. Trigemino-cervical reflex in spinal cord injury. Neurosci Lett 2014; 580:169-72. [PMID: 25128217 DOI: 10.1016/j.neulet.2014.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 07/24/2014] [Accepted: 08/04/2014] [Indexed: 11/27/2022]
Abstract
Abnormal enhancement of polysynaptic brainstem reflexes has been previously reported in patients with spinal cord injury (SCI). We aimed to investigate trigemino-cervical reflex (TCR) in SCI since it may reflect alterations in the connections of trigeminal proprioceptive system and cervical motoneurons. Consecutive 14 patients with SCI and 16 healthy subjects were included in this study. All patients were in the chronic phase. TCR was recorded over sternocleidomastoid (SCM) and splenius capitis (SC) muscles by stimulation of infraorbital nerve. We measured onset latency, amplitudes and durations of responses and compared between groups. We obtained stable responses over both muscles after one sided stimulation in healthy volunteers whereas probability of TCR was decreased in patients over both SCM (78.6% vs. 100%, p=0.050) and SC (71.4% vs. 100%, p=0.022). The absence of TCR was related to use of oral baclofen (≥50mg/day). However, when present, responses of SCI group had higher amplitudes and were more persistent. We demonstrated that TCR probability was similar to healthy subjects in SCI patients who used no or low dose oral baclofen. But it had higher amplitudes and longer durations. It was not obtained in only two patients who used oral baclofen more than 50mg/day.
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Affiliation(s)
- Ayşegül Gündüz
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey.
| | - Nurten Uzun
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Nurettin İrem Örnek
- Department of Physical Therapy and Rehabilitation, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Ünalan
- Department of Physical Therapy and Rehabilitation, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Şafak Sahir Karamehmetoğlu
- Department of Physical Therapy and Rehabilitation, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Meral E Kızıltan
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
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Kızıltan ME, Gunduz A, Kızıltan G, Tekeoğlu A, Sohtaoğlu M. Brainstem and spinal reflex studies in patients with primary progressive freezing of gait. J Neurol Sci 2014; 343:51-5. [PMID: 24867166 DOI: 10.1016/j.jns.2014.05.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 04/12/2014] [Accepted: 05/07/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Meral E Kızıltan
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Aysegul Gunduz
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey.
| | - Gunes Kızıltan
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Anıl Tekeoğlu
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Melis Sohtaoğlu
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
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Gündüz A, Ergin H, Kızıltan ME. Long latency trigemino-cervical reflex in patients with cervical dystonia. Neurol Sci 2014; 36:103-8. [PMID: 25056194 DOI: 10.1007/s10072-014-1893-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 07/14/2014] [Indexed: 11/28/2022]
Abstract
Trigemino-cervical reflex (TCR) is elicited by stimulation of face using various modalities. TCR reflects the interaction between trigeminal system and cervical motoneurons. Such a specific interaction is assumed to play role in development of cervical dystonia (CD) through superior colliculus. In this study, we aimed to investigate alterations of the functional relationship between those structures in CD and in a subgroup with dystonic tremor. A total of consecutive 23 patients with primary CD (7 men, 16 women) and 16 age and sex matched control subjects (7 men, 9 women) were included in this study. TCR was obtained after percutaneous electrical stimulation (with duration of 0.5 ms) of infraorbital branch of trigeminal nerve while recording over splenius capitis and sternocleidomastoid muscles. Presence and onset latencies of TCR did not differ significantly between patients with CD and controls, and same pattern of muscle activation occurred in both groups. Responses of patient group seemed to have higher amplitudes and to be more persistent. There were no significant side-to-side differences of TCR probability, latency, amplitude or duration with respect to the side of head deviation in CD. Increased amplitudes and durations of responses probably reflect increased excitability of the reflex circuit. We suggest that similar latencies and response pattern in comparison to healthy individuals decrease the possibility of structural disturbance. TCR is probably under bilateral basal ganglia and dopaminergic control. Alterations of trigemino-cervical pathway are more extensive and are not solely due to local changes of brainstem interneurons.
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Affiliation(s)
- Ayşegül Gündüz
- Department of Neurology, Cerrahpasa Medical Faculty, Cerrahpasa School of Medicine, Istanbul University, K.M. Pasa, 34098, Istanbul, Turkey,
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Gündüz A, Kızıltan ME, Uygunoğlu U, Delil S, Sohtaoğlu M, Ergin H, Tutuncu M. Understanding the features of posterior auricular muscle response in a facial nerve disease prototype. Kulak Burun Bogaz Ihtis Derg 2013; 23:173-178. [PMID: 23682941 DOI: 10.5606/kbbihtisas.2013.82569] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES This study aims to compare and investigate the changes of posterior auricular muscle response (PAMR) following peripheral facial nerve palsy (PFP) with blink reflex (BR). PATIENTS AND METHODS A total of 75 idiopathic PFP patients and age and sex-matched 38 healthy volunteers were included. Patients with PFP were classified into two groups including early (≤6 months) and late (>6 months) based on the duration of symptoms. Following clinical evaluation, PAMR and BR were recorded. A comparison was performed among the early PFP group (n=52), late PFP group (n=23) and healthy volunteers (n=38). RESULTS We obtained PAMR in 78.9% (n=30) of healthy volunteers, in 60.9% (n=14) of late and in only 38.5% (n=20) of early PFP patients (p=0.001). No habituation was observed following repeated stimuli. The mean latencies were 9.1±1.6, 10.9±1.9 and 12.3±2.0 msec., respectively (p=0.000). R1 and R2 latencies were longer in the early PFP group, compared to other groups (p=0.000). CONCLUSION Posterior auricular muscle response exhibits changes in a manner similar to R1 and R2 of BR in early and late PFP. The occurrence rate of PAMR seems to be lowest or its latency is prolonged in the early PFP.
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Affiliation(s)
- Ayşegül Gündüz
- Department of Neurology, İstanbul University, İstanbul, Turkey.
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Erkol G, Kızıltan ME, Uluduz D, Uzun N. Somatosensory eye blink reflex in peripheral facial palsy. Neurosci Lett 2009; 460:201-4. [DOI: 10.1016/j.neulet.2009.05.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2008] [Revised: 04/02/2009] [Accepted: 05/27/2009] [Indexed: 11/15/2022]
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