Servikal distonili hastalarda sternokleidomastoid kasta kutanöz sessiz periyot değerlendirilmesi
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Dosyalar
Tarih
2020
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Servikal distoni boyun ve omuz kaslarını etkileyen, tekrarlayıcı özellikte, klonik ve tonik hareketlere yol açarak başın anormal postürüne neden olan ve yetişkin yaşta başlayan distoniler arasında en sık görülen distoni tipidir. Distoni patofizyolojisi ile ilgili olarak çeşitli elektrofizyolojik çalışmalar yapılabilmektedir. Bunlardan biri de kutanöz sessiz periyottur(KuSP). KuSP; kutanöz bir sinirin güçlü uyarımını takiben istemli kas aktivitesinde ortaya çıkan kısa süreli duraklama ile karakterize inhibitör bir refleks olup beyin sapı ve medulla spinalisteki ara nöron devrelerinin fonksiyonları hakkında bilgi verebilmektedir. Bu çalışmada servikal distoni patofizyolojisinde rol alması muhtemel beyin sapı inhibitör ara devrelerdeki değişikliklerin KuSP yöntemi ile incelenmesi amaçlanmıştır. Yöntem: Bu prospektif vaka kontrol çalışmasına 20 servikal distonili hasta(15 kadın, 5 erkek) ve 25 kontrol(17 kadın, 8 erkek) dahil edildi. Her iki gruptaki bireylerin her iki sternocleidomastoid (SCM) kasından yüzeyel elektrotlarla KuSP ölçümleri yapıldı. Sessiz periyodun(SP) latans ve interval değerleri görsel inceleme ile milisaniye cinsinden tespit edildi. Hasta grupta distonik SCM'den elde edilen SP paremetereleri hem hastaların sağlam tarafıyla hem de kontrol grubuyla kıyaslandı. Ayrıca her iki gruptaki bireylerin birey içi karşılıklı SCM'lerinin SP paremetrelerinin korelasyon analizi yapıldı. Bulgular: Distonik SCM'nin SP paremetereleri ile kontrol grubu arasında anlamlı farklılık saptanmadı (latans p:0.762, interval p:0.318). Benzer şekilde distonik SCM'nin SP paremetereleri ile hastaların normal tarafı arasında anlamlı fark tespit edilmedi(latans p:0.289, interval p:0,674). Hem hasta hem kontrol gruplarında karşılıklı SCM'lerin SP latansları arasında kuvvetli korelasyon saptandı(hasta r:0.869 p<0.0001, kontrol r:0.926 p<0.0001). Kontrol grubunda aynı kuvvetli korelasyon SP süreleri için de devam ederken(r:0.776, p<0.0001) hasta grupta distonik SCM ile normal SCM'lerin SP süreleri arasındaki korelasyonun kaybolduğu gözlendi(r:0.341, p:0.141). Sonuç: Hem hasta hem kontrol gruplarında karşılıklı SP latansları arasında kuvvetli korelasyon saptanması her iki grupta da SP refleksinin afferent ve efferent yolaklarında bir farklılık olmadığına işaret etmektedir. Kontrol grubunda aynı kuvvetli korelasyon SP süreleri için de devam ederken hasta grupta kaybolması beyin sapı ve medulla spinalis ara nöron bağlantılarındaki fonksiyon bozukluğuna işaret etmektedir. Distonik SCM'nin SP süre ortalamaları normal taraf ve kontrol grubundan farklı değilken korelasyon analiziyle ortaya çıkan karşı SCM ile olan uyumunun kaybolmuş olması ara nöron bağlantılarındaki anormalliğin temelde bir düzen kaybı olabileceğini göstermiştir.
Cervical dystonia (CD) is the most common type of dystonia that affects the neck and shoulder muscles, causes repetitive, clonic and tonic movements and causes abnormal posture of the head and begins in adult age. Various electrophysiological studies can be conducted on the pathophysiology of dystonia. One of these is the cutaneous silent period(CSP). CSP; It is an inhibitory reflex characterized by a short pause in voluntary muscle activity following strong stimulation of a cutaneous sensory nerve and can provide information about the functions of intermediate neuron circuits in the brainstem and medulla spinalis. In this study, it was aimed to investigate the changes in brainstem inhibitory intermediate circuits that may play a role in CD pathophysiology by using CSP method. Method: Twenty CD patients (15 females, 5 males) and 25 controls (17 females, 8 males) were included in this prospective case-control study. CSP measurements were made with superficial electrodes from both sternocleidomastoid (SCM) muscles of individuals in both groups. Latency and interval values of SP were determined by visual inspection in millisecond. In the patient group, SCM parameters obtained from dystonic SCM were compared with both the healthy side of the patients and the control group. In addition, the correlation analysis of SP parameters of intra-individual correlative SCM's of individuals in both groups was performed. Results: There was no significant difference between the SP parameters of dystonic SCM and the control group (latency p: 0.762 / interval p: 0.318). Similarly, no significant difference was found between the SP parameters of dystonic SCM and the normal side of the patients (latency p: 0.289 / interval p: 0.674). A strong correlation was found between SP latencies of mutual SCMs in both patient and control groups (patient r: 0.869 p <0.0001, control r: 0.926 p <0.0001). While the same strong correlation continued in the control group for the SP durations (r: 0.776, p <0.0001), the correlation between dystonic SCM and normal SCMs in the patient group disappeared (r: 0.341, p: 0.141). Conclusion: The strong correlation between the SP latencies of mutual SCM in both patient and control groups indicates that there is no difference in the afferent and efferent pathways of the SP reflex in both groups. While the same strong correlation continued in the control group for the SP durations, its disappearance in the patient group indicates dysfunction in the brainstem and medulla spinalis interneuron circuits. While SP time averages of dystonic SCM were not different from the normal side and control groups, the loss of harmony between otherside SCM revealed by correlation analysis showed that abnormalities in the intermediate neuron circuits may be a loss of regulation.
Cervical dystonia (CD) is the most common type of dystonia that affects the neck and shoulder muscles, causes repetitive, clonic and tonic movements and causes abnormal posture of the head and begins in adult age. Various electrophysiological studies can be conducted on the pathophysiology of dystonia. One of these is the cutaneous silent period(CSP). CSP; It is an inhibitory reflex characterized by a short pause in voluntary muscle activity following strong stimulation of a cutaneous sensory nerve and can provide information about the functions of intermediate neuron circuits in the brainstem and medulla spinalis. In this study, it was aimed to investigate the changes in brainstem inhibitory intermediate circuits that may play a role in CD pathophysiology by using CSP method. Method: Twenty CD patients (15 females, 5 males) and 25 controls (17 females, 8 males) were included in this prospective case-control study. CSP measurements were made with superficial electrodes from both sternocleidomastoid (SCM) muscles of individuals in both groups. Latency and interval values of SP were determined by visual inspection in millisecond. In the patient group, SCM parameters obtained from dystonic SCM were compared with both the healthy side of the patients and the control group. In addition, the correlation analysis of SP parameters of intra-individual correlative SCM's of individuals in both groups was performed. Results: There was no significant difference between the SP parameters of dystonic SCM and the control group (latency p: 0.762 / interval p: 0.318). Similarly, no significant difference was found between the SP parameters of dystonic SCM and the normal side of the patients (latency p: 0.289 / interval p: 0.674). A strong correlation was found between SP latencies of mutual SCMs in both patient and control groups (patient r: 0.869 p <0.0001, control r: 0.926 p <0.0001). While the same strong correlation continued in the control group for the SP durations (r: 0.776, p <0.0001), the correlation between dystonic SCM and normal SCMs in the patient group disappeared (r: 0.341, p: 0.141). Conclusion: The strong correlation between the SP latencies of mutual SCM in both patient and control groups indicates that there is no difference in the afferent and efferent pathways of the SP reflex in both groups. While the same strong correlation continued in the control group for the SP durations, its disappearance in the patient group indicates dysfunction in the brainstem and medulla spinalis interneuron circuits. While SP time averages of dystonic SCM were not different from the normal side and control groups, the loss of harmony between otherside SCM revealed by correlation analysis showed that abnormalities in the intermediate neuron circuits may be a loss of regulation.
Açıklama
Anahtar Kelimeler
Kutanöz sessiz periyod, Cutaneous silent period
Kaynak
WoS Q Değeri
Scopus Q Değeri
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Sayı
Künye
Kır, H. H. (2020). Servikal distonili hastalarda sternokleidomastoid kasta kutanöz sessiz periyot değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü, Nöroloji Anabilim Dalı, Konya.
