The contribution of trigemino-cervical reflexes in distinguishing progressive supranuclear palsy from multiple system atrophy

Serrao, Mariano; Fabio, Roberto Di; Bartolo, Michelangelo; Perrotta, Armando; Tassorelli, Cristina; Davassi, Chiara; Padua, Luca; Sandrini, Giorgio; Pierelli, Francesco

doi:10.1016/j.clinph.2011.02.012

Cited by 18 publications

(11 citation statements)

References 16 publications

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“…However, none has proven effective in prospectively distinguishing early, stillundiagnosable atypical parkinsonian conditions using eventual clinical outcome or autopsy as the "gold standard." These include transcranial sonography of the substantia nigra and basal ganglia, 29 positron emission tomographic (PET) imaging of glucose utilization, 30 presynaptic dopamine uptake 31 or postsynaptic dopamine receptors, 32 single photon emission computed tomographic (SPECT) imaging of tissue metabolism/perfusion, 33 SPECT imaging of the presynaptic dopamine transporter, 34 magnetic resonance spectrography of basal ganglia, 35 diffusion tensor imaging of white matter tracts, 26 optical coherence tomography of the retina, 36 electrophysiological assessment of brainstem reflexes, 37 and cerebrospinal fluid (CSF) measures of phosphorylated tau and neurofilament light chain. 38 In routine clinical practice, establishing a diagnosis of PSP relies only on the history, neurologic exam, and MRI.…”

Section: Diagnostic Studiesmentioning

confidence: 99%

Progressive Supranuclear Palsy

Golbe

2014

Semin Neurol

101

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Progressive supranuclear palsy is a disorder of tau protein aggregation. Its clinical spectrum is now known to be wider than originally described, with a phenotype resembling Parkinson disease accounting for a third of cases. However, at least half of the patients with PSP exhibit the classic bradykinesia with disproportionate postural instability, erect posture with nuchal rigidity, frontal behavioral and cognitive changes, vertical gaze palsy, and other disabling brainstem deficits. Nonmendelian genetic risk factors exist, but PSP is almost entirely sporadic, with a prevalence of five to six persons per 100,000, mean onset age of 63, and median survival of 7 years. Clinical diagnostic criteria with excellent specificity and a clinical rating scale sensitive to progression are available. Diagnosis remains clinical, although magnetic resonance imaging and cerebrospinal fluid measures are showing promise as early-stage screening tools. Multiple candidate neuroprotective medications have proven ineffective to date. Treatment remains supportive, although coenzyme Q-10 has shown preliminary symptomatic efficacy and levodopa may provide transient, modest benefit.

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Section: Diagnostic Studiesmentioning

confidence: 99%

Progressive Supranuclear Palsy

Golbe

2014

Semin Neurol

101

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“…Suppression or loss of TCR in all patients Fig. 1 a Bilateral trigeminocervical response after left infraorbital stimulation in a healthy subject (sensitivity 200 lV/div), b bilateral trigemino-cervical response after right infraorbital stimulation in the same subject as a (sensitivity 200 lV/div), c high amplitude and long duration trigemino-cervical response after left infraorbital stimulation in a cervical dystonia patient (sensitivity 1 mV/div), d similar trigeminocervical response after right infraorbital stimulation in the same patient as c (sensitivity 1 mV/div) with cervico-bulbar lesions [14] or PSP while they were clearly detectable in all the MSA-P patients supported the idea that cholinergic neurons of paramedian pontine reticular formation, gigantocellular reticular nucleus or the intermediate reticular zone would be the integrating center of the reflex [15,16]. From here, impulses are likely to reach polysynaptic chain of excitatory interneurons which terminate on cervical or spinal accessory motoneurons analogously to those described for the masseter inhibitory reflex [17].…”

Section: Discussionmentioning

confidence: 69%

Long latency trigemino-cervical reflex in patients with cervical dystonia

2014

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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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“…It was also absent in PSP while it was clearly detectable in all MSA-P patients [9,10]. This latter finding may be related to the cholinergic neuronal degeneration of the paramedian pontine reticular formation and atrophy of the gigantocellular reticular nucleus and the intermediate reticular zone present in PSP but absent in MSA [9].…”

Section: Discussionmentioning

confidence: 70%

“…Structures in paramedian pontine reticular formation are supposed to be the integrating center of the reflex and have the major role in the generation of TCR. Absence of TCR in progressive supranuclear palsy (PSP) while they were clearly detectable in all the parkinsonism type of multisystem atrophy (MSA-P) patients supports the presence of brainstem generator [9,10].…”

Section: Introductionmentioning

confidence: 90%