A neurophysiological approach to the complex organisation of the spine: F-wave duration and the cutaneous silent period in restless legs syndrome

İşak, Barış; Uluç, Kayıhan; Salcini, Celal; Ağan, Kadriye; Tanridag, Tulin; Us, Önder

doi:10.1016/j.clinph.2010.07.005

Cited by 24 publications

(23 citation statements)

References 51 publications

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“…Moreover, consistent with previous observations, 21 this study confirms that RLS/WED patients have a prolongation of FWD and of the FWD/CMAPD ratio, suggesting an increased motoneuronal excitability. FWD is primarily a function of the number of motoneurons recruited by means of an antidromic pathway, and its prolongation suggests that, at normal persistence (i.e., the ratio between the number of recorded F-waves and the number of delivered stimuli), the recruitment of motoneurons is altered, mainly due to an alteration of the recruiting pattern.…”

Section: P Congiu ML Fantini G Milioli Et Al F-waves In Diagnosissupporting

confidence: 81%

“…In fact, the substantial increase in FWD and in the FWD/ CMAP ratio may suggest an altered modulation of spinal motoneurons, particularly those of smaller size and lower velocity, which would be no longer inhibited by the small interneurons located in the anterior spinal cord. 21 Moreover, similar to what has been observed by Isak et al, 21 an alteration of these aforementioned parameters was present in both lower and upper limbs, even though the patients under examination complained of symptoms almost exclusively in the lower limbs. Furthermore, in the current study, no correlation was observed between either the ulnar or tibial FWD or FWD/CMAPD, and age and duration of RLS, showing that in primary RLS the spinal hyperexcitability is unrelated to demographic variables or duration of the disorder.…”

Section: P Congiu ML Fantini G Milioli Et Al F-waves In Diagnosissupporting

confidence: 71%

“…FWD is primarily a function of the number of motoneurons recruited by means of an antidromic pathway, and its prolongation suggests that, at normal persistence (i.e., the ratio between the number of recorded F-waves and the number of delivered stimuli), the recruitment of motoneurons is altered, mainly due to an alteration of the recruiting pattern. 21 Effectively, the substantial increase in FWD and in the FWD/CMAPD ratio may suggest an altered modulation of spinal motoneurons. In fact, the substantial increase in FWD and in the FWD/ CMAP ratio may suggest an altered modulation of spinal motoneurons, particularly those of smaller size and lower velocity, which would be no longer inhibited by the small interneurons located in the anterior spinal cord.…”

Section: P Congiu ML Fantini G Milioli Et Al F-waves In Diagnosismentioning

confidence: 99%

“…In a 2011 study, Isak et al 21 proposed the use of some parameters to help the diagnosis of primary RLS/WED, namely FWD, FWD/CMAPD ratio, and SPR. Results of the present study confirm these important findings, showing that the first two parameters are very useful for the diagnosis of RLS/WED.…”

Section: P Congiu ML Fantini G Milioli Et Al F-waves In Diagnosismentioning

confidence: 99%

“…[7][8][9][10][11][12][13] Different studies carried out on spinal excitability assessing reflexes in patients affected by RLS-PLMD has led to contrasting results, with some showing an increase in spinal excitability, 14,15 while others showed no differences between patients and controls. 16 Recently, Isak et al 21 suggested that the exploration of some parameters, namely the F-wave duration (FWD), the ratio between FWD and the duration of related compound muscle action potential (CMAPD), FWD/CMAPD, and the silent period ratio (SPR) would be helpful in the diagnosis of primary RLS/WED. CMAP is the early response due to activation of muscle fibers by electrical stimulation of a peripheral motor or mixed nerve.…”

Section: Introductionmentioning

confidence: 99%

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F-Wave Duration as a Specific and Sensitive Tool for the Diagnosis of Restless Legs Syndrome/Willis-Ekbom Disease

Congiu

Fantini

Milioli

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: Restless legs syndrome, also known as Willis-Ekbom disease (RLS/WED), is a frequent condition, though its pathophysiology is not completely understood. The diagnosis of RLS/WED relies on clinical criteria, and the only instrumental tool, the suggested immobilization test, may lead to equivocal results. Recently, neurophysiological parameters related to F-wave duration have been proposed as a diagnostic aid. The aim of this study is to assess and compare the diagnostic values of these parameters in diagnosis of RLS/WED. Methods: Fifteen women affected by primary RLS/WED and 17 age-and sex-matched healthy subjects. A complete electroneurographic evaluation, including nerve conduction studies (NCS), cutaneous silent period (CSP), and F-wave parameters, namely amplitude, F-wave duration (FWD), and the ratio between FWD and duration of the corresponding compound muscle action potential (FWD/CMAPD). Results:No subject showed alterations of the NCS. However, FWD and FWD/CMAPD of both upper and lower limbs were significantly longer in patients than controls. Tibial FWD/CMAPD best discriminated RLS/WED patients from controls. A cutoff of 2.06 yielded a sensitivity of 69.2%, a specificity of 94.1%, a positive predictive power of 90%, and a negative predictive power of 80% (area under the curve = 0.817; 95% confidence interval = 0.674-0.959). The combination of ulnar or tibial FWD/CMAPD increases the sensitivity (85.7%) while slightly decreasing the specificity (87.5%, positive predictive value: 85.7%, negative predictive value: 87.5%). Conclusions: Lower limb FWD/CMAPD ratio may represent a supportive diagnostic tool, especially in cases of evening lower leg discomfort of unclear interpretation.

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Section: P Congiu ML Fantini G Milioli Et Al F-waves In Diagnosissupporting

confidence: 81%

Section: P Congiu ML Fantini G Milioli Et Al F-waves In Diagnosissupporting

confidence: 71%

Section: P Congiu ML Fantini G Milioli Et Al F-waves In Diagnosismentioning

confidence: 99%

Section: P Congiu ML Fantini G Milioli Et Al F-waves In Diagnosismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

F-Wave Duration as a Specific and Sensitive Tool for the Diagnosis of Restless Legs Syndrome/Willis-Ekbom Disease

Congiu

Fantini

Milioli

et al. 2017

Journal of Clinical Sleep Medicine

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Cutaneous silent period in myofascial pain syndrome

et al. 2017

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Introduction: An increased response to painful stimuli without spontaneous pain suggests a role of central hyperexcitability of pain pathways in the pathogenesis of myofascial pain syndrome (MPS). In this study we aimed to test the hypothesis that spinal pain pathways are affected in MPS. We used cutaneous silent period (CSP) parameters to demonstrate the hyperexcitability of spinal pain pathways in MPS. Methods: Twenty-nine patients diagnosed with MPS and 30 healthy volunteers were included in the study. The CSP recordings were performed in the right upper and left lower extremities. Results: In both upper and lower extremities, patients had prolonged CSP latencies (P 5 0.034 and P 5 0.049 respectively) and shortened CSP durations (P 5 0.009 and P 5 0.008, respectively). Discussion: Delayed and shortened CSP in MPS patients implies dysfunction in the inhibitory mechanism of the spinal/supraspinal pain pathways, suggesting central sensitization in the pathogenesis of MPS and supporting our research hypothesis.

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