Cutaneous Silent Periods in the Assessment of Mild Cervical Spondylotic Myelopathy

̌Sťetkářová, Ivana; Kofler, Markus

doi:10.1097/brs.0b013e31818f8be3

Cited by 25 publications

(17 citation statements)

References 41 publications

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“…11,12,21 Conditions that interrupt this reflex pathway should be associated with absence or delay of the cutaneous SP. The cutaneous SP shows a high sensitivity for detecting spinal cord lesions, including intramedullary spinal cord lesions 35 and myelopathy due to spondylosis, 16,17 syringomyelia, 15 whiplash injury 36 or other structural abnormalities of the cervical spine that abolish or alter the cutaneous SP. Cutaneous SP is preserved in radiculopathy, probably because afferent impulses are carried by smaller, slower conducting "injury-resistant" Adelta fibers.…”

Section: Discussionmentioning

confidence: 99%

“…It has been already published that small lesions in the central part of the cervical spinal cord may completely abolish the cutaneous SP. 16,17,35 In theory, sensory dermatomes including nociceptive receptors are overlapping, and activating more the small thin afferent fibers. Transmission along A-delta fibers from different digits and the corresponding C6, C7 or C8 roots, which are more or less impaired, still induce the robust spinal protective reflex, defending the subject from nociceptive stimuli and potential jeopardy.…”

Section: Discussionmentioning

confidence: 99%

“…If patients had signs or symptoms of myelopathy, they were excluded from this study, since myelopathic conditions are known to abolish or alter the CSP. 16,17 The study was approved by the local ethics committees, in compliance with the Declaration of Helsinki. Clinical examination consists of measuring muscle strength (0 to 5 scale; 5 represents full power, 0 is plegic) and evaluation of sensitivity (0 anesthesia, 1 hypoesthesia, 2 normal sensitivity).…”

Section: Methodsmentioning

confidence: 99%

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Preserved cutaneous silent period in cervical root avulsion

Vaško

Boček

Mencl

et al. 2015

The Journal of Spinal Cord Medicine

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Objective: Brachial plexus injuries are usually severe and involve the entire brachial plexus, sometimes occurring with root avulsions. Imaging and electrodiagnostic studies are an essential part of the lesion evaluation; however, the results sometimes show a discrepancy. The cutaneous silent period (SP) is a spinal inhibitory reflex mediated by small-diameter A-delta nociceptive fibers. The aim of the study was to determine if cutaneous SP testing may serve as a useful aid in evaluation of brachial plexus injury and/or in the diagnosis of root avulsion. Methods: In 19 patients with traumatic brachial plexus injury (15 males, age 18-62 years) we performed a clinical examination, CT myelography and neurophysiological testing. A needle EMG was obtained from muscles supplied by C5-T1 myotomes. Cutaneous SP was recorded after painful stimuli were delivered to the thumb (C6 dermatome), middle (C7) and little (C8) fingers while subjects maintained voluntary contraction of intrinsic hand muscles. Results: Electrodiagnostic and imaging studies confirmed root avulsion (partial or total) maximally involving C5, C6 roots in 12 patients, whereas only in 4 of them the cutaneous SP was partially absent. In the remaining subjects, the cutaneous SP was preserved. Conclusion: In brachial plexopathy even with plurisegmental root avulsion, the cutaneous SP was mostly preserved. This method cannot be recommended as a reliable test for diagnosis of single root avulsion; however, it can provide a quick physiological confirmation of functional afferent A-delta fibers through damaged roots and/or trunks. The clinicians may add this test to the diagnosis of spinal cord dysfunction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Preserved cutaneous silent period in cervical root avulsion

Vaško

Boček

Mencl

et al. 2015

The Journal of Spinal Cord Medicine

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“…Thirteen patients had predominant parkinsonian symptoms (MSA-P), two had predominant cerebellar signs (MSA-C), consistent with a known preponderance for MSA-P in Europe 23 . One patient with cervical myelopathy had an absent CSP on the right side, which is not unusual even in mild cervical spondylotic myelopathy 24 . Nine patients were on levodopa treatment with an average of 897 mg/d.…”

Section: Resultsmentioning

confidence: 99%

“…Delayed onset of the CSP has previously been attributed to dysfunction of corticospinal neurons based on findings in stroke, amyotrophic lateral sclerosis and cervical compressive myelopathy 24,36 . Arguably it seems difficult to envision how a motor pathway that is inhibited by A-delta afferent input can facilitate the same circuitry in a way that the onset of its own inhibition is preponed.…”

Section: Discussionmentioning

confidence: 99%

Cutaneous silent periods in multiple system atrophy

̌Sťetkářová¹,

Kofler²,

Majerová³

2015

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aim. The cutaneous silent period (CSP) is a spinal inhibitory reflex primarily mediated by A-delta fibers. Prolonged CSPs have been reported in patients with restless legs syndrome (RLS) and idiopathic Parkinson's disease (IPD). Dopaminergic medication normalizes the CSP, concurring with the effect of levodopa on CSPs. To date, CSPs have not been extensively studied in patients with multiple system atrophy (MSA). The purpose of this study was to confirm abnormal CSP findings in a group of MSA patients and to affirm the lack of influence of levodopa on CSPs during long-term treatment. Methods. We investigated 15 patients (4 males, 11 females, age 58-71 years) who fulfilled the diagnostic criteria for possible MSA. Thirteen patients had predominant parkinsonian symptoms (MSA-P), 2 had predominant cerebellar signs (MSA-C). We recorded CSPs in thenar muscles following noxious digit II stimulation. Sixteen healthy volunteers (6 males, 10 females, range 24-56 years) served as control subjects for CSP recordings. Results. Group average CSP onset was mildly delayed (P<0.01), whereas CSP end latency (P<0.001) were markedly delayed and CSP duration prolonged (P<0.001) in MSA patients compared to healthy controls. MSA patients on levodopa treatment did not differ in their CSPs from those without levodopa. The dose of levodopa did not correlate to any CSP parameter. Conclusion. The observed CSP prolongation corroborates previous findings in a limited number of MSA patients. The ineffectiveness of long-term levodopa on CSP abnormalities is consistent with its poor clinical effect in MSA.

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Influence of muscle contraction and intensity of stimulation on the cutaneous silent period

Rodi

Springer

2010

Muscle and Nerve

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We evaluated the influence of stimulus intensity (SI) and the amount of voluntary muscle contraction (VMC) on parameters of the cutaneous silent period (CSP). The CSP was measured in 15 healthy subjects at 20%, 40%, and 60% of maximal VMC and after an electric stimulus of 10, 15, and 20 times the sensory threshold. Average EMG amplitudes prior to stimulus and during the CSP increased with the amount of VMC. The CSP duration increased, and suppression index decreased, with increasing SI. The CSP onset and end latencies seemed to shorten and prolong, respectively, with the increasing SI, although this was not statistically significant. Considering the more meaningful temporal parameters of the CSP and the suppression index, it is not necessary to control the VMC, but it is advisable to control the SI.

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Cutaneous Silent Periods in the Assessment of Mild Cervical Spondylotic Myelopathy

Cited by 25 publications

References 41 publications

Preserved cutaneous silent period in cervical root avulsion

Preserved cutaneous silent period in cervical root avulsion

Cutaneous silent periods in multiple system atrophy

Influence of muscle contraction and intensity of stimulation on the cutaneous silent period

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