المؤلفون: Stefan Golaszewski, Yvonne Höller, Eugen Trinka, Raffaele Nardone, Aljoscha Thomschewski, Francesco Brigo, AR Ellis, Arne C. Bathke

المصدر: Spinal Cord. 53:534-538

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Traumatic spinal cord injury, medicine.medical_treatment, Pyramidal Tracts, Pilot Projects, Physical medicine and rehabilitation, medicine, Humans, Evoked potential, Spinal cord injury, Spinal Cord Injuries, Motor threshold, Motor cortical function, business.industry, Motor Cortex, Cervical Cord, General Medicine, Middle Aged, Evoked Potentials, Motor, medicine.disease, Functional recovery, Transcranial Magnetic Stimulation, Transcranial magnetic stimulation, medicine.anatomical_structure, Neurology, Female, Neurology (clinical), business, Neuroscience, Motor cortex

الوصف: Transcranial magnetic stimulation study. To further investigate the corticospinal excitability changes after spinal cord injury (SCI), as assessed by means of transcranial magnetic stimulation (TMS). Merano (Italy) and Salzburg (Austria). We studied resting motor threshold (RMT), motor evoked potential (MEP) amplitude and recruitment curve in five subjects with good recovery after traumatic incomplete cervical SCI. RMT did not differ significantly between patients and controls, whereas the slope of MEP recruitment curve was significantly increased in the patients. This abnormal finding may represent an adaptive response after SCI. The impaired ability of the motor cortex to generate proper voluntary movement may be compensated by increasing spinal excitability. The easily performed measurement of MEP recruitment curve may provide a useful additional tool to improve the assessment and monitoring of motor cortical function in subjects with SCI. Increasing our knowledge of the corticospinal excitability changes in the functional recovery after SCI may also support the development of effective therapeutic strategies.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::ad4707f17fb0486832592f207dd6294fTest
https://doi.org/10.1038/sc.2015.12Test

المؤلفون: Yvonne Höller, Peter Höller, Stefan Golaszewski, Andrea Orioli, Eugen Trinka, Aljoscha Thomschewski, Francesco Brigo, Raffaele Nardone

المصدر: Spinal Cord. 52:831-835

مصطلحات موضوعية: Adult, Male, Stress Disorders, Traumatic, Modified Ashworth scale, medicine.medical_treatment, Electromyography, H-Reflex, Double-Blind Method, medicine, Humans, Spasticity, Muscle, Skeletal, Spinal cord injury, Aged, Motor Neurons, Cross-Over Studies, Trauma Severity Indices, medicine.diagnostic_test, business.industry, musculoskeletal, neural, and ocular physiology, Motor Cortex, Reciprocal inhibition, Neural Inhibition, General Medicine, Middle Aged, Evoked Potentials, Motor, medicine.disease, Transcranial Magnetic Stimulation, Transcranial magnetic stimulation, medicine.anatomical_structure, nervous system, Neurology, Muscle Spasticity, Anesthesia, Female, Neurology (clinical), Primary motor cortex, medicine.symptom, business, Motor cortex

الوصف: Randomized, double-blind, crossover, sham-controlled trial. Repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex (M1) leads to a significant reduction of spasticity in subjects with spinal cord injury (SCI), but the physiological basis of this effect is still not well understood. The purpose of this study was to evaluate the disynaptic reciprocal Ia inhibition of soleus motoneurons in SCI patients. Department of Neurology, Merano, Italy and TMS Laboratory, Paracelsus Medical University, Salzburg, Austria. Nine subjects with incomplete cervical or thoracic SCI received 5 days of daily sessions of real or sham rTMS applied over the contralateral M1. We compared the reciprocal inhibition, the Modified Ashworth Scale and the Spinal Cord Injury Assessment Tool for Spasticity at baseline, after the last session and 1 week later in the real rTMS and sham stimulation groups. We found that real rTMS significantly reduced lower limb spasticity and restored the impaired excitability in the disynaptic reciprocal inhibitory pathway. In a small proof-of-concept study, rTMS strengthened descending projections between the motor cortex and inhibitory spinal interneuronal circuits. This reversed a defect in reciprocal inhibition after SCI, and reduced leg spasticity.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::cbc214f6c0ff2d44bd601a0b5ff499ebTest
https://doi.org/10.1038/sc.2014.136Test

المؤلفون: Stefan Golaszewski, Vanessa N. Frey, Eugen Trinka, Francesco Brigo, Piergiorgio Lochner, Raffaele Nardone, Stefan Leis, Yvonne Höller

المصدر: Spinal cord. 54(10)

مصطلحات موضوعية: medicine.medical_specialty, Neurology, diagnosis, cervical spondylogenic myelopathy, SEPs, MEDLINE, Neural Conduction, Neurophysiology, Electromyography, 03 medical and health sciences, 0302 clinical medicine, Physical medicine and rehabilitation, medicine, magnetic resonance imaging, Animals, Humans, 030212 general & internal medicine, Disease management (health), Spinal cord injury, Evoked Potentials, Spinal Cord Injuries, MEPs, medicine.diagnostic_test, business.industry, Disease Management, Magnetic resonance imaging, General Medicine, medicine.disease, Physical therapy, Neurology (clinical), Spondylosis, Paraplegia, business, 030217 neurology & neurosurgery

الوصف: Topical review of the literature.The objective of this review article was to assess indications and usefulness of various neurophysiological techniques in diagnosis and management of cervical spondylogenic myelopathy (CSM).The MEDLINE, accessed by Pubmed and EMBASE electronic databases, was searched using the medical subject headings: 'compressive myelopathy', 'cervical spondylotic myelopathy (CSM)', 'cervical spondylogenic myelopathy', 'motor evoked potentials (MEPs)', 'transcranial magnetic stimulation', 'somatosensory evoked potentials (SEPs)', 'electromyography (EMG)', 'nerve conduction studies (NCS)' and 'cutaneous silent period (CSP)'.SEPs and MEPs recording can usefully supplement clinical examination and neuroimaging findings in assessing the spinal cord injury level and severity. Segmental cervical cord dysfunction can be revealed by an abnormal spinal N13 response, whereas the P14 potential is a reliable marker of dorsal column impairment. MEPs may also help in the differential diagnosis between spinal cord compression and neurodegenerative disorders. SEPs and MEPs are also useful in follow-up evaluation of sensory and motor function during surgical treatment and rehabilitation. EMG and NCS improve the sensitivity of cervical radiculopathy detection and may help rule out peripheral nerve problems that can cause symptoms that are similar to those of CSM. CSP also shows a high sensitivity for detecting CSM.Neuroimaging, especially magnetic resonance imaging, represents the procedure of choice for the diagnosis of CSM, but a correct interpretation of morphological findings can be achieved only if they are correlated with functional data. The studies reported in this review highlight the crucial role of the electrophysiological studies in diagnosis and management of CSM.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::3795d6a53325822f0edd4412da9d43a8Test
https://pubmed.ncbi.nlm.nih.gov/27241448Test

المؤلفون: Yvonne Höller, Andrea Orioli, Eugen Trinka, Alexander Kunz, Francesco Brigo, Raffaele Nardone, Stefan Golaszewski, Piergiorgio Lochner

المصدر: Spinal cord. 52(6)

مصطلحات موضوعية: Adult, Liver Cirrhosis, Male, Weakness, Neural Conduction, Pyramidal Tracts, Neurological examination, Sensory system, Somatosensory system, Spinal Cord Diseases, Upper Extremity, Myelopathy, Evoked Potentials, Somatosensory, Medicine, Humans, Spasticity, Muscle, Skeletal, Aged, Neurologic Examination, medicine.diagnostic_test, business.industry, General Medicine, Middle Aged, Spinal cord, medicine.disease, Evoked Potentials, Motor, medicine.anatomical_structure, Neurology, Lower Extremity, Somatosensory evoked potential, Anesthesia, Female, Neurology (clinical), medicine.symptom, business

الوصف: Study design Experimental neurophysiological study. Objectives The hepatic myelopathy (HM) is characterized by progressive weakness and spasticity of the lower extremities, while there are only a few reports of sensory impairment. However, sensory function has been poorly explored in HM. We believe that an electrophysiological assessment of dorsal columns by somatosensory evoked potentials (SEPs) and of cortico-spinal lateral tracts by motor evoked potentials (MEPs) should be of considerable value in the functional evaluation of the spinal cord involvement in patients with HM. Setting Salzburg (Austria) and Merano (Italy). Methods Eight patients diagnosed with HM were studied with MEPs and SEPs. Neurological examination revealed different degrees of cortico-spinal tract involvement in all patients and sensory abnormalities in three patients. Results Central motor conduction to lower limb muscles was abnormal in all patients, while central sensory conduction was abnormal in seven out of the eight patients. Both central motor and sensory conduction to upper limbs are normal in all patients. Conclusion The main finding is that electrophysiological evidence of central sensory involvement is present in a very high percentage of patients with HM, and that the threshold for electrophysiological abnormalities is below that for clinical manifestations. Therefore, central sensory and motor conduction studies are sensitive methods for detecting, localizing and monitoring spinal cord damage in HM.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::11688d6c9d4aa5f7fa45d1f9cfad709bTest
https://pubmed.ncbi.nlm.nih.gov/24777163Test

المؤلفون: Nardone, R, Höller, Y, Langthaler, P B, Lochner, P, Golaszewski, S, Schwenker, K, Brigo, F, Trinka, E

المصدر: Spinal Cord; January 2017, Vol. 55 Issue: 1 p20-25, 6p

مستخلص: Study design:Repetitive transcranial magnetic stimulation study.Objectives:The analgesic effects of repetitive transcranial magnetic stimulation (rTMS) in chronic pain have been the focus of several studies. In particular, rTMS of the premotor cortex/dorsolateral prefrontal cortex (PMC/DLPFC) changes pain perception in healthy subjects and has analgesic effects in acute postoperative pain, as well as in fibromyalgia patients. However, its effect on neuropathic pain in patients with traumatic spinal cord injury (SCI) has not been assessed.Setting:Merano (Italy) and Salzburg (Austria).Methods:In this study, we performed PMC/DLPFC rTMS in subjects with SCI and neuropathic pain. Twelve subjects with chronic cervical or thoracic SCI were randomized to receive 1250 pulses at 10 Hz rTMS (n=6) or sham rTMS (n=6) treatment for 10 sessions over 2 weeks. The visual analog scale, the sensory and affective pain rating indices of the McGill Pain Questionnaire (MPQ), the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale were used to assed pain and mood at baseline (T0), 1 day after the first week of treatment (T1), 1 day (T2), 1 week (T3) and 1 month (T4) after the last intervention.Results:Subjects who received active rTMS had a statistically significant reduction in pain symptoms in comparison with their baseline pain, whereas sham rTMS participants had a non-significant change in daily pain from their baseline pain.Conclusion:The findings of this preliminary study in a small patient sample suggest that rTMS of the PMC/DLPFC may be effective in relieving neuropathic pain in SCI patients.

المؤلفون: Nardone, R, Höller, Y, Brigo, F, Frey, V N, Lochner, P, Leis, S, Golaszewski, S, Trinka, E

المصدر: Spinal Cord; October 2016, Vol. 54 Issue: 10 p756-766, 11p

مستخلص: Study design:Topical review of the literature.Objective:The objective of this review article was to assess indications and usefulness of various neurophysiological techniques in diagnosis and management of cervical spondylogenic myelopathy (CSM).Methods:The MEDLINE, accessed by Pubmed and EMBASE electronic databases, was searched using the medical subject headings: ‘compressive myelopathy’, ‘cervical spondylotic myelopathy (CSM)’, ‘cervical spondylogenic myelopathy’, ‘motor evoked potentials (MEPs)’, ‘transcranial magnetic stimulation’, ‘somatosensory evoked potentials (SEPs)’, ‘electromyography (EMG)’, ‘nerve conduction studies (NCS)’ and ‘cutaneous silent period (CSP)’.Results:SEPs and MEPs recording can usefully supplement clinical examination and neuroimaging findings in assessing the spinal cord injury level and severity. Segmental cervical cord dysfunction can be revealed by an abnormal spinal N13 response, whereas the P14 potential is a reliable marker of dorsal column impairment. MEPs may also help in the differential diagnosis between spinal cord compression and neurodegenerative disorders. SEPs and MEPs are also useful in follow-up evaluation of sensory and motor function during surgical treatment and rehabilitation. EMG and NCS improve the sensitivity of cervical radiculopathy detection and may help rule out peripheral nerve problems that can cause symptoms that are similar to those of CSM. CSP also shows a high sensitivity for detecting CSM.Conclusion:Neuroimaging, especially magnetic resonance imaging, represents the procedure of choice for the diagnosis of CSM, but a correct interpretation of morphological findings can be achieved only if they are correlated with functional data. The studies reported in this review highlight the crucial role of the electrophysiological studies in diagnosis and management of CSM.

المؤلفون: Nardone, R¹, Höller, Y², Thomschewski, A², Bathke, A C³, Ellis, A R⁴, Golaszewski, S M⁵, Brigo, F⁶, Trinka, E²

المصدر: Spinal Cord. Jul2015, Vol. 53 Issue 7, p534-538. 5p. 3 Charts, 1 Graph.

مصطلحات موضوعية: *CERVICAL vertebrae injuries, *EVOKED potentials (Electrophysiology), *MEDICAL rehabilitation, *NONPARAMETRIC statistics, *PATIENTS, *PROBABILITY theory, *SPINAL cord injuries, *STATISTICS, *TRANSCRANIAL magnetic stimulation, *DATA analysis, *CONTROL groups, *DATA analysis software, *DESCRIPTIVE statistics

مستخلص: Study design:Transcranial magnetic stimulation study.Objectives:To further investigate the corticospinal excitability changes after spinal cord injury (SCI), as assessed by means of transcranial magnetic stimulation (TMS).Setting:Merano (Italy) and Salzburg (Austria).Methods:We studied resting motor threshold (RMT), motor evoked potential (MEP) amplitude and recruitment curve in five subjects with good recovery after traumatic incomplete cervical SCI.Results:RMT did not differ significantly between patients and controls, whereas the slope of MEP recruitment curve was significantly increased in the patients.Conclusion:This abnormal finding may represent an adaptive response after SCI. The impaired ability of the motor cortex to generate proper voluntary movement may be compensated by increasing spinal excitability. The easily performed measurement of MEP recruitment curve may provide a useful additional tool to improve the assessment and monitoring of motor cortical function in subjects with SCI. Increasing our knowledge of the corticospinal excitability changes in the functional recovery after SCI may also support the development of effective therapeutic strategies. [ABSTRACT FROM AUTHOR]

المؤلفون: Nardone, R¹, Höller, Y², Thomschewski, A², Brigo, F³, Orioli, A⁴, Höller, P², Golaszewski, S², Trinka, E²

المصدر: Spinal Cord. Nov2014, Vol. 52 Issue 11, p831-835. 5p. 3 Charts, 4 Graphs.

مصطلحات موضوعية: *SPASTICITY, *CHI-squared test, *CROSSOVER trials, *ELECTROMYOGRAPHY, *FISHER exact test, *HEALTH outcome assessment, *SPINAL cord injuries, *STATISTICS, *TRANSCRANIAL magnetic stimulation, *DATA analysis, *RANDOMIZED controlled trials, *BLIND experiment, *DATA analysis software, *DESCRIPTIVE statistics, *DISEASE complications, *PREVENTION

مستخلص: Study design:Randomized, double-blind, crossover, sham-controlled trial.Objectives:Repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex (M1) leads to a significant reduction of spasticity in subjects with spinal cord injury (SCI), but the physiological basis of this effect is still not well understood. The purpose of this study was to evaluate the disynaptic reciprocal Ia inhibition of soleus motoneurons in SCI patients.Setting:Department of Neurology, Merano, Italy and TMS Laboratory, Paracelsus Medical University, Salzburg, Austria.Methods:Nine subjects with incomplete cervical or thoracic SCI received 5 days of daily sessions of real or sham rTMS applied over the contralateral M1. We compared the reciprocal inhibition, the Modified Ashworth Scale and the Spinal Cord Injury Assessment Tool for Spasticity at baseline, after the last session and 1 week later in the real rTMS and sham stimulation groups.Results:We found that real rTMS significantly reduced lower limb spasticity and restored the impaired excitability in the disynaptic reciprocal inhibitory pathway.Conclusions:In a small proof-of-concept study, rTMS strengthened descending projections between the motor cortex and inhibitory spinal interneuronal circuits. This reversed a defect in reciprocal inhibition after SCI, and reduced leg spasticity. [ABSTRACT FROM AUTHOR]

المؤلفون: Nardone, R¹, Höller, Y², Thomschewski, A², Höller, P², Bergmann, J³, Golaszewski, S⁴, Brigo, F⁵, Trinka, E²

المصدر: Spinal Cord. Jun2014, Vol. 52 Issue 6, p420-427. 8p. 1 Black and White Photograph, 2 Graphs.

مصطلحات موضوعية: *EVOKED potentials (Electrophysiology), *MEDLINE, *ONLINE information services, *HEALTH outcome assessment, *SPINAL cord diseases, *SYSTEMATIC reviews, *TREATMENT effectiveness, *DIAGNOSIS

مصطلحات جغرافية: AUSTRIA, ITALY

مستخلص: Study design:Topical review of the literature.Objectives:The evaluation of patients with myelopathies requires radiological investigations; however, for the correct interpretation of the neuroimaging findings, the functional assessment of corticospinal conduction is helpful or even mandatory in many conditions. The objective of this review article was to assess the utility of the motor evoked potentials (MEPs) in diagnosis and management of the most frequent spinal cord disorders.Setting:Salzburg (Austria) and Merano (Italy).Methods:A MEDLINE search was performed using following terms: 'motor evoked potentials', 'transcranial magnetic stimulation', 'central motor conduction', 'compressive myelopathy', 'spinal cord infarction', 'spinal cord injury', 'syringomyelia', 'myelitis', 'hereditary spastic paraparesis', 'subacute combined degeneration' and 'hepatic myelopathy'.Results:Central motor conduction abnormalities can be detected also in the absence of neuroradiological abnormalities-for example, in patients with subacute combined degeneration or hepatic myelopathy. In the most frequent patients with compressive myelopathies, MEPs were found to be very helpful in determining the functional significance of neuroimaging findings. MEP recording can supplement clinical examination and neuroimaging findings also in the assessment of the spinal cord injury level. In patients with spinal cord infarction, the MEP study can demonstrate spinal involvement even when radiological evidence for spinal cord damage is absent or equivocal, thus allowing an important early diagnosis.Conclusion:MEPs represent a highly sensitive and accurate diagnostic tool in many different spinal cord disorders. MEPs can also be useful in follow-up evaluation of motor function during treatment and rehabilitation. [ABSTRACT FROM AUTHOR]

المؤلفون: Nardone, R¹, Orioli, A², Höller, Y³, Lochner, P², Kunz, A⁴, Golaszewski, S⁴, Brigo, F⁵, Trinka, E³

المصدر: Spinal Cord. Jun2014, Vol. 52 Issue 6, p439-443. 5p. 3 Charts, 1 Graph.

مصطلحات موضوعية: *FUNCTIONAL assessment, *EVOKED potentials (Electrophysiology), *EXPERIMENTAL design, *LIVER, *NEUROPHYSIOLOGY, *SOMATOSENSORY evoked potentials, *SPINAL cord diseases, *DESCRIPTIVE statistics

مصطلحات جغرافية: AUSTRIA, ITALY

مستخلص: Study design:Experimental neurophysiological study.Objectives:The hepatic myelopathy (HM) is characterized by progressive weakness and spasticity of the lower extremities, while there are only a few reports of sensory impairment. However, sensory function has been poorly explored in HM. We believe that an electrophysiological assessment of dorsal columns by somatosensory evoked potentials (SEPs) and of cortico-spinal lateral tracts by motor evoked potentials (MEPs) should be of considerable value in the functional evaluation of the spinal cord involvement in patients with HM.Setting:Salzburg (Austria) and Merano (Italy).Methods:Eight patients diagnosed with HM were studied with MEPs and SEPs. Neurological examination revealed different degrees of cortico-spinal tract involvement in all patients and sensory abnormalities in three patients.Results:Central motor conduction to lower limb muscles was abnormal in all patients, while central sensory conduction was abnormal in seven out of the eight patients. Both central motor and sensory conduction to upper limbs are normal in all patients.Conclusion:The main finding is that electrophysiological evidence of central sensory involvement is present in a very high percentage of patients with HM, and that the threshold for electrophysiological abnormalities is below that for clinical manifestations. Therefore, central sensory and motor conduction studies are sensitive methods for detecting, localizing and monitoring spinal cord damage in HM. [ABSTRACT FROM AUTHOR]