Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015, 159(2):327-332 | DOI: 10.5507/bp.2013.081

Cutaneous silent periods in multiple system atrophy

Ivana Stetkarovaa,b#, Markus Koflerc#, Veronika Majerovad
a Department of Neurology, Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
b Department of Neurology, Na Homolce Hospital, Prague
c Department of Neurology, Hochzirl Hospital, Zirl, Austria
d Department of Neurology and Center of Clinical Neuroscience, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague

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.

Keywords: multiple system atrophy, atypical parkinsonism, spinal reflex, cutaneous silent period, levodopa

Received: May 2, 2013; Accepted: October 15, 2013; Prepublished online: November 12, 2013; Published: June 28, 2015  Show citation

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Stetkarova, I., Kofler, M., & Majerova, V. (2015). Cutaneous silent periods in multiple system atrophy. Biomedical papers, 159(2), 327-332. doi: 10.5507/bp.2013.081
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    References

    1. Gilman S, Wenning GK, Low PA, Brooks DJ, Mathias CJ, Trojanowski JQ, Wood NW, Colosimo C, Dürr A, Fowler CJ, Kaufmann H, Klockgether T, Lees A, Poewe W, Quinn N, Revesz T, Robertson D, Sandroni P, Seppi K, Vidailhet M. Second consensus statement on the diagnosis of multiple system atrophy. Neurology 2008;71:670-6. Go to original source... Go to PubMed...
    2. Grambalova P, Hlustik P, Herman M, Kanovsky P. The occurrence of "typical" MRI findings in progressive supranuclear palsy and multiple system atrophy - a retrospective pilot study. Cesk Slov Neurol N 2010;73/106:538-41.
    3. Nair SR, Tan LK, Mohd Ramli N, Lim SY, Rahmat K, Mohd Nor H. A decision tree for differentiating multiple system atrophy from Parkinson's disease using 3-T MR imaging. Eur Radiol 2013;23(6):1459-66. Go to original source... Go to PubMed...
    4. Wadia PM, Howard P, Ribeirro MQ, Robblee J, Asante A, Mikulis DJ, Lang AE. The Value of GRE, ADC and Routine MRI in Distinguishing Parkinsonian Disorders. Can J Neurol Sci 2013; 40(3):389-402. Go to original source... Go to PubMed...
    5. Umemura A, Oeda T, Hayashi R, Tomita S, Kohsaka M, Yamamoto K, Sawada H. Diagnostic accuracy of apparent diffusion coefficient and 123I-metaiodobenzylguanidine for differentiation of multiple system atrophy and Parkinson's disease. PLoS One 2013;8 (4):e61066. Go to original source... Go to PubMed...
    6. Kimpinski K, Iodice V, Burton DD, Camilleri M, Mullan BP, Lipp A, Sandroni P, Gehrking TL, Sletten DM, Ahlskog JE, Fealey RD, Singer W, Low PA. The role of autonomic testing in the differentiation of Parkinson's disease from multiple system atrophy. J Neurol Sci 2012; 317:92-6. Go to original source... Go to PubMed...
    7. Valls-Solé J. Neurophysiological characterization of parkinsonian syndromes. Neurophysiol Clin 2000;30:352-67. Go to original source... Go to PubMed...
    8. Valls-Solé J, Veciana M, Leon L, Valldeoriola F. Effects of a startle on heart rate in patients with multiple system atrophy. Mov Disord 2002;17(3):546-9. Go to original source... Go to PubMed...
    9. Kofler M, Müller J, Seppi K, Wenning GK. Exaggerated auditory startle responses in multiple system atrophy: a comparative study of parkinson and cerebellar subtypes. Clin Neurophysiol 2003;114(3):541-7. Go to original source... Go to PubMed...
    10. Podnar S, Fowler CJ. Sphincter electromyography in diagnosis of multiple system atrophy: Technical issues. Muscle Nerve 2004;29(1):151-6. Go to original source... Go to PubMed...
    11. Gawel M, Jamrozik Z, Szmidt-Salkowska E, Slawek J, Rowinska-Marcinska K. Is peripheral neuron degeneration involved in multiple system atrophy? A clinical and electrophysiological study. J Neurol Sci 2012;319:81-5. Go to original source... Go to PubMed...
    12. Inghilleri M, Cruccu G, Argenta M, Polidori L, Manfredi M. Silent period in upper limb muscles after noxious cutaneous stimulation in man. Electroencephalogr Clin Neurophysiol 1997;105:109-15. Go to original source... Go to PubMed...
    13. Kofler M. Functional organization of exteroceptive inhibition following nociceptive electrical fingertip stimulation in humans. Clin Neurophysiol 2003;114:973-80. Go to original source... Go to PubMed...
    14. Leis AA, Kofler M, Ross MA. The silent period in pure sensory neuronopathy. Muscle Nerve 1992;15:1345-8. Go to original source... Go to PubMed...
    15. Leis AA, ©tetkárová I, Beric A, Stokic DS. Spinal motor neuron excitability during the cutaneous silent period. Muscle Nerve 1995;18:1464-70. Go to original source... Go to PubMed...
    16. Pullman SL, Ford B, Elibol B, Uncini A, Su PC, Fahn S. Cutaneous electromyographic silent period findings in brachial dystonia. Neurology 1996;46:503-8. Go to original source... Go to PubMed...
    17. Nakashima K, Takahashi K. Silent periods in the abductor pollicis brevis muscle in patients with Parkinson's disease. Electromyogr Clin Neurophysiol 1992;32:215-9.
    18. Serrao M, Parisi L, Valente G, Martini A, Fattapposta F, Pierelli F, Rossi F. L-Dopa decreases cutaneous nociceptive inhibition of motor activity in Parkinson's disease. Acta Neurol Scand 2002;105:196-201. Go to original source... Go to PubMed...
    19. Han JK, Oh K, Kim BJ, Koh SB, Kim JY, Park KW, Lee DH. Cutaneous silent period in patients with restless leg syndrome. Clin Neurophysiol 2007;118:1705-10. Go to original source... Go to PubMed...
    20. Kofler M, Kumru H, ©tetkárová I, Schindler C, Fuhr P. Muscle force up to 50% of maximum does not affect cutaneous silent periods in thenar muscles. Clin Neurophysiol 2007;118:2025-30. Go to original source... Go to PubMed...
    21. Rodi Z, Springer C. Influence of muscle contraction and intensity of stimulation on the cutaneous silent period. Muscle Nerve 2011;43:324-8. Go to original source... Go to PubMed...
    22. Svilpauskaite J, Truffert A, Vaiciene N, Magistris MR. Electrophysiology of small peripheral nerve fibers in man. A study using the cutaneous silent period. Medicina (Kaunas) 2006;42:300-13. Go to PubMed...
    23. Köllensperger M, Geser F, Ndayisaba JP, Boesch S, Seppi K, Ostergaard K, Dupont E, Cardozo A, Tolosa E, Abele M, Klockgether T, Yekhlef F, Tison F, Daniels C, Deuschl G, Coelho M, Sampaio C, Bozi M, Quinn N, Schrag A, Mathias CJ, Fowler C, Nilsson CF, Widner H, Schimke N, Oertel W, del Sorbo F, Albanese A, Pellecchia AM, Barone P, Djaldetti R, Colosimo C, Meco G, Gonzalez-Mandly A, Berciano J, Gurevich T, Giladi N, Galitzky M, Rascol O, Kamm C, Gasser T, Siebert U, Poewe W, Wenning GK, on behalf of the EMSA-SG. Presentation, diagnosis, and management of multiple system atrophy in Europe: Final analysis of the European multiple system atrophy registry. Mov Disord 2010;25(15):2604-12. Go to original source... Go to PubMed...
    24. ©tetkárová I, Kofler M. Cutaneous silent periods in the assessment of mild cervical spondylotic myelopathy. Spine 2009;34:34-42. Go to original source... Go to PubMed...
    25. Öz O, Erdogan C, Yücel M, Akgün H, Kütükcü Y, Gökcil Z, Odabaşi Z. Effect of pramipexole on cutaneous-silent-period parameters in patients with restless legs syndrome. Clin Neurophysiol 2012;123:154-9. Go to original source... Go to PubMed...
    26. Fuhr P, Zeffiro T, Hallett M. Cutaneous reflexes in Parkinson's disease. Muscle Nerve 1992;15:733-9. Go to original source... Go to PubMed...
    27. Clouston PD, Lim CL, Sue C, Morris JGL, Yiannikas C. Apomorphine can increase cutaneous inhibition of motor activity in Parkinson's disease. Electroencephalogr Clin Neurophysiol 1996;101:8-15. Go to original source... Go to PubMed...
    28. Kofler M, Fuhr P, Leis AA, Glocker FX, Kronenberg MF, Wissel J, Stetkarova I. Modulation of upper extremity motor evoked potentials by cutaneous afferents in humans. Clin Neurophysiol 2001;112:1053-63. Go to original source... Go to PubMed...
    29. Serrao M, Parisi L, Pierelli F, Rossi P. Cutaneous afferents mediating the cutaneous silent period in the upper limbs: evidences for a role of low-threshold sensory fibres. Clin Neurophysiol 2001;112:2007-14. Go to original source... Go to PubMed...
    30. Floeter MK. Cutaneous silent periods. Muscle Nerve 2003;28:391-401. Go to original source... Go to PubMed...
    31. Colosimo C, Tiple D, Wenning GK. Management of multiple system atrophy: state of the art. J Neural Transm 2005;112:1695-1704. Go to original source... Go to PubMed...
    32. Kimura J. Disorder of interneurons in Parkinsonism. The orbicularis oculi reflex to paired stimuli. Brain 1973;96:87-96. Go to original source... Go to PubMed...
    33. Frauscher B, Löscher W, Högl B, Poewe W, Kofler M. Auditory startle reaction is disinhibited in idiopathic restless legs syndrome. Sleep 2007;30:489-93. Go to original source... Go to PubMed...
    34. Bara-Jimenez W, Aksu M, Graham B, Sato S, Hallett M. Periodic limb movements in sleep: state-dependent excitability of the spinal flexor reflex. Neurology 2000;54:1609-15. Go to original source... Go to PubMed...
    35. Floeter MK, Gerloff C, Kouri J, Hallett M. Cutaneous withdrawal reflexes of the upper extremity. Muscle Nerve 1998;21:591-8. Go to original source... Go to PubMed...
    36. Gilio F, Bettolo CM, Conte A, Iacovelli E, Frasca V, Serrao M, Giacomelli E, Gabriele M, Prencipe M, Inghilleri M. Influence of the corticospinal tract on the cutaneous silent period: A study in patients with pyramidal syndrome. Neurosci Lett 2008;433:109-13. Go to original source... Go to PubMed...
    37. Koo JS, Park HR, Joo BE, Choi JY, Jung KY, Park KW, Cho SC, Kim BJ. Utility of the cutaneous silent period in the evaluation of carpal tunnel syndrome. Clin Neurophysiol 2010;121 (9):1584-8. Go to original source... Go to PubMed...
    38. Inghilleri M, Berardelli A, Marchetti P, Manfredi M. Effects of diazepam, baclofen and thiopental on the silent period evoked by transcranial magnetic stimulation in humans. Exp Brain Res 1996;109:467-72. Go to original source... Go to PubMed...
    39. Inghilleri M, Conte A, Frasca V, Berardelli A, Manfredi M, Cruccu G. Is the cutaneous silent period an opiate-sensitive nociceptive reflex? Muscle Nerve 2002;25:695-9. Go to original source... Go to PubMed...
    40. Kofler M, Kumru H, Stetkarova I, Ruegg S, Fuhr P, Leis AA. Cutaneous silent periods are not affected by the antihistaminic drug cetirizine. Clin Neurophysiol 2009;120:1013-6. Go to original source... Go to PubMed...
    41. Kofler M, Wissel J, Müller J, Brenneis C. Influence of intrathecal baclofen on silent periods in dystonia. Muscle Nerve 2000;23:1145-6. Go to original source... Go to PubMed...
    42. Stetkarova I, Kofler M. Differential effect of baclofen on cortical and spinal inhibitory circuits. Clin Neurophysiol 2013;124:339-45. Go to original source... Go to PubMed...
    43. Pujia F, Coppola G, Anastasio MG, Brienza M, Vestrini E, Valente GO, Parisi L, Serrao M, Pierelli F. Cutaneous silent period in hand muscles is lengthened by tramadol: Evidence for monoaminergic modulation? Neurosci Lett 2012;528:78-82. Go to original source... Go to PubMed...

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