Sympathetic skin response: effects of botulinum toxin therapy

ELSEVIER

Electroencephalography

and clinical

Neurophysiology

98 (1996)

55P-8OP

Society Proceedings

Italian Society of Clinical Neurophysiology Pavia, 7-10 June 1995

Secretary: Prof. Domenico De Grandis Department

@Neurology,

S. Anna Hospital, Received

1.

Toxic-pharmacological periodic EEG patterns. cases. - P. Benna, M. Bonzanino, M. Montalenti of Neurology, University of Turin, Turin)

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1995

Sympathetic skin response: effects of botulinum toxin therapy. - P. Girlanda, C. Nicolosi, S. Sinicropi, A. Quartarone, V. Macaione, G. Picciolo, C. Messina (Institute of Neurological and Neurosurgical Sciences, University of Messina, Italy)

Autonomic nervous system involvement IS a clinical feature of botulism and mild abnormalities of cardiovascular reflex responses have also been reported after botulinum toxin A (Bo-NT) therapy. The sympathetic skin response (SSR) is a transient change in the electrical potential of the skin evoked by different stimuli and it is thought to mdicate autonomic function. SSR was studied in 20 patients who received Bo-NT for focal movement disorders. The responses were recorded by conventional methods simultaneously from the hand and foot and the stimulus was an electrical pulse delivered to the opposite median nerve at the wrist. SSR was recorded before and 2 weeks after treatment with Bo-NT. Mean age of patients was 55 + 15 years (range 17-73 years) and Bo-NT (BOTOX Allergnn) dosage ranged from IS to

in normal stimula-

Ltd. All rights

Ferruru,

Data demonstrating ipsilateral pathways connecting the premotor cortex to the spinal cord is lacking in the literature in comparison with the amount of papers concerning the assessment of cortico-spinal tracts. The aim of the present paper was to investigate the distribution of these ipsilateral projections in axial and proximal muscles and in particular in pectoral muscles. For our purposes we selected 8 normal healthy volunteers (8 men aged from 28 to 40 years old). Transcranial stimulation was produced using Magstim 200 magnetic stimulators. Magnetic stimulation was given through a figure of eight shaped coil and in some experiment both magnetic stimulators were connected to the same stimulating coil through a Bistim module. The main finding of the present paper was that a double magnetic shock given at ISI of 2050 ms can produce a clear response in the pectoralis muscle, tonically activated, ipsilaterally to the stimulated hemisphere. Such a response, which appeared in 4 of 8 subjects also after a single magnetic shock, was recorded in axial and proximcil muscles but not in forearm and hand muscles. The most interesting result was that the onset of this response was about 6 ms later than the response recorded from the same muscle by stimulation of the opposite hemisphere.

REM-activated seizures in children and adolescent: differential diagnosis with parasomnias and other seizures. - R. Silvestri, A. Lagana, C. Sferro, A. Alagna (Neurological Clinic, Messina University, Messina)

Corticospinal outflow in axial and proximal humans: a study by means of transcranial

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tion. - A. Quartarone”, J.C. RothweBb, V. Di LazzaroC (aNeurological Sciences of University Messina. bMRC Human Movement and Balance Unit, Institute of Neurology, Queen Square, London. ‘Istituto di Neurologia, Universita Cattolica di Roma, Rome)

Abnormal motor behavior during REM sleep, in the absence of ictal EEG abnormalities, has been described by several authors and classified among REM parasomnias as REM behavior disorder. We describe 3 patients who have been video-EEG recorded during developmental age showing specifically REM-activated ictal and interictal EEG abnormalities. Their seizures fit into the complex partial group, the EEG abnormalities being predominantly temporo-occipital with ictal and rnterictal bursts of generalized abnormal EEG discharges. Carbamnzepine stopped the nocturnal ictal phenomena preventmg its spreading to diurnal wakefulness. The differential diagnosis with developmental pnrnsomnias and other types of seizures are taken into consideranon. 3.

Gioveccu,

1 December

Report of two (Department

We report two cases of encephalopathies connected with the assumption of psychoactive substances, both characterized by periodic EEG patterns. 1. A 69-year-old woman, suffering from a bipolar depressive disorder, chronically treated with Lithium and Carbamazepine. She developed a confused state and myoclonus at a Lithium plasmatic level >3 mEq/l. The EEG recordings showed periodic short interval diffuse discharges, a pattern that rapidly normalized after the discontinuation of the drug. 2. An l&year-old boy, with a negative familiar and pathological anamnesis, but with a history of drug abuse (Ecstasy) for 3 months. The main neurological symptoms were a progressive intellectual deterioration and a severe change in personality. The EEG recordings showed a periodic long interval diffuse discharges (PLIDDs) pattern, normalized after hospitalization and suspension of the abuse. These clinical and neurophysiological observations confirm the necessity for repeated EEG recordings in the differential diagnosis among toxic and reversible encephalopathies and progressive encephaiopathies such as Creutzfeld-Jakob disease or subacute sclerosing panencephalitis. 2.

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100 units. The following parameters of SSR have been considered: latency at the onset (hand and foot), hand-foot difference in latency, peak-to-peak amplitude (hand and foot), ratio in amplitude between hand and foot responses. The results obtained in baseline conditions and after Bo-NT therapy are reported in the following table: (Baseline, after Bo-NT, Student’s t test) latency (hand) (I .3 + 0.2 ms, 1.5 + 0.6 ms, N.S.), latency (foot) (2.1 + 0.3 ms, 2 + 0.3 ms, N.S.), latency (hand/foot difference) (0.7 + 0.3 ms, 0.7 + 0.3 ms, N.S.), amplitude (hand) (0.9 + 0.7 mV, 1.3 + 0.9 mV, N.S.), amplitude (foot) (0.7 + 1.1 mV, 0.7 + 1 mV, N.S.), amplitude (hand/foot ratio) (3.1 + 2.9, 3.5 + 3.3, N.S.). In conclusion Bo-NT therapy did not induce significant alterations in sympathetic skin response. 5.

Electrophysiological studies in mild idiopathic carpal tunnel syndrome: follow-up. - P. Girlanda, A. Quartarone, G. Picciolo, V. Macaione, S. Sinicropi, C. Nicolosi, C. Messina (Institute of Neurological and Neurosurgical Sciences, University of Messina, Italy)

We have already used an electrophysiological protocol including the assessment of the ortbodromic sensory conduction velocity of median nerve along the carpal tunnel, the comparison of median and ulnar sensory conduction between ring linger and wrist, the short segment incremental median sensory nerve conduction across the carpal tunnel recording from the 3rd digit (‘inching test’), and the study of the refractory period of transmission (RPT) in 20 patients with mild CTS (37 symptomatic hands) with a distal motor latency of median nerve lower than 4 ms and in 20 control subjects. Combining the different techniques we could reach an overall sensitivity of 83%. We tested the patients again 2 years after the first examination to obtain history and clinical updating and electrophysiological data including distal motor latency (MAP-DL) of median nerve and a sensory conduction study between the 3rd finger and wrist (SCV-3rdF-W). Sixteen patients (30 symptomatic hands) underwent the follow-up examination. Three patients had been treated surgically with complete recovery and 8 hands had received local injection of steroids with transient benefit; 33% of hands which were abnormal at the first electrophysiological study showed a MAP-DL higher than 4 ms at the follow-up examination and 70% of hands revealed abnormal SCV-3rdF-W. No hand was normal at the first control revealed electrophysiological abnormalities at the follow-up. Also statistical comparisons concerning clinical score and electrophysiological findings showed that the group of hands positive at the first electrophysiological control presented a clear-cut worsening at the follow-up while the group of hands negative at the first examination remained unmodified. Therefore the electrodiagnostic protocol that we used in mild CTS revealed not only a high sensitivity but also a good specificity. 6.

Electrophysiological responses deprivation: an in vitro study. Calahresi (Neurological Clinic

of basal ganglia neurons to 02 - G. Bernardi, N.B. Mercuri, P. University Tor Vergata, Rome)

In this work we employed intracellular electrophysiological techniques to examine the effects of hypoxia on rat mesencephalic dopaminergic and striatal medium spiny cells maintained in vitro. Hypoxia was caused by changing the perfusing solution saturated with 95% 02/S% CO2 with one gassed with N2 95%/CO2 5%. Both mesencephalic and striatal cells readily responded to the hypoxic stimulus within l-2 min, but the membrane changes were different. In fact, it was observed that the dopaminergic cells were mainly hyperpolarized while the striatal neurons were depolarized. The two responses were associated with a decrease in apparent input resistance. Under voltage clamp conditions, the membrane hyperpolatization of the dopaminergic neurons was due to an outward current while the membrane depolarzation of striatal cells was due to an inward current. The cellular responses to hypoxia in the dopaminergic cells were largely mediated by an increase in potassium conductance. On the contrary the hypoxia-

Proceedings induced depolarization of striatal cells was largely mediated by an influx of sodium ions as a consequence of the blockade of the Na+/K+ ATP-dependent pump and the opening of sodium channels. By using antagonists for the excitatory amino acids (APV, CNQX) it was observed that neither the membrane hyperpolarization or the membrane depolarization were dependent on the release of endogenous amino acids. The dopaminergic cells were more resistant to hypoxia than the striatal neurons. This is in accordance with clinical evidence showing the particular vulnerability of striatal cells to hypoxia and ischemia. 7.

Execution of differently programmed motor programmed motor sequences. - A. Curra, M. Modugno, R. Agosino, G.W. Manfredi, N. Accornero, A. Berardelli (Neurological Department, University “La Sapienza” of Rome)

Parkinsonian patients are slower than normal subjects in executing sequential arm movements and show a progressive slowing as the sequence is completed. In this study the utilization of advance information to perform motor sequences has been studied in 10 normal and 3 parkinsonian subjects. The kinematics of the hand was monitored using a TV image processor which detected the position of a reflective marker placed on the second finger of the subject (ELITE System, BTS). Subjects performed sequences following visual targets on a screen. In the KNOWN sequences all the targets were displayed on the screen before a verbal starting signal (pre-programmed). In the UNKNOWN sequences the targets were displayed consecutively after the starting signal (not-pre-programmed). (1) Patients were slower than controls in executing both UNKNOWN and KNOWN sequences; (2) both groups were faster in performing the KNOWN sequences, but MT reduction was significantly shorter in patients; (3) a progressive slowing of MT as the sequences were completed, was present in both groups during the UNKNOWN task, but only in the patients during the KNOWN task. These results support the hypothesis that parkinsonians have more difficulties in executing movements that need to be programmed in advance than stimulus-response movements. 8.

Coherence and power spectral analysis in simple and complex finger movements. - P. Manganotti, C. Toro, L. Leocani, P. Zhuang, M. Hallett (NfH Bethesda, MD)

The sensorimotor cortical activation during movement was studied electrophysiologically in 7 right handed subjects using the coherence and power spectral analysis techniques. The motor task involved four finger movement sequences of increasing complexity, Movements were metronome paced at a rate of 2 Hz. Sequences were performed in 2 trials of 120 linger movements each. Coherence and power spectral analysis were computed within alpha and beta frequency bands for 29 scalp EEG channels. Both hands showed coherence increase and power decrease over central and frontal scalp electrodes within and across hemispheres during finger sequences compared to rest. Also coherence decreases were observed across posterior scalp electrodes. In both frequency bands, coherence increases and the power decreases were greater for sequences of higher complexity. These findings suggest that more complex tasks require higher levels of local cortical activation and the establishment of broader functional connections over the sensorimotor areas. 9.

Computerized chromatic visual field analysis in M.S. Accorneroa S. Rinalduzzi”, M. Filippp’, E. Millefiorini”, Capitaniob,’ G.C. Filligoib (aDipartimento di Scienze rologiche. bDip Infocom Universita “La Sapienza” Rome)

- N. L. Neu-

A software procedure running on a PC with standard peripherals has been developed in order to define chromatic perception extension in the central visual field (40 X 24). Accuracy and rapidity appear the major features. Sensitivity of the test is also high since mild chromatic visual