Sistemik lupus eritematozus hastalarında reflekslerinin elektrofizyolojik olarak incelenmesi

ÖZETAmaç: Sistemik lupus eritematozus (SLE) santral ve periferik sinir sistemini de etkileyebilenmultisistemik bir hastalıktır. Periferik sinir sistemi tutulum oranı çalışmalarda değişkenlikgöstermektedir. Öte yandan bu hastalarda santral sinir sistemi tutulumunu inceleyenelektrofizyolojik bir çalışma bulunmamaktadır. Bu çalışmamızdaki amaç, SLE tanısıylaizlenen ve nörolojik tutulumu olan ve olmayan hastalarda beyin sapı refleksleri ve siniriletim çalışmaları gerçekleştirerek olası sinir sistemi tutulumunu araştırmaktı.Gerekçe – Yöntem: Çalışmaya Marmara Üniversitesi Tıp Fakültesi Romatoloji AnabilimDalı tarafından SLE tanısı ile takip edilen 18–62 yaş arası (yaş ortalaması 39) 38 hastaalındı. Hastaların birinde nedeni tespit edilmemiş olan tek taraflı internal karotid arteroklüzyonu, ikisinde non-spesifik baş ağrısı mevcuttu. Diğer hastaların nörolojik belirti veyabulgusu yoktu. Kontrol grubunu 35 sağlıklı gönüllü (yaş ortalaması 38) oluşturdu.Sonuçlar: Hasta ve kontrollerde rutin sinir iletim çalışmaları ile beyin sapı refleksleri (gözkırpma refleksi, çene refleksi, masseter inhibitör refleksi) çalışıldı. Hastaların %29’ındamotor veya duyu sinir iletim anormalliği saptandı. Bunların çoğunluğu aksonal tutulum ileuyumluydu. Beyin sapı refleks çalışma sonuçlarına göre SLE hastalarının %60.5’inde gözkırpma refleksi, %13’ünde masseter refleksi, %37’sinde ise masseter inhibitör refleksanormalliği mevcuttu. Bu anormalliklerin çoğu latans uzaması şeklindeydi ve demiyelinizanbir sürece işaret etmekteydi.Çıkarımlar: Yaklaşık her 4 SLE hastasından birinde elektrofizyolojik olarak periferik sinirsistem tutulumu görülmektedir. Bu bulguların klinik önemi şu aşamada belli değildir, takipdeğerlendirmelere ihtiyaç vardır. SLE hastalarında beyin sapı refleks anormallikleri çalışılanteste bağlı olarak %13 ile %60 arasında değişmektedir ve anormalliği en fazla saptayan testgöz kırpma refleksidir. SLE hastalarının tüm beyin sapı refleks çalışmaları birliktedeğerlendirildiğinde mevcut bulgular lateral kaudal pons, lateral medulla, inhibitör veyaeksitatör internöronlarda fonksiyonel bütünlüğün bozulduğunu düşündürmektedir.ANAHTAR SÖZCÜKLER:Sistemik lupus eritematozus, periferik sinir sistemi, rutin sinir iletim çalışmaları, santral sinirsistemi, beyin sapı refleks çalışmalarıİNGİLİZCE ÖZET (ABSTRACT)Aim: Systemic lupus erythematosus (SLE) is a multisystem disorder which may affectcentral and peripheral nervous systems. The rate of peripheral nervous system involvementvaries between different studies. However, at present, we do not have any data about theutility of electrophysiological studies that can assess the involvement of central nervoussystem. In this study, we aimed to investigate the possible involvement of nervous systemby the assessment of the brain stem reflex tests and by the nerve conduction studies in agroup of patients with SLE with or without neurological symptoms.Materials and Methods: Thirty eight patients diagnosed as SLE by the RheumatologyDepartment of Marmara University Medicine Faculty (mean age: 39-years; range: 18-62years) were enrolled to the study. One of the patients had unilateral occlusion of the internalcarotid artery and the other two had a non specific headache. The remaining patients had noneurologic sign or symptom. The control group was consisted of 35 healthy volunteers(mean age: 38-years)Results: Routine nerve conduction studies and brain stem reflexes (blink reflex, masseterreflex, masseter inhibtory reflex) were studied in both patients and controls. Motor andsensory nerve conduction abnormality was found in 29% of patients. In most of the casesthis abnormality was axonal. According to the brain stem reflex test results, 60.5% of SLEpatients had abnormality in blink reflex test, 13% of them abnormality in masseter reflex testand 37% of the patients had abnormality in masseter inhibitory reflex test. The majorabnormality in most of the cases was a prolonged latency and this finding was pointing out ademyelinating process.Conclusions: In almost ¼ of the patients with SLE, there is an electrophysiologicalinvolvement in the peripheral nervous system. The clinical value of this finding is not cleartoday and follow-up evaluations are needed. Related to the evaluated test, 13% to 60.5% ofSLE patients have an abnormality in brain stem reflex tests and blink reflex is the mostpowerful one to detect the abnormality. When we review all the results of the brain stemreflex tests of SLE patients, we might find that the functional integrity of the inhibitory andexcitatory interneurons of the lateral part of the pons and medulla is affected.KEYWORDS:Systemic Lupus Erithematozus, peripheral nervous system, nerve conductionstudies, central nervous system, brainstem reflex studie

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Progressive nonfluent aphasia is a slowly progressive degenerative disease characterized by atrophy in left hemisphere particularly frontotemporal. It is one of three subtypes of frontotemporal lobar degeneration (frontotemporal dementia). Unlike Alzheimer’s disease it begins between 45-65 years of age and occurs equally in both sexes usually. The reported youngest case was 21 years old. Atrophy is seen in the left hemisphere more in temporal lobe on magnetic resonance imaging. Approximately half of the cases have family history. In early it might confuse with depression and therefore diagnosis may be delayed. Brain magnetic resonance imaging is important for verification of diagnosis. In this paper, a case who early onset progressive nonfluent aphasia was mentioned

The use of quantitative eeg for differentiating frontotemporal dementia from late-onset bipolar disorder

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