The Observation Of Clinical And Electrophysiological Tests İn The Cases with Hemifacial Spasm Under The Treatment Of Botulinum Toxin

Biz çalışmamızda 16 idiyopatik HFS olgusunda BoNT’nin klinik ve elektrofizyolojik etkilerini araştırmayı amaçladık. Bu amaçla HFS olgularını BoNT enjeksiyonu öncesinde ve enjeksiyon sonrası 1’inci hafta, 1’inci ay ve 4’üncü ayda göz kırpma refleksi, orbikülaris okuli BKAP ve ASU testi ile değerlendirdik. Ayrıca her vizitte olguların HFS şiddeti ve HFS-7 yaşam kalitesi ölçek skorlarını hesapladık. Çalışmamızın sonucunda BoNT enjeksiyonu sonrası tüm izlem zamanlarında HFS şiddeti ve HFS-7 yaşam kalitesi ölçek skorlarında anlamlı azalma olduğu görüldü. Orbikülaris okuli BKAP amplitüdlerinde anlamlı düşüş gözlendi ve etkilenen taraf orbikülaris okuli kasında düşük frekans ASU testinde dekrement yanıt izlendi. Göz kırpma refleksi testinde etkilenen taraf orbikülaris okuli erken ve geç yanıt latansları (R1,İR2, KR2) ile orbikülaris oris R1 sinkinetik yanıt latanslarında anlamlı gecikme olduğu görüldü. Ayrıca orbikülaris oris kası sinkinetik yanıtlarının amplitüd ve alan değerlerinde anlamlı düşüş olduğu saptandı. Tüm bu bulgular BoNT enjeksiyonu sonrası 1’inci ayda en belirgin olup 4’üncü ayda halen devam etmekteydi. Çalışmamızda önemli bir bulgu olarak HFS şiddet ve HFS-7 yaşam kalitesi ölçeği ile orbikülaris oris sinkinetik yanıt amplitüd ve alan değişimleri arasında anlamlı koralasyon saptandı. 116 Sonuç olarak bizim çalışmamız BoNT’nin nöromusküler kavşak etkilerinin yanı sıra trigeminal afferent sistem üzerinden fasiyal sinir motor nükleusunun uyarılabilirliğini baskılayarak beyin sapı devreleri üzerinde etkisi olduğunu göstermektedir. Ayrıca HFS olgularının sinkinetik yanıt amplitüd ve alan değeri ile klinik şiddetin korele olması, göz kırpma refleksinin elektrofizyolojik olarak hastalık şiddet değerlendirilmesinde kullanılabileceğini düşündürmektedir.In our study, we aimed to investigate the clinical and electrophysiological effects of BoNT in 16 idiopathic HFS cases. For this purpose, we evaluated the HFS cases with blink reflex, orbicularis oculi CMAP and repetitive nerve stimulation test, before the BoNT injection and at the first week, at the first and fourth months of post treatment period. We also calculated the HFS severity and HFS-7 quality of life scale scores at each visit. As a result of our study, there was significant decrease in HFS severity and HFS-7 quality of life scale scores at all follow-up periods after BoNT injection. CMAP amplitudes of the orbicularis oculi muscle were significantly decrease after BoNT injection and decrement responses were observed in low frequency repetitive nerve stimulation test on the affected side. The latencies of blink reflexes (R1, İR2, KR2) of the affected orbicularis oculi muscle and R1 synkinetic responses of the orbicularis oris muscle were significantly increased after BoNT injection. There was also a significant decrease in amplitude and area values of orbicularis oris muscle synkinetic responses. All these findings were the most prominent at the 1st month after BoNT injection and still continued at the 4th month. In our study, a significant correlation was found between HFS severity and 118 HFS-7 quality of life scale and orbicularis oris synkinetic response amplitude and area changes. In conclusion, our study shows that BoNT has an effect on the brainstem circuits by suppressing the excitability of the facial nerve motor nucleus via the trigeminal afferent system as well as the neuromuscular junction effects. In addition, the orbitalis oris synkinetic response amplitude and area value correlated with HFS severity suggest that blink reflex can be used electrophysiologically to evaluate disease severity

Ischemic preconditioning and nicotinamide in spinal cord protection in an experimental model of transient aortic occlusion

Objectives: Spinal cord injury is a devastating complication after aortic surgery. The aim of the present study is to examine the effects of ischemic preconditioning (IPC) and nicotinamide containing perfusate in transient aortic occlusion in the rat. Methods: Thirty-two male Spraque-Dawley rats under general anesthesia were randomly assigned to four groups (n = 8 in each group). The infrarenal aortas were clamped for 45 min. Groups were as follows: Group 1, undergoing occlusion but receiving no treatment. Group 2, had 5 min of IPC before occlusion. Group 3, received nicotinamide (0.2 ml/l) during the transient occlusion. Group 4, received combined IPC (5 min) and nicotinamide infusion during the transient occlusion. The rats were then allowed for recovery and were tested for their neurological status. All animals were sacrificed at the end of the 48 It and spinal cords also examined histologically. Anti-poly (ADP-ribose) polymerase p85 fragment pAb was used as an immunohistochemical marker for detection of apoptosis. Results: In 24 h paraplegia represented as grade 0 and 1 occurred in six animals in Group 1 and two animals in Groups 2 and 3 and one in Group 4. In 48 h six animals in Group 1 and only one animal in Groups 2 and 3 showed a paraplegia. The incidence of neurologic deficit was significantly reduced in animals who had IPC and nicotinamide infusion (P < 0.05). At 48 h, combined IPC and nicotinamide showed a significant benefit compared to nicotinamide but not to the IPC alone. Histologic examination of the spinal cords revealed that a neuronal necrosis contributes to acute spinal cord degeneration after a period of aortic occlusion and both nicotinamide and IPC have protective effects against neuronal necrosis. No difference was found among the groups. Conclusions: Both IPC and nicotinamide are beneficial in protection against neurological damage in transient aortic occlusion. IPC alone as expected is significantly beneficial both at 24 and 48 h compared to controls. At 24 h combined nicotinamide and IPC show significant benefit compared to only nicotinamide, but this difference is not maintained at 48 h. (C) 2003 Elsevier Science B.V. All rights reserved