Dataset Information

A novel exaggerated "spino-bulbo-spinal like" reflex of lower brainstem origin.

ABSTRACT:

Background

Many different oligosynaptic reflexes are known to originate in the lower brainstem which share phenomenological and neurophysiological similarities.

Objective

To evaluate and discuss the differences and aberrancies among these reflexes, which are hard to discern clinically using neurophysiological investigations with the help of a case report.

Methods

We describe the clinical and neurophysiological assessment of a young man who had a childhood history of opsoclonus-myoclonus syndrome with residual mild ataxia and myoclonic jerks in the distal extremities presenting with subacute onset total body jerks sensitive to sound and touch (in a limited dermatomal distribution), refractory to medications.

Results

Based on clinical characteristics and insights gained from neurophysiological testing we could identify a novel reflex of caudal brainstem origin.

Conclusions

The reflex described is likely an exaggerated normal reflex, likely triggered by a dolichoectatic vertebral arterial compression and shares characteristics of different reflexes known to originate in caudal brainstem, which subserve distinctive roles in human postural control.

SUBMITTER: Merchant SH

PROVIDER: S-EPMC6451678 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Publications

A novel exaggerated "spino-bulbo-spinal like" reflex of lower brainstem origin.

Merchant Shabbir Hussain SH Vial Felipe F Leodori Giorgio G Fahn Stanley S Pullman Seth L SL Hallett Mark M

Parkinsonism & related disorders 20181006

<h4>Background</h4>Many different oligosynaptic reflexes are known to originate in the lower brainstem which share phenomenological and neurophysiological similarities.<h4>Objective</h4>To evaluate and discuss the differences and aberrancies among these reflexes, which are hard to discern clinically using neurophysiological investigations with the help of a case report.<h4>Methods</h4>We describe the clinical and neurophysiological assessment of a young man who had a childhood history of opsoclo ...[more]

PMID: 30316728

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Project description:Image-based subject-specific models and simulations are recently being introduced to complement current state-of-the-art mostly static insights of the adult spinal deformity (ASD) pathology and improve the often poor surgical outcomes. Although the accuracy of a recently developed subject-specific modeling and simulation framework has already been quantified, its reliability to perform marker-driven kinematic analyses has not yet been investigated. The aim of this work was to evaluate the reliability of this subject-specific framework to measure spine kinematics in ASD patients, in terms of 1) the overall test-retest repeatability; 2) the inter-operator agreement of spine kinematic estimates; and, 3) the uncertainty of those spine kinematics to operator-dependent parameters of the framework. To evaluate the overall repeatability 1], four ASD subjects and one control subject participated in a test-retest study with a 2-week interval. At both time instances, subject-specific spino-pelvic models were created by one operator to simulate a recorded forward trunk flexion motion. Next, to evaluate inter-operator agreement 2], three trained operators each created a model for three ASD subjects to simulate the same forward trunk flexion motion. Intraclass correlation coefficients (ICC's) of the range of motion (ROM) of conventional spino-pelvic parameters [lumbar lordosis (LL), sagittal vertical axis (SVA), thoracic kyphosis (TK), pelvic tilt (PT), T1-and T9-spino-pelvic inclination (T1/T9-SPI)] were used to evaluate kinematic reliability 1] and inter-operator agreement 2]. Lastly, a Monte-Carlo probabilistic simulation was used to evaluate the uncertainty of the intervertebral joint kinematics to operator variability in the framework, for three ASD subjects 3]. LL, SVA, and T1/T9-SPI had an excellent test-retest reliability for the ROM, while TK and PT did not. Inter-operator agreement was excellent, with ICC values higher than test-retest reliability. These results indicate that operator-induced uncertainty has a limited impact on kinematic simulations of spine flexion, while test-retest reliability has a much higher variability. The definition of the intervertebral joints in the framework was identified as the most sensitive operator-dependent parameter. Nevertheless, intervertebral joint estimations had small mean 90% confidence intervals (1.04°-1.75°). This work will contribute to understanding the limitations of kinematic simulations in ASD patients, thus leading to a better evaluation of future hypotheses.

Dataset Information

A novel exaggerated "spino-bulbo-spinal like" reflex of lower brainstem origin.

Background

Objective

Methods

Results

Conclusions

Publications

A novel exaggerated "spino-bulbo-spinal like" reflex of lower brainstem origin.

Similar Datasets

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