Huzursuz bacak sendromunda periferik, beyinsapı ve kortikal eksitabilitelerdeki diürnal değişikliklerin incelenmesi
Investigation of peripheral, brain stem and cortical excitabilities in restless legs syndrome
Yazar: AYŞEGÜL GÜNDÜZ
Danışman: DOÇ. DR. NURTEN UZUN ADATEPE
İstanbul Üniversitesi / Cerrahpaşa Tıp Fakültesi / Nöroloji Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2008
Konu: Nöroloji = Neurology

Özet:
Bilimsel zemin ve giriş: RLS, bacak ve/veya kollarda anormal bir duyumun veya karşı konulamayan hareket ettirme ihtiyacının olduğu ve hareketlerle azaldığı bir hastalıktır. Şikayetler, özellikle akşam saatlerinde rahatsız edicidir. RLS patogenezinde supraspinal seviyelerdeki disinhibisyonun rolü gösterilmiş fakat sirkadiyen ritm ile olan ilişkisi elektrofizyolojik olarak netleştirilememiştir. Çalışmamızda, RLS'li hastalarda korteks, beyin sapı ve periferik seviyelerde diürnal ritm ile ilişkili olası eksitabilite değişiklikleri elektrofizyolojik olarak incelenmiştir.Bireyler ve yöntem: Primer RLS tanısı alan 11 hasta ile yaş ve cinsiyet uyumlu 8 sağlıklı birey çalışmaya dahil edildi. Değerlendirmeye katılan tüm bireylere, ulnar sinirin motor ileti çalışmaları ve F-yanıtları, beyin sapı incelemelerine yönelik GKR ve GKR-TE, santral değerlendirmeler için ise tekli uyaran ile TMU çalışmaları yapıldı. İncelemeler gündüz yakınmasız erken öğle saatlerinde ve yakınmaların olduğu gece geç saatlerde uygulandı. İstatistiksel analizde veriler hasta-kontrol ve gece-gündüz grupları arasında karşılaştırıldı. Ayrıca, beyin sapı eksitabilitesinin değerlendirilmesi için GKR-R2 yanıtının amplitüd ve alan toparlanma eğrileri oluşturuldu.Sonuçlar: RLS-kontrol grupları arasında gece istirahat ve aktif motor eşiklerin RLS grubunda daha düşüktü. Aktif motor eşik istatistiksel olarak anlamlıydı (28,5±6,2; 40,4±8,4, p=0,006, z=-2,761). RLS grubunda gece elde edilen R2 latansı ise daha kısaydı (36,1±4,2, 34,2±5,9, p=0,033, z=2,134).Yorum: Normal bireylerle RLS'liler arasında gündüz de bir miktar eksitabilite farkı olduğu görülmekte, fakat gece normal bireylerde eksitabilite azalması oluşuyorken, RLS'de bu durum tersine dönmektedir. Sonuç olarak, RLS'li bireylerde gece normallerde gözlenen beyin sapı ve kortikal eksitabilitedeki azalmanın ortaya çıkmaması patogenezden sorumlu olabilir.

Abstract:
Background and introduction: RLS is characterised by abnormal sensation or irresistable urge to move which decreases by movement and predominant during night. Studies showed supraspinal disinhibition, however, relation to circadian rhthym has not yet been cleared. Therefore, in our study we investigated diurnal changes of cortical, brain stem and peripheral excitability by means of electrophysiology.Subjects and method: Eleven patients diagnosed as primary RLS and age and sex matched 8 healthy controls are included. All patients and subjects underwent ulnar nerve motor conduction and F studies, blink reflex investigations by single and double stimulation and trasncranial magnetic stimulation test by single stimulation during day and night. Daytime investigations were performed during early afternoon when there are no symptoms and nocturnal investigation were done late night when symptoms appeared. Data obtained from patients and control were compared and daytime and nocturnal parameters were also compared with each other. Furthermore, to assess brain stem excitability BR recovery curves are formed.Results: Comparing nocturnal data of the RLS-control groups, it was shown that resting and active motor thresholds were lower in RLS group and active motor threshold reached statistical significance (28.5±6.2 vs 40.4±8.4, p=0.006, z=-2.761). In RLS group, nocturnal R2 latency was shorter (36.1±4.2 vs 34.2±5.9; p=0.033, z=2.134).Conclusion: Our study showed that while excitability decreases during night in healthy subjects, in RLS, this mechanism reverses. Finally, dissapperance of decrease in brain stem and cortical excitability may be responsible in the pathogenesis of RLS.Background and introduction: RLS is characterised by abnormal sensation or irresistable urge to move which decreases by movement and predominant during night. Studies showed supraspinal disinhibition, however, relation to circadian rhthym has not yet been cleared. Therefore, in our study we investigated diurnal changes of cortical, brain stem and peripheral excitability by means of electrophysiology.Subjects and method: Eleven patients diagnosed as primary RLS and age and sex matched 8 healthy controls are included. All patients and subjects underwent ulnar nerve motor conduction and F studies, blink reflex investigations by single and double stimulation and trasncranial magnetic stimulation test by single stimulation during day and night. Daytime investigations were performed during early afternoon when there are no symptoms and nocturnal investigation were done late night when symptoms appeared. Data obtained from patients and control were compared and daytime and nocturnal parameters were also compared with each other. Furthermore, to assess brain stem excitability BR recovery curves are formed.Results: Comparing nocturnal data of the RLS-control groups, it was shown that resting and active motor thresholds were lower in RLS group and active motor threshold reached statistical significance (28.5±6.2 vs 40.4±8.4, p=0.006, z=-2.761). In RLS group, nocturnal R2 latency was shorter (36.1±4.2 vs 34.2±5.9; p=0.033, z=2.134).Conclusion: Our study showed that while excitability decreases during night in healthy subjects, in RLS, this mechanism reverses. Finally, dissapperance of decrease in brain stem and cortical excitability may be responsible in the pathogenesis of RLS.Background and introduction: RLS is characterised by abnormal sensation or irresistable urge to move which decreases by movement and predominant during night. Studies showed supraspinal disinhibition, however, relation to circadian rhthym has not yet been cleared. Therefore, in our study we investigated diurnal changes of cortical, brain stem and peripheral excitability by means of electrophysiology.Subjects and method: Eleven patients diagnosed as primary RLS and age and sex matched 8 healthy controls are included. All patients and subjects underwent ulnar nerve motor conduction and F studies, blink reflex investigations by single and double stimulation and trasncranial magnetic stimulation test by single stimulation during day and night. Daytime investigations were performed during early afternoon when there are no symptoms and nocturnal investigation were done late night when symptoms appeared. Data obtained from patients and control were compared and daytime and nocturnal parameters were also compared with each other. Furthermore, to assess brain stem excitability BR recovery curves are formed.Results: Comparing nocturnal data of the RLS-control groups, it was shown that resting and active motor thresholds were lower in RLS group and active motor threshold reached statistical significance (28.5±6.2 vs 40.4±8.4, p=0.006, z=-2.761). In RLS group, nocturnal R2 latency was shorter (36.1±4.2 vs 34.2±5.9; p=0.033, z=2.134).Conclusion: Our study showed that while excitability decreases during night in healthy subjects, in RLS, this mechanism reverses. Finally, dissapperance of decrease in brain stem and cortical excitability may be responsible in the pathogenesis of RLS.