Cilde uygulanan ağrılı elektrik uyarısıyla üst ekstremite kaslarında oluşan eşzamanlı refleks yanıtların elektromiyografi ile incelenmesi

Nasim Eftekhari; Mehmet Cemal Kahya; Sibel Kocaaslan Atlı

doi:10.19161/etd.1481645

EN TR

Examination of simultaneous reflex responses in the upper extremity muscles by recording electromyography with painful electrical stimulation on the skin

Abstract

Materials and Methods: Records of the single motor unit and surface electromyography were obtained by administering painful electrical stimulation to the dorsal surface of the dominant hand of nine healthy participants. The electrical stimulus, delivered in the form of a 0,2 ms square pulse, was randomly applied at intervals of 1-2 seconds. Averages are computed throughout 400 ms before and 500 ms after the stimulus. Analyses were conducted by selecting 16 suitable motor units from among the recordings. Reflex latency and duration were obtained from the cumulative sum graphs of surface electromyography, peristimulus time histogram, and peristimulus frequencygram analyses. Results: A cutaneous silent period was observed in all motor units of the dominant arm. According to the peristimulus frequencygram approach, the inhibition time observed in motor units was found to be 94.8 ms longer than that found by the peristimulus time histogram approach (p<0,05). Excitation was observed in both the histogram and surface electromyography, but not in the frequencygram. Inhibition was observed in the muscle on the dominant side, but not on the other side. Conclusion: The peristimulus frequencygram method has been shown in the literature to sample the postsynaptic potential developed on a motor nöron. In our study, the finding of long inhibition with the frequencygram method has supported that inhibitory circuits in the medulla spinalis create long-term inhibition. The excitation observed in the peristimulus time histogram was not seen in the peristimulus frequencygram analysis. We recommend the use of the frequencygram method in addition to classical methods in reflex examinations.

Keywords

Cilde uygulanan ağrılı elektrik uyarısıyla üst ekstremite kaslarında oluşan eşzamanlı refleks yanıtların elektromiyografi ile incelenmesi

Öz

Amaç: Bu araştırmada, sağlıklı bireylerde ağrılı elektriksel uyarımın bilateral m. brachioradialis kasındaki refleks yanıtını klasik analiz ve frekans analiz yöntemlerini birlikte kullanarak incelemek amaçlanmıştır. Gereç ve Yöntem: Dokuz sağlıklı katılımcının dominant el sırtına ağrılı elektrik uyaranı verilerek tek motor ünite ve yüzeyel elektromiyografi kayıtları alındı. Elektrik uyarısı 0,2 ms süreli kare puls şeklinde, 1-2 saniye aralıklarla rastgele uygulandı. Uyarıdan 400 ms öncesi ve 500 ms sonrasındaki kısmın ortalaması alındı. Kayıtlarda 16 motor ünite seçilerek analizi yapıldı. Yüzeyel elektromiyografi, peristimulus time histogram ve peristimulus frekansgram analizlerinin kümülatif toplam grafiklerinden refleks latans ve süre bilgileri elde edildi. Bulgular: Dominant kolda motor ünitelerin hepsinde kütanöz sessiz periyot gözlemlendi. Peristimulus frekansgram’da motor ünitelerde gözlenen inhibisyon süresi peristimulus time histograma göre 94,8 ms daha uzun olduğu görüldü (p<0,05). Histogram ve yüzeyel elektromiyografide eksitasyon görülürken, frekansgramda gözlenmedi. Dominant taraftaki kasta inhibisyon gözlemlenirken diğerinde görülmedi. Sonuçlar: Peristimulus frekansgram yöntemi motor nöronda oluşan postsinaptik potansiyeli doğru bir şekilde gösterir. Araştırmamızda frekansgram yöntemiyle inhibisyonun uzun bulunması medulla spinaliste inhibitör devrelerin uzun süreli inhibisyon oluşturduğunu desteklemiştir. Peristimulus time histogramda görülen eksitasyon peristimulus frekansgram analizinde görülmedi. Refleks incelemelerinde klasik yöntemlere ek olarak frekansgram yönteminin de kullanılması uygun olacaktır. NOT: Bu çalışmanın ön raporu, 6-9 Eylül 2023 tarihleri arasında Türkiye Biyofizik Derneği tarafından İzmir Teknoloji Enstitüsü'nde düzenlenen 5. Uluslararası/34. Ulusal Biyofizik Kongresi’nde poster bildiri olarak sunulmuştur.

Anahtar Kelimeler

Destekleyen Kurum

Türkiye Bilimsel ve Teknolojik Araştırma Kurumu, İzmir Kâtip Çelebi Üniversitesi Bilimsel Araştırma Projeleri Koordinatörlüğü

Proje Numarası

1002-A Hızlı Destek 123S213, 2023-TYL-SABE-0019

Teşekkür

Yazarlar makalenin kritik değerlendirmesi ve katkıları için Prof. Dr. Kemal Sıtkı Türker’e teşekkür eder. Bu çalışma, Türkiye Bilimsel ve Teknolojik Araştırma Kurumu tarafından 1002-A Hızlı Destek kapsamında 123S213 Numaralı proje ve İzmir Kâtip Çelebi Üniversitesi Bilimsel Araştırma Projeleri Koordinatörlüğü tarafından 2023-TYL-SABE-0019 proje numarası ile desteklenmiştir. Projeye verdikleri destekten ötürü teşekkürlerimizi sunarız.

Kaynakça

Kofler M, Leis AA, Valls-Solé J. Cutaneous silent periods–Part 2: Update on pathophysiology and clinical utility. Clinical Neurophysiology. 2019;130(4):604-15.
Floeter MK. Cutaneous silent periods. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine. 2003;28(4):391-401.
Floeter MK, Gerloff C, Kouri J, Hallett M. Cutaneous withdrawal reflexes of the upper extremity. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine. 1998;21(5):591-8.
Kofler M, Poustka K. Interside comparison of cutaneous silent periods in thenar muscles of healthy male and female subjects. Clinical neurophysiology. 2004;115(9):2123-7.
Arslan BT, Özyurt MG, İşak B, Cecen S, Türker KS. Single motor unit estimation of the cutaneous silent period in ALS. Clinical Neurophysiology. 2024;157:110-9.
Drnda S, Suljic E. Diabetes Mellitus Type Has Impact on Cutaneous Silent Period. Medical Archives. 2019;73(5):326.
Han J-K, Oh K, Kim B-J, Koh S-B, Kim J-Y, Park K-W, et al. Cutaneous silent period in patients with restless leg syndrome. Clinical neurophysiology. 2007;118(8):1705-10.
Kahya MC, Sebik O, Türker KS. Cutaneous silent period evoked in human first dorsal interosseous muscle motor units by laser stimulation. Journal of Electromyography and Kinesiology. 2016;31:104-10.

Kahya MC, Utku Yavuz Ş, Türker KS. Cutaneous silent period in human FDI motor units. Experimental brain research. 2010;205(4):455-63.
Kofler M. Functional organization of exteroceptive inhibition following nociceptive electrical fingertip stimulation in humans. Clinical neurophysiology. 2003;114(6):973-80.
Rogasch NC, Burne JA, Binboğa E, Türker KS. Synaptic potentials contributing to reflex inhibition in gastrocnemius following tendon electrical stimulation. Clinical neurophysiology. 2011;122(6):1190-6.
Romaniello A, Truini A, Galeotti F, De Lena C, Willer J, Cruccu G. Cutaneous silent period in hand muscle is evoked by laser stimulation of the palm, but not the hand dorsum. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine. 2004;29(6):870-2.
Uginčius P, Atiş E, Türker KS. Reflex responses of human masseter motor units to mechanical stimulation of the teeth. Journal of Neurophysiology. 2014;111(1):51-61.
Serrao M, Parisi L, Pierelli F, Rossi P. Cutaneous afferents mediating the cutaneous silent period in the upper limbs: evidences for a role of low-threshold sensory fibres. Clinical Neurophysiology. 2001;112(11):2007-14.
Tiric-Campara M, Denislic M, Djelilovic-Vranic J, Alajbegovic A, Tupkovic E, Gojak R, et al. Cutaneous silent period in the evaluation of small nerve fibres. Medical Archives. 2014;68(2):98.
Türker K, Powers R. Black box revisited: a technique for estimating postsynaptic potentials in neurons. Trends in neurosciences. 2005;28(7):379-86.
Türker K, Powers R. Estimation of postsynaptic potentials in rat hypoglossal motoneurones: insights for human work. The Journal of Physiology. 2003;551(2):419-31.
Turker KS, Powers R. Effects of large excitatory and inhibitory inputs on motoneuron discharge rate and probability. Journal of neurophysiology. 1999;82(2):829-40.
Powers RK, Robinson FR, Konodi MA, Binder MD. Effective synaptic current can be estimated from measurements of neuronal discharge. Journal of neurophysiology. 1992;68(3):964-8.
Powers RK, Türker K. Estimates of EPSP amplitude based on changes in motoneuron discharge rate and probability. Experimental brain research. 2010;206:427-40.
Kumru H, Opisso E, Valls‐Solé J, Kofler M. The effect of a prepulse stimulus on the EMG rebound following the cutaneous silent period. The Journal of physiology. 2009;587(3):587-95.
Türker K, Yang J, Brodin P. Conditions for excitatory or inhibitory masseteric reflexes elicited by tooth pressure in man. Archives of oral biology. 1997;42(2):121-8.
Koutris M, Türker KS, van der Weijden JJ, van Selms MK, Lobbezoo F. Two different analyzing methods for inhibitory reflexes: Do they yield comparable outcomes? Journal of Neuroscience Methods. 2016;274:49-52.
Preston DC, Shapiro BE. Electromyography and neuromuscular disorders e-book: clinical-electrophysiologic- ultrasound correlations: Elsevier Health Sciences; 2020.
Don R, Pierelli F, Ranavolo A, Serrao M, Mangone M, Paoloni M, et al. Modulation of spinal inhibitory reflex responses to cutaneous nociceptive stimuli during upper limb movement. European Journal of Neuroscience. 2008;28(3):559-68.
Kofler M, Kumru H, Stetkarova I, Schindler C, Fuhr P. Muscle force up to 50% of maximum does not affect cutaneous silent periods in thenar muscles. Clinical neurophysiology. 2007;118(9):2025-30.
Brinkworth RS, Türker KS. A method for quantifying reflex responses from intra-muscular and surface electromyogram. Journal of Neuroscience Methods. 2003;122(2):179-93.
Brodin P, Miles TS, Türker KS. Simple reaction-time responses to mechanical and electrical stimuli in human masseter muscle. Archives of oral biology. 1993;38(3):221-6.
Kim J, Han S, Yoon T. Minimal electrical stimulation intensity and duration to elicit maximal cutaneous silent period in hand. Neurophysiologie Clinique/Clinical Neurophysiology. 2009;39(6):291-4.
Kofler M, Leis A, Valls-Solé J. Cutaneous silent periods–Part 1: Update on physiological mechanisms. Clinical Neurophysiology. 2019;130(4):588-603.
Rogasch NC, Burne JA, Türker KS. Comparison of the inhibitory response to tendon and cutaneous afferent stimulation in the human lower limb. Journal of Neurophysiology. 2012;107(2):564-72.
Türker KS, Cheng HB. Motor-unit firing frequency can be used for the estimation of synaptic potentials in human motoneurones. Journal of neuroscience methods. 1994;53(2):225-34.
Prasartwuth O, Binboğa E, Türker KS. A study of synaptic connection between low threshold afferent fibres in common peroneal nerve and motoneurones in human tibialis anterior. Experimental brain research. 2008;191:465-72.
Kofler M, Poustka K. Ipsi-and contralateral exteroceptive EMG modulation in uni-and bilaterally activated thenar muscles. Clinical neurophysiology. 2005;116(2):300-7.
Todd G, Rogasch NC, Türker KS. Transcranial magnetic stimulation and peristimulus frequencygram. Clinical neurophysiology. 2012;123(5):1002-9.
Inghilleri M, Conte A, Frasca V, Berardelli A, Manfredi M, Cruccu G. Is the cutaneous silent period an opiate‐ sensitive nociceptive reflex? Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine. 2002;25(5):695-9.
Deuschl G, Eisen A. Long-latency reflexes following electrical nerve stimulation. The International Federation of Clinical Neurophysiology. 1999.
Kofler M, Valls-Solé J, Vasko P, Boček V, Štetkárová I. Influence of limb temperature on cutaneous silent periods. Clinical Neurophysiology. 2014;125(9):1826-33.
Gündüz A, Aydın Ş, Kızıltan ME. Cutaneous silent period: A literature review. Neurological Sciences and Neurophysiology. 2020;37(3):101-9.
KRANZ H, ADORJANI C, BAUMGARTNER G. The effect of nociceptive cutaneous stimuli on human motoneurons. Brain. 1973;96(3):571-90.
Rodi Z, Springer C. Influence of muscle contraction and intensity of stimulation on the cutaneous silent period. Muscle & nerve. 2011;43(3):324-8.

Ayrıntılar

Birincil Dil

Türkçe

Konular

İnsan Biyofiziği

Bölüm

Araştırma Makalesi

Yazarlar

Nasim Eftekhari
0000-0002-6553-6004
Türkiye

Mehmet Cemal Kahya ^*
0000-0002-3920-0574
Türkiye

Sibel Kocaaslan Atlı
0000-0002-7604-3870
Türkiye

Yayımlanma Tarihi

12 Mart 2025

Gönderilme Tarihi

13 Mayıs 2024

Kabul Tarihi

8 Ekim 2024

Yayımlandığı Sayı

Yıl 2025 Cilt: 64 Sayı: 1

DOI

https://doi.org/10.19161/etd.1481645

IZ

https://izlik.org/JA88KX46JS

Kaynak Göster

RIS / Bibtex

Vancouver

1.Nasim Eftekhari, Mehmet Cemal Kahya, Sibel Kocaaslan Atlı. Cilde uygulanan ağrılı elektrik uyarısıyla üst ekstremite kaslarında oluşan eşzamanlı refleks yanıtların elektromiyografi ile incelenmesi. ETD. 01 Mart 2025;64(1):21-3. doi:10.19161/etd.1481645