Cocito Dario, Peci Erdita, Garbossa Diego, Ciaramitaro Palma
Department of Neuroscience "Rita Levi Montalcini", University of Torino, 10126 Torino, Italy.
ICS Maugeri, 10124 Torino, Italy.
J Clin Med. 2022 Aug 29;11(17):5080. doi: 10.3390/jcm11175080.
Brainstem syndromes have frequently been reported in Chiari syndrome and in syringobulbia; previous studies have shown that determining the central motor conduction time (CMCT) along the circuit of the phrenic nerve makes the assessment of the voluntary control of the respiratory pathway possible. In our study, we evaluated the transcranial magnetic stimulation (TMS) of the phrenic nerve in patients affected by Chiari syndrome and/or syringomyelia (Syr) with the aim of identifying subclinical neurophysiological alterations. One hundred patients (75 females; average age: 51 ± 13.08 SD; range: 18-76) affected by Chiari syndrome and/or Syr without dyspnea were selected. The magnetic stimulation of the second motor neuron correlating with the phrenic nerve was performed using cervical magnetic stimulation (C5-MEP); the cortical MEP after magnetic stimulation (Cz-MEP) was recorded by magnetic stimulation of the motor cortex (areas corresponding to the diaphragm). The CMCT was calculated. The differences between the patients and controls were calculated (Student's test). In 13% of the patients, the Cz-MEP were absent bilaterally, and the CMCT was not evaluable. In all these cases, bulbar/cervical Syr was present at MRI; in 10 of them, this was associated with CM1. A bilateral response was obtained in all the other patients (87%), and the CMCTs were normal. All the patients with alterations/absence of Cz-MEP presented bulbar/cervical Syr at MRI. The C5-MEP latency was prolonged or absent in 48%; of these, 84% presented bulbar/cervical Syr associated with CM1 at MRI. The C5-MEP latency values were significantly higher in the group of patients. Neurophysiological alterations of the diaphragmatic pathway were recorded in a group of Chiari syndrome and, particularly, in bulbar/cervical Syr. Future studies with larger cohorts of patients are needed to further assess the specific role of the TMS of the phrenic nerve in CM/Syr patients.
脑干综合征在Chiari综合征和延髓空洞症中屡有报道；既往研究表明，测定沿膈神经回路的中枢运动传导时间（CMCT）可使评估呼吸通路的自主控制成为可能。在我们的研究中，我们评估了Chiari综合征和/或脊髓空洞症（Syr）患者的膈神经经颅磁刺激（TMS），目的是识别亚临床神经生理学改变。选择了100例无呼吸困难的Chiari综合征和/或Syr患者（75例女性；平均年龄：51±13.08标准差；范围：18 - 76岁）。使用颈部磁刺激（C5-MEP）对与膈神经相关的第二运动神经元进行磁刺激；通过对运动皮层（对应于膈肌的区域）进行磁刺激记录磁刺激后的皮层运动诱发电位（Cz-MEP）。计算CMCT。计算患者与对照组之间的差异（Student检验）。13%的患者双侧Cz-MEP缺失，CMCT无法评估。在所有这些病例中，MRI显示存在延髓/颈部Syr；其中10例与CM1相关。所有其他患者（87%）获得双侧反应，CMCT正常。所有Cz-MEP改变/缺失的患者MRI显示存在延髓/颈部Syr。48%的患者C5-MEP潜伏期延长或缺失；其中84%的患者MRI显示延髓/颈部Syr与CM1相关。患者组的C5-MEP潜伏期值显著更高。在一组Chiari综合征患者中，尤其是在延髓/颈部Syr患者中，记录到了膈神经通路的神经生理学改变。需要对更多患者进行进一步研究，以进一步评估膈神经TMS在CM/Syr患者中的具体作用。
