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Journal of Neurology

, Volume 254, Issue 1, pp 14–19 | Cite as

Cutaneous silent periods in the evaluation of cord compression in cervical spondylosis

  • Y.L. LoEmail author
  • Y.E. Tan
  • Y.F. Dan
  • T.H. Leoh
  • S.B. Tan
  • C.T. Tan
  • L.L. Chan
ORIGINAL COMMUNICATION

Abstract

Objective

The clinical diagnosis of cervical spondylotic myelopathy (CSM) may be challenging in patients with cervical spondylosis (CS). Routine nerve conduction studies (NCS) may not evaluate cord compression adequately.

Methods

We obtained cutaneous silent periods (CSP) in 26 consecutive patients presenting with clinical features of CS, in comparison with 30 normal controls. The results were also compared with transcranial magnetic stimulation (TMS) findings, and magnetic resonance imaging of the cervical cord as the gold standard.

Results

CSP findings showed similarly high sensitivity of up to 96% with TMS in evaluating cervical cord dysfunction.

Conclusion

In specific clinical settings, CSP is of value for the diagnosis of CSM in CS. CSP measurement is advocated as a simple and rapid diagnostic adjunct to NCS in evaluating CS patients with possible cord compromise.

Keywords

nerve conduction studies cord compression cervical spondylosis 

Notes

Acknowledgement

The authors thank S Fook-Chong for her advice.

References

  1. 1.
    Wilkinson M, (1960) The morbid anatomy of cervical spondylosis and myelopathyBrain 83: 589–617PubMedCrossRefGoogle Scholar
  2. 2.
    Yomenobu K, (2000) Cervical radiculopathy and myelopathy: when and what can surgery contribute to treatment Eur Spine J 9: 1–7CrossRefGoogle Scholar
  3. 3.
    Kanchiku T, Taguchi T, Kaneko K, et al. (2001) A correlation between magnetic resonance imaging and electrophysiological findings in cervical spondylotic myelopathy Spine 26:294–9CrossRefGoogle Scholar
  4. 4.
    Floeter MK, (2003) Cutaneous silent periods. Muscle Nerve 28:391–401PubMedCrossRefGoogle Scholar
  5. 5.
    Inghilleri M, Cruccu G, Argenta M, Polidori L, Manfredi M, (1997) Silent period in upper limb muscles after noxious cutaneous stimulation in man Electroencephalogr Clin Neurophysiol 105:109–115PubMedCrossRefGoogle Scholar
  6. 6.
    Hess CW, Mills KR, Murray NMF, (1987b) Responses in small hand muscles from magnetic stimulation of the human brain J Physiol 388:397–419Google Scholar
  7. 7.
    Rossini PM, Pauri F, (1999) Central motor conduction time studies. In: Paulus W Hallet M Rossini PM Rothwell JC. Transcranial magnetic stimulation. Amsterdam: Elsevier 199–211Google Scholar
  8. 8.
    Lo YL, Ratnagopal P, (2001) Transcranial magnetic stimulation studies in the Miller Fisher syndrome: evidence of corticospinal tract abnormality J Neurol Neurosurg Psychiatry 71:210–214PubMedCrossRefGoogle Scholar
  9. 9.
    Krantz H, Adorjani C, Baumgartner G, (1973) The effect of nociceptive cutaneous stimuli in human motor nrurons Brain 96:571–590CrossRefGoogle Scholar
  10. 10.
    Leis AA, Ross MA, Emori T, Matsue Y, Saito T, (1991) The silent period produced by electrical stimulation of mixed peripheral nerves. Muscle Nerve 14:1202–1208PubMedCrossRefGoogle Scholar
  11. 11.
    Uncini A, Kujirai T, Gluck B, Pullman S, (1999) Silent period induced by cutaneous stimulation. Electroencephalogr Clin Neurophysiol 110:1475–1480Google Scholar
  12. 12.
    Kaneko K, Kawai S, Fuchigami Y, Morita H, Ofuji A, (1997) Cutaneous silent period in syringomyelia. Muscle Nerve 20:884–886PubMedCrossRefGoogle Scholar
  13. 13.
    Kaneko K, Kawai S, Taguchi T, Fuchigami Y, Yonemura H, Fujimoto H, (1998) Cortical motor neuron excitability during cutaneous silent period. Electroencephalogr Clin Neurophysiol 109:364–368PubMedCrossRefGoogle Scholar
  14. 14.
    Logigian EL, Plotkin GM, Shefner JM, (1999). The cutaneous silent period is mediated by spinal inhibitory reflex. Muscle Nerve 22:467–472PubMedCrossRefGoogle Scholar
  15. 15.
    Brunzholzl C, Claus D, (1994) Central motor conduction time to upper and lower limbs in cervical cord lesions. Arch Neurol 51:245–249Google Scholar
  16. 16.
    Tavy DLJ, Franssen H, Keunen RWM, et al. (1999) Motor and sensory evoked potentials in asymptomatic spondylotic cord compression Muscle Nerve 22:628–634PubMedCrossRefGoogle Scholar
  17. 17.
    Lo YL, Chan LL, Lim W, Tan SB, Tan CT, Chen JLT, Fook-Chong S, Ratnagopal P, (2004) Systematic correlation of transcranial magnetic stimulation and cord compression on MRI in cervical spondylotic myelopathy Spine 29:1137–1145PubMedCrossRefGoogle Scholar
  18. 18.
    Leis AA, (1994) Conduction abnormalities detected by silent period testing Electroencephalogr Clin Neurophysiol 93:444–449PubMedGoogle Scholar

Copyright information

© Steinkopff Verlag Darmstadt 2007

Authors and Affiliations

  • Y.L. Lo
    • 1
    Email author
  • Y.E. Tan
    • 2
  • Y.F. Dan
    • 2
  • T.H. Leoh
    • 2
  • S.B. Tan
    • 3
  • C.T. Tan
    • 3
  • L.L. Chan
    • 4
  1. 1.Dept. of NeurologyNational Neuroscience Institute, Singapore General HospitalSingaporeSingapore
  2. 2.Dept. of NeurologySingapore General HospitalSingaporeSingapore
  3. 3.Dept. of Orthopedic SurgerySingapore General HospitalSingaporeSingapore
  4. 4.Dept. of Diagnostic RadiologySingapore General HospitalSingaporeSingapore

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