Difference between revisions of "Store:EMen03"

Revision as of 10:10, 1 May 2023

Multiple sclerosis and trigeminal reflexes

We must make an additional premise about axonal demyelination in multiple sclerosis. From a study by Joanna Kamińska andt al.^[1] It appears that multiple sclerosis (MS) is a chronic inflammatory and demyelinating disease of autoimmune origin. The main agents responsible for the development of MS include exogenous, environmental and genetic factors. MS is characterized by multifocal and temporally dispersed damage to the central nervous system (CNS) leading to axonal damage. Among the clinical courses of MS we can distinguish relapsing-remitting multiple sclerosis (RRMS), secondary progressive multiple sclerosis (MSPS), primary progressive multiple sclerosis (PPMS) and relapsing progressive multiple sclerosis (PRMS). Depending on the severity of the signs and symptoms, MS can be described as either benign MS or malignant MS. The diagnosis of MS is based on the McDonald's diagnostic criteria, which link the clinical manifestation with the characteristic lesions demonstrated by magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis, and visual evoked potentials.

It should be noted that despite the enormous progress in MS and the availability of different diagnostic methods, this disease still represents a diagnostic challenge. It may be due to the fact that MS has a different clinical course and a single test is missing, which would have the appropriate diagnostic sensitivity and specificity for rapid and accurate diagnosis.

Precisely in reference to this last observation we must point out another significant piece of information arising from a study by S K Yates and W F Brown^[2] in which we read that the jaw masseter reflex is present in all control subjects, but is generally absent in sclerosis patients. defined multiple (SM). In some MS patients, latency was prolonged. However, abnormalities in the jaw reflex are less common than blink reflex responses to supraorbital nerve stimulation. However, there have been patients in whom the reflex blinks were normal but the jaw jerk responses were abnormal. The latter observation suggests that the jaw reflex may sometimes be useful in detecting brainstem lesions in MS.

But at this point the doubt becomes true in the sense: what should we think of the anomalies of the trigeminal reflexes highlighted in our Mary Poppins? Could we be facing a form of 'Multiple Sclerosis'? How do we distinguish the location of any unwinding, Central or Peripheral in the trigeminal nervous system?

Figure 6: Electrophysiologically detected jaw jerk in the right (upper traces) and left (lower traces) masseters
Figure 7: Electrophysiologically detected mechanical silent period in the right (upper overlapping traces) and left (lower overlapping traces) masseters

↑ Joanna Kamińska, Olga M Koper, Kinga Piechal, Halina Kemona . Multiple sclerosis - etiology and diagnostic potential.Postepy Hig Med Dosw. 2017 Jun 30;71(0):551-563.doi: 10.5604/01.3001.0010.3836.
↑ S K Yates, W F Brown. The human jaw jerk: electrophysiologic methods to measure the latency, normal values, and changes in multiple sclerosis.Neurology. 1981 May;31(5):632-4.doi: 10.1212/wnl.31.5.632.

[1] Joanna Kamińska, Olga M Koper, Kinga Piechal, Halina Kemona . Multiple sclerosis - etiology and diagnostic potential.Postepy Hig Med Dosw. 2017 Jun 30;71(0):551-563.doi: 10.5604/01.3001.0010.3836.

[2] S K Yates, W F Brown. The human jaw jerk: electrophysiologic methods to measure the latency, normal values, and changes in multiple sclerosis.Neurology. 1981 May;31(5):632-4.doi: 10.1212/wnl.31.5.632.

[1]

[2]

@@ Line 1: / Line 1: @@
-=== Esclerosis múltiple y reflejos del trigémino ===
+=== Multiple sclerosis and trigeminal reflexes ===
-Debemos hacer una premisa adicional sobre la desmilienización axonal en la esclerosis múltiple. De un estudio de Joanna Kamińska et al.<ref>Joanna Kamińska, Olga M Koper, Kinga Piechal, Halina Kemona . [https://pubmed.ncbi.nlm.nih.gov/28665284/ Multiple sclerosis - etiology and diagnostic potential].Postepy Hig Med Dosw. 2017 Jun 30;71(0):551-563.doi: 10.5604/01.3001.0010.3836.
+We must make an additional premise about axonal demyelination in multiple sclerosis. From a study by Joanna Kamińska andt al.<ref>Joanna Kamińska, Olga M Koper, Kinga Piechal, Halina Kemona . [https://pubmed.ncbi.nlm.nih.gov/28665284/ Multiple sclerosis - etiology and diagnostic potential].Postepy Hig Med Dosw. 2017 Jun 30;71(0):551-563.doi: 10.5604/01.3001.0010.3836.
-</ref> parece que la esclerosis múltiple (EM) es una enfermedad inflamatoria y desmielinizante crónica de origen autoinmune. Los principales agentes responsables del desarrollo de la EM incluyen factores exógenos, ambientales y genéticos. La EM se caracteriza por daño multifocal y temporalmente disperso del sistema nervioso central (SNC) que conduce al daño axonal. Entre los cursos clínicos de la EM podemos distinguir la esclerosis múltiple remitente-recurrente (EMRR), la esclerosis múltiple progresiva secundaria (SPSM), la esclerosis múltiple progresiva primaria (EMPP) y la esclerosis múltiple progresiva recurrente (EMPR). Según la gravedad de los signos y síntomas, la EM se puede describir como EM benigna o EM maligna. El diagnóstico de la EM se basa en los criterios de diagnóstico de McDonald's, que vinculan la manifestación clínica con las lesiones características demostradas por resonancia magnética nuclear (RMN), análisis del líquido cefalorraquídeo (LCR) y potenciales evocados visuales.
+</ref> It appears that multiple sclerosis (MS) is a chronic inflammatory and demyelinating disease of autoimmune origin. The main agents responsible for the development of MS include exogenous, environmental and genetic factors. MS is characterized by multifocal and temporally dispersed damage to the central nervous system (CNS) leading to axonal damage. Among the clinical courses of MS we can distinguish relapsing-remitting multiple sclerosis (RRMS), secondary progressive multiple sclerosis (MSPS), primary progressive multiple sclerosis (PPMS) and relapsing progressive multiple sclerosis (PRMS). Depending on the severity of the signs and symptoms, MS can be described as either benign MS or malignant MS. The diagnosis of MS is based on the McDonald's diagnostic criteria, which link the clinical manifestation with the characteristic lesions demonstrated by magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis, and visual evoked potentials.
-Cabe destacar que a pesar del enorme avance en la EM y la disponibilidad de diferentes métodos diagnósticos, esta enfermedad aún representa un desafío diagnóstico. Puede deberse al hecho de que la EM tiene un curso clínico diferente y falta una sola prueba, que tendría la sensibilidad y especificidad diagnósticas apropiadas para un diagnóstico rápido y preciso.
+It should be noted that despite the enormous progress in MS and the availability of different diagnostic methods, this disease still represents a diagnostic challenge. It may be due to the fact that MS has a different clinical course and a single test is missing, which would have the appropriate diagnostic sensitivity and specificity for rapid and accurate diagnosis.
-  <blockquote>Precisamente en referencia a esta última observación debemos señalar otro dato significativo surgido de un estudio de S K Yates y W F Brown<ref>S K Yates, W F Brown. The human jaw jerk: electrophysiologic methods to measure the latency, normal values, and changes in multiple sclerosis.Neurology. 1981 May;31(5):632-4.doi: 10.1212/wnl.31.5.632.
+  <blockquote>Precisely in reference to this last observation we must point out another significant piece of information arising from a study by S K Yates and W F Brown<ref>S K Yates, W F Brown. The human jaw jerk: electrophysiologic methods to measure the latency, normal values, and changes in multiple sclerosis.Neurology. 1981 May;31(5):632-4.doi: 10.1212/wnl.31.5.632.
-</ref> en el que leemos que el reflejo mandibular del masetero está presente en todos los sujetos de control, pero por lo general está ausente en los pacientes con esclerosis. múltiple definido (SM). En algunos pacientes con EM, la latencia se prolongó. Sin embargo, las anomalías en el reflejo mandibular son menos comunes que las respuestas del reflejo de parpadeo a la estimulación del nervio supraorbitario. Sin embargo, ha habido pacientes en los que los parpadeos reflejos eran normales pero las respuestas de sacudidas mandibulares eran anormales. La última observación sugiere que el reflejo mandibular puede ser útil en ocasiones para detectar lesiones del tronco encefálico en la EM.</blockquote>Pero en este punto la duda se hace realidad en el sentido: ¿qué debemos pensar de las anomalías de los reflejos del trigémino destacadas en nuestra Mary Poppins? ¿Podríamos estar ante una forma de 'Esclerosis Múltiple'? ¿Cómo distinguimos la ubicación de cualquier desmienzación, Central o Periférica en el sistema nervioso trigémino?
+</ref> in which we read that the jaw masseter reflex is present in all control subjects, but is generally absent in sclerosis patients. defined multiple (SM). In some MS patients, latency was prolonged. However, abnormalities in the jaw reflex are less common than blink reflex responses to supraorbital nerve stimulation. However, there have been patients in whom the reflex blinks were normal but the jaw jerk responses were abnormal. The latter observation suggests that the jaw reflex may sometimes be useful in detecting brainstem lesions in MS.</blockquote>But at this point the doubt becomes true in the sense: what should we think of the anomalies of the trigeminal reflexes highlighted in our Mary Poppins? Could we be facing a form of 'Multiple Sclerosis'? How do we distinguish the location of any unwinding, Central or Peripheral in the trigeminal nervous system?
 <center>
 <gallery widths="350" heights="200" perrow="4" slideshow""="">
-File:Spasmo emimasticatorio JJ.jpg|Figura 6: Tirón mandibular detectado electrofisiológicamente en los maseteros derecho (trazos superiores) e izquierdo (trazos inferiores)
+File:Spasmo emimasticatorio JJ.jpg|Figure 6: Electrophysiologically detected jaw jerk in the right (upper traces) and left (lower traces) masseters
-File:Spasmo emimasticatorio SP.jpg|Figura 7: Período de silencio mecánico detectado electrofisiológicamente en los maseteros derecho (trazas superpuestas superiores) e izquierdo (trazas superpuestas inferiores)
+File:Spasmo emimasticatorio SP.jpg|Figure 7: Electrophysiologically detected mechanical silent period in the right (upper overlapping traces) and left (lower overlapping traces) masseters
 </gallery>
 </center>