Ekstansör Plantar Yanıt (Babinski Bulgusu) Patofizyolojisinin Elektrofizyolojik Yöntemlerle İncelenmesi

Abstract

İn this study, to understand the pathophysiology of the extansor plantar reflex(Babinski sign), we examined electrophsyology of the extansor hallucis longus(EHL) muscle on patients with babinski sign and control groups. With this purpose, we stuided the cortical silent period(KoSS) with the transcranial magnetic situmilation(TMS) of the cortex, and the cutaneous silent period(KuSS) with the situmilation of the peripheral nerves. We thought that the electrophsylogic differences between patient and control groups may point the underlying pathophysilogy of the extansor plantar reflex(EPY), and the difference between KuSS and KoSS parameters may show the spinal and supraspinal location of the EPY.

With the recording of the EHL and gastrocnemius muscles at 13 healthy controls and 9 patients who have EPY due to spinal or cranial lesion, we examined KuSS on the situmilation of the sural nerve, and KoSS with the situmilation of those muscles' field of representation in the cortex using the TMS. We measured the onset, termination and duration of the KuSS and KoSS.

The main finding of this study is that, the KuSS duration of EHL muscle of the patients who have EPY, either shorter or unmeasurable than the healthy controls. The shortening observed in the patient group was significant ( patients group 30,14±6,49 ms, healthy controls group 45,3±5,43 ms, p0,0001). All of the patients whom we gathered KuSS on the EHL muscle, the KuSS durations were even shorter than the lower limit of the control group's KuSS duration. In cases with unilateral Babinski finding that could be compared with EHL muscle on the other side, EHL KuSS was found to be normal on the intact side.

All these findings suggest a decrease in the efficiency of the spinal inhibitory circuits (disinhibition), especially in the presence of a spinal lesion, in relation to the pathophysiology of EPY. To demonstrate this change, cutaneous silent period study which is a non-invasive method, may provide a new opportunity for objective detection of extensor plantar response.