Abnormal head nociceptive withdrawal reaction to facial nociceptive stimuli in Parkinson's disease.
BACKGROUND
Trigemino-cervical-spinal reflexes (TCSRs) are complex brainstem stereotyped nociceptive responses involved in a defensive withdrawal reaction of the head from facial nociceptive stimuli.


OBJECTIVE
The present study was undertaken to collect data on possible TCSR abnormalities in idiopathic Parkinson's disease (PD) and investigate any correlation with motor signs and L-DOPA administration.


METHODS
TCSRs were registered from the semispinalis capitis and biceps brachii muscles after electrical stimulation of the supraorbital nerve in 18 patients with PD and 24 controls. The latency (L) and area (A), as well as the sensory (ST), painful (PT) and reflex (RT) thresholds were measured during the 'off' and 'on' state, and possible correlations with the UPDRS III total score, selected subscores (tremor, neck rigidity, upper limb rigidity, akinesia, rising from a chair, posture and posture instability) and duration of illness were investigated.


RESULTS
Significant changes between controls and PD patients were found in the L, A, PT and RT of TCSRs. These results were not significantly influenced by L-DOPA treatment. A significant correlation was found between neck rigidity, postural instability scores and duration of illness and the TCSR L and A values in PD patients in the 'off' state.


CONCLUSIONS
TCSRs abnormalities, combined with dopamine resistance, are consistent with a primary loss of brainstem neurons mediating a complex sensory-motor integration including neck muscle tone and postural control as well as the head withdrawal reaction to the nociceptive stimuli.


CONCLUSIONS
TCSRs may represent a useful tool for the assessment of brainstem sensory-motor function in PD as well as other movement and degenerative disorders.
Perrotta
A
A
Dipartimento di Neurologia e Otorinolaringoiatria, Università di Roma La Sapienza, Viale dell'Università 30, 00185 Rome, Italy. armandperrotta@inwind.it
Serrao
M
M
Bartolo
M
M
Valletta
L
L
Locuratolo
N
N
Pujia
F
F
Fattapposta
F
F
Bramanti
P
P
Amabile
G A
GA
Pierelli
F
F
Parisi
L
L
D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage / Q000627:therapeutic use; D015259:Dopamine Agents / Q000008:administration & dosage / Q000627:therapeutic use; D004558:Electric Stimulation; D004576:Electromyography; D004594:Electrophysiology; D005145:Face; D005260:Female; D019416:Head Movements / Q000502:physiology*; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage / Q000627:therapeutic use; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000502:physiology; D010146:Pain / Q000503:physiopathology*; D010300:Parkinson Disease / Q000503:physiopathology*; D011930:Reaction Time / Q000502:physiology; D012018:Reflex / Q000502:physiology
D000978:Antiparkinson Agents; D015259:Dopamine Agents; D007980:Levodopa