Altered bulbocavernosus reflex in patients with multiple system atrophy.
OBJECTIVE
Multiple system atrophy (MSA) is characterized by a combination of symptoms including autonomic dysfunction, parkinsonism, cerebellar ataxia, and cortico-spinal disorders. The disease can have either predominant parkinsonism or cerebellar features (MSA-P and MSA-C, respectively). The measurement of the bulbocavernosus reflex (BCR) and pudendal nerve somatosensory-evoked potentials (PSEPs) was originally developed to diagnose diabetic cystopathy and other neuropathologic diseases that share similar symptoms with MSA. We investigated the relationship between abnormalities of neurophysiological parameters and MSA, and estimated the potential value of BCR.


METHODS
Fifty-one MSA patients (28 and 23 MSA-P and 23 MSA-C patients, respectively) and 30 healthy controls who were seen at the Department of Neurology were included in the study. A Keypoint EMG/EP system was used to test BCR and PSEPs, and the latencies and amplitudes were recorded for statistical analyses.


RESULTS
The BCR was elicited in 78.4% patients with MSA (22/28 MSA-P, 18/23 MSA-C). Prolonged BCR latencies were found in patients with MSA compared with healthy controls (p < 0.001). BCR amplitudes were significantly lower in the MSA group than the control group (p < 0.001). PSEP P41 amplitudes were not significantly different between the MSA and control groups in males (p = 0.608) or females (p = 0.897). There were no significant differences in PSEP latencies among the MSA-P, MSA-C, and control groups (p = 1.0, p = 0.263, and p = 0.060, respectively).


CONCLUSIONS
MSA patients exhibit prolonged BCR latencies and lower amplitudes, which provides a rough anatomical localization of nervous system lesions in MSA patients.
a Zhejiang Provincial Top Key Discipline in Surgery, Wenzhou Key Laboratory of Surgery, Department of Surgery , The First Affiliated Hospital, Wenzhou Medical University , Wenzhou , China.|b School of the First Clinical Medical Sciences , Wenzhou Medical University , Wenzhou , China.
Zhang-Yang
ZY
Wang
a Zhejiang Provincial Top Key Discipline in Surgery, Wenzhou Key Laboratory of Surgery, Department of Surgery , The First Affiliated Hospital, Wenzhou Medical University , Wenzhou , China.|b School of the First Clinical Medical Sciences , Wenzhou Medical University , Wenzhou , China.
Yun-Hao
YH
Chen
a Zhejiang Provincial Top Key Discipline in Surgery, Wenzhou Key Laboratory of Surgery, Department of Surgery , The First Affiliated Hospital, Wenzhou Medical University , Wenzhou , China.
Ya-Ya
YY
Xu
c Department of Neurology , The First Affiliated Hospital, Wenzhou Medical University , Wenzhou , China.
Xun
X
Wang
c Department of Neurology , The First Affiliated Hospital, Wenzhou Medical University , Wenzhou , China.
Bei
B
Shao
c Department of Neurology , The First Affiliated Hospital, Wenzhou Medical University , Wenzhou , China.
Xiao-Ting
XT
Niu
a Zhejiang Provincial Top Key Discipline in Surgery, Wenzhou Key Laboratory of Surgery, Department of Surgery , The First Affiliated Hospital, Wenzhou Medical University , Wenzhou , China.|c Department of Neurology , The First Affiliated Hospital, Wenzhou Medical University , Wenzhou , China.
Bi-Cheng
BC
Chen
c Department of Neurology , The First Affiliated Hospital, Wenzhou Medical University , Wenzhou , China.
Huan-Jie
HJ
Huang
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D004576:Electromyography; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000503:physiopathology*; D011930:Reaction Time / Q000502:physiology; D012021:Reflex, Abnormal / Q000502:physiology*; D012189:Retrospective Studies
Bulbocavernosus reflex; Electrophysiological test; Multiple system atrophy; Pudendal nerve somatosensory-evoked potentials; Sacral reflex arc