gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Intrinsic hyperexcitability of the distant spinal cord in patients with cervical cord lesions

Meeting Abstract

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  • Georgios Naros - Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Deutschland
  • Marina Liebsch - Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Deutschland
  • Marcos Tatagiba - Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Deutschland
  • Florian Ebner - Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 127

doi: 10.3205/17dgnc690, urn:nbn:de:0183-17dgnc6905

Published: June 9, 2017

© 2017 Naros et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Damage of the proximal spinal cord is associated with negative (e.g. paresis) and/or positive (e.g. hyperreflexia) motor symptoms of the upper and lower limbs. While negative symptoms are attributed to the disturbance of corticospinal output, positive symptoms are supposed to evolve from an increase of spinal excitability. This study evaluated the spinal output gain after transcortical and transspinal stimulation in patients with intra- (IM) and extramedullary (EM) lesions of the cervical spine.

Methods: Spinal output gain was evaluated by motor-evoked potentials (MEPs) after transcranial magnetic stimulation (TMS) and transspinal electrical stimulation (TES) in seventy paired-matched patients with IM and EM lesions of the upper cervical spinal cord. A multivariate analysis of covariance (MANCOVA) was applied on MEP amplitudes and latencies establishing the impact of lesion type, paresis and hyperreflexia while controlling for gender, age and body height.

Results: There was a significant higher rate of positive motor symptoms (i.e. hyperreflexia) in patients with IM lesions. The MANCOVA revealed a significant reduction of MEP conduction times to the lower limbs after TMS in patients with lower limb paresis. In contrast, there was a significant increase of MEP amplitudes after TES associated with lower limb hyperreflexia.

Conclusion: The present study suggests an intrinsic hyperexcitability of the lower spinal cord in response to efferent input in patients with lower limb hyperreflexia.