Evaluation of Blink Reflex in Patients with Steatosis

Year 2015, Volume: 40 Issue: 4, 714 - 722, 02.10.2015

Erkan Cüre , Serkan Kırbaş Medine Cüre Ahmet Tüfekçi Aynur Kırbaş Süleyman Yüce Sabri Oğullar

https://doi.org/10.17826/cutf.49314

Abstract

Purpose: The blink reflex (BR) is a useful electrodiagnostic method for evaluating neuropathies. The aim of our study was to investigate the role of the BR in the early diagnosis of neuropathy in simple steatosis. Material and Methods: A total of 86 subjects were enrolled in this study: 56 patients (29 female, 27 male) with simple steatosis and 30 healthy controls (17 female, 13 male). After the electrical stimulation of the supraorbital nerve, two responses in the orbicularis oculi muscle occur, the early ipsilateral response and the late bilateral response latencies, which were recorded. Results: The triglyceride levels and lipid accumulation products were higher in the patients with steatosis than in the controls. When compared to the control group, the patient group had early right ipsilateral latency, late right ipsilateral latency, late right contralateral latency, early left ipsilateral latency, late left ipsilateral latency, and late left contralateral latency. Conclusion: There is a slowdown of the BR in the steatosis stage; therefore, by performing the BR, neuropathy can be detected at an early stage in patients with steatosis.

Keywords

Blink reflex, neuropathy, steatosis, non-alcoholic fatty liver disease, hypertriglyceridemia

Steatozlu Hastalarda Blink Refleksin Değerlendirilmesi

Abstract

Amaç: Blink refleks (BR) nöropatileri değerlendirmek için kullanılan yararlı bir elektrodiagnostik yöntemdir. Biz bu çalışmada basit steatozda nöropatinin erken tanısında BR’in rolünü incelemeyi amaçladık. Materyal ve Metod: Çalışmaya basit steatozlu 56 hasta (29 kadın, 27 erkek) ve 30 sağlıklı kontrol (17 kadın, 13 erkek) olmak üzere toplam 86 kişi dahil edildi. Supraorbital sinirin elektriksel uyarımından sonra orbikularis okuli kasında ortaya çıkan iki cevap, erken ipsilateral cevap ve geç bilateral cevap gecikme zamanları kaydedildi. Bulgular: Trigliserid düzeyi ve lipid akümülasyon skoru steatozlu hastalarda kontrol grubundan daha yüksekti. Kontrol grubuyla karşılaştırıldığında hasta grubunda erken sağ ipsilateral gecikme, geç sağ ipsilateral gecikme, geç sağ kontralateral gecikme, erken sol ipsilateral gecikme, geç sol ipsilateral gecikme ve geç sol kontralateral gecikme zamanı uzundu. Sonuç: Steatoz aşamasında BR’de yavaşlama vardır. Steatozlu hastalarda BR ölçülerek nöropati gelişimi erken aşamada tespit edilebilir

Keywords

Blink refleks, nöropati, steatoz, non-alkolik yağlı karaciğer, hipertrigliseridemi

References

• Smith AG. Impaired glucose tolerance and metabolic syndrome in idiopathic neuropathy. J Peripher Nerv Syst. 2012;17:15-21.
• Lupachyk S, Watcho P, Hasanova N, Julius U, Obrosova IG. Triglyceride, nonesterified fatty acids, and prediabetic neuropathy: role for oxidative- nitrosative stress. Free Radic Biol Med. 2012;52:1255-63.
• Pirgon Ö, Bilgin H, Çekmez F, Kurku H, Dündar BN. Association Between Insulin Resistance and Oxidative Stress Parameters in Obese Adolescents with Non-Alcoholic Fatty Liver Disease. J Clin Res Pediatr Endocrinol. 2013;5:33-9.
• Day CP. Clinical spectrum and therapy of non- alcoholic steatohepatitis. Dig Dis. 2012;30:69-73.
• Alexander J, Torbenson M, Wu TT, Yeh MM. Non- alcoholic fatty liver disease contributes to hepatocarcinogenesis in non-cirrhotic liver: A clinical and pathological study. J Gastroenterol Hepatol. 2013;28:848-54.
• Tran A, Gual P. Non-alcoholic steatohepatitis in morbidly obese patients. Clin Res Hepatol Gastroenterol. 2013;37:17-29.
• Kasturiratne A, Weerasinghe S, Dassanayake AS, Rajindrajith S, de Silva AP, Kato N, et al. Influence of non-alcoholic fatty liver disease on the development of diabetes mellitus. J Gastroenterol Hepatol. 2013;28:142-7.
• Zdunska A, Cegielska J, Kochanowski J. Variability of the blink reflex in patients with migraine. Neurol Neurochir Pol. 2013;47:352-6.
• Kimura J. The blink reflex. In: Kimura J, editor. Electrodiagnosis in Diseases of Muscle and Nerve. New York, Oxford, 2001;3:409-38..
• Valls-Sole J. Assessment of excitability in brainstem circuits mediating the blink reflex and the startle reaction. Clin Neurophysiol. 2012;123:13-20.
• Preston DC, Shapiro BE. Blink Reflex. In: Preston DC, Shapiro BE, editors. Electromyography & Disorders Clinical-Electrophysiologic Correlations. United States, Elsevier, 2005;2:59-64..
• Leon L, Casanova-Molla J, Lauria G, Valls-Sole J. The somatosensory blink reflex in upper and lower brainstem lesions. Muscle Nerve. 2011;43:196-202.
• Gokcel A, Ozsahin AK, Sezgin N, Karakose H, Ertorer ME, Akbaba M, et al. High prevalence of diabetes in Adana, a southern province of Turkey. Diabetes Care. 2003;26:3031-4.
• Bedogni G, Kahn HS, Bellentani S, Tiribelli C. A simple index of lipid overaccumulation is a good marker of liver steatosis. BMC Gastroenterol. 2010;10:98.
• Schwenzer NF, Springer F, Schraml C, Stefan N, Machann J, Schick F. Non-invasive assessment and quantification of liver steatosis by ultrasound, computed tomography and magnetic resonance. J Hepatol. 2009;51:433–45.
• Hamaguchi M, Kojima T, Itoh Y, Harano Y, Fujii K, Nakajima T, et al. The severity of ultrasonographic findings in nonalcoholic fatty liver disease reflects the metabolic syndrome and visceral fat accumulation. Am J Gastroenterol. 2007;102:2708-15.
• Zorba OÜ, Kirbas S, Uzun H, Önem K, Çetinkaya M, Rifaioğlu MM. Is There a Relation between Reticular Formation and Storage Symptoms in Men. LUTS: Lower Urinary Tract Symptoms. 2013;91:417-22.
• Kawano Y, Cohen DE. Mechanisms of hepatic triglyceride accumulation in non-alcoholic fatty liver disease. J Gastroenterol. 2013;48:434-41.
• Kamath S, Chavez AO, Gastaldelli A, Casiraghi F, Halff GA, Abrahamian GA, et al. Coordinated defects in hepatic long chain fatty acid metabolism and triglyceride accumulation contribute to insulin resistance in non-human primates. PLoS One. 2011;6:27617.
• Higuchi N, Kato M, Tanaka M, Miyazaki M, Takao S, Kohjima M, et al. Effects of insulin resistance and hepatic lipid accumulation on hepatic mRNA expression levels of apoB, MTP and L-FABP in non- alcoholic fatty liver disease. Exp Ther Med. 2011;2:1077-81.
• Abenavoli L, Milic N. Dietary intervention in non- alcoholic fatty liver disease. J Acad Nutr Diet. 2013;113:211.
• Leiter LA. The prevention of diabetic microvascular complications of diabetes: is there a role for lipid lowering? Diabetes Res Clin Pract. 2005;68:3-14.
• Vincent AM, Russell JW, Low P, Feldman EL. Oxidative stress in the pathogenesis of diabetic neuropathy. Endocr Rev. 2004;25:612–28.
• Vincent AM, Callaghan BC, Smith AL, Feldman EL. Diabetic neuropathy: cellular mechanisms as therapeutic targets. Nat Rev Neurol. 2011;7:573–83.
• Vincent AM, Perrone L, Sullivan KA, Backus C, Sastry AM, Lastoskie C, et al. Receptor for advanced glycation end products activation injures primary sensory neurons via oxidative stress. Endocrinology. 2007;148:548–58.
• Wiggin TD, Sullivan KA, Pop-Busui R, Amato A, Sima AA, Feldman EL. Elevated triglycerides correlate with progression of diabetic neuropathy. Diabetes. 2009;58:1634-40.
• Vincent AM, Hayes JM, McLean LL, Vivekanandan- Giri A, Pennathur S, Feldman EL. Dyslipidemia- induced neuropathy in mice: the role of oxLDL/LOX- 1. Diabetes. 2009;58:2376–85.
• McCall KD, Holliday D, Dickerson E, Wallace B, Schwartz AL, Schwartz C, et al. Phenylmethimazole blocks palmitate-mediated induction of inflammatory cytokine pathways in 3T3L1 adipocytes and RAW 264.7 macrophages. J Endocrinol. 2010;207:343-53.
• Herman RM, Brower JB, Stoddard DG, Casano AR, Targovnik JH, Herman JH, et al. Prevalence of somatic small fiber neuropathy in obesity. Int J Obes (Lond). 2007;31:226-35.
• Miscio G, Guastamacchia G, Brunani A, Priano L, Baudo S, Mauro A. Obesity and peripheral neuropathy risk: a dangerous liaison. J Peripher Nerv Syst. 2005;10:354-8.
• Smith AG, Rose K, Singleton JR. Idiopathic neuropathy patients are at high risk for metabolic syndrome. J Neurol Sci. 2008;273:25-8.
• Nazliel B, Yetkin I, Irkeç C, Koçer B. Blink reflex abnormalities in diabetes mellitus. Diabetes Metab Res Rev. 2001;17:396–400.
• Al-Azzawi LM, Mirza K, Kummoona R. The usefulness of the blink reflex in the early diagnosis of cranial nerve neuropathy associated with diabetes mellitus. 2004;44:323–7.
• Trujillo-Hernandez B, Huerta M, Perez-Vargas D, Trujillo X, Vasquez C. Blink reflex alterations in recently diagnosed diabetic patients. J Clin Neurosci. 2003;10:306-9.
• Ongerboer de Visser BW, Kuypers HCGM. Late blink refleks changes in lateral medullary lesions: an electrophysiological and neuro-anatomical study of Wallenberg's syndrome. Brain. 1978;101:285-94.
• Oh JS. Reflex Tests. Nerve Conduction Studies. In: Oh JS, editor. Clinical Electromyography. United States, Williams-Wilkins. 1993;2:364-7.