Assessment of Brainstem Reflexes with Transcranial Magnetic Stimulation in Bruxism: The Role of Central Mechanisms in Pathophysiology

Abstract

Objectives: We aim to prove the central etiology hypothesis for bruxism, we plan to examine the structural components that contribute to the occurance of RMMA/Bruxism such as cortical, subcortical structures and as a key roleplaying component, the brainstem structures by investigating the MEP, CSP, MIR (SP1 and SP2) and the blink reflex (R1 and R2) and central conduction time. Materials and Methods: In this study, a total of 77 subjects investigated to find any difference between the two groups. The MIR and blink reflexes studied by transcranial magnetic stimulation (TMS) and electric stimulation. The cortical silent period (CSP) evoked in contralateral masseter muscle by TMS. Central motor conducting times were evaluated. Results: The absence of SP2 (component of MIR), R2 (component of blink reflex) latency and left APB (abductor pollicis brevis) muscle F wave latency are found to be significantly different between two groups. Conclusions: As a result of our study, the loss of the SP2 component and the prolongation of the latency of the R2 component, and the localization of reflex circuits in the brainstem, although their pathways are separate, bruxer suggested that the pathophysiology may have a central origin in most of the bruxers.

Keywords

• Bruxism
• Transcranial Magnetic Stimulation
• Masseter Inhibitory Reflex

Bruksizmde Transkraniyal Manyetik Stimülasyon ile Beyin Sapı Reflekslerinin Değerlendirilmesi: Merkezi Mekanizmaların Patofizyolojideki Rolü

Abstract

Amaç: Bu çalışmada bruksizmin merkezi mekanizmalarla ilgili olabileceği hipotezini kanıtlamak için MEP, CSP, MIR (SP1 and SP2), göz kırpma refleksi (R1 and R2) ve merkezi iletim zamanını inceleyerek RMMA/Bruksizm oluşumuna katkıda bulunan kortikal, subkortikal yapılar ve anahtar rol oynayan beyin sapı yapıları gibi yapısal bileşenlerin incelenmesi amaçlanmaktadır. Gereç ve Yöntemler: Bu çalışmada, iki grup arasında herhangi bir fark olup olmadığını bulmak için toplam 77 kişi ile çalışılmıştır. MIR ve göz kırpma refleksleri, transkraniyal manyetik stimülasyon (TMS) ve elektrik stimülasyonu ile incelenmiştir. Kortikal sessiz periyot (CSP) kontralateral masseter kasta TMS ile uyarılmıştır. Merkezi motor iletim süreleri değerlendirilmiştir. Bulgular: SP2 (MIR komponenti)’nin olmayışı, R2 (blink refleks komponenti)’nin latansı ve sol APB (Abdüktör pollisis brevis) kastan ölçülen F dalgası latansı incelendiğinde iki grup arasında istatistiksel olarak anlamlı şekilde fark bulunmuştur. Sonuç: Çalışmamız sonucunda SP2 bileşeninin kaybolması ve R2 bileşeninin gecikme süresinin uzaması ve beyin sapındaki refleks devrelerinin lokalizasyonu, yolları ayrı olmasına rağmen, patofizyoloji bruksistlerin çoğunda merkezi bir kökene sahip olabileceğini desteklemektedir.

Keywords

• Bruksizm
• Transkraniyal Manyetik Stimülasyon
• Masseter Inhibitor Reflex

References

1. Aramideh M, Ongerboer de Visser BW. Brainstem reflexes: Electrodiagnostic techniques, physiology, normative data, and clinical applications. Muscle Nerve. 2002; 26(1):14–30.
2. Boudreau, S.A., Lontis, E.R., Caltenco, H. et al. Features of cortical neuroplasticity associated with multidirectional novel motor skill training: a TMS mapping study. Exp. Brain. Res. 2013; 225(4):513–526.
3. Brocard F, Verdier D, Arsenault I, J. P. Lund, Kolta A. Emergence of ıntrinsic bursting in trigeminal sensory neurons parallels the acquisition of mastication in weanling rats. J. Neurophysiol. 2006; 96(5): 2410–2424.
4. Cantello R, Gianelli M, Civardi C, Mutani R. Magnetic brain stimulation: The silent period after the motor evoked potential. Neurology. 1992;42(10):1951-9.
5. Cohen L. G, Bandinelli S, Topka H. R, Fuhr P, Roth B. J, Hallett M, Topographic maps of human motor cortex in normal and pathological conditions: mirror movements, amputations and spinal cord injuries. Electroencephalogr. Clin. Neurophysiol. Suppl., 1991;43:36-50.
6. Cruccu G, Agostino R, Fornarelli M, Inghilleri M, Manfredi M. Recovery cycle of the masseter inhibitory reflex in man. Neurosci. Lett. 1984;49(1-2):63–68.
7. Cruccu G, Pauletti G, Agostino R, Berardelli A, Manfredi M. Masseter inhibitory reflex in movement disorders. Huntington’s chorea, Parkinson’s disease, dystonia, and unilateral masticatory spasm”, Electroencephalogr. Clin. Neurophysiol. Evoked Potentials. 1991;81(1):24-30.
8. Deng H, Gao S, Lu S, Kumar A, Zhang Z, Svensson P. Alteration of occlusal vertical dimension induces signs of neuroplastic changes in corticomotor control of masseter muscles: Preliminary findings. J. Oral Rehabil. 2018;45(9):710-719.

9. Galloway G. M, Dias B. R, Brown J. L, Henry C. M, Brooks D. A, Uggie E. W. Transcranial magnetic stimulation-may be useful as a preoperative screen of motor tract function. J. Clin. Neurophysiol. 2013;30(4):386-389.
10. Gastaldo E, Quatralo R, Graziani A, Eleopra R, Tugnoli V, Tola M.R. Granieri E. The excitability of the trigeminal motor system in sleep bruxism: A transcranial magnetic stimulation and brainstem reflex study. J. Orofac. Pain 2006;20(2):1-11.
11. Guaita M, Högl B. Current treatments of bruxism. Curr. Treat. Options. Neurol. 2016;18(10):2-15. Hallett M. Transcranial Magnetic Stimulation: A Primer. Neuron 2007; 55(2):187-196.
12. Herrero Babiloni A, De Beaumont L, Lavigne GJ. Transcranial magnetic stimulation: Potential use in obstructive sleep apnea and sleep bruxism. Sleep Med. Clin. 2018;13(4):571-582.
13. Huang H, Song Y. H, Wang J. J, Guo Q, Liu W. C. Excitability of the central masticatory pathways in patients with sleep bruxism. Neurosci. Lett. 2014; 558:82-86.
14. İnan R, Şenel GB, Yavlal F, Karadeniz D, Gündüz A, Kızıltan ME. Sleep bruxism is related to decreased inhibitory control of trigeminal motoneurons, but not with reticulobulbar system. Neurol. Sci. 2017;38(1):75-81.
15. Inghilleri M, Berardelli A, Marchetti P, Manfredi M. Effects of diazepam, baclofen and thiopental on the silent period evoked by transcranial magnetic stimulation in humans. Exp Brain Res. 1996;109(3):467-72.
16. Kolta A, Morquette P, Lavoie R, Arsenault I, Verdier D. Modulation of rhythmogenic properties of trigeminal neurons contributing to the masticatory CPG, Progress in Brain Research. 2010; 187(1):137-148.
17. Koyano K, Tsukiyama Y, Ichiki R, Kuwata T. Assessment of bruxism in the clinic. J Oral Rehabil. 2008;35(7):495-508.
18. Lal SJ, Weber, DDS KK. Bruxism Management. 2022 Oct 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.
19. Lavigne G, Kato T, Kolta A, Sessle B. J. Neurobiological mechanisms involved in sleep bruxism. Critical Reviews in Oral Biology and Medicine. 2003;14(1):30-46.
20. Lavigne G. J, Kato T, Kolta A, Sessle BJ. Neurobiological mechanisms involved in sleep bruxism. Crit. Rev. Oral Biol. Med. 2003;14(1):30-46.
21. Lavigne G. J, Rompré P. H, Montplaisir J. Sleep bruxism: Validity of clinical research diagnostic criteria in a controlled polysomnographic study. J. Dent. Res. 1996;75(1):546-552.
22. Lida T, Komiyama O, Obara R, Baad-Hansen L, Kawara M, Svensson P. Repeated clenching causes plasticity in corticomotor control of jaw muscles. Eur. J. Oral. Sci. 2014;122(1): 42-8.
23. Lobbezoo F, Ahlberg J, Glaros AG, Kato T, Koyano K, Lavigne GJ, et al. Bruxism defined and graded: an international consensus. J. Oral Rehabil. 2013;40(1):2-4.
24. Lobbezoo F, Ahlberg J, Raphael KG, Wetselaar P, Glaros AG, Kato T, et al. International consensus on the assessment of bruxism: Report of a work in progress. J. Oral Rehabil. 2018;45(11):837-844.
25. Lund, J. P.; Kolta, A., Adaption of the central masticatory pattern to the biomechanical properties of food, International Congress Series, 2005;1284: 11-20.
26. Lund, J.P., Kolta, A. Generation of the central masticatory pattern and its modification by sensory feedback. Dysphagia. 2006; 21:167-174.
27. Malick A, Strassman R. M, Burstein R. Trigeminohypothalamic and reticulohypothalamic tract neurons in the upper cervical spinal cord and caudal medulla of the rat, J. Neurophysiol. 2000;84(4):2078-112.
28. Manfredini D, Serra-Negra J, Carboncini F, Lobbezoo F. Current concepts of bruxism. Int. J. Prosthodont. 2017;30(5):437–438.
29. Melis M, Abou-Atme Y. S. Prevalence of bruxism awareness in a sardinian population. Cranio 2003;21(2):1-8. Nélio V, Ângelo T, Ribeiro O A, Baptista A. Bruxism – Literature review. International Journal of Dentistry and Oral Health. 2015;1(5):1-5.
30. Ongerboer De Visser B. W., Cruccu G, Manfredi M., Koelman M.Th.J.H. Effects of brainstem lesions on the masseter inhibitory reflex: Functional mechanisms of reflex pathways. Brain. 1990;113(3):781-792.
31. Ongerboer De Visser B. W., Kuypers H. G. J. M. Late blink reflex changes in lateral medullary lesions: An electrophysiological and neuro-anatomical study of wallenberg’s syndrome. Brain. 1978;101(2):285-294.
32. Pauletti G, Berardelli A, Cruccu G, Agostino R, Manfredi M. Blink reflex and the masseter inhibitory reflex in patients with dystonia. Movement Disorders 1993;8(4):495-500.
33. Priori A, Berardelli A, Inghilleri M, Accornero N, Manfredi M. Motor cortical inhibition and the dopaminergic system: Pharmacological changes in the silent period after transcranial brain stimulation in normal subjects, patients with parkinson’s disease and drug-induced parkinsonism. Brain. 1994;117(2):317-23.
34. Raphael KG, Santiago V, Lobbezoo F. Is bruxism a disorder or a behaviour? Rethinking the International consensus on defining and grading of bruxism. J. Oral Rehabil. 2016;43(10):791-8.
35. Rossi S, Hallet M, Rossini P.M. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clinical Neurophysiology 2009;120(12):2008-2039.
36. Rossini P. M, Rossi S. Transcranial magnetic stimulation: Diagnostic, therapeutic, and research potential. Neurology, 2007;68(7):484-8.
37. Scott G, Westberg K. G, Vrentzos N, Kolta A, Lund J. P. Effect of lidocaine and NMDA injections into the medial pontobulbar reticular formation on mastication evoked by cortical stimulation in anaesthetized rabbits. Eur. J. Neurosci. 2003;17(10):2156-2162.
38. Takatori M, Nozaki S, Nakamura Y. Control of trigeminal motoneurons exerted from bulbar reticular formation in the cat. Experimental Neurology. 1981; 72(1): 122-140.
39. Tanaka S, Kogo M, Chandler S. H, Matsuya T. Localization of oral-motor rhythmogenic circuits in the isolated rat brainstem preparation, Brain Res. 1999; 6;821(1):190-199.
40. Tsuboi A, Kolta A, Chen C. C., Lund J. P. Neurons of the trigeminal main sensory nucleus participate in the generation of rhythmic motor patterns. Eur. J. Neurosci. 2003;17(2):229-239.
41. Tzvetanov P, Rousseff RT, Radionova Z. Abnormalities of masseter inhibitory reflex in patients with episodic tension-type headache. J Zhejiang Univ Sci B. 2009;10(1):52-6.
42. Udupa K, Chen R. Central motor conduction time. Handb Clin Neurol. 2013; 116: 375-86. Winocur E, Hermesh H, Littner D, Shiloh R, Peleg L, Eli I. Signs of bruxism and temporomandibular disorders among psychiatric patients. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2007; 103(1):60-63.