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I17 Sensory Processing In Huntington's Disease

2014, Journal of Neurology, Neurosurgery & Psychiatry

Abstract

. Demonstrative recordings showing the decrease in CHEPs amplitude of HD patients (right side graphs) with respect to healthy subjects (left side graphs) in the condition Rest (Upper) and React (Lower) traces.

SENSORY PROCESSING IN HUNTINGTON’S DISEASE A Mirallave, C Cabib, M Morales, E Muñoz, X Gasull, J Valls-Solé EMG Unit. Neurology Department. Hospital Clinic of Barcelona (Spain). IDIBAPS (InsBtut D´invesBgació AugusF Pi i Sunyer). Facultat de Medicina, Universitat de Barcelona. INTRODUCTION: A consistent feature of patients with HD is the decrease in amplitude of somatosensory evoked potentials (SEPs). Previous studies on the subject have not been able to rule out the influence of cognitive impairment completely. Indirect evidence of the influence of the striatum, which is degenerated in HD, on these findings is however available and comes from the quinolinic rat model of HD which showed diminished SEPs and functional studies in humans with PET showing a correlation between striatal atrophy and altered processing at the sensory cortex. We studied Long Latency evoked potentials and the conscious awareness of the time of perception of a sensory stimulus (AW). We hypothesized that, if abnormalities in sensory processing involve disorders of cognition, HD patients would show disturbed AW, while if they involve preconscious processing, they may show in abnormalities of several forms of early sensorimotor processing, such as reaction time. PATIENTS AND METHODS We studied 11 genetically confirmed stage I-II HD patients, without significant cognitive impairment, Figure 1 with a mean age of 46.8 years, and in 12 healthy control subjects, matched for age and gender. We studied quantitative sensory testing (QST) to determine sensory and pain thresholds. The main procedure consisted in two test conditions (Rest and React). We recorded the long latency evoked potentials to above pain threshold contact heat (CHEPs, N2P2), along with the SSR in the condition Rest and simple reaction time task in the condition React, and measured AW with the Libet´s clock method (Figure 1): A computer screen was placed at a distance of about 1 m from the subject at eye level, showing a two-dimensional clock face. The examiner initiated the trial by pressing a computer key to start the Libet’s clock and, with a random delay, the stimulus was delivered at the same time as the recording system for the EPs, the SSR and the reaction time. We requested subjects to accurately estimate the position of the clock handle at the time they felt the stimulus. The difference between the subject’s estimate and the actual position of the clock handle at the time of stimulus delivery was considered the time of AW. The time difference between peak latency of the evoked potential and AW was calculated as the Central Perception Time (CPT). Ten artifact-free trials were collected for each stimulation condition RESULTS We found no significant differences in QST between patients and healthy subjects. As expected, evoked potentials amplitude was lower and evoked potentials peak latency was longer in patients than in healthy subjects (F[1,22]=11.1; p=0.003 for amplitude and F[1,22]=1.72; p=0.03 for latency). Significant differences were also observed in AW, which was delayed in HD patients with respect to healthy subjects (F[1,22]=3.62; p=0.007) but no differences were observed for group nor for condition in CPT. No significant differences were found on SSR latency, peak amplitude or habituation index. Mean reaction times were significantly prolonged in patients with respect to healthy subjects (F[1,20]=5.2 p=0.03). We found no statistically significant differences between rest and react for any stimulus type (p>0.05). Table 1. Clinical characterisBcs of the paBents motor Table 2 Characteristics of the evoked potentials, Awareness and CPT. Fig.2. Demonstrative recordings showing the decrease in CHEPs amplitude of HD patients (right side graphs) with respect to healthy subjects (left side graphs) in the condition Rest (Upper) and React (Lower) traces. COMMENTS AND CONCLUSION We confirmed the reduction of the EPs amplitude and prolongation of EPs latency in patients with respect to control subjects. However, our patients did not show significant cognitive impairment. Moreover, they had normal QST values for perception and pain. Even if AW values were slightly prolonged, CPT values were in normal range compared to control subjects. This suggests that cognitive processing of sensory information at higher levels such as attention and cognition of a stimulus is not impaired in our HD subjects. Take home message 1. The alteration of the evoked potentials at early stages of the disease is not likely related to disorders of cognition. Simple Reaction Times, which don’t need full consciousness of a stimulus to take place, and which also depend on the salience and novelty of a stimulus as do Long Latency Evoked Potentials of the “pain matrix”, were also prolonged. Sensory feedback to motor acts is regulatd by the striatum, and the ability to react to a highly salient stimulus by stopping ongoing motor acts is promoted by Thalamostriatal projections to the dorsomedial striatum which regulates the activity of the dorsolateral striatum in order to stop the ongoing motor acts and react. Therefore, striatal degeneration may take part in the loss of salience of a sensory stimulus and would impair the ability to react. This at the same time could alter the characteristics of the EPs. Our study showed results that favor this idea. Take home message 2. Recognition of stimulus salience may be impaired in HD. We can therefore conclude by saying that conscious perception of a stimulus is not altered at least at early stages of the disease, when cognitive decline is not present on clinical grounds. The alterations of the evoked potentials described in these patients cannot therefore be attributed to unattention or cognitive decline. An alternative hypothesis may be the loss of stimulus salience, possibly related to striatal degeneration, which also impairs the ability to react towards a highly salient stimulus and stop ongoing motor acts. 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