Perna Plégica Também Mexe?
DOI:
https://doi.org/10.46531/sinapse/CC/230045/2023Palavras-chave:
Geradores de Padrão Central, Lesões da Medula Espinal, LocomoçãoResumo
The spinal cord is responsible for several types of involuntary movements, from segmental spinal myoclonus to stepping automated movements generated by spinal central pattern generators (CPG). We present the case of a 47-year-old inpatient woman admitted for suspected spondylodiscitis. Immediate neurologic evaluation was requested in day 2 due to involuntary movements. The neurological examination revealed paraplegia with hyperreflexia, bilateral Babinski’s sign, thermal-algic and tactile sensory level by T5 and proprioceptive compromise of the lower limbs. Involuntary, stimulus-sensitive, wide, rhythmic and stereotyped movements of the left lower limb were observed, involving several muscle groups, similar to stepping movements. Further investigation documented myelopathy secondary to dorsal extradural lesion D2-D3, whose excision led to the complete resolution of these movements. Given the characteristics of these movements, we assume that they are stepping automatism movements generated by CPG.Downloads
Referências
Termsarasab P, Thammongkolchai T, Frucht SJ. Spinal-generated movement disorders: a clinical review. J Clin Mov Disord. 2015;2:18. doi: 10.1186/s40734-015-0028-1. Erratum in: J Clin Mov Disord. 2016;3:18.
Caviness JN. Segmental Myoclonus. In: Hyperkinetic Movement Disorders: Differential Diagnosis and Treatment. London: Wiley-Blackwell; 2012. p.221-35.
Massimi L, Battaglia D, Paternoster G, Martinelli D, Sturiale C, Di Rocco C. Segmental spinal myoclonus and metastatic cervical ganglioglioma: an unusual association. J Child Neurol. 2009;24:365-9. doi: 10.1177/0883073808323027.
Marrufo M, Politsky J, Mehta S, Morgan JC, Sethi KD. Paroxysmal Kinesigenic Segmental Myoclonus due to a spinal cord glioma. Mov Disord. 2007;22:1801-3. doi: 10.1002/mds.21635.
Lagueny A, Tison F, Burbaud P, Le Masson G, Kien P. Stimulus-sensitive spinal segmental myoclonus improved with injections of botulinum toxin type A. Mov Disord. 1999;14:182-5. doi: 10.1002/1531-8257(199901)14:1<182::aidmds1040>3.0.co;2-8.
Calancie B. Spinal myoclonus after spinal cord injury. J Spinal Cord Med. 2006;29:413-24. doi: 10.1080/10790268.2006.11753891.
Calancie B, Needham-Shropshire B, Jacobs P, Willer K, Zych G, Green BA. Involuntary stepping after chronic spinal cord injury. Evidence for a central rhythm generator for locomotion in man. Brain. 1994;117:1143-59. doi: 10.1093/brain/117.5.1143.
Minassian K, Jilge B, Rattay F, Pinter MM, Binder H, Gerstenbrand F, Dimitrijevic MR. Stepping-like movements in humans with complete spinal cord injury induced by epidural stimulation of the lumbar cord: electromyographic study of compound muscle action potentials. Spinal Cord. 2004;42:401-16. doi: 10.1038/sj.sc.3101615.
Sherrington CS. Flexion-reflex of the limb, crossed extension reflex and the stepping reflex and standing. J Physiol. 1910;40:28–121.
Brown TG. The intrinsic factors in the act of progression in the mammal. Proc R Soc Lond Ser B. 1911;84:308–19.
Minassian K, Hofstoetter US, Dzeladini F, Guertin PA, Ijspeert A. The Human Central Pattern Generator for Locomotion: Does It Exist and Contribute to Walking? Neuroscientist. 2017;23:649-663. doi: 10.1177/1073858417699790.
MacKay-Lyons M. Central pattern generation of locomotion: a review of the evidence. Phys Ther. 2002;82:69-83. doi: 10.1093/ptj/82.1.69.
Lee PH, Lee JS, Yong SW, Huh K. Repetitive involuntary leg movements in patients with brainstem lesions involving the pontine tegmentum: evidence for a pontine inhibitory region in humans. Parkinsonism Relat Disord. 2005;11:10510. doi: 10.1016/j.parkreldis.2004.09.005.
Lee JW, Shin KJ, Ha SY, Park J, Park KM. A patient with unilateral periodic leg movements associated with pontine infarction. J Mov Disord. 2015;8:37-9. doi: 10.14802/jmd.14017.
Forrsberg H, Grillner S, Halberstain J. The locomotion of the low spinal cat, 1: coordination within a hindlimb. Acta Physiol Scand. 1980;108:269–81.
Barbeau H, Rossignol S. Recovery of locomotion after chronic spinalization in the adult cat. Brain Res. 1987;412:84–95.
Delcomyn F. Neural basis of rhythmic behavior in animals. Sci Wash DC. 1980;210:492–8.
Shik ML, Severin FV, Orlovsky GN. Control of walking and running by means of electrical stimulation of the midbrain. Biophysics. 1966;11:756–65.
Duysens J, Van de Crommert HW. Neural control of locomotion; The central pattern generator from cats to humans. Gait Posture. 1998;7:131-41. doi: 10.1016/s09666362(97)00042-8.
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