www.ksmf.org/arhimed   arhimed@ksmf.org   [5/10/2025 7:21:27 AM] http://www.ksmf.org/arhimed/poglej.asp?id=87 Kognitivne motnje in depresivnost pri bolnikih s tortikolisom Avtor: Maja Radobuljac, Klemen Rogelj Mentor: doc.dr. Zvezdan Pirtošek, dr. med. Izhodišce: Tortikolis je žarišcna distonija vratnih mišic. Verjamemo, da je posledica motnje v delovanju bazalnih ganglijev. Ceprav ga že dvajset let uspešno zdravijo z botulinom, njegove etiologije in mehanizma nastanka še vedno ne poznamo. V zadnjem casu je bilo odkritih pet locenih zank, ki povezujejo bazalne ganglije s frontalno možgansko skorjo: dve motoricni, dve kognitivni in eno limbicno; tako bi bolniki s tortikolisom poleg motoricnih motenj (distonije) lahko imeli tudi moteno razpoloženje in spoznavne procese. Namen: Želeli smo ugotoviti, ali imajo bolniki s tortikolisom moteno tudi razpoloženje (depresija), spoznavne procese in selektivno pozornost; ter ali tudi ti nemotoricni simptomi izzvenijo po uspešnem zdravljenju z botulinom. Metode: Primerjali smo 7 bolnikov in 6 starostno primerljivih zdravih preiskovancev. Testirali smo jih dvakrat: bolnike pred terapijo z botulinom in dva meseca po njej, kontrolne preiskovance pa tudi v razmaku dveh mesecev. Za ocenjevanje razpoloženja smo uporabili vprašalnike o zaznavanju lastnega telesa (samopodobi) in o nacinih soocanja z boleznijo. Z uporabo slušnih poznih izzvanih potencialov (metoda slušnega poskusnega vzorca nenavadnosti in test slušne selektivne pozornosti) ter reakcijskega casa smo ocenili spoznavne procese in pozornost. Rezultati: Rezultati so pokazali, da imajo bolniki s tortikolisom negativno samopodobo, ki se po uspešnem zdravljenju z botulinom izboljša. Selektivna slušna pozornost pri njih ni prizadeta. Ti bolniki imajo krajše latence pri metodi slušnega poskusnega vzorca nenavadnosti, vendar pa so njihovi reakcijski casi daljši. Zakljucki: Dokazali smo, da je depresivnost bolnikov s tortikolisom v vecini reaktivna. Krajše latence slušnih poznih izzvanih potencialov bi lahko odražale ojacano vzdražnost možganskih struktur, povezanih s spoznavnimi procesi (kognicijo). Mehanizem ojacane vzdražnosti so za motoricni in somatosenzoricni sistem dokazali že z drugimi metodami, naša naloga pa je prva, ki je pokazala enak mehanizem tudi v kognitivnem sistemu. «» [Abstract / English version] Cognitive disfunction and depression in patietns with torticollis Author: Maja Radobuljac, Klemen Rogelj Mentor: doc.dr. Zvezdan Pirtošek, dr. med. Background: Torticollis is a focal dystonia of the neck muscles, believed to reflect a disorder of the basal ganglia. It is successfully treated with botulinum toxin, but its aetiology and mechanism remain elusive. Recently five separate anatomical loops have been shown to connect basal ganglia to the frontal cortex: two motor, two cognitive and one limbic. Consequently besides motor disorder (dystonia) patients with torticollis could also have mood and cognitive impairment. Objectives: Our aim was to find out whether in patients with torticollis there is also an impairment of mood (depression), cognition and selective attention; and whether a successful symptomatic treatment with botulinum toxin alleviates these non-motor symptoms as well. Methods: In seven patients with torticollis we used questionnaires on body-concept and on ways of coping with the disease for assessment of mood (depression). Using event related potentials (the auditory oddball task and the auditory selective attention task) and reaction times we assessed cognition and attention. They were tested twice: before the treatment with botulinum and two months afterwards. Patients were compared to six age-matched healthy volunteers. Results: Our results show that patients with torticollis have negative body-concept, which improves after the treatment with botulinum toxin. There is no impairment of auditory selective attention. Auditory oddball potentials are of shorter latencies in patients, but their reaction times are longer. Conclusions: Depression in patients with torticollis seems to be largely reactive. Shorter latencies of the event related potentials might reflect an enhanced excitability of the cognition-related structures. The mechanism of the enhanced excitability has previously been shown with other methods for the motor and somatosensory systems, but ours is the first study that postulates the same mechanism also for the cognitive system.