Dokument: Beeinträchtigte taktile zeitliche Diskrimination bei Patienten mit hepatischer Enzephalopathie
Titel: | Beeinträchtigte taktile zeitliche Diskrimination bei Patienten mit hepatischer Enzephalopathie | |||||||
Weiterer Titel: | Impaired Tactile Temporal Discrimination in Patients With Hepatic Encephalopathy | |||||||
URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=54401 | |||||||
URN (NBN): | urn:nbn:de:hbz:061-20201013-112204-0 | |||||||
Kollektion: | Dissertationen | |||||||
Sprache: | Deutsch | |||||||
Dokumententyp: | Wissenschaftliche Abschlussarbeiten » Dissertation | |||||||
Medientyp: | Text | |||||||
Autor: | Lazar, Moritz [Autor] | |||||||
Dateien: |
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Beitragende: | Prof. Dr. Schnitzler, Alfons [Gutachter] Prof. Dr. Seitz, Rüdiger [Gutachter] | |||||||
Dewey Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit | |||||||
Beschreibungen: | Das sensorische System erhält und verarbeitet kontinuierlich Stimuli aus der
Umwelt. Um zwei einzelne Stimuli als zeitlich getrennte Ereignisse unterscheiden zu können, muss die zeitliche Distanz, d. h. die Asynchronität der Stimuli (stimulus onset asynchrony, SOA) eine bestimmte Dauer überschreiten. Wenn zwei Stimuli diese zeitliche Reizschwelle unterschreiten, werden sie als ein einzelnes, gemeinsames Ereignis interpretiert. Für Patienten mit hepatischer Enzephalopathie (HE) wurden in der Vergangenheit bereits verschiedene Einschränkungen sensorischer Qualitäten beschrieben wie z. B. eine verlangsamte visuelle zeitliche Diskrimination mittels der sogenannten kritischen Flimmerfrequenz (critical flicker frequency, CFF). Die vorliegende Arbeit untersuchte nun die taktile zeitliche Diskriminationsfähigkeit von Patienten mit HE unter der Annahme, dass diese Patientengruppe längere SOAs benötigt, um zwei Stimuli als zeitlich getrennte Ereignisse wahrnehmen zu können. Um diese Hypothese zu überprüfen, wurden Patienten mit unterschiedlichen Schweregraden der HE sowie altersentsprechende, gesunde Probanden einem taktilen zeitlichen Diskriminationstest unterzogen. Alle Teilnehmer erhielten mehrfach zwei taktile Stimuli mit unterschiedlichen SOAs, die über Ringelektroden am linken Zeigefinger appliziert wurden. Nach jeder Stimulation sollten die Probanden berichten, ob sie 1 oder 2 Stimuli wahrgenommen hatten. Es zeigte sich, dass HE Patienten einen signifikant längeren SOA (Median: 154,4 ms, erstes Quartil: 103,5 ms, drittes Quartil: 169,3 ms) benötigten, um zwei Stimuli als getrennte Ereignisse wahrnehmen zu können als gesunde Probanden gleichen Alters (Median: 96,8 ms, erstes Quartil: 31,4 ms, drittes Quartil: 124,1 ms, p < 0,01). Darüber hinaus konnte gezeigt werden, dass die Fähigkeit zur zeitlichen, taktilen Diskrimination negativ mit der Fähigkeit zur zeitlichen visuellen Diskrimination korrelierte (r = -0,37, p = 0,033). Diese Ergebnisse zeigen, dass die taktile zeitliche Diskrimination bei Patienten mit HE beeinträchtigt ist. Darüber hinaus deuten sie darauf hin, dass taktile und visuelle Einschränkungen HE Patienten in ähnlicher Weise betreffen. Dies könnte für einen gemeinsamen zugrundeliegenden, pathophysiologischen Schlüssel- Mechanismus sprechen. Ein solcher Mechanismus könnte die postulierte, globale Verlangsamung neuronaler Oszillationen bei HE Patienten sein.The sensory system continuously receives and processes stimuli from the external world. To discriminate two stimuli as two temporally separated events the temporal distance between those stimuli or the stimulus onset asynchrony (SOA) needs to exceed a certain threshold. If the SOA is shorter than the specific threshold, two stimuli will be perceived as one single event. It is known that patients with hepatic encephalopathy (HE) present a broad variety of neuropsychiatric symptoms, e.g. impairments of the sensory modality. The deterioration of the visual temporal discrimination ability can be measured by the critical flicker frequency (CFF). In the present work, the tactile temporal discrimination of patients with HE is analyzed, assuming that longer SOAs are needed to perceive two stimuli as temporally separated events. To test this hypothesis patients with varying grades of HE and age-matched healthy controls performed a tactile temporal discrimination task. All participants received multiple pairs of tactile stimuli with varying SOAs, applied by ringelectrodes to the left index finger. After each stimulation participants reported whether they perceived the simulation as 1 or 2 separate stimuli. HE patients needed a significantly longer SOA (median: 154.4 ms, first quartile: 103.5 ms, third quartile: 169.3 ms) to discriminate between two stimuli in comparison to healthy individuals (median: 96.8 ms, first quartile: 31.4 ms, third quartile: 124.1 ms, p < 0.01). In addition, it was shown that the tactile temporal discrimination ability correlates negatively with the visual temporal discrimination ability (r = -0.37, p = 0.033). The present results provide evidence that the tactile temporal discrimination is substantially impaired in patients with HE. Furthermore, the findings indicate that both the tactile temporal discrimination ability as well as the visual temporal discrimination ability in HE patients deteriorate in parallel. This outcome argues for a common underlying pathophysiological key mechanism. Such a mechanism can be represented by the known global slowing of neuronal oscillations in patients with HE. | |||||||
Quelle: | AGARWAL, R. & BAID, R. 2016. Asterixis. J Postgrad Med, 62, 115-7.
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Lizenz: | Urheberrechtsschutz | |||||||
Fachbereich / Einrichtung: | Medizinische Fakultät | |||||||
Dokument erstellt am: | 13.10.2020 | |||||||
Dateien geändert am: | 13.10.2020 | |||||||
Promotionsantrag am: | 07.10.2020 | |||||||
Datum der Promotion: | 07.10.2020 |