Modifica di Hemimasticatory spasm (sezione)

===Multiple sclerosis and trigeminal reflexes===
We must make a further premise regarding axonal demyelination in multiple sclerosis. A study by Joanna Kamińska et el.<ref>Joanna Kamińska, Olga M Koper, Kinga Piechal, Halina Kemona . [https://pubmed.ncbi.nlm.nih.gov/28665284/ Multiple sclerosis - etiology and diagnostic potential].Postepy Hig Med Dosw. 2017 Jun 30;71(0):551-563.doi: 10.5604/01.3001.0010.3836.</ref> demonstrated that multiple sclerosis (MS) is a chronic inflammatory and demyelinating disease of autoimmune origin. The main agents responsible for the development of MS include exogenous, environmental and genetic factors. MS is characterized by multifocal and temporally scattered damage to the Central Nervous System (CNS) leading to axonal damage. Among the clinical courses of MS we can distinguish relapsing-remitting multiple sclerosis (RRMS), secondary progressive multiple sclerosis (SPSM), primary progressive multiple sclerosis (PPMS) and relapsing progressive multiple sclerosis (RPMS). Depending on the severity of the signs and symptoms, MS can be described as benign MS or malignant MS. The diagnosis of MS is based on the McDonald's diagnostic criteria, which link the clinical manifestation with the characteristic lesions demonstrated by magnetic resonance imaging (MRI); by analysis of cerebrospinal fluid (CSF) and visual evoked potentials. It should be emphasized that, despite enormous progress regarding MS and the availability of different diagnostic methods, this disease still represents a diagnostic challenge. It may result from the fact that MS has a different clinical course and lacks a single test of appropriate diagnostic sensitivity and specificity for rapid and accurate diagnosis. Precisely in reference to this last observation we must point out another significant data that emerged from a study by S K Yates and W F Brown<ref>S K Yates, W F Brown. The human jaw jerk: electrophysiologic methods to measure the latency, normal values, and changes in multiple sclerosis.Neurology. 1981 May;31(5):632-4.doi: 10.1212/wnl.31.5.632.</ref> in which we read that the jaw jerk of the masseter is present in all control subjects but commonly absent in patients with sclerosis defined multiple (SM). In some MS patients the latency was prolonged. Jaw jerk abnormalities, however, are less frequent than blink reflex responses to supraorbital nerve stimulation. However, there have been patients in whom the blink reflex was normal but the jaw jerk responses were abnormal. <blockquote>The latter observation suggests that the jaw jerk may occasionally be useful in the detection of brainstem lesions in MS.</blockquote>But at this point the doubt becomes reality: what should we think, then, of the anomalies of the trigeminal reflexes that emerged in our Mary Poppins? Could we be facing a form of 'Multiple Sclerosis? How do we distinguish the location of any demyenization whether Central or Peripheral? (Figure 3 and 4)
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File:Spasmo emimasticatorio JJ.jpg|'''Figure 3:''' Mandibular reflex detected electrophysiologically on the right (upper traces) and left (lower traces) masseters.
File:Spasmo emimasticatorio SP.jpg|'''Figure 4:''' Mechanical silent period detected electrophysiologically on the right (upper overlapping traces) and left (lower overlapping traces) masseters
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