Affective disorders and brainstem raphe and substantia nigra echogenicity in evaluation of Burning mouth syndrome therapy efficiency

Afektivni poremećaji, pogotovo depresija, su česti komorbiditeti kod pacijenata sa primarnim Sindromom pekućeg bola usne duplje (pSPU). Jedra rafe (RM) predstavljaju glavni izvor serotonina u mozgu i smatra se da njegov nedostatak može izazvati simptome pSPU. Ispitivanja sa primenom transkranijalne parenhimske sonografije (TCS) su utvrdila hipoehogenost struktura RM kod 50-70% pacijenata sa unipolarnom depresijom koja je povezana sa odgovorom na inhibitore preuzimanja serotonina, što podržava hipotezu da hipoehogenost RM može biti marker oštećene centralne transmisije serotonina. Takođe se u etiologiji pSPU govori o izmenjenom dopaminergičkom nigrostrijatnom putu, koji polazi iz supstancije nigre (SN) ka bazalnim ganglijama (corpus striatum-u). SPU se manifestuje hroničnim osećajem peckanja i žarenja u usnoj dupllji i predstavlja osećaj pečenja u ustima i dizestezije koje se ponavljaju tokom dana, više od 2 sata i duže od 3 meseca, bez klinički evidentnih lezija. Pojava ovog oboljenja češća je kod osoba ženskog pola, srednje i starije životne dobi. Ovaj Sindrom može biti primarni i sekundarni. Etiologija sekundarnog SPU može biti lokalna i sistemska. Nastanak pSPU se dovodi u vezu sa sniženom ehogenosti jedara rafe, koje je prisutna i kod pacijenata sa unipolarnom depresijom i depresijom udruženom sa Parkinsonovom bolesti. Cilj: Cilj ovog istraživanja je bio da se evaluiraju kliničke karakteristike SPU, neurološki i psihološki profil pacijenata, uz eliminaciju lokalnih i sistemskih etioloških faktora. Dodatno, cilj je bio utvrđivanje povezanosti ehogenosti jedara rafe i SN sa kliničkim i afektivnim statusom pacijenata. Takođe, istraživanje je imalo za cilj procenu efikasnosti primenjene terapije. Materijal i metode: Istraživanjem je obuhvaćeno 70 pacijenata sa simptomima SPU, od kojih je nakon anamneze, kliničkog pregleda i dopunskih ispitivanja, u studiju uključeno njih 30. Ehogenost RM i SN je procenjivana upotrebom TCS. Svim pacijentima je ordiniran lek fluoksetin iz grupe selektivnih inhibitora preuzimanja serotonina. Kontrolni pregledi su se obavljali nakon 3 i 6 meseci...Affective disorders, particularly depression, are frequent comorbidities in patients with primary Burning mouth syndrome (pBMS). Brainstem raphe (BR) represents main source of serotonin and it is assumed that it´s deficiency can cause pBMS symptoms. Studies with transcranial parenchymal sonography (TCS) determined the presence of BR hypoehogenicity in 50-70% of patients with unipolar depression which is linked with responsivity to serotonin-reuptake inhibitors (SSRI). The latter supports the hypothesis that raphe hypoehogenicity can be a marker of damaged serotonin central transmission. Etiology of pBMS, also, refers to the changes in dopamine nigrostraital pathway that starts in substantia nigra (SN) toward basal ganglia (corpus striatum). BMS manifests with chronic intraoral burning sensations and represents an intraoral burning or dysaesthetic sensation, recurring daily for more than two hours during the period longer than three months without any pathological changes of oral mucosa. BMS is more frequent in women, mostly middle aged and elderly, and it can be divided into primary and secondary form. Etiology of secondary BMS (sBMS) can be local and systemic. The onset of the pBMS is related to BR hypoechogenicity which can be noticed in patients with unipolar depression and depression in Parkinson disease. Objective: The aims of this study were to evaluate clinical characterstics of BMS, neurological and psychological status of patients with elimination of local and systemic etiological factors. Additionally, aim was to determine connection between raphe and substantia nigra echogenicity and clinical and affective status of patients. Also, this study had objective to define therapy efficiency. Methods: The study included 70 patients with complaint of oral burning sensation, from which 30 patients were included into the research after taking anamnesis, clinical examination and supplementary tests. Echogenicity of BR and SN was determined with TCS examination. Medication fluoxetine from the SSRI group was prescribed to all patients. Control examinations were conducted after 3 and 6 months..