Tuesday 6 November 2018

Vibration sensitvity / numbness

I had seen loss of vibration sensitivity in the legs as one of the potential HSP symptoms. At work I deal in noise and vibration, and so this had caught my attention.

Wearing my "work" hat I was determining that generally we dont experience vibration that often, and I know that humans are quite sensitive to vibration. I was trying to think of a situation when you would know that it is vibrating whilst at the same time noticing that you weren't feeling it in your legs. I couldn't think of a situation like this!

However, earlier in the year I went to the HSP clinic and they tested my vibration sensitivity, and it was actually very easy. A tuning fork was set vibrating, and the handle was then placed on my leg - could I feel it? And so, my vibration sensitivity is retained for now (at least).

I wondered where the origins of this came from. A quick bit of internet searching suggests that the use of a tuning fork to detect vibration sensitivity is usually credited to Heinrich Rumpf, who published findings in 1889.

Various extracts from articles:

The use of the tuning fork to clinically test vibration sense is generally credited to Heinrich Rumpf, professor and director of the poliklinik in the University of Marburg, who published his findings in 1889. A controversy surrounded its significance. Tomson, Treitel, Rydel, and Seiffer argued that it was a discrete sensation, sometimes impaired when touch and pressure sensation were preserved, in tabes and polyneuritis. Egger in Dejerine’s clinic, and Schwaner, thought that the receptors lay in the periosteum but the sensation (pallaesthesiae) was conducted by bone. However, vibration sense was not generally accepted as a valid clinical test for another 10 years.
https://jnnp.bmj.com/content/65/5/728

 Although vibratory sense had been described by Cardano and Ingrassia in the 16th century and tests had been developed by Rinne and Rumpf by the 19th century, it was not until 1903 that Rydel and Seiffer found that vibratory sense and proprioceptive sense were closely related and that both senses were carried in the posterior columns of the spinal cord. By 1955, the sensory examination included tests for light-touch, superficial pain, temperature, position sense, vibration, muscle (deep pain), and two-point discrimination.
https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-2002-36762

I couldn't find an easy article describing when vibration sensitivity became part of the standard neurological test, but it would appear to be somewhere between about 1900 and 1955.

My next path is to look at early mentions of vibration with HSP, and see when that was first mentioned. Finding copies of old medical journals on-line for free is a challenge! This paper from 1963 notes that loss of vibration sense is one of the more frequent "additional" symptoms of HSP - it's about two thirds of the way down the left hand column on page 518.  here https://jnnp.bmj.com/content/jnnp/26/6/516.full.pdf. Assuming that the text on P518 is referring to the referenced articles, it suggests that it was spotted either in the early 1900's or in the 1950's. Further investigation is required.

I note that this paper also has references for a load of the early HSP papers!


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