[Sphenopalatine ganglion stimulation in the treatment of chronic refractory cluster headache. A preliminary multicenter study in Russia]. / Stimulyatsiya krylonebnogo gangliya v lechenii khronicheskoi klasternoi golovnoi boli. Rezul'taty pervogo mul'titsentrovogo opyta v Rossii.

OBJECTIVE: To analyze the results of sphenopalatine ganglion stimulation in treatment of chronic headache. MATERIALS AND METHODS: Medical histories of patients who underwent sphenopalatine ganglion stimulation in 4 clinical centers have been analyzed. The analysis included the type of pain and its characteristics, methods of surgery, CT, MRI, radiography before and after surgery. The follow-up data of patients with implanted pulse generators was collected in an outpatient clinic or by telephone review. RESULTS: The study included 15 patients with chronic refractory headache, including 14 with cluster headache and one female patient with features of trigeminal autonomic cephalgia without a clear definition of the type of pain. Trial stimulation was performed in 10 patients to determine analgesic effect. Among them stimulation was favorable in 7 cases, and 6 of them underwent pulse generator implantation. In total, 11 (73%) patients underwent implantation with a follow-up from 1 to 60 months. Among them only 6 (54%) patients use stimulation, the remaining 5 (46%) cases had device-related complications (migration, infection of system). Cluster headache has a significant improvement in long-term follow-up. CONCLUSIONS: Sphenopalatine ganglion stimulation may have high potential in the treatment of chronic drug-resistant cluster headache. The complication rate demonstrates that operative technique should be improved.

Heart rate increase after pulmonary vein isolation predicts freedom from atrial fibrillation at 1 year.

INTRODUCTION: Ablation of atrial vagal ganglia has been associated with improved pulmonary vein isolation (PVI) outcomes. Disruption of vagal reflexes results in heart rate (HR) increase. We investigated the association between HR change after PVI and freedom from atrial fibrillation (AF) at 1 year. METHODS AND RESULTS: Patients who underwent PVI for paroxysmal AF were identified from the Johns Hopkins Hospital AF registry. Electrocardiograms taken pre-PVI and post-PVI were used to determine the change in HR. Patients followed-up at 3, 6, and 12 months. Of 257 patients (66% male, age 59+/-11 years), 134 (52%) remained free from AF at 1 year. The average HR increased from 60.6 ± 11.3 beats per minute (bpm) pre-PVI to 70.7 ± 12.0 bpm post-PVI. Patients with recurrence of AF had lower post-PVI HR than those who remained free from AF (67.8 ± 0.2 vs 73.3 ± 13.0 bpm; P <.001). The probability of AF recurrence at 1-year decreased as the change in HR increased (estimated odds ratio [OR], 0.83; 95% confidence interval [CI, 0.74-0.93]; P = .002). HR increase more than 15 bpm was associated with the lowest odds of AF recurrence (estimated OR, 0.39; 95% [0.17-0.85]; P = .018) compared to HR decrease. CONCLUSIONS: Resting HR was found to increase after PVI. Increase in HR more than 15 bpm has a positive association with remaining free from atrial fibrillation at 1 year.

Effects of autonomic denervations on the rhythms in axial length and choroidal thickness in chicks.

In chicks, axial length and choroidal thickness undergo circadian oscillations. The choroid is innervated by both branches of the autonomic nervous system, but their contribution(s) to these rhythms is unknown. We used two combination lesions to test this. For parasympathectomy, nerve VII was sectioned presynaptic to the pterygopalatine ganglia, and the ciliary post-ganglionics were cut (double lesion; n = 8). Triple lesions excised the sympathetic superior cervical ganglion as well (n = 8). Sham surgery was done in controls (n = 7). 8-14 days later, axial dimensions were measured with ultrasonography at 4-h intervals over 24 h. Rhythm parameters were assessed using a "best fit" function, and growth rates measured. Both types of lesions resulted in ultradian (> 1 cycle/24 h) rhythms in choroidal thickness and axial length, and increased vitreous chamber growth (Exp-fellow: double: 69 µm; triple: 104 µm; p < 0.05). For double lesions, the frequency was 1.5 cycles/day for both rhythms; for triples the choroidal rhythm was 1.5 cycles/day, and the axial was 3 cycles/day. For double lesions, the amplitudes of both rhythms were larger than those of sham surgery controls (axial: 107 vs 54 µm; choroid: 124 vs 29 µm, p < 0.05). These findings provide evidence for the involvement of abnormal ocular rhythms in the growth stimulation underlying myopia development.

Catheter Ablation of Bradyarrhythmia: From the Beginning to the Future.

Enhanced parasympathetic tone may cause sinus bradycardia or pauses, transient or permanent atrioventricular block, with resultant vasovagal syncope. A substantial portion of these patients may be highly symptomatic and refractory to the conventional therapies and may require cardiac pacemaker implantation. Cardioneuroablation is a little known technique for management of patients with excessive vagal activation based on radiofrequency catheter ablation of main parasympathetic autonomic ganglia around the heart. Due to complicated inclusion criteria, ganglia detection methods, and ablation endpoints, routine usage of the procedure cannot be recommended at this time. In this comprehensive review, we aimed to discuss all aspects of cardioneuroablation procedure in bradyarrhythmias.

Feasibility of endoscopic submandibular ganglion neurectomy for drooling.

We performed endoscopic transoral neurectomy of the submandibular and sublingual glands to treat drooling. We bilaterally operated two adult cases with treatment-resistant drooling. In these patients, conventional treatment had failed. Repeated botilinum toxin type A (BOTOX®, Abdi Ibrahim Pharmaceutical Company, Istanbul, Turkey) injections had been effective but were becoming less so. The patients benefited from surgery in that their saliva scores decreased. No issue emerged over 6 months of follow-up. Endoscopic transoral neurectomy of the submandibular and sublingual glands reduces saliva production and allows management of drooling in treatment-resistant patients. Laryngoscope, 127:1604-1607, 2017.

Integrity of the Ganglionated Plexi Is Essential to Parasympathetic Innervation of the Atrioventricular Node by the Right Vagus Nerve.

INTRODUCTION: Radiofrequency isolation of pulmonary vein can be accompanied by transient sinus bradycardia or atrioventricular nodal (AVN) block, suggesting an influence on vagal cardiac innervation. However, the importance of the atrial fat pads in relation with the vagal innervation of AVN in humans remains largely unknown. The aim of this study was to evaluate the role of ganglionated plexi (GP) in the innervation of the AVN by the right vagus nerve. METHODS AND RESULTS: Direct epicardial high-frequency stimulation (HFS) of the GP (20 patients) and the right vagus nerve (10 patients) was performed before and after fat pad exclusion or destruction in 20 patients undergoing thoracoscopic epicardial ablation for the treatment of persistent AF. Asystole longer than 3 seconds or acute R-R prolongation over 25% was considered as a positive response to HFS. Prior to the ablation, positive responses to HFS were detected in 3 GPs in 7 patients (35%), 2 GPs in 5 patients (25%), and one GP in 8 patients (40%). After exclusion of the fat pads, all patients had a negative response to HFS. All the patients who exhibited a positive response to right vagus nerve stimulation (n = 10) demonstrated negative responses after the ablation. CONCLUSION: The integrity of the GP is essential for the right vagus nerve to exert physiological effects of on AVN in humans.

Sphenopalatine Ganglion Stimulation in Neurovascular Headaches.

The interest for the sphenopalatine ganglion (SPG) in neurovascular headaches dates back to 1908 when Sluder presented his work on the role of the SPG in 'nasal headaches', which are now part of the trigeminal autonomic cephalalgias and cluster headache (ICHD-III-beta). Since then various interventions with blocking or lesional properties have targeted the SPG (transnasal injection of lidocaine and other agents, alcohol or steroid injections, radiofrequency lesions, or even ganglionectomy); success rates vary, but benefit is usually transient. Here we briefly review some anatomophysiological characteristics of the SPG and hypotheses about its pathophysiological role in neurovascular headaches before describing recent therapeutic results obtained with electrical stimulation of the SPG. Based on results of a prospective randomized controlled study, SPG stimulation appears to be an effective treatment option for patients with chronic cluster headaches; efficacy data indicate that acute electrical stimulation of the SPG provides significant attack pain relief and in many cases pain freedom compared to sham stimulation. Moreover, in some patients SPG stimulation has been associated with a significant and clinically meaningful reduction in cluster headache attack frequency; this preventive effect of SPG stimulation warrants further investigation. For migraine attacks, the outcome of a proof-of-concept study using a temporary electrode implanted in the pterygopalatine fossa was less encouraging; however, an ongoing multicenter trial is evaluating the efficacy of long-term SPG stimulation against sham stimulation for acute and preventive treatment in patients with frequent migraine.

Transoral submandibular ganglion neurectomy: an anatomical feasibility study.

BACKGROUND: The management of sialorrhea can be difficult for both the patient and the clinician. Current management includes behavioral modification, anticholinergics, botulinum injections, and a variety of surgical options, which all have demonstrated some efficacy. As minimally invasive procedures flourish, we explore the feasibility of highly selective transoral submandibular neurectomy (TOSN) for the management of sialorrhea. METHODS: Ten human cadaver dissections of the floor of mouth were performed bilaterally, for a total of 20 separate cases. An intraoral technique for highly selective, submandibular ganglion neurectomy is demonstrated. RESULTS: A transoral submandibular ganglion neurectomy was performed in 10 cadavers (20 neurectomies) easily and reliably, without injury to the submandibular duct or the main trunk of the lingual nerve. CONCLUSION: Transoral submandibular neurectomy is an attractive addition to the armamentarium of surgical options for the treatment of medically intractable sialorrhea. Further study in selected patients would need to be performed to demonstrate clinical feasibility.

Parasympathetic influences on emmetropization in chicks: evidence for different mechanisms in form deprivation vs negative lens-induced myopia.

Ciliary ganglionectomy inhibits the development of myopia in chicks (Schmid et al., 1999), but has no effect on the compensatory responses to spectacle lenses (Schmid and Wildsoet, 1996). This study was done to assess the potential influence of the other parasympathetic input to the choroid, the pterygopalatine ganglia, on the choroidal and axial responses to retinal defocus, and to form deprivation. 4-5 week-old chicks had one of the following surgeries to one eye: (1) Section (X) of the autonomic part of cranial N VII (input to the pterygopalatine ganglia) (PPGX, n = 16), (2) PPGX plus ciliary ganglionectomy (PPG/CGX, n = 23) or (3) PPGX plus superior cervical ganglionectomy (PPG/SCGX, n = 10). Experimental eyes were fitted with positive or negative lenses, or diffusers, several days after surgery. In one group of PPG/CGX, eyes did not wear any devices (n = 8). Intact (no surgery) controls were done for all visual manipulations (lenses or diffusers). Sham surgeries were done for the PPG/CGX condition (n = 4). Ocular dimensions were measured using A-scan ultrasonography prior to the surgery, 5 days later when visual devices were placed on the eyes, at the end of lens- or diffuser-wear, and in the case of diffusers, 4 days after diffuser removal to look at "recovery". Refractive errors were measured using a Hartinger's refractometer. IOP was measured in 7 PPG/CGX birds 7d after surgery. PPGX/CGX resulted in choroidal thickening (125 µm) and a decrease in IOP over one week post-surgery. It also prevented the development of myopia in response to form deprivation (X vs intact: 0.2 D vs -4.1 D; p < 0.005), by preventing the increase in axial elongation (250 µm vs 670 µm/5d; p < 0.005). In fact, growth rate slowed below normal (X vs fellow eyes: 250 µm vs 489 µm/5d; p = 0.002). By contrast, there were no effects of this lesion on the development of myopia in response to negative lenses (X vs intact: -5.4 D vs -5.3 D). All three lesions inhibited the compensatory choroidal thickening in response to myopic defocus (ANOVA, p = 0.0008), but had no effect on the thinning response to hyperopic defocus. These results argue for different underlying mechanisms for the growth responses to form deprivation vs negative lens wear. They also imply that choroidal thickening and thinning are not opposing elements of a single mechanism.

Effects of radiofrequency thermocoagulation of the sphenopalatine ganglion on headache and facial pain: correlation with diagnosis.

AIMS: To study the effect of radiofrequency thermocoagulation (RFT) of the sphenopalatine ganglion (SPG) on headache and facial pain conditions following critical reevaluation of the original diagnosis. METHODS: This was a retrospective study of clinical records gathered over 4 consecutive years of all 15 facial pain or headache patients who underwent RFT of the SPG at a tertiary pain clinic; diagnoses were reevaluated, after which the effect of RFT on facial pain was assessed. RESULTS: After application of new criteria for Sluder's neuralgia (SN) and strict criteria for cluster headache (CH), seven patients out of the 15 turned out to have been diagnosed correctly. Nine of the 15 patients showed considerable pain relief after RFT of the SPG. Positive results were most frequent among patients with Sluder's neuropathy, atypical facial pain, and CH. However, repeated RFT procedures were needed in most patients. CONCLUSION: Correct headache and facial pain diagnosis is vital to assess the outcome of different treatment strategies. Even in a tertiary center, headache and facial pain can be misdiagnosed. RFT of the SPG may be effective in patients with facial pain, but repeated procedures are often needed.

A computed tomography scan and anatomical cadaveric study of the pterygopalatine ganglion for use in Gamma Knife treatment of cluster headache.

OBJECT: Gamma Knife surgery has recently been used to treat patients with cluster headaches. Both the trigeminal nerve root and the pterygopalatine ganglion (PPG) have been targeted. However, there are no clear-cut anatomical landmarks on computed tomography (CT) scans or magnetic resonance images that accurately identify the PPG. Therefore, the authors performed microsurgical dissections on latex-injected cadaver heads to expose the PPG and correlated the findings with thin-slice axial CT scans obtained in the same heads to determine how best to target the PPG. METHODS: Three cadaver heads (five sides) previously injected with colored latex were dissected using skull base approaches and microsurgical techniques to identify the PPG and surrounding structures. Measurements were then made to different osseous anatomical landmarks such as the foramen rotundum, vidian canal, and so on. The PPG was marked with a radiopaque marker and thin-slice CT scans were obtained in the cadaver heads to develop some correlates that could be used to identify where the PPG is located on CT scans. RESULTS: The PPG was clearly identified in all specimens and had a mean diameter of 3.58 +/- 0.6 mm. The PPG was always located in the same plane (lateral and vertical) as the vidian canal and was located on average 2.7 +/- 0.3 mm from the end of the canal. The vidian canal was clearly identified on coronal CT scans and had a diameter of 3.05 mm. CONCLUSIONS: There was a clear and constant relationship between the PPG and vidian canal. The vidian canal is easily identified on coronal CT scans and can be used as a landmark to target the PPG with the Gamma Knife.

Evaluation of novel dry eye model: preganglionic parasympathetic denervation in rabbit.

PURPOSE: To evaluate ocular surface status after interruption of preganglionic, parasympathetic neural control after surgical removal of the greater superficial petrosal nerve (GSPN). METHODS: New Zealand White rabbits underwent unilateral section and removal of a 5-mm portion of the GSPN by a route through the inner ear; no ocular or orbital tissue was involved. Before and 7 days after surgery, all animals underwent preliminary examination, including fluorescein staining, rose bengal instillation, blink rate, tear breakup time (BUT), tear flow, and impression cytology. Total tarsorrhaphy was carried out in four additional rabbits, and another four animals underwent unilateral sham procedures. The GSPN, pterygopalatine ganglion, lacrimal gland, and conjunctiva were evaluated by light and transmission electron microscopy (TEM). RESULTS: GSPN sectioning resulted in significant changes of the ocular surface after 7 days: intense rose bengal staining of the conjunctiva, fluorescein staining of the cornea, increased blink rate (P < 0.05), decreased BUT (P < 0.005), decreased tear flow by 26% (P < 0.005), and decreased goblet cell density (P < 0.01). TEM revealed massive accumulation of secretory granules in lacrimal acinar cells. The changes were also seen after tarsorrhaphy. Neither the contralateral control nor the sham eyes were affected. CONCLUSIONS: The effects of GSPN nerve section led to the rapid onset of a dry eye condition in the rabbits that continued for at least 1 week. The authors suggest that continuous neural drive of the pterygopalatine ganglion is necessary to maintain adequate tear flow and mucin secretion. It is likely the trigeminal system is the afferent origin of this continuous neural tone.

Cyberknife targeting the pterygopalatine ganglion for the treatment of chronic cluster headaches.

OBJECTIVE: Cluster headache (CH) is a severe unilateral and periorbital facial pain syndrome that is often associated with autonomic symptoms, including ipsilateral lacrimation, nasal congestion, conjunctival injection, miosis, ptosis, and eyelid edema. We evaluated the treatment of medically refractory CH with CyberKnife (Accuray, Inc., Sunnyvale, CA) stereotactic radiosurgery targeting the pterygopalatine ganglion. CLINICAL PRESENTATION: A 56-year-old man presented with a 20-year history of medically refractory CH. His symptoms were described as left-sided, severe, stabbing, burning, and often being associated with tearing and rhinorrhea. These headaches occurred virtually every morning and interfered with sleep, lifestyle, and work performance. INTERVENTION: The patient underwent two pterygopalatine nerve block trials, both of which resulted in the complete relief of headaches for a 24-hour period. Contrast-enhanced computed axial tomography and magnetic resonance imaging scans were fused for target identification and treatment planning. The target volume measured 0.296 cm3 and a single fraction of 45.50 Gy was delivered to the 78% isodose line with a maximum dose of 65 Gy. The patient kept a detailed diary of his headaches and was followed for 12 months after treatment. CONCLUSION: Results of CyberKnife targeting of the pterygopalatine ganglion in a patient with medically intractable CHs have revealed a significant decrease in the severity and frequency of headaches after a 12-month follow-up period. In addition, the patient has been able to reduce his medication intake, allowing for a significant decrease in medication-related side effects. Longer follow-up periods and additional studies are required to determine the long-term efficacy and late side effects of this treatment strategy.

The microsurgical anatomy of the ciliary ganglion and its clinical importance in orbital traumas: an anatomic study.

The ciliary ganglion can easily be injured during surgery for the repair of orbital fractures and laterally situated intraorbital mass lesions. The aim of this study is to elucidate the microsurgical anatomy of the ciliary ganglion and to emphasize its clinical importance in orbital traumas and surgeries. The orbits of 10 adult cadavers were fixed with 10 % formalin and dissected under the microscope with special attention to the presence and location of the ciliary ganglion. The motor (parasympathetic), sympathetic, and sensory roots, and the short ciliary nerves were exposed. Its relationship with other intraorbital neural and vascular structures were investigated. Some anatomic landmarks were determined and the distances between these landmarks were measured. The ciliary ganglion is an intraorbital neural structure approximately 3 mm in size, situated near the orbital apex, posterolateral to the globe in loose areolar tissue between the optic nerve and lateral rectus muscle. The mean distance between the ganglion and the optic nerve was 2.9 mm (range: 2.70 - 3.10 mm) and the mean distance between the lateral rectus muscle and the ganglion was 10.4 mm (range: 9.20 - 11.20 mm). Six to 10 short ciliary nerves arise from the ganglion and run forward in a curving manner with the ciliary arteries above and below the optic nerve. The ciliary ganglion should be taken into the account especially during lateral approaches to the orbit and the patients should be warned before the surgery about possible mydriatic or tonic pupils as a complication.

The otic ganglion in rats and its parotid connection: cholinergic pathways, reflex secretion and a secretory role for the facial nerve.

Otic ganglionectomy in rats was found to have affected the parotid gland more profoundly than section of the auriculotemporal nerve as assessed by reduction in gland weight (by 33 versus 20%) and total acetylcholine synthesizing capacity (by 88 versus 76%) 1 week postoperatively and, when assessed on the day of surgery under adrenoceptor blockade, by reflex secretion (by 99 versus 88%). The facial nerve contributed to the acetylcholine synthesizing capacity of the gland. Section of the nerve only, at the level of the stylomastoid foramen, reduced the acetylcholine synthesis by 15% and, combined with otic ganglionectomy, by 98% or, combined with section of the auriculotemporal nerve, by 82%. The facial nerve was secretory to the gland, and the response was of a cholinergic nature. The nerve conveyed reflex secretion of saliva and caused secretion of saliva upon stimulation. Most of the facial secretory nerve fibres originated from the otic ganglion, since after otic ganglionectomy (and allowing for nerve degeneration) the secretory response to facial nerve stimulation was markedly reduced (from 23 to 4 microl (5 min)(-1)). The persisting secretory response after otic ganglionectomy, exaggerated due to sensitization, and the residual acetylcholine synthesizing capacity (mainly depending on the facial nerve) showed that a minor proportion of pre- and postganglionic nerve fibres relay outside the otic ganglion. The great auricular nerve, which like the facial nerve penetrates the gland, caused no secretion of saliva upon stimulation. Avulsion of the auriculotemporal nerve was more effective than otic ganglionectomy in reducing the acetylcholine synthesizing capacity (by 94 versus 88%) and as effective as otic ganglionectomy in abolishing reflex secretion (by 99%). When aiming at parasympathetic denervation, avulsion may be the preferable choice, since it is technically easier to perform than otic ganglionectomy.

Interindividual variation in distribution of extramural ganglion cells in the male pelvis: a semi-quantitative and immunohistochemical study concerning nerve-sparing pelvic surgery.

OBJECTIVE: We examined distribution and numbers of extramural ganglion cells in the male pelvis, classifying them as sympathetic or parasympathetic. METHODS: Specimens were obtained from 14 formalin-fixed donated male cadavers. Semiserial sections were processed for histologic examination, and for immunohistochemistry using anti-tyrosine hydroxylase (TH) or anti-peptide histidine isoleucine (PHI). RESULTS: Like those along the sacral sympathetic trunk, most other pelvic ganglion cells were located in and along nerve components. Yet the ganglion cell clusters attached to pelvic viscera accounted for 22% to 38% of ganglion cells. These were seen at the dorsal aspect of the bladder, the bladder/prostate junction, the dorsal aspect of the seminal vesicle, and along the prostate, but not along the extrapelvic pudendal nerve, cavernous tissues including the penile hilum, the rhabdosphincter, retropubic fat or recto-urethral muscle. Two fold interindividual variation was seen for total ganglion cell number (3044 to 6522) in the pelvis. TH-positive and PHI-positive cells intermingled at various ratio in every ganglion cell cluster. Sympathetic TH-positive proportions tended to be site-specific. CONCLUSIONS: Pelvic autonomic cells exist not only in nerve components but also along viscera. Even nerve-sparing radical prostatectomy can compromise visceral ganglia. Simple classification of pelvic nerve components as sympathetic or parasympathetic would seem misleading given coexistence of both cell types in a ganglion.

Slow-transit constipation after radical hysterectomy type III.

BACKGROUND: This study investigated ways to reduce the rate of slow-transit constipation after radical hysterectomy type III. METHODS: A prospective study was conducted involving 59 consecutive patients with cervical cancer stage IB1-IIIA at high risk for parametrial or lymph node involvement who were treated between May 1996 and March 1999 by laparoscopically assisted radical vaginal hysterectomy type III. RESULTS: During laparoscopic transection of the cardinal ligament, particular attention was focused on conservation of the pelvic splanchnic nerves. After vaginal removal of the uterus, a vaginal sacrocolporectopexy was performed transvaginally. Nerve preservation and pexy of the rectum allowed a significant reduction of postoperative constipation, as compared with classic radical hysterectomy without conservation of the splanchnic pelvic nerves and without sacrocolporectopexy. CONCLUSION: Refinements in the preparation of the parasympathetic nerves during radical pelvic surgery and refixation of the terminal rectum helps to prevent postoperative constipation.

Kinin B1 receptor-mediated motor responses in normal or inflamed rat urinary bladder in vivo.

The rat urinary bladder is one of the few in vivo preparations in which kinin B1 receptor-mediated contractile responses have been described, but the nature (local or reflex) of these responses has not been characterized. We have investigated the motor effects of i.v. or topical (onto the bladder serosa) administration of the selective kinin B1 receptor agonist [des-Arg9]-bradykinin ([des-Arg9]-BK) in the normal or inflamed (cyclophosphamide-induced) urinary bladder in urethane-anaesthetized rats. In both normal and inflamed bladders [des-Arg9]-BK produced a tonic contraction of low amplitude (< 15 mmHg) with phasic contractions of high amplitude (> or = 15 mmHg) superimposed (micturition reflex contractions). In inflamed bladders, the response to [des-Arg9]-BK was more prominent than in controls. Similar observations were made after the topical administration of [des-Arg9]-BK. In order to evaluate any time-dependency in the expression of B1 receptor-mediated bladder responses, [des-Arg9]-BK was administered in separate groups of control animals at 30 and 240 min after the completion of surgical procedures required for set-up of the preparation: no bladder contraction was detected at 30 min whereas both local and reflex contractions could be elicited by [des-Arg9]-BK at 240 min after the set up. In ganglionectomized rats, the response to [des-Arg9]-BK or the selective tachykinin NK2 receptor agonist [betaAla8]NKA(4-10) was evaluated at 30 and 240 min after the set up in inflamed or in control animals. The response to [des-Arg9]-BK was greater after inflammation although a time-dependent increase was evident in both groups; in contrast, the response to [betaAla8]NKA(4-10) was similar in both groups and remained constant over the observation period. After induction of inflammation, the tonic contraction induced by [des-Arg9]-BK in ganglionectomized rats was dose-dependently reduced by the kinin B1 receptor antagonist [desArg10]Hoe 140. The contractile response (number of micturition reflex contractions) induced by [des-Arg9]-BK in normal rats with intact pelvic nerves at 240 min from the set up was not changed after the administration of the selective B2 receptor antagonist Hoe 140. These results indicate that stimulation of bladder kinin B1 receptors evokes a local, tonic-type contraction with reflex contractions superimposed in both normal and inflamed bladders, but in the latter situation the motor responses are magnified.