Electrophysiological assessment of a peptide amphiphile nanofiber nerve graft for facial nerve repair.

Facial nerve injury can cause severe long-term physical and psychological morbidity. There are limited repair options for an acutely transected facial nerve not amenable to primary neurorrhaphy. We hypothesize that a peptide amphiphile nanofiber neurograft may provide the nanostructure necessary to guide organized neural regeneration. Five experimental groups were compared, animals with (1) an intact nerve, (2) following resection of a nerve segment, and following resection and immediate repair with either a (3) autograft (using the resected nerve segment), (4) neurograft, or (5) empty conduit. The buccal branch of the rat facial nerve was directly stimulated with charge balanced biphasic electrical current pulses at different current amplitudes whereas nerve compound action potentials (nCAPs) and electromygraphic responses were recorded. After 8 weeks, the proximal buccal branch was surgically reexposed and electrically evoked nCAPs were recorded for groups 1-5. As expected, the intact nerves required significantly lower current amplitudes to evoke an nCAP than those repaired with the neurograft and autograft nerves. For other electrophysiologic parameters such as latency and maximum nCAP, there was no significant difference between the intact, autograft, and neurograft groups. The resected group had variable responses to electrical stimulation, and the empty tube group was electrically silent. Immunohistochemical analysis and transmission electron microscopy confirmed myelinated neural regeneration. This study demonstrates that the neuroregenerative capability of peptide amphiphile nanofiber neurografts is similar to the current clinical gold standard method of repair and holds potential as an off-the-shelf solution for facial reanimation and potentially peripheral nerve repair.

Sexual dimorphism and hormone responsiveness in the spinal cord of the socially monogamous prairie vole (Microtus ochrogaster).

Prairie voles (Microtus ochrogaster) are exceptional among rodents in that many aspects of their brain and behavior are not masculinized by exogenous aromatizable androgens. However, the sexually differentiated endpoints studied to date rely on estrogenic mechanisms in other mammals. We examined whether sexual differentiation of an androgen receptor-dependent sex difference would be similarly distinct in prairie voles. Male mammals have more and larger motoneurons projecting to perineal muscles than do females. This sex difference normally arises from males' perinatal androgen exposure and can be eliminated by treating developing females with androgens. Gross dissection revealed bulbospongiosus muscles in adult male, but not female, prairie voles. Retrograde tracing from males' bulbocavernosus muscles and the external anal sphincter from both sexes revealed sexually dimorphic populations of labeled motoneurons in the ventral horn of the lumbar spinal cord. Similar to other rodents, males had twice as many motoneurons as females, although no sex difference in motoneuron size was detected. Unexpectedly, prenatal or early postnatal exposure to testosterone propionate had no effect on adult females' motoneuron number or size. In adulthood, gonadectomy alone or followed by chronic testosterone treatment also had no effect on females' motoneuron size or number, although castration reduced motoneuron size in males. Comparing gonadally intact weanlings confirmed that the sex difference in motoneuron number exists before adulthood. As with some other sexually dimorphic traits, and perhaps related to their unique social organization, sexual differentiation of the prairie vole spinal cord differs from that found in most other laboratory rodents.

Beneficial effect of rituximab monotherapy in multifocal motor neuropathy.

Multifocal motor neuropathy (MMN) is a chronic, pure motor, asymmetric neuropathy for which intravenous immunoglobulin (IVIg) is widely regarded as first-line treatment. Rituximab is a monoclonal antibody against CD20+ cells that causes prolonged B cell depletion, a well-tolerated therapy currently explored in several immune-mediated neurologic disorders. We report three patients with MMN, who had become increasingly less responsive to IVIg but showed sustained clinical improvement following rituximab monotherapy. We provide a review of the literature on rituximab for MMN and conclude that rituximab may represent an efficacious, well-tolerated and cost-effective therapeutic option for MMN patients with declining response to IVIg.

Neurotoxicity assessment using zebrafish.

INTRODUCTION: Transparency is a unique attribute of zebrafish that permits direct assessment of drug effects on the nervous system using whole mount antibody immunostaining and histochemistry. METHODS: To assess pharmacological effects of drugs on the optic nerves, motor neurons, and dopaminergic neurons, we performed whole mount immunostaining and visualized different neuronal cell types in vivo. In addition, we assessed neuronal apoptosis, proliferation, oxidation and the integrity of the myelin sheath using TUNEL staining, immunostaining and in situ hybridization. The number of dopaminergic neurons was examined and morphometric analysis was performed to quantify the staining signals for myelin basic protein and apoptosis. RESULTS: We showed that compounds that induce neurotoxicity in humans caused similar neurotoxicity in zebrafish. For example, ethanol induced defects in optic nerves and motor neurons and affected neuronal proliferation; 6-hydroxydopamine caused neuronal oxidation and dopaminergic neuron loss; acrylamide induced demyelination; taxol, neomycin, TCDD and retinoic acid induced neuronal apoptosis. DISCUSSION: Effects of drug treatment on different neurons can easily be visually assessed and quantified in intact animals. These results support the use of zebrafish as a predictive model for assessing neurotoxicity.

Assessment of motoneuron death during development following neonatal nerve crush and Mg2+ treatment.

BACKGROUND: Sciatic nerve injury in neonatal rats impairs muscle recovery and significantly reduces the number of surviving motoneurons. We examined the rate of motoneuron death after sciatic nerve crush in neonatal rats, as well as the neuroprotective effect of systemic MgSO4 administration, by assessing the number of horseradish peroxidase -labelled motoneurons in the spinal cord ventral horn, after injecting EDL and TA muscles. MATERIAL/METHODS: Left sciatic nerve crush was performed on the 2nd postnatal day. MgSO4 (0.05 ml of 1 M solution/10 g body weight) was administered subcutaneously, daily for twelve days. Animals were examined for the number of motoneurons of EDL and TA muscles, in the spinal cord ventral horns at 14, 21, and 28 days postnatally (P) and adulthood. 24 h to 48 h after intramuscular HRP injection, the animals were perfused transcardially with a fixative containing glutaraldehyde. Serial sections of the spinal cords were cut and processed for Hanker-Yates staining, and the number of labeled motoneurons was measured under a camera lucida. RESULTS: Nerve crush resulted in 37% motoneuron survival at P14, 33% at P21, 28% at P28 and 21% in adult rats. Following MgSO4 administration motoneuron survival rates of 51%, 47%, 44% and 39% were observed respectively, for the different age groups. The values obtained in magnesium-treated rats proved to be significantly different (p<0.05), compared to non-treated rats of the same age group. CONCLUSIONS: Nerve crush after birth resulted in significant motoneuron death, established already at P14. MgSO4 administration induced significant motoneuron survival.

Optical assessment of motoneuron function in a "twenty-four-hour" acute spinal cord slice model from fetal rats.

In acute slice preparations of most brain regions, neuronal functions are preserved for only few hours. Since the effects of growth factors or neurotoxic agents are often manifested beyond this time scale, corresponding studies are typically performed on cultured cells. However, cell cultures are generated and maintained under vastly different conditions that can grossly alter neuronal properties. For example, glutamate application to motoneuronal cultures has been reported to modulate neurite formation in some studies while in others it has been reported to kill cells. Here, we have examined whether acute spinal cord slices from rat fetuses can be used within a time window of 24 h for assessment of long-term effects of neuromodulators. In these slices, we have studied the action of glutamate on lumbar motoneurons loaded with fura-2 and rhodamine-123 to monitor intracellular Ca2+ ([Ca2+]i) and mitochondrial potential (Deltapsi), respectively. Further, loading with fura-2 or propidium iodide allowed for morphological assessment of cell viability and death, respectively. Pulses (15 s) or 1 h application of glutamate (300 microM) evoked a moderate (approximately 500 nM) [Ca2+]i rise, but no change of Deltapsi. Even after 24 h, no glutamate-induced cell death was observed and glutamate pulse-evoked [Ca2+]i transients were comparable to controls. The data demonstrate that glutamate does not deregulate [Ca2+]i homeostasis in fetal motoneurons in situ. We propose that acute spinal cord slices from perinatal rodents are a robust model that allows for analysis of neuronal properties and cell viability within a time window of at least 24 h.

[Interest of anesthetic blocks for assessment of the spastic patient. A series of 815 motor blocks]. / L'apport des blocs anesthésiques dans l'évaluation du patient spastique. A propos d'une serie de 815 blocs moteurs.

BACKGROUND: The purpose of the study was to emphasize the value of anesthetic blocks in the approach to the spastic patient. The report relates our experience concerning 566 patients (ranging in age from 4 to 72 years, mean 48 years) tested by 815 motor blocks performed within a "spasticity and dystonia evaluation" unit. The spasticity was mainly due to stroke (56%), cerebral palsy (21%) and traumatic brain injury (14%). METHODS: Motor blocks were performed with standardized procedure (specific needle, neurostimulator, localization technique), analytic and functional assessment. RESULTS: The anesthetic was mostly 1% non-adrenalized etidocaine, chosen for its onset and duration of action. Re-injections were few and side effects exceptional. Quality and motor blocks results were technique-dependent and required patient cooperation. The spasticity disappeared in blocked muscles. Tardieu and Ashworth modified scale showed constantly decreased spasticity (2 to 3 points) with better sensitivity for the Tardieu modified score. Local anesthetic blocks determined the relative contributions of overactivity and of muscle shortening in the generation of the pathologic posture, the muscle or muscles responsible for the spastic pattern and the level of active performance of the antagonistic muscle. New stability was evaluated by functional assessment of gait posture and prehension. CONCLUSION: At the present time, anesthetic motor blocks represent a necessary and decisive stage procedure as regards spastic patient assessment. This method is particularly useful to anticipate a new functional balance and simulate treatment. Motor blocks provide acute knowledge of the pathological pattern and a better adjustment of therapeutic directions.

Electromyographic assessment of ulnar nerve motor block induced by lidocaine.

STUDY OBJECTIVE: To determine the differences in the onset time and duration of motor block produced by lidocaine 1% and lidocaine 2% via a quantitative and objective method, the measurement of compound muscle action potentials (CMAPs). STUDY DESIGN: Prospective study. SETTING: Main operating rooms of a university hospital. PATIENTS: 20 consecutive patients undergoing surgery not requiring intraoperative muscle relaxation. INTERVENTIONS: General anesthesia with unilateral ulnar nerve block was administered. In patients' nondominant (experimental) arms, an insulated block needle was placed adjacent to the ulnar nerve at the wrist while continuous nerve stimulation was delivered to ensure its proper placement. Through this needle, lidocaine 1% or lidocaine 2% was injected. The dominant (control) arm received no injection. MEASUREMENTS AND MAIN RESULTS: Monitoring of ulnar nerve-evoked CMAPs was performed simultaneously on both arms. Ulnar nerve function was assessed at baseline and then at 10-second intervals by automatically measuring the amplitude of the evoked CMAPs on a two-channel electromyogram. The mean (+/- SEM) baseline CMAP amplitude prior to injection of lidocaine 1% was 3.10 +/- 0.87 mV and 3.06 +/- 0.89 mV for the experimental and control ulnar nerves, respectively (p = NS); for lidocaine 2%, baseline CMAP amplitude was 3.58 +/- 1.39 mV and 3.70 +/- 1.46 mV, respectively (p = NS). Over the course of the study, the control CMAP amplitude varied by < 12%. At the experimental ulnar nerve, 90% CMAP decrease after injection of lidocaine 1% and lidocaine 2% occurred 7.5 +/- 2 minutes and 5 +/- 1.5 minutes, respectively (p = NS), whereas maximal blockade was achieved after 15 +/- 3 minutes and 11 +/- 5 minutes, respectively (p = NS). Recovery of CMAP to 90% of baseline occurred 184 +/- 31 minutes after injection of lidocaine 1% and 248 +/- 30 minutes following lidocaine 2% (p = NS). CONCLUSION: The present study describes a technique that can be used in vivo to objectively measure the speed of onset and duration of local anesthetic-induced motor blockade. Although statistically not different, lidocaine 2% demonstrated a faster onset and longer duration of ulnar nerve motor block than lidocaine 1%.

Functional assessment of Ca(2+)-current in the mouse motor nerve terminals.

The purpose of this study was to characterize voltage-gated Ca2+ channels on the mouse motor nerve terminals. Mouse diaphragm and triangularis sterni preparations were used for this study in order to assess the functional Ca2+ channels in the transmitter release. The results showed that omega-conotoxin MVIIC (CTx-MVIIC, 0.5-1 microM) but not omega-conotoxin GVIA (1 mM) markedly inhibits not only the nerve-evoked muscle contractions accompanied by a decrease in the amplitude of end plate potentials (epps) in the mouse phrenic-nerve diaphragm but also the Ca(2+)-waveforms in the nerve terminals of triangularis sterni. The inhibitory effects of CTx-MVIIC were considered to be specifically presynaptic rather than myogenic, since none of the electrical properties of muscle fibers including action potentials, resting membrane potentials and the miniature endplate potential, were affected. Moreover, Na(+)- and K(+)-waveforms of the nerve terminals were unaffected by CTx-MVIIC. At a saturating concentration of 3-5 mM, CTx-MVIIC exerted a maximal inhibitory effect by 38% of 3,4-diaminopyridine-prolonged epps area and inhibited only the slow component of Ca(2+)-current, respectively, and the remaining fast component could be inhibited by subsequent addition of cadmium chloride (Cd2+). All of these findings indicate that at least two components (a slow CTx-MVIIC sensitive component and a fast Cd2+ sensitive component) of the mouse motor nerve terminals would cooperate in the induction of the transmitter release from motor nerve endings.

Assessment of the neurotoxicity of styrene, styrene oxide, and styrene glycol in primary cultures of motor and sensory neurons.

The neurotoxicity of styrene and its major metabolites, styrene oxide and styrene glycol, was investigated in dissociated primary cultures of murine spinal cord-dorsal root ganglia (DRG)-skeletal muscle using morphological and electrophysiological endpoints. Styrene and styrene oxide (but not styrene glycol) were acutely cytotoxic to both neuronal and non-neuronal cells in the cultures; concentrations in excess of 2 and 0.2 mM, respectively, induced blebbing, vacuolation, detachment from the substratum and cell death in neuronal and non-neuronal cells within 4 days. No effects on neuronal morphology were observed in cultures treated with sublethal concentrations of styrene or styrene oxide for up to 3 weeks. The results suggest that oxidation of multiple cellular macromolecules that underlies the toxicity of styrene in other organ systems may also be responsible for damage to cells in the nervous system. No changes in action potential production indicative of a 'solvent effect' on membrane electrical properties was apparent in cultures treated with up to 8 mM styrene or 10 mM styrene glycol.

Assessment of exposure to arsenic among smelter workers: a five-year follow-up.

In a group of 43 smelter workers exposed to inorganic arsenic dust for 13-45 years, nerve conduction velocities (NCVs) were significantly lower in two peripheral nerves as compared with matching referents. With multivariate data analysis, a significant negative correlation was found between cumulative absorption of arsenic and NCV in four examined nerves and the sural amplitude. Clinical symptoms of neuropathy and other symptoms related to arsenic exposure were moderate, though the difference between the groups was significant. The mean total absorption of arsenic was calculated to be less than 5 g, and the maximal absorption about 20 g. These data indicate that the adverse effect of arsenic on the peripheral nerves is dependent on long-term exposure rather than on short-term fluctuations in exposure levels.

A rat sciatic nerve model for independent assessment of sensory and motor block induced by local anesthetics.

The purpose of this study was to develop a reliable model to independently quantify motor and sensory block produced by local anesthetics. The sciatic nerve was blocked in 52 rats by injecting 0.2 mL of 0.125%, 0.25%, 0.5%, or 0.75% bupivacaine (n = 13 for each concentration). Accurate needle placement was achieved using a nerve stimulator at 0.2 mA and 1 Hz. Ten control rats received 0.9% saline (n = 5) or sham nerve stimulation (n = 5). Motor block was assessed by measuring hindpaw grip strength with a dynamometer. Sensory block was determined by measuring hindpaw withdrawal latency from radiant heat. The intensity of both motor and sensory block measured at 30-min intervals was plotted against time until full recovery to obtain the area under the curve. Intergroup comparisons using analysis of variance showed increasing area under the curve with increasing concentrations of bupivacaine for motor blocks (P < 0.05 for all intergroup comparisons except 0.5% vs 0.75%) and sensory blocks (P < 0.05 for all intergroup comparisons). Normal saline or sham nerve stimulation did not result in any motor or sensory block.

Clinical, biochemical, electrophysiologic, and histologic assessment of chlorpyrifos induced delayed neuropathy in the cat.

The ability of a supralethal dose of chlorpyrifos to produce delayed neuropathy was examined using assessments of clinical signs, electromyography (EMG), motor nerve conduction velocity (MNCV), lymphocyte neuropathy target esterase activity (LNTE), and histologic changes in nervous system tissues. Cats were exposed to a single, im injection of corn oil (vehicle control), DFP (positive control) at 5.0 mg/kg, or chlorpyrifos at 300 mg/kg and observed for 60 days. Atropine and 2-PAM were administered to chlorpyrifos exposed cats one to two times a day for 14 to 24 days in response to the appearance of cholinergic signs. Anorectic cats during the acute toxicosis were force fed by hand and hydration was maintained by administering fluids sc. Onset of ataxia (mean +/- SD) for the positive control and chlorpyrifos exposed cats were 16.2 +/- 1.8 days (range of 14-19 days) and 19.0 +/- 1.4 days (range of 17-21 days), respectively. Functional deficits for both groups were confined to the hindlimbs and characterized by a crouched-waddling gait, hypermetria, and proprioceptive deficits. Maximal inhibition of LNTE activity was 96% at 24 hr postdosing in the positive control group and 46% at 7 days postdosing in the chlorpyrifos group. No EMG or MNCV abnormalities were detected in any of the treatment groups. Axonal degeneration was similar for the positive control and chlorpyrifos exposed cats. Ascending tracts of the cervical spinal cord and descending tracts of the thoracic and lumbar spinal cord were most severely affected and peripheral nerves were only mildly affected. The clinical and histologic effects produced indicate that chlorpyrifos can cause delayed neuropathy in the domestic cat. The moderate but prolonged inhibition of LNTE produced by chlorpyrifos is atypical of classic organophosphorus delayed neurotoxicants.

Retrograde transport of nerve growth factor (NGF) in motoneurons of developing rats: assessment of potential neurotrophic effects.

The potential functional significance of nerve growth factor (NGF) receptors in spinal motoneurons was studied in newborn rats. 125I-NGF was specifically retrogradely transported by motoneurons from their peripheral nerve terminals. This transport was blocked by an excess of unlabeled NGF but not by cytochrome c. 125I-cytochrome c was not transported. The monoclonal anti-rat NGF receptor antibody, but not a control antibody, was also transported. Despite this ability of motoneurons to transport NGF, treatment of newborn rats with this factor did not increase motoneuron size or synthesis of neurotransmitter enzymes and did not prevent cell death after axotomy. We conclude that NGF receptors of spinal motoneurons can bind, internalize, and retrogradely transport NGF. However, these receptors do not mediate the classic trophic effects of NGF.