Making sense of music: Insights from neurophysiology and connectivity analyses in naturalistic listening conditions.

According to the latest frameworks, auditory perception and memory involve the constant prediction of future sound events by the brain, based on the continuous extraction of feature regularities from the environment. The neural hierarchical mechanisms for predictive processes in perception and memory for sounds are typically studied in relation to simple acoustic features in isolated sounds or sound patterns inserted in highly certain contexts. Such studies have identified reliable prediction formation and error signals, e.g., the N100 or the mismatch negativity (MMN) evoked responses. In real life, though, individuals often face situations in which uncertainty prevails and where making sense of sounds becomes a hard challenge. In music, not only deviations from predictions are masterly set up by composers to induce emotions but sometimes the sheer uncertainty of sound scenes is exploited for aesthetic purposes, especially in compositional styles such as Western atonal classical music. In very recent magnetoencephalography (MEG) and electroencephalography (EEG) studies, experimental and technical advances in stimulation paradigms and analysis approaches have permitted the identification of prediction-error responses from highly uncertain, atonal contexts and the extraction of prediction-related responses from real, continuous music. Moreover, functional connectivity analyses revealed the emergence of cortico-hippocampal interactions during the formation of auditory memories for more predictable vs. less predictable patterns. These findings contribute to understanding the general brain mechanisms that enable us to predict even highly uncertain sound environments and to possibly make sense of and appreciate even atonal music.

Effect of electroacupuncture on brachial plexus post-traumatic neuralgia: A case report.

Background: Brachial plexus injury is a serious peripheral nerve injury that severely disables upper limbs and affects patients' daily life and work Acupuncture and Electroacupuncture have traditionally been used to treat neuropathic pain. However, there is still lacking evidence as regard to their effects on pain following traumatic nerve and plexus lesions. Neurotmesis after brachial plexus injury also causes movement disorders of the denervated muscles and loss of sensory function in the skin. Case report: We report a case of a brachial plexus injury due to humeral fracture, predominantly involving the lower trunk and the medial cord, treated with electroacupuncture. Results. We documented a positive significant response, based on clinical examination, pain scores and neurophysiologic findings. Conclusions: Repeated Electroacupuncture can relieve neuropathic pain due to brachial plexus injury. However, additional studies are needed to verify the efficacy and effectiveness of this approach.

Restless Legs Syndrome and Periodic Limb Movements of Sleep: From Neurophysiology to Clinical Practice.

SUMMARY: This article summarizes restless legs syndrome (RLS), periodic limb movements of sleep, and periodic limb movement disorder. RLS is a common sleep disorder with a prevalence of 5% to 15% in the general population. RLS can present in childhood, and incidence increases with age. RLS can be idiopathic or secondary to iron deficiency, chronic renal failure, peripheral neuropathy, and medications such as antidepressants (with higher rates for mirtazapine and venlafaxine, while bupropion may reduce symptoms at least in the short term), dopamine antagonists (neuroleptic antipsychotic agents and antinausea medications), and possibly antihistamines. Management includes pharmacologic agents (dopaminergic agents, alpha-2 delta calcium channel ligands, opioids, benzodiazepines) and nonpharmacologic therapies (iron supplementation, behavioral management). Periodic limb movements of sleep are an electrophysiologic finding commonly accompanying RLS. On the other hand, most individuals with periodic limb movements of sleep do not have RLS. The clinical significance of the movements has been argued. Periodic limb movement disorder is a distinct sleep disorder that arises in individuals without RLS and is a diagnosis of exclusion.

ERD modulations during motor imageries relate to users' traits and BCI performances.

Improving user performances is one of the major issues for Motor Imagery (MI) - based BCI control. MI-BCIs exploit the modulation of sensorimotor rhythms (SMR) over the motor and sensorimotor cortices to discriminate several mental states and enable user interaction. Such modulations are known as Event-Related Desynchronization (ERD) and Synchronization (ERS), coming from the mu (7-13 Hz) and beta (15-30 Hz) frequency bands. This kind of BCI opens up promising fields, particularly to control assistive technologies, for sport training or even for post-stroke motor rehabilitation. However, MI - BCIs remain barely used outside laboratories, notably due to their lack of robustness and usability (15 to 30% of users seem unable to gain control of an MI-BCI). One way to increase user performance would be to better understand the relationships between user traits and ERD/ERS modulations underlying BCI performance. Therefore, in this article we analyzed how cerebral motor patterns underlying MI tasks (i.e., ERDs and ERSs) are modulated depending (i) on nature of the task (i.e., right-hand MI and left-hand MI), (ii) the session during which the task was performed (i.e., calibration or user training) and (iii) on the characteristics of the user (e.g., age, gender, manual activity, personality traits) on a large MI-BCI data base of N=75 participants. One of the originality of this study is to combine the investigation of human factors related to the user's traits and the neurophysiological ERD modulations during the MI task. Our study revealed for the first time an association between ERD and self-control from the 16PF5 questionnaire.

Unpredictability of the "when" influences prediction error processing of the "what" and "where".

The capability to establish accurate predictions is an integral part of learning. Whether predictions about different dimensions of a stimulus interact with each other, and whether such an interaction affects learning, has remained elusive. We conducted a statistical learning study with EEG (electroencephalography), where a stream of consecutive sound triplets was presented with deviants that were either: (a) statistical, depending on the triplet ending probability, (b) physical, due to a change in sound location or (c) double deviants, i.e. a combination of the two. We manipulated the predictability of stimulus-onset by using random stimulus-onset asynchronies. Temporal unpredictability due to random onsets reduced the neurophysiological responses to statistical and location deviants, as indexed by the statistical mismatch negativity (sMMN) and the location MMN. Our results demonstrate that the predictability of one stimulus attribute influences the processing of prediction error signals of other stimulus attributes, and thus also learning of those attributes.

The Influence of Modern Neurophysiology on the Previous Definitions of "Segment" and "Interference Field" in Neural Therapy.

BACKGROUND: In neural therapy, local anesthetics are injected for diagnostic and therapeutic purposes. In this process, therapy makes use of the regulatory functions and plastic properties of the nervous system, especially its autonomic part. Up until now, a distinction has been made between "local/segmental neural therapy" and "interference field therapy." This division dating back to the middle of the last century was based on the assumption that anatomical and clinical segments were identical. However, this is only true for the projection symptoms, which are limited to metamerism. All pathophysiological processes beyond this segment were called "interference field events" ("outside of any segmental order" and "not explainable by neuroanatomical circuitry"). SUMMARY: However, modern neurophysiology no longer recognizes segmental boundaries, taking into account the occurrence of cross-segmental sensitization processes, neuroplastic changes, immune processes, and neurogenic inflammation. In addition, new insights into neuroanatomical circuitry have also contributed to segmental expansion. Thus, in recent years, much of the interference field activity has been assigned to an "extended" segment; however, even there, no segment boundaries can be defined. Thus, the former definition of the interference field effect (considered to be outside any segmental order) is considered obsolete. Nowadays, interference fields are called "neuromodulatory triggers." They can act anywhere, both locally and fairly distant, and even systemically. KEY MESSAGES: Thus, it is no longer tenable to classify interference field therapy as "unscientific" and "not recognized" while local and segmental neural therapy is being scientifically recognized. In the work at hand, the interference fields discovered by the Huneke brothers become scientifically definable as "neuromodulatory triggers" by showing that clinically and pathologically, hardly any segmental boundaries exist.

Thalamocortical Dysconnectivity In Lifelong Premature Ejaculation: A Functional MRI Study.

OBJECTIVES: To detect seed-based functional connectivity (FC) between various cortical sub-regions and the thalamus in lifelong premature ejaculation (LPE) patients and explore whether specific thalamocortical networks are significantly altered in PE patients compared to healthy controls (HCs) METHODS: Fifty non-medicated LPE patients and 40 age-matched HCs underwent a resting-state functional MRI. FC was adopted to identify specific thalamocortical connectivity between the thalamus and 6 cortical regions of interest (i.e., the motor cortex/supplementary motor, the prefrontal cortex, the temporal lobe, the posterior parietal cortex, the somatosensory cortex and the occipital lobe). In LPE patients, regression analysis was subsequently conducted to assess relationships of thalamocortical connectivity with the Premature Ejaculation Diagnostic Tool (PEDT) score and the Intravaginal Ejaculatory Latency Time (IELT). RESULTS: LPE patients had significantly decreased FC between the motor cortex and bilateral ventral thalamus, between the prefrontal cortex and left dorsomedial thalamus, as well as between the temporal cortex and bilateral ventromedial thalamus. In LPE patients, PEDT score was significantly positively associated with the thalamus-posterior parietal cortex FC, and negatively associated with the thalamus-temporal cortex FC, while IELT was positively associated with the thalamus-temporal cortex and thalamus-motor cortex FC. CONCLUSION: These results enrich the imaging evidence for the understanding of the neurobiological mechanisms and/or consequences of LPE.

Neuroauriculotherapy: Framework and Remarks for a possible use in Voice Medicine / Neuroauriculoterapia: marco y observaciones para un posible uso en medicina de la voz

Aim. Neuroauriculotherapy (NAT) is a branch of medicine, which, thanks to its diagnostic and therapeutic value, is a powerful tool at the service of both physician and patient. In our experience, as it is discussed in this article, neuroauriculotherapy can have successful applications in voice science and in phoniatrics. The aim of this article is to open a discussion about possible applications of neuroauriculotherapy in voice medicine. Introduction. From the diagnostic point of view, it is possible to explore, with a palpeur (i.e., a tool that provides a constant pressure) or a "spot-hunter", the presence of a perturbation into a particular organ or area, and its return to normal during treatment. Indeed, at the level of the ear auricle, representations of an organ, its in-nervation, its muscular components, etc., are fixed. These spots or voxels correspond absolutely to the respective sensory, motor, visceral, among other spots. Therefore, if any abnormal potential comes from the periphery, it will illuminate the spots both at the cortical level and in the pavilion ­a real display with a constantly active touch screen. The spot can be treated with needles in the context of a neurophysiological strategy to send a message to the brain.Reflection. NAT appears to be a good method to improve the treatment of voice problems, enhancing the results of other therapies based on drugs or rehab and in-ducing relaxation. In neuroauriculotherapy, the ear is used to give the brain orders in a process which has a logical basis in neurophysiology.Conclusion. Diseases of the vocal tract can be dysfunctional or organic. According to our clinical experience, we can say that neuroauriculotherapy can be used in both cases. Neuroauriculotherapy is also extremely effective in voice therapy, both alone and in combination with other therapies, as there is no conflict among them

Objetivo. La neuroauriculoterapia (NAT) es una rama de la medicina que, gracias a su valor diagnóstico y terapéutico, constituye una poderosa herramienta al servicio del médico y del paciente. En nuestra experiencia, como se comenta en este artículo, la neuroauriculoterapia puede tener aplicaciones exitosas en la ciencia de la voz y en foniatría. El objetivo de este artículo es abrir una discusión sobre las posibles aplica-ciones de la neuroauriculoterapia en la medicina de la voz.Introducción. Desde el punto de vista del diagnóstico, es posible explorar, con un palpeur (i.e., una herramienta que proporciona una presión constante) o un "spot-hunter", la presencia de una perturbación en un órgano o área en particular, y su retorno a la normalidad durante el tratamiento. En efecto, a nivel del pabellón auricular se fijan representaciones de un órgano, su inervación, sus componentes musculares, etc. Estos puntos o vóxeles corresponden absolutamente a los respectivos puntos sensoriales, motores, viscerales, entre otros. Por lo tanto, si algún potencial anormal proviene de la periferia, iluminará los puntos tanto a nivel cortical como en el pabellón ­una pantalla real con una pantalla táctil constantemente activa. El punto se puede tratar con agujas en el contexto de una estrategia neurofisiológica para enviar un mensaje al cerebro.Reflexión. NAT parece ser un buen método para mejorar el tratamiento de los problemas de voz, potenciando los resultados de otras terapias basadas en fármacos o rehabilitación e induciendo a la relajación. En neuroauriculoterapia se utiliza el oído para dar órdenes al cerebro en un proceso que tiene una base lógica en la neurofisiología.Conclusión. Las enfermedades del tracto vocal pueden ser disfuncionales u orgáni-cas. Según nuestra experiencia clínica, podemos decir que la neuroauriculoterapia se puede utilizar en ambos casos. La neuroauriculoterapia también es extremadamente eficaz en la terapia de la voz, tanto sola como en combinación con otras terapias, ya que no existe conflicto entre ellas

Characterizing the postnatal hypothalamic-pituitary-adrenal axis response of in utero heat stressed pigs at 10 and 15 weeks of age.

In utero heat stress alters postnatal physiological and behavioral stress responses in pigs. However, the mechanisms underlying these alterations have not been determined. The study objective was to characterize the postnatal hypothalamic-pituitary-adrenal axis response of in utero heat-stressed pigs. Pigs were subjected to a dexamethasone suppression test followed by a corticotrophin releasing hormone challenge at 10 and 15 weeks of age. Following the challenge, hypothalamic, pituitary, and adrenal tissues were collected from all pigs for mRNA abundance analyses. At 10 weeks of age, in utero heat-stressed pigs had a reduced (P < 0.05) cortisol response to the corticotrophin releasing hormone challenge versus controls. Additionally, the cortisol response tended to be greater overall (P < 0.10) in 15 versus 10-week-old pigs in response to the dexamethasone suppression test. The cortisol response tended to be reduced overall (P < 0.10) in 15 versus 10-week-old pigs in response to the corticotrophin releasing hormone challenge. Hypothalamic corticotropin releasing hormone mRNA abundance tended to be greater (P < 0.10) in in utero heat-stressed versus control pigs at 15-weeks of age. In summary, in utero heat stress altered some aspects of the hypothalamic-pituitary-adrenal axis related to corticotropin releasing hormone signaling, and age influenced this response.

Gamma-Band Auditory Steady-State Response as a Neurophysiological Marker for Excitation and Inhibition Balance: A Review for Understanding Schizophrenia and Other Neuropsychiatric Disorders.

Altered gamma oscillations have attracted considerable attention as an index of the excitation/inhibition (E/I) imbalance in schizophrenia and other neuropsychiatric disorders. The auditory steady-state response (ASSR) has been the most robust probe of abnormal gamma oscillatory dynamics in schizophrenia. Here, we review recent ASSR studies in patients with schizophrenia and other neuropsychiatric disorders. Preclinical ASSR research, which has contributed to the elucidation of the underlying pathophysiology of these diseases, is also discussed. The developmental trajectory of the ASSR has been explored and may show signs of the maturation and disruption of E/I balance in adolescence. Animal model studies have shown that synaptic interactions between parvalbumin-positive GABAergic interneurons and pyramidal neurons contribute to the regulation of E/I balance, which is related to the generation of gamma oscillation. Therefore, ASSR alteration may be a significant electrophysiological finding related to the E/I imbalance in neuropsychiatric disorders, which is a cross-disease feature and may reflect clinical staging. Future studies regarding ASSR generation, especially in nonhuman primate models, will advance our understanding of the brain circuit and the molecular mechanisms underlying neuropsychiatric disorders.

Evolution from four mental states to the highest state of consciousness: A neurophysiological basis of meditation as defined in yoga texts.

This chapter provides a theoretical introduction to states of consciousness and reviews neuroscientific investigations of meditation. The different states of consciousness consist of four mental states, i.e., cancalata (random thinking), ekagrata (non-meditative focusing), dharna (focused meditation), and dhyana (meditation) as defined in yoga texts. Meditation is a self-regulated mental process associated with deep relaxation and increased internalized attention. Scientific investigations on meditation reported changes in electrophysiological signals and neuroimaging measures. But most outcomes of meditation studies showed inconsistent results, this may be due to heterogeneity in meditation methods and techniques evolved in the last 200 years. Traditionally, the features of meditation include the capacity to sustain a heightened awareness of thoughts, behaviors, emotions, and perceptions. Generally, meditation involves non-reactive effortless monitoring of the content of experience from moment to moment. Focused meditation practice involves awareness on a single object and open monitoring meditation is a non-directive meditation involved attention in breathing, mantra, or sound. Therefore, results of few empirical studies of advanced meditators or beginners remain tentative. This is an attempt to compile the meditation-related changes in electrophysiological and neuroimaging processes among experienced and novice practitioners.

Neurophysiology of human touch and eye gaze in therapeutic relationships and healing: a scoping review.

OBJECTIVE: The primary objective of this scoping review was to examine and map the range of neurophysiological impacts of human touch and eye gaze, and consider their potential relevance to the therapeutic relationship and to healing. INTRODUCTION: Clinicians, and many patients and their relatives, have no doubt as to the efficacy of a positive therapeutic relationship; however, much evidence is based on self-reporting by the patient or observation by the researcher. There has been little formal exploration into what is happening in the body to elicit efficacious reactions in patients. There is, however, a growing body of work on the neurophysiological impact of human interaction. Physical touch and face-to-face interaction are two central elements of this interaction that produce neurophysiological effects on the body. INCLUSION CRITERIA: This scoping review considered studies that included cognitively intact human subjects in any setting. This review investigated the neurophysiology of human interaction including touch and eye gaze. It considered studies that have examined, in a variety of settings, the neurophysiological impacts of touch and eye gaze. Quantitative studies were included as the aim was to examine objective measures of neurophysiological changes as a result of human touch and gaze. METHODS: An extensive search of multiple databases was undertaken to identify published research in the English language with no date restriction. Data extraction was undertaken using an extraction tool developed specifically for the scoping review objectives. RESULTS: The results of the review are presented in narrative form supported by tables and concept maps. Sixty-four studies were included and the majority were related to touch with various types of massage predominating. Only seven studies investigated gaze with three of these utilizing both touch and gaze. Interventions were delivered by a variety of providers including nurses, significant others and masseuses. The main neurophysiological measures were cortisol, oxytocin and noradrenaline. CONCLUSIONS: The aim of this review was to map the neurophysiological impact of human touch and gaze. Although our interest was in studies that might have implications for the therapeutic relationship, we accepted studies that explored phenomena outside of the context of a nurse-patient relationship. This allowed exploration of the boundary of what might be relevant in any therapeutic relationship. Indeed, only a small number of studies included in the review involved clinicians (all nurses) and patients. There was sufficient consistency in trends evident across many studies in regard to the beneficial impact of touch and eye gaze to warrant further investigation in the clinical setting. There is a balance between tightly controlled studies conducted in an artificial (laboratory) setting and/or using artificial stimuli and those of a more pragmatic nature that are contextually closer to the reality of providing nursing care. The latter should be encouraged.

A novel simplistic fabrication technique for cranial epidural electrodes for chronic recording and stimulation in rats.

BACKGROUND: The demand for neuromodulatory and recording tools has resulted in a surge of publications describing techniques for fabricating devices and accessories in-house suitable for neurological recordings. However, many of these fabrication protocols use equipment which are not common to biological laboratories, thus limiting researchers to the use of commercial alternatives. New method:We have developed a simple yet robust implantable stimulating surface electrode which can be fabricated in all wet-bench laboratories. RESULTS: Female Sprague-Dawley rats received epidural implantation of the electrodes over the fore and hind limb areas of their motor cortex. Stimulation of the motor cortex successfully evoked fore- and hind limb motor outputs. The device was also able to record surface potentials of the motor cortex following epidural stimulation of the spinal cord. Comparisons with existing methods:For stimulation of the motor cortex, often stiff stainless or copper wires are roughly tucked underneath the skull, with little accuracy of localization. While, commercially available devices utilize burr holes and screw electrodes. Our new electrode design provides us stereotaxic accuracy that was not previously available. CONCLUSION: We developed a chronic implantable electrode capable of being fabricated in all wet-labs, are robust, versatile and electrically sensitive enough for long-term chronic use. The simple and versatile electrode design provides scientific, economical and ethical benefits.

The Neurophysiological Effect of Acoustic Stimulation with Real-time Sleep Spindle Detection.

Sleep spindle is a salient brain activity found in the sigma frequency range (11-16 Hz) during sleep stage 2. It has been demonstrated that sleep spindle is related to memory consolidation, neurodegenerative disease, and mental disorders. Slow wave activity (0.5-4 Hz) is the most prominent EEG activity during sleep and appears as a large, spontaneous synchronization of cortical neurons. The role of slow wave activity has been proposed to regulate synaptic strength and memory consolidation. Many studies have investigated the effect of acoustic stimuli during the sleep slow wave. However, there have been few studies which investigated an effect of acoustic stimulation during sleep spindle activity. In this study, we examined the neurophysiological effect of acoustic stimulation during sleep spindle activity. We delivered pink noise after the detection of sleep spindle, and surmised that acoustic stimulation after sleep spindle detection may preserve delta activity during ongoing sleep. Further, we observed suppression of the sleep spindle activity around the times of acoustic stimulation and evoked slow wave activity and theta band activity immediately after tone onset.

Epilepsia, Mozart y su sonata K.448: ¿es terapéutico el "efecto Mozart"? / Epilepsy, Mozart and his sonata K.448: is the 'Mozart effect' therapeutic?

Objetivos. Presentar una revisión del denominado "efecto Mozart", explicar por qué se eligió a Mozart y su sonata K.448, y repasar la bibliografía disponible sobre el tratamiento de la epilepsia con la citada sonata. Desarrollo. Existe abundante bibliografía sobre los mecanismos cerebrales que nos permiten percibir, procesar y responder al estímulo musical. También se ha demostrado la plasticidad cerebral que, en especial el adiestramiento musical, desencadena. El «efecto Mozart» se planteó a raíz de la comprobación de que la audición de la sonata K.448 mejoraba habilidades cognitivas, pero el hecho de que esos resultados se puedan deber no a la música en sí, sino a que el oyente aumente su nivel de alerta o disfrute con ella, generó controversia. En este contexto de debate se publicó un volumen importante de estudios sobre el «efecto Mozart» en el campo de la epilepsia, que se repasan en este trabajo. Conclusiones. El «efecto Mozart» tiene base científica, pero su propia naturaleza limita la calidad metodológica de los estudios. La música de Mozart, elegida por su exquisita estructura, ha podido aumentar aún más la polémica porque también resulta del gusto de una gran mayoría. Aún está lejos de consolidarse como tratamiento antiepiléptico no farmacológico, pero podría aumentar la evidencia científica con estudios cuyo diseño minimice los factores de confusión citados (AU)

Aims. To present a review of the so-called 'Mozart effect', to explain why Mozart and his sonata K.448 were chosen, and to review the available literature on the treatment of epilepsy with that sonata. Development. Profuse literature exists on the cerebral mechanisms that allow us to perceive, process and respond to the musical stimulus. Cerebral plasticity, especially in people with musical training, has also been demonstrated. The 'Mozart effect' arose from the finding that hearing the sonata K.448 improved cognitive abilities, but the fact that these results may be due not to the music itself but to the listener increasing arousal or enjoyment generated controversy. In this context of debate, a large number of papers about the 'Mozart effect' in the field of epilepsy were published, and are reviewed in this work. Conclusions. The ‘Mozart effect’ has a scientific basis but its nature limits the methodological quality of the research. The music of Mozart, chosen for its exquisite structure, has been able to increase even more the controversy because also it is of the taste of a great majority. It is still far from being consolidated as a non-pharmacological antiepileptic treatment, but it could increase the scientific evidence with studies whose design minimizes the cited confounding factors (AU)

Shedding light on the fundamental mechanism underlying hypnotic analgesia.

Owing to the increasing importance of clinical hypnosis in pain therapy and palliative care, there is a growing interest in uncovering the mechanism underlying hypnotic analgesia. The neurophysiological findings suggest that the hypnotic state is associated with an altered operating mode of the brain that is clearly different from the normal operating mode. While in the normal operating mode a dolorogenic stimulus induces a highly synchronized large-scale activity pattern that leads to the experience of pain, the altered operating mode inhibits the synchronization of spatially divided brain regions. As a consequence, the conscious experience of pain cannot arise. In order to gain a deeper understanding of the mechanism, a novel theoretical framework is made use of. It accepts consciousness as a fundamental property of the universe and is based on the hypothesis that the whole range of phenomenal qualities is built into the frequency spectrum of a ubiquitous background field. The body of evidence supports the view that in the normal operating mode our brains act as filters that extract the plethora of phenomenal nuances selectively from this field. In the altered operating mode, which establishes under hypnotic conditions, the extraction of phenomenal qualities is partially prevented. From this perspective, hypnotic analgesia is due to an impairment of the fundamental mechanism underlying conscious perception.

Update on the Pathophysiology and Management of Anorectal Disorders

Anorectal disorders are common and present with overlapping symptoms. They include several disorders with both structural and functional dysfunction(s). Because symptoms alone are poor predictors of the underlying pathophysiology, a diagnosis should only be made after evaluating symptoms and physiologic and structural abnormalities. A detailed history, a thorough physical and digital rectal examination and a systematic evaluation with high resolution and/or high definition three-dimensional (3D) anorectal manometry, 3D anal ultrasonography, magnetic resonance defecography and neurophysiology tests are essential to correctly identify these conditions. These physiological and imaging tests play a key role in facilitating a precise diagnosis and in providing a better understanding of the pathophysiology and functional anatomy. In turn, this leads to better and more comprehensive management using medical, behavioral and surgical approaches. For example, patients presenting with difficult defecation may demonstrate dyssynergic defecation and will benefit from biofeedback therapy before considering surgical treatment of coexisting anomalies such as rectoceles or intussusception. Similarly, patients with significant rectal prolapse and pelvic floor dysfunction or patients with complex enteroceles and pelvic organ prolapse may benefit from combined behavioral and surgical approaches, including an open, laparoscopic, transabdominal or transanal, and/or robotic-assisted surgery. Here, we provide an update on the pathophysiology, diagnosis, and management of selected common anorectal disorders.