Attack-related brainstem activation in a patient with SUNCT syndrome: an ictal fMRI study.

The authors report functional magnetic resonance imaging (fMRI) study data of a 60-year-old patient having short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome. Three consecutive pain attacks were detected during the imaging session and strong brainstem activation was found. It was concluded that the brainstem can be involved in the pain signal transmission in SUNCT syndrome.

Investigation of specificity of auricular acupuncture points in regulation of autonomic function in anesthetized rats.

Auricular acupuncture has been used for various autonomic disorders in clinical practice. It has been theorized that different auricular areas have distinct influence on autonomic functions. The present study aims to examine the effects of acupuncture stimulation at different auricular areas on cardiovascular and gastric responses. In male Sprague-Dawley rats anesthetized with pentobarbital sodium, five auricular areas, which were located at the apex of the helix (A(1)), the middle of the helix (A(2)), the tail of the helix (A(3)), the inferior concha (A(4)) and the middle of the antihelix (A(5)), had been selected for stimulation with manual acupuncture (MA) and different parameters of electroacupuncture (EA). A mild depressor response (6%-12% decrease from baseline) was evoked from A(1), A(3) and A(4) by MA and from all five areas by EA (100 Hz-1 mA). The biggest depressor response (-18.4+/-3.1 mmHg, p<0.001) was evoked from A(4). A small bradycardia was evoked by MA from A(4) and by EA at A(3), A(4) and A(5.) Increase in intragastric pressure (8-14 mmH(2)O) was evoked by MA from A(1), A(3) and A(4) and by EA at A(2.) These results show that similar patterns of cardiovascular and gastric responses could be evoked by stimulation of different areas of the auricle. The present results do not support the theory of a highly specific functional map in the ear. Rather, there is a similar pattern of autonomic changes in response to auricular acupuncture, with variable intensity depending on the area of stimulation.

Tearing without pain after trigeminal root section for cluster headache.

The cranial autonomic symptoms (CAS) in patients with cluster headache (CH) are considered to occur as a result of intense ophthalmic division pain. Five CH patients underwent transection of the trigeminal nerve root but continued to experience periodic CAS without pain, whereas another five patients continued to experience typical cluster headaches. These findings confirm that CH is generated by a central pacemaker and the pain may be expressed without activation of the peripheral trigeminovascular network.

Intraoperative identification and neurophysiologic parameters to verify pelvic autonomic nerve function during total mesorectal excision for rectal cancer.

BACKGROUND: Preservation of parasympathetic and sympathetic nerves is required to avoid urogenital function disturbances after total mesorectal excision (TME) for rectal carcinoma. This study sought to determine whether intraoperative stimulation of parasympathetic nerves with monitoring of bladder contraction is useful in meeting this demand. STUDY DESIGN: In a prospective pilot study, 17 patients, 11 men and 6 women, underwent TME with pelvic autonomic nerve preservation performed by an experienced surgeon. The parasympathetic nerves were stimulated by an electrostimulation device (Screener 3625, Medronic), and the resulting bladder contraction was measured manometrically in all patients. Variations in pulse rate and voltage were measured to determine optimal stimulation parameters. A standardized questionnaire was used to record urogenital function disturbances. Residual urine volume was measured by ultrasound pre- and postoperatively. Shortterm outcomes data were evaluated to establish a possible association between intraoperative test results and postoperative bladder function. RESULTS: In 15 of 17 patients undergoing TME with pelvic autonomic nerve preservation for rectal carcinoma, the parasympathetic nerves were identified based on nerve stimulation-induced bladder contraction. Two patients with negative results on intraoperative nerve stimulation had persisting bladder dysfunction requiring an indwelling catheter after discharge from hospital. In spite of a short median followup of 2 months (range 1 to 4 months), in 7 of 10 men with intact erectile function prior to surgery, postoperative erectile dysfunction could be excluded. The study showed a pulse rate of 35 Hz and an electric potential of 12 V to be optimal stimulation parameters, associated with a mean intravesical pressure rise of 12.7 cm H(2)O (range 2.8 to 18.0 cm H(2)O). CONCLUSIONS: Intraoperative nerve stimulation with monitoring of intravesical pressure represents a technically simple procedure for the identification and verification of function of pelvic parasympathetic nerves during TME for rectal carcinoma.

Use of chronic sacral nerve stimulation in neurological voiding disorders.

AIM: Neurogenic low urinary tract dysfunctions unresponsive to medical and conservative therapy are difficult to manage. Nowadays they can be treated with Sacral Nerve Stimulation (SNS), even if clinical experiences reported in literature are still limited. METHODS: We performed SNS in 6 patients with neurogenic bladder: 3 patients had incontinence-urgency (1 myelitis, 1 multiple sclerosis, 1 autonomic polineuropathy) and 3 patients had urinary retention (1 incomplete spinal cord lesion, 1 operation for discal hernia T5-T6, 1 hysterectomy). RESULTS: Among cases with incontinence-urgency we achieved complete control of the bladder in 2 patients while in 1 patient the number of urinary losses was reduced of the 80%. In 2 patients with urinary retention we obtained complete recovery of the bladder function, while in 1 patient the number of cateterisms/die reduced of 50%, the urinary volume for micturion increased and residual urinary volume decreased. Results were unchanged during the follow-up (maximum 26 months), except for 1 patient in which a partial loss of effectiveness occurred. CONCLUSIONS: Chronic electric stimulation of S3 sacral roots via an implanted neuroprotesis is therefore an effectiveness, save and promising therapeutic option in treatment of neurogenic bladder dysfunctions.

A study on the central neural pathway of the heart, Nei-Kuan (EH-6) and Shen-Men (He-7) with neural tracer in rats.

The purpose of this morphological study was to investigate the relations between meridians, acupoints and viscera using neuroanatomical tracers. The labeled areas of the spinal ganglia, sympathetic chain ganglia, spinal cord and the brain projecting to the heart, Nei-Kuan (EH-6) and Shen-Men (He-7) were observed following injection of WGA-HRP and pseudorabies virus (PRV). The results were as follows. Overlapping bilaterally labeled ganglion areas after heart, Nei-Kuan (EH-6) or Shen-Men (He-7) injection of WGA-HRP were found in middle cervical, stellate and T4 sympathetic and T2-T6 spinal ganglia. In brain, labeled neurons from all three sites were found in the A1 noradrenalin cell group/C1 adrenalin cell group/caudoventrolateral reticular n., n. tractus solitarius, n. ambiguus, rostroventrolateral n., C3 adrenaline cell group, raphe obscurus n., raphe pallidus n., raphe magnus n., lateral paragigantocellular reticular n., locus coeruleus, subcoeruleus n., Kolliker-Fuse n., A5 cell group, central gray matter, paraventricular hypothalamic n. and arcuate hypothalamic n.. In conclusion, these morphological results suggest that the interrelationship of acupoints (Nei-Kuan and Shen-Men) and viscera (heart) may be related to the central autonomic centers of the spinal cord and brain.

Cholinergic and noradrenergic modulation of the slow (approximately 0.3 Hz) oscillation in neocortical cells.

1. The pedunculopontine tegmental (PPT) cholinergic nucleus and the locus coeruleus (LC) noradrenergic nucleus were electrically stimulated to investigate their effects on the recently described slow oscillation (approximately 0.3 Hz) of neocortical neurons. Intracellular recordings of slowly oscillating, regular-spiking and intrinsically bursting neurons from cortical association areas 5 and 7 (n = 140) were performed in anesthetized cats. 2. Pulse trains to the PPT nucleus produced the blockage of rhythmic (approximately 0.3 Hz) depolarizing-hyperpolarizing sequences in 79% of tested cortical neurons and transformed this slow cellular rhythm into tonic firing. The latency of the cortical cellular response to PPT stimulation was 1.2 +/- 0.5 (SE) s and its duration was 15.9 +/- 1.9 s. The PPT-elicited suppression of the slow cellular oscillation was accompanied by an activation of the electroencephalogram (EEG) having a similar time course. Fast Fourier transform analyses of EEG activities before and after PPT stimulation showed that the PPT-evoked changes consisted of decreased power of slow rhythms (0-8 Hz) and increased power of fast rhythms (24-33 Hz); these changes were statistically significant. 3. The blockage of the slow cellular oscillation was mainly achieved through the diminution or suppression of the long-lasting hyperpolarizations separating the rhythmic depolarizing envelopes. This effect was observed even when PPT pulse trains disrupted the oscillation without inducing overt depolarization and increased firing rate. The durations of the prolonged hyperpolarizations were measured during a 40-s window (20 s before and 20 s after the PPT pulse train) and were found to decrease from 1.5 +/- 0.2 to 0.7 +/- 0.1 s. The values of the product resulting from the duration (in seconds), the amplitude (in millivolts), and number of such hyperpolarizing events within 20-s periods were 51.5 +/- 5 and 5.1 +/- 1.9 before and after PPT stimulation, respectively. 4. The PPT effect was suppressed by systemic administration of a muscarinic antagonist, scopolamine, but not by mecamylamine, a nicotinic antagonist. 5. The PPT effect on cellular and EEG cortical slow oscillation survived, although its duration was reduced, in animals with kainate-induced lesions of thalamic nuclei projecting to areas 5 and 7 (n = 3) as well as in animals with similar excitotoxic lesions leading to extensive neuronal loss in nucleus basalis (n = 2). These data indicate that the PPT effect is transmitted to neocortex through either thalamic or basal forebrain relays.(ABSTRACT TRUNCATED AT 400 WORDS)

Input from the frontal cortex and the parafascicular nucleus to cholinergic interneurons in the dorsal striatum of the rat.

Evidence derived from many experimental approaches indicates that cholinergic neurons in the dorsal striatum (caudate-putamen) are responsive to excitatory amino acids. Furthermore, evidence from physiological experiments indicate that the excitatory input is derived from the cortex and/or the thalamus. The object of the present experiment was to anatomically test whether cholinergic neurons receive cortical and/or thalamic input in the dorsal striatum using a combined anteograde tracing and immunocytochemical approach at both the light- and electron-microscopic levels. Rats received injections of the anterograde tracers Phaseolus vulgaris-leucoagglutinin or biocytin at multiple sites in the frontal cortex or parafascicular nucleus of the thalamus. Sections of the striatum were stained to reveal the anterogradely transported markers and then immunostained to reveal choline acetyltransferase immunoreactivity. The striata of these animals contained dense networks of anterogradely labelled fibres that were dispersed throughout the neuropil and interspersed with the choline acetyltransferase-immunoreactive (i.e. cholinergic) perikarya and dendrites. The anterogradely labelled fibres were often closely apposed to the choline acetyltransferase-immunoreactive neurons. Examination of electron-microscopic sections failed to demonstrate cortical terminals in synaptic contact with the cholinergic neurons even when choline acetyltransferase-immunoreactive structures were examined that had first been identified in the light microscope as having cortical terminals closely apposed to them. In these cases it was often observed that the cortical terminal, although apposed to the membrane of the labelled neurone, made synaptic contact with an unlabelled spine that was in the vicinity. In contrast to the cortical input, analysis of material that was double-stained to reveal thalamostriatal terminals and choline acetyltransferase-immunoreactive structures, revealed that the thalamostriatal terminals were often in asymmetrical synaptic contact with the perikarya and dendrites of cholinergic neurons. It is concluded that the cholinergic neurons of the dorsal striatum, like those of the ventral striatum or nucleus accumbens [Meredith and Wouterlood (1990) J. comp. Neurol. 296, 204-221] receive very little or no input from the cortex but are under a prominent synaptic control by the thalamostriatal system. Those pharmacological effects of excitatory amino acids on the cholinergic systems of the striatum are therefore presumably related to the thalamostriatal and not the corticostriatal system.

Manual practico clinico terapeutico para las intoxicaciones agudas / Manual practices clinical therapeutic for the sharp intoxications

Contiene: Epidemiologia y prevencion,bases terapeuticas en las intoxicaciones agudas, antidotos locales, procedimiento para la excrecion del toxico, tratamiento sintomatico y de sosten cuadros de enlace,antidotos y antogenistas, intoxicaciones del sistema nervioso central, intoxicaciones del sistema nervioso autonomo, intoxicaciones medicamentosas, accidentes terapeuticos, toxicos domesticos, plaguicadas

Hypothalamic descending afferents to cells of origin of the greater petrosal nerve in the rat, as revealed by a combination of retrograde HRP and anterograde autoradiographic techniques.

Projections from the hypothalamus to cells of origin of the greater petrosal nerve were studied by the HRP and autoradiographic techniques in the rat. After an injection of [3H]amino acids into the hypothalamus and an application of HRP to the greater petrosal nerve, we found that a compact group of HRP-labeled neurons was located within a dense accumulation of silver grains in the nucleus reticularis parvocellularis. The present results show that the hypothalamus projects directly to cells of origin of the greater petrosal nerve.

Extrinsic neural influences on gastrointestinal motility.

The gastrointestinal tract is capable of carrying on all its major functions after all extrinsic nerves have been cut. This automaticity is due to the local nervous mechanisms in the walls of the gastrointestinal tract and the inherent properties of the smooth muscles in its walls, and gastrointestinal hormones. All levels of the central nervous system have been shown, by stimulation and ablation studies, to influence the motility of the entire gastrointestinal tract. Throughout many cerebral areas there are loci which, on stimulation, exert both inhibitory, and less often, excitatory influence on gastrointestinal motility. These influences are mediated by sympathetic and parasympathetic visceral efferent nerves, as well as humoral agents from the neurohypophysis. Thus, they impose an influence of higher control on the automatically efficient intrinsic motility. They are guided by information received from visceral, cranial, and somatic afferents, as well as intracerebral, or psychic inputs. Under normal circumstances they only influence gastrointestinal activity as will best afford the optimal functioning of a performance done automatically with efficiency and finesse.