Brief Electrical Stimulation Improves Functional Recovery After Femoral But Not After Facial Nerve Injury in Rats.

Brief low-frequency electrical stimulation (ES, 1 h, 20 Hz) of the proximal nerve stump has emerged as a potential adjunct treatment for nerve injury. Despite available experimental and clinical data, the potentials and limitations of the ES therapy still have to be defined using different animal models, types of nerves, and clinical settings. Here, we show that brief ES of the proximal stump of the transected rat femoral nerve causes, as estimated by motion analysis, enhanced functional recovery reaching preoperative levels within 5 months of injury, in contrast to the incomplete restoration in sham-stimulated (SS) animals. The functional advantage seen in ES rats was associated with higher numbers, as compared with SS, of correctly targeted quadriceps motoneurons. In contrast, ES prior to facial nerve suture did not lead to improvement of whisking compared with SS. Lack of functional effects of the treatment was correlated with lack of changes, as compared with SS, in the precision of muscle reinnervation and frequency of abnormally innervated muscle fibers. These results show that ES is an effective therapy in a spinal nerve injury model leading to complete restoration of function. Although this finding and the safety of the procedure are encouraging, the results for the facial nerve model suggest that brief ES may not be a universal treatment for nerve injuries. Anat Rec, 302:1304-1313, 2019. © 2019 Wiley Periodicals, Inc.

Electro-acupuncture improves responsiveness to insulin via excitation of somatic afferent fibers in diabetic rats.

The effects of electro-acupuncture (EA) on plasma concentration of glucose and on responsiveness to insulin were examined in an animal model of diabetes, the streptozotocin-treated rat. Two weeks after treatment with streptozotocin, rats were anesthetized with urethane-chloralose and subjected to the EA for 10 min delivered to the tibialis anterior muscle of one side. The stimulation produced no significant changes in plasma glucose concentration. In contrast, EA increased the response of plasma glucose to insulin (0.2 U kg(-1)). The effect of EA on the responsiveness to insulin was abolished by section of both sciatic and femoral nerves ipsilateral to the side of the EA. These results show that EA in diabetic rats has no effect on plasma glucose concentration while it augments the responsiveness to insulin, and we show that this occurs via a mechanism that involves the somatic afferent nerves.

Polysialic acid glycomimetics promote myelination and functional recovery after peripheral nerve injury in mice.

alpha2,8 Polysialic acid (PSA) is a carbohydrate attached to the glycoprotein backbone of the neural cell adhesion molecule (NCAM) and implicated in nervous system development and repair. Here, we investigated whether PSA can improve functional recovery after peripheral nerve lesion in adult mice. We applied a functional PSA mimicking peptide or a control peptide in a polyethylene cuff used to surgically reconnect the severed stumps of the femoral nerve before it bifurcates into the motor and sensory branches. Using video-based motion analysis to monitor motor recovery over a 3 month postoperative period, we observed a better functional outcome in the PSA mimetic-treated than in control mice receiving a control peptide or phosphate buffered saline. Retrograde tracing of regenerated motoneurons and morphometric analyses showed that motoneuron survival, motoneuron soma size and axonal diameters were not affected by treatment with the PSA mimetic. However, remyelination of regenerated axons distal to the injury site was considerably improved by the PSA mimetic indicating that effects on Schwann cells in the denervated nerve may underlie the functional effects seen in motor recovery. In line with this notion was the observation that the PSA mimetic enhanced the elongation of Schwann cell processes and Schwann cell proliferation in vitro, when compared with the control peptide. Moreover, Schwann cell proliferation in vivo was enhanced in both motor and sensory branches of the femoral nerve by application of the PSA mimetic. These effects were likely mediated by NCAM through its interaction with the fibroblast growth factor receptor (FGFR), since they were not observed when the PSA mimetic was applied to NCAM-deficient Schwann cells, and since application of two different FGFR inhibitors reduced process elongation from Schwann cells in vitro. Our results indicate the potential of PSA mimetics as therapeutic agents promoting motor recovery and myelination after peripheral nerve injury.

Electrical stimulation accelerates motor functional recovery in autograft-repaired 10 mm femoral nerve gap in rats.

Electrical stimulation has been shown to enhance peripheral nerve regeneration after nerve injury. However, the impact of electrical stimulation on motor functional recovery after nerve injuries, especially over long nerve gap lesions, has not been investigated in a comprehensive manner. In the present study, we aimed to determine whether electrical stimulation (1 h, 20 Hz) is beneficial for motor functional recovery after a 10 mm femoral nerve gap lesion in rats. The proximal nerve stump was electrically stimulated for 1 h at 20 Hz frequency prior to nerve repair with an autologous graft. The rate of motor functional recovery was evaluated by single frame motion analysis and electrophysiological studies, and the nerve regeneration was investigated by double labeling and histological analysis. We found that brief electrical stimulation significantly accelerated motor functional recovery and nerve regeneration. Although the final outcome, both in functional terms and morphological terms, was not improved by electrical stimulation, the observed acceleration of functional recovery and axon regeneration may be of therapeutic importance in clinical setting.

[Neuralgia of the genitofemoral nerve after hernioplasty. Therapy by peripheral nerve stimulation]. / Neuralgie des N. genitofemoralis nach Hernioplastik. Therapie durch periphere Nervenstimulation.

The peripheral nerve stimulation (PNS) is an established therapy in the management of neuropathic pain. Here, we describe a case of successful epifascial stimulation in the proximity of the genitofemoral nerve, which was injured during an endoscopic hernioplasty. During the following months the patient developed an intense neuropathy of this nerve, which we now treated by permanent PNS with an 8-polar electrode. During the 1 year follow-up the patient described a pain reduction of nearly 70%. There were no adverse events until now. In conclusion, PNS is a promising procedure in the treatment of neuralgia after hernioplasty.

Neural mechanism of bradycardiac responses elicited by acupuncture-like stimulation to a hind limb in anesthetized rats.

The effects of acupuncture-like stimulation of a hind limb on heart rate were examined in anesthetized rats. An acupuncture needle, having a diameter of either 160 or 340 microm, was inserted into the skin and underlying muscles at a depth of about 5 mm and twisted right and left twice every second for 1 min. Stimulation by a needle with a diameter of either 160 or 340 microm produced a decrease in heart rate. Severance of the femoral and sciatic nerves ipsilateral to the hind-limb stimulation completely abolished the bradycardiac response. Also, heart rate was significantly decreased by acupuncture-like stimulation of the hind-limb muscles alone, but was not significantly influenced by the stimulation of the hind-limb skin alone. The bradycardiac response induced by acupuncture-like stimulation was not influenced by bilateral severance of the vagal nerves at the cervical level, but was abolished by bilateral stellectomy. Acupuncture-like stimulation of the hind limb induced a decrease in the activity of the cardiac sympathetic efferent nerve as well as a decrease in heart rate. These results indicate that the decrease in heart rate induced by acupuncture-like stimulation of a hind limb is a reflex response. The afferent pathway is composed of hind-limb muscle afferents, and the efferent pathway is composed of cardiac sympathetic nerves.

One hour electrical stimulation accelerates functional recovery after femoral nerve repair.

The clinical outcome of peripheral nerve injuries requiring surgical repair is usually poor and efficient therapies do not exist. Recent work has suggested that low-frequency electrical stimulation of the severed nerve which produces repeated discharges of the parent motoneuron perikarya positively influences axonal regeneration, even if applied once for a period of only 1 h. Here we provide the first evidence for locomotor functional benefits of such stimulation. We transected the femoral nerve of adult C57BL/6J mice proximal to the bifurcation of the quadriceps and saphenous branches and electrically stimulated the proximal nerve stump for 1 h at 20-Hz frequency prior to nerve repair with a silicone cuff. Three months later, the ability of the quadriceps muscle to extend the knee in sham-stimulated mice had recovered to 63% of the preoperative values as estimated by single-frame motion analysis. After electrical stimulation, the outcome was only slightly better (73%) but the rate of functional recovery was considerably accelerated. Near-maximum recovery was achieved 6 weeks earlier than in the control group. The beneficial effects were associated with larger motoneuron cell bodies and increased diameters of regenerated axons in the quadriceps nerve branch, but not with enhanced preferential reinnervation by motoneurons of muscle as opposed to skin. The observed acceleration of functional restoration and the positive effects on motoneurons and regenerated axons indicate the potential of a clinically feasible approach for improvement of nerve repair outcome in human patients in which delayed target reinnervation is a factor limiting recovery.

Transient femoral neuropathy after harvest of bone from the iliac crest.

A 31-year-old woman had bone harvested from the left anterior iliac crest as a graft for an augmentation genioplasty. For postoperative analgesia, she was given a bupivacaine infusion into the iliac wound. She developed a temporary left femoral mononeuropathy from which she recovered completely.

Femoral nerve injury complicating continuous psoas compartment block.

OBJECTIVES: The objective of this case report is to describe a femoral nerve injury after a psoas compartment block (PCB) and to discuss the probable mechanisms of injury and neuron regeneration. To date, this is the first report of severe femoral nerve injury after PCB. CASE REPORT: A 60-year-old, American Society of Anesthesiologists II woman underwent right total knee replacement under general anesthesia and continuous PCB for postoperative analgesia. Postoperatively, she showed signs of severe femoral nerve injury. A physical therapy program and muscle electrical stimulation were instituted and continued for 6 months. The patient recovered completely with no residual motor or sensory deficit and had no other complication. CONCLUSIONS: Severe nerve injuries after regional anesthesia techniques remain infrequent and probably unreported. Our case report suggests that severe femoral nerve injury should be added to the list of reported complications during PCB. This case report is also encouraging because it shows the possibility of a good recovery after such injury.

Electrical stimulation accelerates and enhances expression of regeneration-associated genes in regenerating rat femoral motoneurons.

1. In this study we investigated whether electrical stimulation accelerates the upregulation of Talpha1-tubulin and GAP-43 (regeneration-associated genes; RAGs) and the downregulation of the medium-molecular-weight neurofilament (NFM), in concert with stimulation-induced acceleration of BDNF and trkB gene expression and axonal regeneration. 2. Two weeks prior to unilateral femoral nerve transection and suture, fluorogold (Fluorochrome Inc., Denver) or fluororuby (Dextran tetramethylrhodamine, Mol. Probes, D-1817, Eugene, OR) was injected into quadriceps muscles of the left and right hindlimbs to label the femoral motoneuron pools as previously described. Over a period of 7 days, fresh spinal cords were processed for semiquantitation of mRNA by using in situ hybridization. 3. There was an increase in Talpha1-tubulin and GAP-43 mRNA and a decline in the NFM mRNA at 7 days after nerve suture and sham stimulation but not in intact nerves. In contrast, 1-h stimulation of sutured but not intact nerves dramatically accelerated the changes in gene expression: mRNA levels of Talpha1-tubulin and GAP-43 were significantly elevated above control levels by 2 days while NFM mRNA was significantly reduced by 2 days in the sutured nerves. Thereby, the neurofilament/tubulin expression ratio was reduced at 2 days after suture and stimulation, possibly allowing more tubulin to be transported faster into the growing axons to accelerate the elongation rate following stimulation. Importantly, the changes in RAGs and NFM gene expression were delayed relative to the accelerated upregulation of BDNF and trkB mRNA by electrical stimulation. 4. The temporal sequence of upregulation of BDNF and trkB, altered gene expression of RAGs and NFM, and accelerated axonal outgrowth from the proximal nerve stump are consistent with a key role of BDNF and trkB in mediating the altered expression of RAGs and, in turn, the promotion of axonal outgrowth after electrical stimulation.

[The results of internal saphenous vein stripping under local anesthesia in outpatient care (700 cases)]. / Résultat des strippings saphène interne sous anesthésie locale en ambulatoire (700 cas).

700 operations involving complete removal of varicose veins in a single stage by invaginated long stripping and phlebectomies under local anesthesia on an out-patient basis were reviewed. Anesthesia consisted of local injections and a femoral block using Mepivacaine or Lidocaine. The out-patient approach adopted did not cause any complications. 95% of patients were satisfied with the method of anesthesia. Three types of neurological sequelae were studied: local numbness due to tearing of a strip of nerve by Muller's hook (7%) was transitory: sub-malleolar numbness was avoided when the lower incision for the stripping was low and sub-malleolar; damage to the saphenous nerve occurs in 1.2 per cent of cases following general anesthesia because of recognition of the particular pain associated with stretching of the nerve during stripping and passage through this junctional area by the Müller technique.