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1.
Adv Exp Med Biol ; 1190: 323-331, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31760653

RESUMEN

Guillain-Barré syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy, and pathophysiologically classified into acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), and acute motor and sensory axonal neuropathy (AMSAN). The main pathophysiological mechanism is complement-mediated nerve injury caused by antibody-antigen interaction in the peripheral nerves. Antiglycolipid antibodies are most pathogenic factors in the development of GBS, but not found in 40% of patients with GBS. One of the principal target regions in GBS is the node of Ranvier where functional molecules including glycolipids are assembled. Nodal dysfunction induced by the immune response in nodal axolemma, termed "nodopathy," can electrophysiologically show reversible conduction failure, axonal degeneration, or segmental demyelination. To detect new target molecules in antiglycolipid antibody-negative GBS and to elucidate the pathophysiology in the subacute and the subsequent phases of the disorder are the next problems.


Asunto(s)
Proteínas del Sistema Complemento/inmunología , Síndrome de Guillain-Barré/fisiopatología , Nervios Periféricos/fisiopatología , Anticuerpos/inmunología , Axones/inmunología , Axones/patología , Glucolípidos/inmunología , Síndrome de Guillain-Barré/inmunología , Humanos , Conducción Nerviosa , Nódulos de Ranvier/patología
2.
J Electromyogr Kinesiol ; 48: 197-204, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31442925

RESUMEN

PURPOSE: People with Joint Hypermobility Syndrome (JHS) suffer with fatigue. The purpose of this project was to investigate the contribution of central and peripheral fatigue. METHODS: Electrical stimulation of the musculocutaneous nerve to biceps brachii, and transcranial magnetic stimulation over the motor cortex supplying biceps brachii were used. Peripheral and central fatigue were assessed during a control, fatiguing and recovery phase protocol. RESULTS: JHS participants perceived greater fatigue during the protocol compared to a control group and did not recover. Central and peripheral fatigue did not occur in the control group. However, the JHS group showed central fatigue. MEP amplitude increased in the JHS group during the fatiguing protocol (p < 0.01) before recovering. Superimposed twitch amplitude increased in the JHS group during the fatiguing protocol and stayed elevated during the recovery phase (p < 0.04). Time to peak (TTP) amplitude of the torque generated by the TMS was longer in the JHS group (p < 0.05). RMS during MVCs decreased during the fatiguing protocol reaching significance during the recovery phase (p < 0.01). CONCLUSION: JHS participants suffered central but not peripheral fatigue. A modified strength programme to target this is discussed.


Asunto(s)
Fatiga/etiología , Inestabilidad de la Articulación/fisiopatología , Corteza Motora/fisiopatología , Fatiga Muscular , Nervios Periféricos/fisiopatología , Adulto , Fatiga/fisiopatología , Femenino , Humanos , Inestabilidad de la Articulación/complicaciones , Masculino , Músculo Esquelético/inervación , Músculo Esquelético/fisiopatología , Torque
3.
Curr Opin Ophthalmol ; 30(5): 386-394, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31393326

RESUMEN

PURPOSE OF REVIEW: Dry eye disease (DED) is a chronic multifactorial disease that affects millions of people worldwide. Despite ongoing research, treatment for DED remains a challenge. Neurostimulation for tear production is a rapidly evolving field that culminated in the development of the intranasal tear neurostimulator (ITN). In this article, we review the neuroanatomy and pathophysiology of tear production and the evolution of neurostimulation for the treatment of DED. RECENT FINDINGS: The ITN was approved for commercial use in April 2017. This innovation stemmed from the success of lacrimal nerve and anterior ethmoid nerve stimulation animal studies. Since then, numerous pilot studies and multicenter randomized controlled trials demonstrate increased aqueous tear production, improved DED-related symptoms, and device safety. Recent studies also report the positive effects of intranasal stimulation on mucin and lipid secretion. SUMMARY: Neurostimulation for enhanced tear production is a promising new treatment option for DED. Stimulation of the lacrimal nerve and anterior ethmoid nerve both effectively increase tear volume. The ITN is a noninvasive device that effectively increases aqueous tear volume and may improve tear composition, including mucin and lipid concentrations. Further studies are needed to determine proper patient selection and the long-term efficacy of neurostimulation for DED.


Asunto(s)
Síndromes de Ojo Seco/terapia , Terapia por Estimulación Eléctrica/métodos , Aparato Lagrimal/inervación , Nervios Periféricos/fisiopatología , Lágrimas/metabolismo , Animales , Síndromes de Ojo Seco/metabolismo , Síndromes de Ojo Seco/fisiopatología , Humanos , Aparato Lagrimal/metabolismo
5.
Biomed Res Int ; 2019: 4750624, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31317030

RESUMEN

Introduction: The aim of this research was to test, in an animal model, the nerve regeneration technique with a hypoallergenic acellular dermal matrix used to wrap the microsurgical neural suture. Materials and Methods: Two groups of rats received the cut of limb right median nerves. The regeneration technique considers for both groups an end-to-end nerve suture. In the experimental group (A) was used also a wrapping protocol by a conduit of collagen matrix currently used in oral surgery. The animals underwent functional grasping tests (at 1, 3, 5, and 7 months) and a histological and quantitative analysis of distal nerve was performed at the end of experimental time. Result: After seven months, the grasping test reveals functional recovery in each tested animal; this improvement is more evident in Group A. The fibers appear well organized with restored myelin sheaths in both groups. Group A showed a great quantity of connective tissue surrounding the nerve. The quantitative morphology analysis in both groups shows a similar fibers density, fiber diameter, and myelin thickness. The differences between the groups in axon mean diameter are significant. In Group A M/d, D/d, and g-ratio is significantly higher compared to control group. Conclusions: Histological and functional assessments show a functional recovery of the injured nerve in the test groups, stressed by the results of the grasping tests and the meaningful increasing in fiber diameter and higher g-ratio. Moreover, a connective tissue cuff distinguishes the distal portion of the injured nerve. Considering the easy availability and handling of the material used in this study we can conclude that this experimental technique can be considered as a valid alternative to protect nerves in nerve wrap surgery.


Asunto(s)
Nervio Mediano/crecimiento & desarrollo , Vaina de Mielina/genética , Regeneración Nerviosa/efectos de los fármacos , Nervios Periféricos/efectos de los fármacos , Dermis Acelular/metabolismo , Animales , Axones/metabolismo , Modelos Animales de Enfermedad , Humanos , Nervio Mediano/efectos de los fármacos , Procedimientos Neuroquirúrgicos/métodos , Nervios Periféricos/fisiopatología , Ratas , Recuperación de la Función , Nervio Ciático/fisiopatología
6.
Muscle Nerve ; 60(3): 271-278, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31228263

RESUMEN

INTRODUCTION: Use of peripheral nerve ultrasound alongside standard electrodiagnostic tests may help to gain insight into the pathophysiology of peripheral nerve involvement in type 2 spinocerebellar ataxia (SCA2). METHODS: Twenty-seven patients with SCA2 underwent ultrasound cross-sectional area (CSA) measurement of median, ulnar, sural and tibial nerves, and motor (median, ulnar, tibial) and sensory (median, ulnar, radial, sural) nerve conduction studies. RESULTS: Twenty patients had pathologically small-nerve CSAs, suggestive of sensory neuronopathy. In these patients, electrophysiology showed non-length-dependent sensory neuropathy (14 of 20), "possible sensory neuropathy" (1 of 20), or normal findings (5 of 20). Four different patients had length-dependent sensory neuropathy on electrophysiology, and 1 had enlarged nerve CSAs. Regression analysis showed an inverse relationship between ataxia scores and upper limb nerve CSA (P < 0.03). DISCUSSION: Our findings suggest that a majority of patients with SCA2 (74%) have a sensory neuronopathy and this correlates with disability. A minority of patients have findings consistent with axonal neuropathy (18%). Muscle Nerve, 2019.


Asunto(s)
Nervios Periféricos/fisiopatología , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Ataxias Espinocerebelosas/fisiopatología , Extremidad Superior/fisiopatología , Adulto , Anciano , Ataxia Cerebelosa/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proteínas del Tejido Nervioso/metabolismo , Conducción Nerviosa/fisiología , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Trastornos de la Sensación/fisiopatología , Ultrasonografía/métodos
7.
Ideggyogy Sz ; 72(5-6): 159-164, 2019 May 30.
Artículo en Inglés | MEDLINE | ID: mdl-31241259

RESUMEN

Background and purpose: The purpose of this prospective study was to investigate whether mid-term treatment with oral isotretinoin may impact peripheral nerve function. Methods: In this study, we included 28 patients with no apparent neurological or neurophysiological findings. The patients received treatment with oral isotretinoin for papulopustular or nodulocystic acne. The patients with normal findings in the first examination were given 1 mg/kg/day oral isotretinoin. Neurological examinations and electroneurographic studies were performed before and 6 months after the onset of isotretinoin treatment. Results: Clinical examinations and electroneurographic evaluations prior to treatment revealed no abnormalities in any of the patients. However, 20 patients (72%) displayed one or more abnormal values in the tested parameters after treatment. Although the mean amplitudes of compound muscle action potential of the ulnar and median nerves did not vary, significant decreases were observed in the mean sensory conduction velocities of median, ulnar, sural, medial plantar, medial dorsal cutaneous, and dorsal sural nerves 6 months after the onset of treatment. Conclusion: Systemic use of isotretinoin may cause electroneurographic changes. Probable electroneurographic alterations may be detected at a much earlier period via dorsal sural nerve tracing when electrophysiological methods used in routine clinical practice cannot detect these changes.


Asunto(s)
Acné Vulgar/tratamiento farmacológico , Fármacos Dermatológicos/administración & dosificación , Isotretinoína/administración & dosificación , Conducción Nerviosa/efectos de los fármacos , Nervios Periféricos/efectos de los fármacos , Nervio Sural/efectos de los fármacos , Administración Oral , Fármacos Dermatológicos/efectos adversos , Esquema de Medicación , Humanos , Isotretinoína/efectos adversos , Nervios Periféricos/fisiopatología , Estudios Prospectivos , Enfermedades de la Piel/tratamiento farmacológico , Nervio Sural/fisiopatología
8.
J Clin Neuromuscul Dis ; 20(4): 165-172, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31135619

RESUMEN

OBJECTIVES: Multifocal motor neuropathy (MMN) is a treatable autoimmune polyneuropathy, which may prove challenging diagnostically in the setting of absent conduction blocks or advanced axonal loss. Relatively few studies have examined the role of ultrasound (US) in MMN. METHODS: Retrospective, cross-sectional study of patients with MMN who underwent peripheral nerve US. Charts were reviewed to extract clinical, sonographic, and electrophysiological data. RESULTS: Eleven patients with MMN underwent US between 2013 and 2015; of these 11 patients, 7 had ≥3 abnormal nerve segments, and 6 had ≥5 sites of increased cross-sectional area (CSA). There was moderate correlation between the degree of amplitude drop observed in the median and ulnar motor nerves, and CSA. Significant correlation between CSA and limb strength was only observed for the median nerve. CONCLUSIONS: Peripheral nerve US shows promise as a diagnostic tool in MMN and may be helpful to distinguish MMN from motor neuron disease.


Asunto(s)
Conducción Nerviosa/fisiología , Nervios Periféricos/diagnóstico por imagen , Polineuropatías/diagnóstico por imagen , Ultrasonografía , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nervios Periféricos/fisiopatología , Polineuropatías/fisiopatología , Estudios Retrospectivos
9.
Muscle Nerve ; 60(2): 155-160, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31032944

RESUMEN

INTRODUCTION: Existing normal value references for pediatric nerve conduction studies (NCS) are based on limited sample sizes with uncertain reliability, suggesting a need for better normative data. METHODS: Electronic medical records were reviewed for pediatric patients (0 to <18 years) with normal findings on electromyography and NCS during the period from January 1, 1997 through September 20, 2017. Electrodiagnostic and demographic data were collected. Gaussian and descriptive statistics were used to establish normal values by age group. RESULTS: In this study we analyzed 1,918 normal NCS on 1,849 unique pediatric patients. Patients were stratified by age: 0 to <1 month; 1 to <6 months; 6 to <12 months; 12 to <24 months; 2 to <3 years; 3 to <4 years; 4 to <5 years; 5 to <10 years; 10 to <15 years; and 15 to <18 years. Normal reference ranges for amplitude, conduction velocity, and distal latency were established for each age group for 4 motor and 4 sensory nerves. DISCUSSION: The large sample size of this study provides reliable reference values for interpreting pediatric NCS. Muscle Nerve 60: 155-160, 2019.


Asunto(s)
Electromiografía , Conducción Nerviosa/fisiología , Nervios Periféricos/fisiopatología , Adolescente , Niño , Preescolar , Electrodiagnóstico , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Valores de Referencia
10.
Neurosurg Clin N Am ; 30(2): 211-217, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30898272

RESUMEN

Although the first publications on clinical use of peripheral nerve stimulation for the treatment of chronic pain came out in the mid-1960s, it took 10 years before this approach was used to stimulate the occipital nerves. The future for occipital nerve stimulation is likely to bring new indications, devices, stimulation paradigms, and a decrease in invasiveness. As experience increases, one may expect that occipital nerve stimulation will eventually gain regulatory approval for more indications, most likely for occipital neuralgia, migraines and cluster headaches. This process may require additional studies, at least for approval from the US Food and Drug Administration.


Asunto(s)
Dolor Crónico/terapia , Terapia por Estimulación Eléctrica/métodos , Neuralgia/terapia , Nervios Periféricos/fisiopatología , Dolor Crónico/fisiopatología , Humanos , Neuralgia/fisiopatología , Resultado del Tratamiento
11.
Injury ; 50(4): 848-854, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30910242

RESUMEN

BACKGROUND: Complex digital injuries involving soft-tissue loss and digital nerve defect continues to pose a reconstructive challenge. This study reports the repair of such neurocutaneous defect with the bipedicled nerve flap or the Littler flap and compares the results of the two techniques. METHODS: A retrospective study was conducted in 59 patients who had a neurocutaneous defect in the single digit treated with the bipedicled nerve flap or the Littler flap from Jul 2008 to May 2016. The patients were divided into two groups based on which flap was chosen. At the final follow-up, the two groups were compared for static two-point discrimination and Semmes-Weinstein monofilament scores on both flap and pulp, and pain, cold intolerance and patient satisfaction of the reconstructed digit. RESULTS: Significant differences were found in static two-point discrimination, pain, cold intolerance, and patient satisfaction (p < 0.05). In comparison with the bipedicled flap group, the Littler flap group presented better discriminatory sensation in the flap and pulp, but exhibited higher incidence of pain and cold intolerance in the reconstructed digit. In the donor digits, the bipedicled flap group achieved lower pain incidence. Finally, the bipedicled flap group attained a larger degree of satisfaction than the Littler flap group. CONCLUSIONS: When reconstructing a complex neurocutaneous defect in the digit, choosing the bipedicled nerve flap rather than the Littler flap attains lower incidence of pain and cold intolerance, and higher patient satisfaction. Our results suggest that repair of the transected digital nerves can reduce neuroma incidence.


Asunto(s)
Traumatismos de los Dedos/fisiopatología , Dedos/inervación , Nervios Periféricos/cirugía , Traumatismos de los Tejidos Blandos/fisiopatología , Colgajos Quirúrgicos , Adulto , Femenino , Traumatismos de los Dedos/cirugía , Dedos/cirugía , Estudios de Seguimiento , Humanos , Masculino , Satisfacción del Paciente/estadística & datos numéricos , Nervios Periféricos/fisiopatología , Procedimientos Quirúrgicos Reconstructivos , Recuperación de la Función , Estudios Retrospectivos , Traumatismos de los Tejidos Blandos/cirugía , Colgajos Quirúrgicos/irrigación sanguínea , Resultado del Tratamiento
12.
Med Sci Monit ; 25: 1709-1717, 2019 Mar 06.
Artículo en Inglés | MEDLINE | ID: mdl-30837449

RESUMEN

BACKGROUND In colorectal cancer (CRC), perineural invasion (PNI) is usually identified histologically in biopsy or resection specimens and is considered a high-risk feature for recurrence of CRC and is an indicator for adjuvant therapy. Preoperative identification of PNI could help determine the need for adjuvant therapy and the approach to surgical resection. This study aimed to develop and validate a nomogram for the preoperative prediction of PNI in patients with CRC. MATERIAL AND METHODS A total of 664 patients with CRC from a single center were classified into a training dataset (n=468) and a validation dataset (n=196). The least absolute shrinkage and selection operator (LASSO) regression model was used to select potentially relevant features. Multivariate logistic regression analysis was used to develop the nomogram. The performance of the nomogram was assessed based on its calibration, discrimination, and clinical utility. RESULTS The nomogram consisted of five clinical features and provided good calibration and discrimination in the training dataset, with an area under the curve (AUC) of 0.704 (95% CI, 0.657-0.751). Application of the nomogram in the validation cohort showed acceptable discrimination, with the AUC of 0.692 (95% CI, 0.617-0.766) and good calibration. Decision curve analysis (DCA) showed that the nomogram was clinically useful. CONCLUSIONS The nomogram developed in this study might allow clinicians to predict the risk of PNI in patients with CRC preoperatively. The nomogram showed favorable discrimination and calibration values, which may help optimize preoperative treatment decision-making for patients with CRC.


Asunto(s)
Técnicas de Apoyo para la Decisión , Invasividad Neoplásica/diagnóstico , Nomogramas , Anciano , Área Bajo la Curva , Biomarcadores de Tumor , China , Neoplasias Colorrectales/complicaciones , Neoplasias Colorrectales/metabolismo , Neoplasias Colorrectales/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Nervios Periféricos/fisiopatología , Reproducibilidad de los Resultados , Estudios Retrospectivos , Factores de Riesgo , Tomografía Computarizada por Rayos X/métodos
13.
Muscle Nerve ; 59(5): 587-590, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30680752

RESUMEN

INTRODUCTION: Tangier disease (TD) is an autosomal recessive disorder characterized by severe reduction in high-density lipoprotein and accumulation of cholesterol esters in peripheral nerves and other tissues. The aim of this study was to evaluate whether nerve high-resolution ultrasonography (HRUS) can detect morphological nerve changes in TD. METHODS: Three related patients of a previously reported Italian family with Tangier disease, carrying the Y1698X mutation in ABCA1, underwent clinical, neurophysiological, and quantitative nerve HRUS evaluation. Nerve HRUS data were compared with normal controls. RESULTS: Despite neurophysiological abnormalities, no quantitative HRUS abnormality was detected in peripheral nerves. DISCUSSION: Normalcy of HRUS in neurophysiologically abnormal nerves suggests possible subtle abnormalities that escape quantitative HRUS detection. Systematic studies in larger TD cohorts with different mutations are needed to confirm our findings. Muscle Nerve 59:587-587, 2019.


Asunto(s)
Nervios Periféricos/diagnóstico por imagen , Enfermedad de Tangier/diagnóstico por imagen , Transportador 1 de Casete de Unión a ATP/genética , Anciano , Plexo Braquial/diagnóstico por imagen , Plexo Braquial/fisiopatología , Femenino , Humanos , Masculino , Nervio Mediano/diagnóstico por imagen , Nervio Mediano/fisiopatología , Persona de Mediana Edad , Conducción Nerviosa , Nervios Periféricos/fisiopatología , Nervio Peroneo/diagnóstico por imagen , Nervio Peroneo/fisiopatología , Hermanos , Nervios Espinales/diagnóstico por imagen , Nervios Espinales/fisiopatología , Enfermedad de Tangier/fisiopatología , Nervio Cubital/diagnóstico por imagen , Nervio Cubital/fisiopatología , Ultrasonografía/métodos
14.
Neurosci Lett ; 694: 111-115, 2019 02 16.
Artículo en Inglés | MEDLINE | ID: mdl-30472359

RESUMEN

Peripheral group III metabotropic glutamate receptors (mGluRs) function to modulate pain signaling in inflammatory states. Here, we established in vivo experimental settings, including dynamic weight bearing test and in vivo single nerve recording, to elucidate how the group III mGluRs contribute to inhibiting pain transmission at the peripheral sensory nerve terminal in inflammatory states (1 and 3 days) elicited by Complete Freund's Adjuvant (CFA). As a result, CFA-induced nociceptive behaviors were significantly alleviated after administration of 100 and 200 µM L-AP4 (l-2-amino-4-phosphonobutylate; group III mGluR agonist). In addition, neuronal discharges evoked by 6- and 26-g von Frey filaments at the nerve significantly decreased after administration of 200 µM L-AP4. However, this event was not observed in non-inflammatory state. These results suggest that the group III mGluRs negatively regulate nociceptive behavior and pain transmission by lessening neuronal firing rates at the peripheral nerve in inflammation.


Asunto(s)
Artritis/fisiopatología , Dolor/fisiopatología , Nervios Periféricos/fisiopatología , Receptores de Glutamato Metabotrópico/fisiología , Células Receptoras Sensoriales/fisiología , Transmisión Sináptica , Animales , Artritis/inducido químicamente , Adyuvante de Freund/administración & dosificación , Articulación de la Rodilla/fisiopatología , Masculino , Nocicepción , Propionatos/administración & dosificación , Ratas Sprague-Dawley , Receptores de Glutamato Metabotrópico/antagonistas & inhibidores
15.
Neurosci Lett ; 702: 3-5, 2019 05 29.
Artículo en Inglés | MEDLINE | ID: mdl-30503914

RESUMEN

This overview covers advances in mechanisms of chronic pain and their consequent clinical opportunities. Our research field is fractured into two separate camps: "peripheralists" and "centralists". While the strong position of the first group is the contention that mechanisms of chronic pain can be understood within the limits of afferent inputs and spinal cord circuitry, the second group insists that the rest of the brain plays a critical role. Here we attempt to conjoin these positions, across clinical pain conditions and animal studies, and demonstrate that the effort can lead to novel translational concepts.


Asunto(s)
Sistema Nervioso Central/fisiopatología , Dolor Crónico/fisiopatología , Sistema Nervioso Periférico/fisiopatología , Animales , Encéfalo/fisiopatología , Humanos , Nocicepción/fisiología , Nervios Periféricos/fisiopatología , Médula Espinal/fisiopatología , Terminología como Asunto , Investigación en Medicina Traslacional
16.
Anesth Analg ; 129(1): 276-286, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-30507840

RESUMEN

BACKGROUND: Chronic pain is one of the most common complaints in patients with human immunodeficiency virus (HIV)-associated sensory neuropathy. Ryanodine receptor (RyR) and mitochondrial oxidative stress are involved in neuropathic pain induced by nerve injury. Here, we investigated the role of RyR and mitochondrial superoxide in neuropathic pain induced by repeated intrathecal HIV glycoprotein 120 (gp120) injection. METHODS: Recombinant HIV glycoprotein gp120MN was intrathecally administered to induce neuropathic pain. Mechanical threshold was tested using von Frey filaments. Peripheral nerve fiber was assessed by the quantification of the intraepidermal nerve fiber density in the skin of the hindpaw. The expression of spinal RyR was examined using Western blots. Colocalization of RyR with neuronal nuclei (NeuN; neuron marker), glial fibrillary acidic protein (GFAP; astrocyte marker), or ionizing calcium-binding adaptor molecule 1 (Iba1; microglia marker) in the spinal cord was examined using immunohistochemistry. MitoSox-positive profiles (a mitochondrial-targeted fluorescent superoxide indicator) were examined. The antiallodynic effects of intrathecal administration of RyR antagonist, dantrolene (a clinical drug for malignant hyperthermia management), or selective mitochondrial superoxide scavenger, Mito-Tempol, were evaluated in the model. RESULTS: We found that repeated but not single intrathecal injection of recombinant protein gp120 induced persistent mechanical allodynia. Intraepidermal nerve fibers in repeated gp120 group was lower than that in sham at 2 weeks, and the difference in means (95% confidence interval) was 8.495 (4.79-12.20), P = .0014. Repeated gp120 increased expression of RyR, and the difference in means (95% confidence interval) was 1.50 (0.504-2.495), P = .007. Repeated gp120 also increased mitochondrial superoxide cell number in the spinal cord, and the difference in means (95% confidence interval) was 6.99 (5.99-8.00), P < .0001. Inhibition of spinal RyR or selective mitochondrial superoxide scavenger dose dependently reduced mechanical allodynia induced by repeated gp120 injection. RyR and mitochondrial superoxide were colocalized in the neuron, but not glia. Intrathecal injection of RyR inhibitor lowered mitochondrial superoxide in the spinal cord dorsal horn in the gp120 neuropathic pain model. CONCLUSIONS: These data suggest that repeated intrathecal HIV gp120 injection induced an acute to chronic pain translation in rats, and that neuronal RyR and mitochondrial superoxide in the spinal cord dorsal horn played an important role in the HIV neuropathic pain model. The current results provide evidence for a novel approach to understanding the molecular mechanisms of HIV chronic pain and treating chronic pain in patients with HIV.


Asunto(s)
Proteína gp120 de Envoltorio del VIH , Hiperalgesia/inducido químicamente , Mitocondrias/metabolismo , Neuralgia/inducido químicamente , Nervios Periféricos/metabolismo , Canal Liberador de Calcio Receptor de Rianodina/metabolismo , Asta Dorsal de la Médula Espinal/metabolismo , Superóxidos/metabolismo , Animales , Modelos Animales de Enfermedad , Hiperalgesia/metabolismo , Hiperalgesia/fisiopatología , Masculino , Neuralgia/metabolismo , Neuralgia/fisiopatología , Umbral del Dolor , Nervios Periféricos/fisiopatología , Ratas Sprague-Dawley , Transducción de Señal , Asta Dorsal de la Médula Espinal/fisiopatología
17.
J Clin Neurophysiol ; 36(1): 82-84, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30260816

RESUMEN

We report the case of a 74-year-old woman with treatment-naive chronic inflammatory demyelinating polyneuropathy evaluated by both nerve conduction studies and nerve ultrasound (NUS) before and after initial treatment. Performing both nerve conduction study and NUS before and after initial treatment seems rare for treatment-naive chronic inflammatory demyelinating polyneuropathy. This case yielded two major findings. First, improvement of nerve swelling as evaluated by NUS correlated well with the improvement of neurological symptoms. Second, NUS improvements were seen right after treatment, whereas electrophysiological improvements were not. Nerve ultrasound might thus allow for judgment of curative effects much more immediately and sensitively than nerve conduction study in treatment-naive chronic inflammatory demyelinating polyneuropathy.


Asunto(s)
Conducción Nerviosa , Nervios Periféricos/diagnóstico por imagen , Nervios Periféricos/fisiopatología , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/diagnóstico , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/terapia , Ultrasonografía , Anciano , Femenino , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Factores Inmunológicos/uso terapéutico , Nervios Periféricos/patología , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/fisiopatología , Resultado del Tratamiento
18.
J Ultrasound Med ; 38(6): 1583-1596, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30444266

RESUMEN

OBJECTIVES: To investigate the utility of shear wave elastography (SWE) in detecting morphologic abnormalities of the median nerve and posterior tibial nerve in transverse and longitudinal axes in adolescents with type 1 diabetes mellitus (DM) without diabetic peripheral neuropathy (DPN). METHODS: The median nerves and posterior tibial nerves of 25 adolescents with diagnosis and follow-up of type 1 DM without DPN and 32 healthy volunteers were evaluated with SWE by 2 observers on the transverse and longitudinal axes. The cross-sectional area and thickness of the nerves and disease duration were noted, and probable associations of these parameters with SWE features were analyzed. Interobserver and intraobserver correlations were also examined. The statistical significance level was set at P < .05. RESULTS: Both the median nerve and posterior tibial nerve were smaller, thinner, and stiffer in the patient group for both observers on both axes. The disease duration weakly correlated with median nerve SWE features (r = 0.245-0391). The thickness and cross-sectional area had no correlations with SWE features. CONCLUSIONS: The median nerve and posterior tibial nerve in adolescents with type 1 DM without DPN have morphologic abnormalities that can be displayed by SWE regardless of the imaging axis. Shear wave elastography may have a potential role in subclinical DPN, but the reliability of the findings is not as high as desirable.


Asunto(s)
Diabetes Mellitus Tipo 1/fisiopatología , Diagnóstico por Imagen de Elasticidad/métodos , Nervio Mediano/diagnóstico por imagen , Nervios Periféricos/diagnóstico por imagen , Nervios Periféricos/fisiopatología , Nervio Tibial/diagnóstico por imagen , Adolescente , Adulto , Niño , Neuropatías Diabéticas , Femenino , Humanos , Masculino , Nervio Mediano/fisiopatología , Reproducibilidad de los Resultados , Nervio Tibial/fisiopatología , Adulto Joven
19.
Arch Phys Med Rehabil ; 100(5): 908-913, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30352224

RESUMEN

OBJECTIVE: The main objective is to investigate the diagnostic accuracy and the relation of touch sensation and subjective sensory symptoms in the medial aspect of the hand dorsum, and neurography of the dorsal ulnar cutaneous nerve (DUCN) in ulnar neuropathy at the elbow (UNE). Secondary objective is to report the electrophysiological occurrence of anatomical variant of sensory innervation of the medial aspect of the hand dorsum from superficial radial nerve (SRN). DESIGN: Prospective, cohort study. SETTING: Electromyography laboratory. PARTICIPANTS: Consecutive participants (N=282), those with UNE (n=81) and those without UNE (n=201), were enrolled. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Accuracy and agreement between sensory clinical findings of the medial hand dorsum and neurography of DUCN in UNE diagnosis. RESULTS: DUCN neurographic and sensory findings had high specificity and relatively low sensitivity. Normal or abnormal sensory nerve action potential (SNAP) of DUCN matched with normal or abnormal touch sensation of the medial aspect of hand dorsum. Abnormal DUCN SNAP was related to the clinical severity of UNE and to the axonal damage of the ulnar nerve. Anatomical variant of the innervation of hand dorsum from SRN was demonstrated in 31 of 564 hands (6.2%) belonging to 26 of 282 participants (9.2%). If the variant was present, DUCN SNAP of the same side was more frequently absent or of low amplitude. CONCLUSIONS: The utility of DUCN neurography and sensory findings of the medial aspect of the dorsum of the hand is limited in the diagnosis of UNE. However, if DUCN SNAP is absent or low in amplitude, it is advisable to check the presence of the anatomical variant of the innervation of the medial aspect of the hand dorsum from SRN.


Asunto(s)
Mano/inervación , Nervios Periféricos/diagnóstico por imagen , Nervios Periféricos/fisiopatología , Tacto , Neuropatías Cubitales/diagnóstico , Neuropatías Cubitales/fisiopatología , Potenciales de Acción , Adulto , Variación Anatómica/fisiología , Estudios de Casos y Controles , Codo , Electromiografía , Femenino , Mano/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad
20.
J Neurol Neurosurg Psychiatry ; 90(4): 424-427, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30355606

RESUMEN

OBJECTIVE: To assess whether the involvement of the peripheral nervous system (PNS) belongs to the phenotypic spectrum of sporadic Creutzfeldt-Jakob disease (sCJD). METHODS: We examined medical records of 117 sCJDVV2 (ataxic type), 65 sCJDMV2K (kuru-plaque type) and 121 sCJDMM(V)1 (myoclonic type) subjects for clinical symptoms, objective signs and neurophysiological data. We reviewed two diagnostic nerve biopsies and looked for abnormal prion protein (PrPSc) by western blotting and real-time quaking-induced conversion (RT-QuIC) in postmortem PNS samples from 14 subjects. RESULTS: Seventy-five (41.2%) VV2-MV2K patients, but only 11 (9.1%) MM(V)1, had symptoms or signs suggestive of PNS involvement occurring at onset in 18 cases (17 VV2-MV2K, 9.3%; and 1 MM(V)1, 0.8%) and isolated in 6. Nerve biopsy showed a mixed predominantly axonal and demyelinating neuropathy in two sCJDMV2K. Electromyography showed signs of neuropathy in half of the examined VV2-MV2K patients. Prion RT-QuIC was positive in all CJD PNS samples, whereas western blotting detected PrPSc in the sciatic nerve in one VV2 and one MV2K. CONCLUSIONS: Peripheral neuropathy, likely related to PrPSc deposition, belongs to the phenotypic spectrum of sCJDMV2K and VV2 and may mark the clinical onset. The significantly lower prevalence of PNS involvement in typical sCJDMM(V)1 suggests that the PNS tropism of sCJD prions is strain dependent.


Asunto(s)
Síndrome de Creutzfeldt-Jakob/epidemiología , Encefalopatía Espongiforme Bovina/epidemiología , Enfermedades del Sistema Nervioso Periférico/epidemiología , Nervio Ciático/patología , Nervio Sural/patología , Ataxia , Síndrome de Creutzfeldt-Jakob/complicaciones , Síndrome de Creutzfeldt-Jakob/metabolismo , Síndrome de Creutzfeldt-Jakob/fisiopatología , Enfermedades Desmielinizantes , Electromiografía , Encefalopatía Espongiforme Bovina/complicaciones , Encefalopatía Espongiforme Bovina/metabolismo , Encefalopatía Espongiforme Bovina/fisiopatología , Humanos , Mioclonía , Nervios Periféricos/patología , Nervios Periféricos/fisiopatología , Enfermedades del Sistema Nervioso Periférico/metabolismo , Enfermedades del Sistema Nervioso Periférico/patología , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Proteínas Priónicas/metabolismo
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