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PubMed1979

Dorsal spinal cord stimulation in the treatment of multiple sclerosis.

Previously published work indicated significant improvement in the symptoms of multiple sclerosis with dorsal spinal cord stimulation. In this study 23 patients with multiple sclerosis documented by history, examination, laboratory studies, and clinical course were treated with dorsal spinal cord stimulation and followed for 19 to 45 months (mean, 32 months). Pre- and postoperative clinical assessment was carried out using the Kurtzke Scale. Walking velocity, upper limb coordination, sphincter function, and sensory function were also evaluated quantitatively. No statistically significant objective improvement in any of these measures was demonstrated. Fifty per cent of the patients initially reported subjective symptomatic improvement, but this declined to 30% at last follow-up. Fifteen of 23 patients experienced complications related mainly to the hardware used and required a total of 21 subsequent operative procedures for correction of these complications. These results do not support the continued clinical use of dorsal spinal cord stimulation in the symptomatic treatment of multiple sclerosis.

Electric Stimulation Therapy↗

PubMedDate not supplied

[Clinical techniques for use in neurological physical examinations. I. General organisation, cranial and peripheral spinal nerves].

AIMS: The purpose of this work is to focus on the main practical aspects of the techniques used for the physical examination of the nervous system and to present an approach for the practice of this study in adult patients. DEVELOPMENT: We recommend clinicians to carry out a brief but consistent and effective exploration in a systematic, flexible and orderly manner to check for alterations in the functioning of the nervous system. Should any anomalies be detected, then a more detailed and thorough neurological exploration must be performed selectively. The techniques and data from this examination are organised into five broad categories: mental status, cranial nerves, motor function, reflex function and sensory function. The practical aspects of the main techniques used in the physical exploration are reviewed and we also describe the technique to be employed for palpating the main peripheral nerves. CONCLUSIONS: The study offers a detailed description of the chief clinical techniques used in the physical exploration of the cranial nerves and for the palpation of the peripheral nerves; we also present an approach to performing the neurological examination. Furthermore, we highlight the importance of physically examining the nervous system in contemporary medicine and the need to continually perfect the way these techniques are performed in order to achieve an efficient clinical practice.

Cranial Nerves↗

PubMed1986

[Axillary brachial plexus block with lidocaine HCl and carbonated lidocaine].

An accordance with the clinical examination recommended by Lanz and Theiss, we studied 26 patients undergoing a blockade of the axillary plexus with lidocaine-CO2 or lidocaine-HCl. Furthermore, we determined the blood concentrations of these local anaesthetics. The study showed no significant differences between the two groups of patients, except that the onset of the blockade was more reliable in one group. There was less impairment of motor function than sensory function. Blood lidocaine concentrations amounted to 2.46 mg/l (mean value) within 25 min. Slight cerebral intoxication could be seen in four patients, with no correlation with possibly high lidocaine concentrations. Lidocaine CO2 is recommended as a rapid blockade of short duration in outpatient regional anesthesia.

Adolescent↗

PubMed2000

Can a battery of functional and sensory tests corrobrate the sensorineural complaints of subjects working with vibrating tools?

OBJECTIVES: The objective of the present paper is to study the relationship between the early sensorineural symptoms, classified according to the Stockholm scale, and the results of the main functional and sensory tests described in the literature, in subjects working with vibrating tools. METHODS: Three groups of male workers were selected from industry: one group (69 subjects) exposed to hand-arm vibration in several workplaces, one group (62) performing heavy and repetitive hand and arm work but without exposure to vibration, and one control group (46) performing light and non-repetitive tasks without vibration. All the workers were interviewed by questionnaire, about their personal characteristics, their health status, their actual and past working conditions and the episodes of tingling at the level of the fingers. From these reported symptoms, the sensorineural stage of the hand-arm vibration was determined using the Stockholm scale. Based on the review of the literature, we selected six functional and sensory tests: maximum voluntary grip force, maximum angles of the wrist, pressure perception threshold test, vibration perception threshold test, distal sensory latency and the Purdue Pegboard test. Each test was performed by the workers in the three groups. RESULTS: No main differences were observed between the personal characteristics of the three groups. According to the Stockholm scale, the sensorineural symptoms were mainly at stage SN1, with 9% at stage SN2 and none at stage SN3. These symptoms are associated with exposure to vibration, and had a prevalence of 40% in group 1, versus 20% in the two other groups. Furthermore, 25% of the workers exposed to vibration complained of symptoms at least once a week, compared with only 2% in the other groups. The multivariate logistic regression analysis showed an association between the existence of symptoms and a decrease in the maximum flexion angle of the wrist and an increase in the pressure perception threshold. This association, however, was too low to determine limit values with a sensitivity and specificity sufficiently high to make a reliable diagnosis. CONCLUSIONS: The sensorineural symptoms at stage N1 on the Stockholm scale, experienced occasionally by some 40% of the users of vibrating tools, could not be corroborated by the functional and sensory tests.

Adult↗

PubMed1994

The effects of epilepsy surgery on the sensorimotor function of children.

The motor and sensory functions of 50 children were investigated before and six months after epilepsy surgery; 34 infants were assessed 24 months after surgery. Postoperatively, 20 children were seizure-free and 22 had a significant reduction of seizures. Epilepsy surgery was found to be an effective mode of treatment for intractable seizures in childhood, even in multiply handicapped individuals. Motor and sensory functions did not deteriorate after surgery; in fact, significant improvements were found in more than half of the children, including those with multiple handicaps. Improvements were most obvious in the seizure-free group, but were also noted in those with reduced seizure frequency. The younger children benefited more from surgery as regards sensorimotor function than did older children and adolescents.

Adolescent↗

PubMed2003

The significance of sensory-motor functions as indicators of brain dysfunction in children.

Sensory-perceptual and motor functions are closely dependent on the integrity of the brain and nervous system. Standardized tests have been developed to assess these functions, but such tests are not routinely used to evaluate children who are suspected of having a neuropsychological basis for their difficulties. Higher-level functions (such as verbal and academic abilities, executive functioning, etc.) are obviously important in producing successful performances, but the brain and nervous system correlates of these abilities are less well defined than the correlates for sensory-motor abilities. Our contention is that tests from these two general areas (higher-level and lower-level aspects of brain functioning) can be used effectively in a complementary manner to evaluate individual children. The first step in this process is to evaluate formal sensory-motor tests and to assess their validity as a brief preliminary examination used to differentiate between brain-damaged and control children. The results of this study demonstrated striking differences between the groups and indicated that sensory-motor testing might serve very effectively, when used in conjunction with higher-level tests, to identify those children whose higher-level impairment is due to brain impairment rather than a lack of environmental opportunities or advantages.

Brain Diseases↗

PubMed1994

Insulin sensitivity and sensory nerve function.

The central and peripheral nervous systems do not require insulin for glucose uptake. However, insulin receptors have been detected in these regions. The aim of this study was to examine peripheral sensory nerve function and its dependence on insulin using healthy non-diabetic control subjects, obese individuals, and diabetic (insulin dependent and non-insulin dependent diabetes mellitus) subjects. The results revealed that the warm and cold perception thresholds, reflecting the functional states of unmyelinated C-fibres and A-delta fibres respectively, increased with reduced insulin sensitivity and with increased fasting insulin concentrations. From such data in non-diabetic subjects with measured insulin sensitivity, it appeared that sensory nerve function was disturbed in normoglycemic but insulin resistant states, suggesting that insulin has an action on nervous tissue in addition to its effects on glucose metabolism. The mechanisms of this action remain to be elucidated.

Cold Temperature↗

PubMed1992

Hyperthermia-induced damage to rat sciatic nerve assessed in vivo with functional methods and with electrophysiology.

A 5-mm segment of the rat sciatic nerve was treated in vivo with hyperthermia (43-45 degrees C) for different times using a brass thermode. The effect of this local heat treatment on the nerve was assessed with electrophysiology and using two functional assays. Hyperthermia led to a dose-dependent decrease of motor and sensory function. Electrophysiological examination showed a decrease in amplitude of motor and reflex responses rather than a decrease in conduction velocities. Calculated ED50 values were not significantly different for the two functional and for the electrophysiological methods. Functional recovery from nerve damage took place in all cases. Measured at the same level of damage, i.e., 50% function loss, it took 14 days to recover from complete sensory function loss and 20 days from complete motor function loss. Although both motor and sensory functions were restored, 30 days after hyperthermia no responses could be detected with electrophysiology, this as a result of the thin myelin sheaths that occur upon recovery.

Animals↗

PubMed1991

Capsaicin-sensitive bronchopulmonary receptors with dual sensory-efferent function: mode of action of capsaicin antagonists.

It has been suggested that capsaicin-sensitive interoceptors subserve dual sensory-efferent function in sense of being sites not only for initiating sensory impulses but also for release of mediators. The efferent response of smooth muscle contraction to capsaicin was analyzed in vitro on the trachea and main bronchi of the guinea-pig. Tetrodotoxin-resistant neurogenic contraction of the trachea evoked by capsaicin was inhibited by pretreatment of the tissue with the mast cell depleting agent of compound 48/80. Pretreatment of the preparation with indomethacin or with antagonists of histamine and 5-HT caused no changes in the responses. Electrical field stimulation of the nerve fibres in the main bronchi induced prolonged capsaicin-sensitive bronchoconstriction. Participation of mast cells and particularly leukotrienes in the responses is suggested. Sensory effect and site of action of capsaicin and its antagonists at the pulmonary receptors were tested in vivo by recording the Bezold-Jarisch reflex in the rat. Ruthenium red (0.5-2 mg/kg i.v.) and resiniferatoxin (0.1 micrograms/kg i.v.) did not evoke the vagal reflex triad of bradycardia, fall in blood pressure and apnoea, but antagonized the effect of capsaicin. The cardiorespiratory reflex triad evoked by stimulation of the regenerative region of the receptors by veratridine was not inhibited by ruthenium red. Furthermore, bradycardia evoked by electrical stimulation of the vagal nerve remained unchanged after pretreatment of the rat with either ruthenium red or resiniferatoxin. It is suggested that capsaicin excites the generator region of the receptors. Ruthenium red and resiniferatoxin antagonize its effect at different sites of the capsaicin receptor coupled cation channel.

Animals↗

PubMed1994

Cognitive and sensori-motor functioning in the absence of the corpus callosum: neuropsychological studies in callosal agenesis and callosotomized patients.

The aim of the present study was to investigate the role of the corpus callosum in cognitive and sensori-motor functioning as measured by a neuropsychological test battery. After a brief review and analysis of the literature, we report our own studies in acallosal subjects (n = 9) and callosotomized patients (n = 25). The main instrument of evaluation was the Michigan Neuropsychological Test Battery. This battery was supplemented by age-appropriate intelligence tests. The performance of the acallosal group was compared to that of two matched control groups: one group consisting of children and adolescents that attended the same school as the acallosals and a second group of subjects recruited from regular schools. The callosotomized patients, tested pre- and post-operatively, served as their own controls. Taken together, the results of the reviewed and personal studies suggest that absence of the corpus callosum does not necessarily impede cognitive functioning. However, samples drawn from clinical populations tend to show a larger variability as to their mental abilities. In keeping with previous findings, our results indicate that the corpus callosum does play a role in bimanual motor coordination although other pathways (probably ipsilateral and/or subcortical) may provide adequate compensation in many cases. The data further suggest that the corpus callosum may be important for interhemispheric transfer of tactuo-motor learning when a spatial component is involved. Finally, our results are consistent with a facilitatory role of the corpus callosum in cognitive and sensori-motor functioning which allows for interhemispheric compensation as part of cerebral reorganization in the case of unilateral brain damage.

Adolescent↗

PubMed1994

Analyses of 94 consecutive spinal cord injury patients using ASIA definition and modified Frankel score classification.

Serial neurological examinations were analysed on 94 consecutive spinal cord injury (SCI) patients admitted for rehabilitation to the Swiss Paraplegic Center at the Clinic Balgrist Zurich, Switzerland between 1987 and 1992. Patients' data were examined adopting ASIA and modified Frankel definitions in order to compare the two classifications in terms of consistency and prognostic value. The modified Frankel definition was subdivided into five categories (A, B, C, D and E). On admission (discharge) 43 (37) patients were classified as Frankel A, 23 (11) patients in group B, 26 (42) patients in group C, 2 (2) patients as Frankel D and 0 (2) patients in group E. A qualitative analysis of the results on the base of a maximal score of 100 points (A = 0, B = 25, C = 50, D = 75 and E = 100 points) suggested a mean score improvement from 21.5 (+/- 22.5) to 29.0 (+/- 26.3) or 7.5 (+/- 7.1), regarding all 94 patients during follow up (admission/discharge). The median improvement was one modified Frankel grade (A/B to B/C). No detailed assessments were yielded concerning motor and sensory functions. Using ASIA definition, a continuous numerical score of motor and sensory function was observed. Recovery during follow up was determined by detailed motor and sensory function. For all 94 patients (quadriplegics and tetraplegics), the average motor recovery according to the ASIA definition was 9.4 (+/- 9.6). The mean ASIA motor score improved from 52.2 (+/- 17.3) on admission to 61.6 (+/- 17.9) on discharge.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2006

Do diagnostic segmental nerve root blocks in chronic low back pain patients with radiation to the leg lack distinct sensory effects? A preliminary study.

BACKGROUND: The present preliminary study documents the effects of a selective nerve root block (SNB) with short or long acting local anaesthetic compared with baseline measurements in patients with chronic low back pain radiating to the leg with maximum pain in one dermatome (L4). METHODS: Ten consecutive patients underwent 20 controlled SNBs at L4 with ropivacaine 0.25% and lidocaine 1% in a prospective, randomized, double blind, crossover fashion. Baseline measurements included sensory function (assessed by pinprick on both unaffected and painful leg) and pain (Verbal Numeric Rating Scale; VNRS, 0-10). A change in size of areas with altered sensory function >10% and a VNRS change of 2 points were considered clinically significant. P-values<0.05 were considered statistically significant. RESULTS: Asymptomatic hypoaesthesia, variable in extent and non-dermatomal in distribution, was present in seven patients at baseline. It appeared to be more extensive and distal with longer duration of pre-existing pain. SNB produced no consistent changes in extent and distribution of hypoaesthetic areas. Change in VNRS did not correlate with the extent of pre-block or post-block hypoaesthesia. No differences in effects were found between lidocaine and ropivacaine. CONCLUSIONS: Pre-block assessment of sensory function is essential to assess the net effect of SNBs. In this small study group, SNBs failed to demonstrate uniform or distinct effects on sensory function.

Adult↗

PubMed2007

C-Peptide replacement therapy and sensory nerve function in type 1 diabetic neuropathy.

OBJECTIVE: C-peptide replacement in animals results in amelioration of diabetes-induced functional and structural abnormalities in peripheral nerves. The present study was undertaken to examine whether C-peptide administration to patients with type 1 diabetes and peripheral neuropathy improves sensory nerve function. RESEARCH DESIGN AND METHODS: This was an exploratory, double-blinded, randomized, and placebo-controlled study with three study groups that was carried out at five centers in Sweden. C-peptide was given as a replacement dose (1.5 mg/day, divided into four subcutaneous doses) or a dose three times higher (4.5 mg/day) during 6 months. Neurological examination and neurophysiological measurements were performed before and after 6 months of treatment with C-peptide or placebo. RESULTS: The age of the 139 patients who completed the protocol was 44.2 +/- 0.6 (mean +/- SE) years and their duration of diabetes was 30.6 +/- 0.8 years. Clinical neurological impairment (NIA) (score >7 points) of the lower extremities was present in 86% of the patients at baseline. Sensory nerve conduction velocity (SCV) was 2.6 +/- 0.08 SD below body height-corrected normal values at baseline and improved similarly within the two C-peptide groups (P < 0.007). The number of patients responding with a SCV peak potential improvement >1.0 m/s was greater in C-peptide-treated patients than in those receiving placebo (P < 0.03). In the least severely affected patients (SCV < 2.5 SD below normal at baseline, n = 70) SCV improved by 1.0 m/s (P < 0.014 vs. placebo). NIA score and vibration perception both improved within the C-peptide-treated groups (P < 0.011 and P < 0.002). A1C levels (7.6 +/- 0.1% at baseline) decreased slightly but similarly in C-peptide-and placebo-treated patients during the study. CONCLUSIONS: C-peptide treatment for 6 months improves sensory nerve function in early-stage type 1 diabetic neuropathy.

Adult↗

PubMed1998

The effect of exercise training on functional recovery after sciatic nerve crush in the rat.

Two separate experiments were carried out in order to evaluate the influence of moderate swim training and treadmill running on the rate of recovery of sensorimotor function following sciatic nerve injury in the rat. Nerve injury was induced by sciatic nerve crush. In the first experiment, rats were subjected to swim exercise (180 m daily), either for 7 days before, or for 14 consecutive days after nerve injury. In the second experiment rats were exercised on a motor driven treadmill device (10 m/min for 30 min twice daily) for 21 days. The recovery from nerve injury was assessed by means of an analysis of the free walking pattern (motor function) and the foot withdrawal reflex (sensory function) by electrical stimulation. The swim training program before or after crush did not affect the recovery of locomotor or sensory function. Treadmill running significantly deteriorated the gradual return of motor function (p < 0.05), but did not influence sensory recovery. We conclude that swim training does not interfere with functional sensorimotor recovery after sciatic nerve injury, and that a mild program of treadmill running retards recovery. We hypothesize that the retardation of recovery as a result of treadmill running is the consequence of the stress inflicted by the negative reinforcement used in the treadmill, or due to the severity of the training. /Ø?>

Animals↗

PubMed1999

G(o) protein-dependent survival of primary accessory olfactory neurons.

Extensive G protein-coupled receptor families in both the main and accessory olfactory systems have been implicated in axonal targeting, sensory function, and cell survival. Although sensory function seems to be mediated by G proteins, axonal guidance and cell survival may be G protein-independent processes. In the accessory olfactory system, the G(o)-containing neurons in the basal vomeronasal organ (VNO) project to the posterior accessory olfactory bulb (AOB), whereas more apically located VNO neurons contain G(i2) and project to the anterior AOB. Herein, we investigate the organization of the accessory olfactory system in mice with a targeted deletion in the G(o)alpha gene. The accessory olfactory system seems normal at birth; however, postnatally, the number of G(o)-receptor-containing VNO neurons decreases by half, and apoptotic neurons are detected. The axons of VNO neurons remain restricted to the posterior AOB. The posterior AOB is reduced in size but contains a synaptophysin-positive layer with the normal number of glomeruli. The posterior AOB has reduced mitral cell c-Fos immunoreactivity, consistent with decreased sensory activation of G(o) protein-coupled VNO receptor neurons. Thus, in the accessory olfactory system, receptor-coupled G proteins are required for cell survival.

Animals↗

PubMed1994

F response and H reflex for monitoring nerve block during epidural analgesia with ropivacaine.

The effect of a single epidural injection of ropivacaine on the motor and sensory function controlled from the L5/S1 level was investigated in 28 male volunteers. Concentrations of 1%, 0.75%, or 0.5% ropivacaine, 20 mL, administered at the L2/3 level were studied. Motor function was assessed quantitatively (measurement of muscle force by mechano-transducers), and sensory function by the pinprick method. In addition, F response and H reflex, tests which measure the conduction velocity in the central parts of peripheral nerves, were used. Epidural ropivacaine caused dose-dependent prolongation of the latencies of both these variables. F response latency recovered significantly later than motor function measured by mechano-transducers in the two lower concentration groups. H reflex latency recovered significantly later than sensory function assessed by the pinprick method in all three concentration groups. The time needed for recovery of F and H latencies was not significantly longer than the time from epidural injection to mobilization. At the time when the subjects could go through the mobilization procedure, 12 of 28 subjects were not completely recovered. In 5 of these 12 subjects, the H reflex latency was persistently prolonged at the end of the investigation, long after the subjects felt "normal" again. On follow-up recordings 5 mo later, the baseline latency had been regained in all five subjects. We conclude that F response and H reflex latencies are good indicators of the inhibition of nerve impulse conduction induced by epidural analgesia.

Adult↗

PubMed1991

Neuroeffector functions of sensory fibres: implications for headache mechanisms and drug actions.

The results of recent investigations designed to elucidate the neuroeffector functions of sensory fibres, the cause of migraine headache and the mechanism of action of antimigraine drugs are reviewed and discussed. Neurogenic inflammation (vasodilatation and neurogenic plasma extravasation) is one explanation for the development of headaches and the blood flow changes which occur during migraine headache. Numerous studies have recently been carried out on rats and guinea-pigs into the effects of antimigraine agents, including ergot alkaloids, sumatriptan and non-steroidal anti-inflammatory drugs (NSAIDs), on neurogenic plasma protein extravasation in the dura mater induced by electrical stimulation of trigeminal ganglia or systemic administration of capsaicin. It is known that the dura mater is able to produce headaches in man. Ergot alkaloids have been shown to block neurogenic inflammation via a C-fibre dependent neuronal mechanism. Sumatriptan appears to act fairly similarly although, whereas the ergot alkaloids are non-selective for either 5-hydroxytryptamine (5-HT; serotonin) receptors or 5-HT1, sumatriptan is selective for 5-HT1 receptors. The antimigraine action of NSAIDs may be via either an effect on blood vessels or an effect on the nerve fibre. The antimigraine effects of ergot alkaloids, sumatriptan and NSAIDs are discussed in the light of the common vasoconstrictor actions of these agents and knowledge that vasodilatation is apparently not responsible for migraine headache pain in most cases.

Animals↗

PubMed2002

The effect of two episodes of denervation and reinnervation on skeletal muscle contractile function.

Sensory or motor "baby-sitting" has been proposed as a clinical strategy to preserve muscle integrity if motion-specific axons must regenerate over a long distance to reach denervated target muscles. Denervated muscles are innervated temporarily by using axons from nearby sensory or motor nerves. After motion specific motor axons have reached the target, the baby-sitter nerve is severed and motion-specific axons are directed to the target. Although this strategy minimizes denervation time, the requisite second episode of denervation and reinnervation might be deleterious to muscle contractile function. This study was designed to test the hypothesis that two sequential episodes of skeletal muscle denervation and reinnervation result in greater force and power deficits than a single peripheral nerve injury and repair. Adult Lewis rats underwent either transection and epineurial repair or sham exposure of the left peroneal nerve. After a 4-month recovery period, the contractile properties of the extensor digitorum longus muscle of the sham exposure group (control, n = 9) and one of the nerve division and repair groups (repair group 1, n = 9) were evaluated with measurements of the maximum tetanic isometric force, peak power, and maximal sustained power. A third group of rats underwent a second cycle of nerve division and repair (repair group 2, n = 9) at this same time point. Four months postoperatively, contractile properties of the extensor digitorum longus muscles were evaluated. Maximum tetanic isometric force and peak power were significantly reduced in repair group 2 rats as compared with repair group 1 and control rats. Maximal sustained power was not significantly different between the groups. These data support our working hypothesis that skeletal muscle contractile function is adversely affected by two cycles of denervation and reinnervation as compared with a single episode of nerve division and repair.

Animals↗