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PubMed1982

Intraoperative monitoring of evoked potentials.

Sensory EPs were recorded intraoperatively in 173 neurosurgical procedures (71 VEPs, 66 BAEPs, and 31 SSEPs) to evaluate the utility of this technique. EPs could be safely recorded in all cases, but the yield of useful results varied with each sensory modality. BAEPs were recorded reliably in 100% of the cases and intraoperative latency changes accurately predicted postoperative hearing deficits in 10%. Potential hearing deficits were detected in another 15%. BAEP changes were associated with brainstem dysfunction in only one case. VEP changes were difficult to interpret intraoperatively because of contamination by a high degree of variability and both false negative and false positive results. Changes in VEP amplitudes related to surgical manipulation of the optic chiasm were only suggested. SSEP changes were recorded reliably in only 75% of the cases and no correlations between SSEP changes and postoperative sensory function were established. Again, intraoperative amplitude attenuation of the SSEP waveform with surgical manipulation only suggested a potential sensory deficit. Intraoperative EP monitoring is a valuable technique that provides a functional analysis of the sensory nervous system during surgical procedures. Specific sensory stimuli and improved data analysis will increase the utility of this CNS monitor.

Acoustic Stimulation↗

PubMed2005

Chronic enhancement of the intrinsic growth capacity of sensory neurons combined with the degradation of inhibitory proteoglycans allows functional regeneration of sensory axons through the dorsal root entry zone in the mammalian spinal cord.

Peripherally conditioned sensory neurons have an increased capacity to regenerate their central processes. However, even conditioned axons struggle in the presence of a hostile CNS environment. We hypothesized that combining an aggressive conditioning strategy with modification of inhibitory reactive astroglial-associated extracellular matrix could enhance regeneration. We screened potential treatments using a model of the dorsal root entry zone (DREZ). In this assay, a gradient of inhibitory chondroitin sulfate proteoglycans (CSPGs) stimulates formation of dystrophic end bulbs on adult sensory axons, which mimics regeneration failure in vivo. Combining inflammation-induced preconditioning of dorsal root ganglia in vivo before harvest, with chondroitinase ABC (ChABC) digestion of proteoglycans in vitro allows for significant regeneration across a once potently inhibitory substrate. We then assessed regeneration through the DREZ after root crush in adult rats receiving the combination treatment, ChABC, or zymosan pretreatment alone or no treatment. Regeneration was never observed in untreated animals, and only minimal regeneration occurred in the ChABC- and zymosan-alone groups. However, remarkable regeneration was observed in a majority of animals that received the combination treatment. Regenerated fibers established functional synapses, as demonstrated electrophysiologically by the presence of an H-reflex. Two different postlesion treatment paradigms in which the timing of both zymosan and ChABC administration were varied after injury were ineffective in promoting regeneration. Therefore, zymosan pretreatment, but not posttreatment, of the sensory ganglia, combined with ChABC modification of CSPGs, resulted in robust and functional regeneration of sensory axons through the DREZ after root injury.

Animals↗

PubMed2004

Angeli's salt and spinal motor neuron injury.

UNLABELLED: Nitroxyl anion or its conjugate acid (NO-/HNO) and nitric oxide (NO) may both have pro-oxidative and cytotoxic properties. Superoxide dismutase (SOD) enzyme has been shown to convert reversibly HNO to NO. Mutations found in the SOD enzyme in some familial amyotrophic lateral sclerosis (ALS) patients affect redox properties of the SOD enzyme in a manner, which may affect the equilibrium between NO and HNO. Therefore, we studied the effects of HNO releasing compound, Angeli's salt (AS), on both motor and sensory functions after intrathecal administration in the lumbar spinal cord of a male rat. These functions were measured by rotarod, spontaneous activity, paw- and tail-flick tests. In addition, we compared the effect of AS to NO releasing papanonoate, old AS solution and sulphononoate in the motor performance test. The effect of intrathecal delivery of AS on the markers of the spinal cord injury and oxidative/nitrosative stress were further studied. RESULTS: Freshly prepared AS (5 or 10 micromol), but not papanonoate, caused a marked decrease in the rotarod performance 3-7 days after the intrathecal administration. The peak motor deficiency was noted 3 days after AS (5 micromol) delivery. Old, degraded, AS solution and nitrous oxide releasing sulphononoate did not decrease motor performance in the rotarod test. AS did not affect the sensory stimulus evoked responses as measured by the paw-flick and tail-flick tests. Immunohistological examination revealed that AS caused injury related changes in the expression of glial fibrillary acidic protein (GFAP), fibroblast growth factor (FGF-2) and laminins in the spinal cord. Moreover, AS increased nitrotyrosine immunoreactivity in the spinal motor neurons. Therefore, we conclude that AS, but not NO releasing papanonoate, causes motor neuron injury but does not affect the function of sensory nerves in behavioural tests.

Animals↗

PubMed2002

Functional topography of the low postcentral area.

OBJECT: The goal of this study was to establish a reliable method for identification of face and tongue sensory function in the lower central area. METHODS: All positron emission tomography (PET) clinical activation studies performed over a 3-year period at the Montreal Neurological Institute and Hospital were evaluated by coregistering the PET images with three-dimensional reconstructions of magnetic resonance images obtained in the same patients. In addition to stereotactic coordinates and measurements based on distance from the sylvian fissure, gyral and sulcal landmarks were analyzed to determine their reliability in localizing the sensory areas of the tongue and lower face. The convolutional anatomy of the central area is an important guide to the identification of function. The sensory area of the tongue is recognized as a triangular region at the base of the postcentral gyrus; the sensory area of the lower face resides in the narrowed portion of the postcentral gyrus, immediately above the tongue area. CONCLUSIONS: Cortical landmarks such as the substrata of tongue and face sensory impressions are more reliable guides than stereotactic coordinates or measurements for localizing function.

Adolescent↗

PubMed2000

Cross-modal reorganization of human cortical functions.

Recent technological development has opened fascinating opportunities in research on cognitive functions of the human brain. For example, cortical representations of sensory functions and their reorganization, which have been studied thoroughly in animals, are far better understood in humans now than they were only a decade ago. Hemodynamic and electromagnetic studies have demonstrated that a modality-specific brain area that is totally deprived of its normal sensory input becomes responsive to stimulation of other modalities. The functional significance of this cross-modal activation was recently indicated by, for example, studies showing that the occipital cortex of the blind is activated by sound changes, when the task is to detect these changes. Moreover, trans-cranial magnetic stimulation applied to the occipital cortex of blind individuals results in distortions and omissions of letters in Braille text being read by the subject. Contrary to prevailing views, cross-modal neural reorganization might, as shown by recent results, take place even in the mature human brain.

Adult↗

PubMed2004

Pre- and postnatal development studies of lasofoxifene, a selective estrogen receptor modulator (SERM), in Sprague-Dawley rats.

BACKGROUND: Lasofoxifene is a nonsteroidal selective estrogen receptor modulator (SERM) developed for the treatment of postmenopausal osteoporosis. The purpose of these studies was to evaluate the effects of lasofoxifene on the postnatal development, behavior, and reproductive performance of offspring of female rats given lasofoxifene during organogenesis and lactation. METHODS: Two range-finding studies were conducted to determine the effects of lasofoxifene at doses from 0.01-10 mg/kg on parturition and lactation in pregnant rats and on the early postnatal development of the offspring, and to optimize the dosing regimen. Maternal milk and plasma were sampled for concentrations of lasofoxifene on Lactation Days 4, 7, and 14. In the pre- and postnatal development study, lasofoxifene was administered to pregnant and lactating rats by oral gavage at dose levels of 0.01, 0.03, and 0.1 mg/kg on Gestation Days 6-17 and Lactation Days 1-20. Maternal body weight and food consumption were measured throughout pregnancy, and body weight was measured throughout lactation. Parturition was monitored closely. The F1 offspring were measured for viability, body weight, anogenital distance, the appearance of postnatal developmental indices and reflex behaviors, sensory function, in an age-appropriate functional observational battery, motor activity, auditory startle, passive avoidance, and the Cincinnati Water Maze. The F1 generation was assessed for reproductive function, and the F2 offspring were measured for body weight and viability throughout the lactation period. RESULTS: In the range-finding studies, indications of maternal toxicity included decreased body weight and food consumption, increased length of gestation, prolonged parturition, dystocia, and increased offspring mortality at birth. Concentrations of lasofoxifene in maternal plasma were similar to those in milk, increased with increasing dose, and remained consistent over a 10-day period. In the pre- and postnatal development study, maternal body weights and food consumption were decreased in all treated groups during gestation. Length of gestation was increased, parturition was prolonged, and dystocia was noted in the dams in the 0.1 mg/kg group. There was increased pup mortality in the F1 litters in the 0.1 mg/kg group and all treated groups had decreased offspring body weights beginning at 1 week of age, continuing into the postweaning period and, for the F1 males, into adulthood. Female F1 offspring in the 0.03 and 0.1 mg/kg groups had increased body weights as adults. There were delays in the age of appearance of preputial separation in the males in the 0.1 mg/kg group and vaginal opening in the females in all treated groups. Body temperature was decreased by <0.5 degrees C after weaning for male and female offspring in the 0.1 mg/kg group. The sensory, behavioral, and functional measures, including the tests of learning and memory, were unaffected by treatment. Mating success was lower for the F1 animals in the 0.1 mg/kg group, but there were no effects on the reproductive parameters. Mating, reproduction, and maternal behavior of the F1 animals in the 0.01 and 0.03 mg/kg groups and the survival and body weights of the F2 offspring in all treated groups through Postnatal Day 21 were unaffected by treatment. CONCLUSION: The maternal findings in this study were related to the pharmacologic activity of lasofoxifene. Inhibition of growth of the F1 offspring after perinatal exposure to lasofoxifene was observed, but there were no significant effects on the sensory, behavioral, or functional measures, including learning and memory. There were no effects on the F2 generation. The findings are consistent with those reported for at least one other SERM. The findings of this study do not suggest increased risk for the primary indication of use in postmenopausal women.

Animals↗

PubMed2003

Sensory and autonomic function in the hands of patients with non-specific arm pain (NSAP) and asymptomatic office workers.

Chronic pain in the upper limb associated with repetitive movements of the arm and hand is often seen in patients in the absence of specific pathology such as epicondylitis, carpal tunnel syndrome and tenosynovitis. This condition has been given many names and will be referred to here as non-specific arm pain (NSAP). Previous work has shown elevated vibration thresholds and reduced flare suggesting a neuropathic cause for this condition. In order to examine this further the present study has assessed functions that involve both large sensory nerve fibres (vibration) and small dorsal root fibres (flare) and sympathetic fibres (vasoconstriction). NSAP patients and also a group of office workers who intensively used display screen equipment but who did not have NSAP were also studied along with an age-matched control group. In the median innervated area of the hand we measured flare responses to iontophoresis of histamine (a sensory C-fibre effect), and sympathetic vasoconstrictor responses to ice stimulation over C7. To tie in with previous studies, vibration threshold over areas of the hand innervated by the median, ulnar and radial nerves was also evaluated. All measures were carried out over both hands in each subject. Significant differences from controls were found on all three measures for the NSAP patient group and on two measures for the office workers. Flare area was reduced by 33% in the patients and by 30% in the office workers. Reflex vasoconstriction was reduced by 20% in the patient group but was not altered in office worker group. Over the median innervated area on the hand, vibration threshold was elevated by 47% in the patients and by 21% in the office workers. These results confirm previous findings showing reduced function associated with both small and large sensory fibres in the NSAP patients and additionally, for the first time, demonstrate a functional change related to sympathetic fibres. Office workers demonstrate a similar but smaller trend for reduced nerve function associated with both small and large sensory fibre function, but had no change in the sympathetic reflex.

Adult↗

PubMed2006

Ultrastructure of tarsal sensilla and other integument structures of two Pseudocellus species (Ricinulei, Arachnida).

Ricinuleids are one of the least investigated groups of Arachnida. In particular, knowledge of their ultrastructure is poor. Observations of the distal tarsomeres of ricinuleids show differences in their shape and equipment of surface structures. Legs I and II are used by the Ricinulei to explore their surroundings with tentative movements. The tarsomeres of these legs show similarities in shape and surface structures that distinguish them from those of legs III and IV. In this study, 11 different structures of the tarsomere surfaces of two cave-dwelling species, Pseudocellus pearsei and P. boneti from México, were investigated for the first time with scanning and transmission electron microscopy and discussed regarding their possible function: 1) a single treelike ramifying seta resembles a no pore single-walled (np-sw) sensillum; 2) setae occurring in a small number and possessing a bipartite shaft represent terminal pore single-walled (tp-sw) sensilla. The surface of the proximal half of the shaft shows small branches. The distal half has a smooth surface; 3) long setae with conspicuous longitudinal lamellae show characteristics of chemoreceptive wall pore single-walled (wp-sw) sensilla; 4) frequent small wp-sw sensilla with flat and irregular lamellae; 5) very short wp-sw sensilla occurring solitary or in groups; 6) a few short setae with smooth surface correspond to wp-sw sensilla; 7) a single short clubbed seta articulating in a flat pit is considered to be a np-sw sensillum; 8) common long setae with a pointed tip show characteristics of mechanoreceptive np-sw sensilla; 9) ventral setae with adhesive and mechanosensory function are accompanied by multicellular "class III" glands; 10) slit organs with mechanoreceptive function; and 11) dome-like tubercles with no indication of sensorial function. Several of these sensilla form a sensory field on the dorsofrontal surface which is particularly pronounced on the distal tarsomeres of legs I and II.

Animals↗

PubMed1999

Strategies for providing upper extremity amputees with tactile and hand position feedback--moving closer to the bionic arm.

A continuing challenge for prostheses developers is to replace the sensory function of the hand. This includes tactile sensitivity such as finger contact, grip force, object slippage, surface texture and temperature, as well as proprioceptive sense. One approach is sensory substitution whereby an intact sensory system such as vision, hearing or cutaneous sensation elsewhere on the body is used as an input channel for information related to the prosthesis. A second technique involves using electrical stimulation to deliver sensor derived information directly to the peripheral afferent nerves within the residual limb. Stimulation of the relevant afferent nerves can ultimately come closest to restoring the original sensory perceptions of the hand, and to this end, researchers have already demonstrated some degree of functionality of the transected sensory nerves in studies with amputee subjects. This paper provides an overview of different types of nerve interface components and the advantages and disadvantages of employing each of them in sensory feedback systems. Issues of sensory perception, neurophysiology and anatomy relevant to hand sensation and function are discussed with respect to the selection of the different types of nerve interfaces. The goal of this paper is to outline what can be accomplished for implementing sensation into artificial arms in the near term by applying what is present or presently attainable technology.

Amputees↗

PubMed2001

Model of neuropathic intermittent claudication in the rat: methodology and application.

In the present study we characterize a rat neurogenic intermittent claudication model which was accomplished by placing two pieces of silicone rubber of various sizes into the lumbar (L4 and L6) epidural space. After induction of spinal stenosis walking function was measured using a treadmill apparatus and sensory functions were tested by measuring thermal and tactile withdrawal threshold (von Frey filaments) for the period of 28 days after stenosis. In addition, local spinal cord blood flow (SCBF) was measured, periodically, before and after induction of stenosis using laser Doppler. After implantation of two pieces of silicone rubber (width 1.25 mm, height 1.0 mm, length 4.0 mm) a significant running dysfunction, as evidenced by shortening of running distance, was measured as soon as 24 h after stenosis (178.5+/-59.1 m vs 681.3+/-70.2 m). This effect persisted for 28 days after surgery. Similarly, a significant tactile (but not thermal) hypersensitivity was measured for a period of 28 days (1.2+/-0.3 g vs 14.9+/-0.2 g). In this experimental group the measurement of local SCBF revealed a significant (30-50%) reduction in the territory of spinal stenosis measured at 3,7,14 or 28 days after surgery. Implantation of larger pieces of silicon rubber (1.5 mm width) caused a significant increase in the incidence of urinary retention and mortality rate. These data show that chronic partial spinal compression at L4 and L6 spinal level lead to the development of significant motor/sensory dysfunction which resemble those seen in patients with neurogenic intermittent claudication. The lack of motor dysfunction under resting conditions but its appearance during forced exercise also suggest that the development of local spinal ischemia can represent one of the mechanisms.

Animals↗

PubMed1981

Sensory control of dauer larva formation in Caenorhabditis elegans.

As a sensory response to starvation or overcrowding, Caenorhabditis elegans second-stage larvae may molt into a developmentally arrested state called the dauer larva. When environmental conditions become favorable for growth, dauer larvae mold and resume development. Some mutants unable to form dauer larvae are simultaneously affected in a number of sensory functions, including chemotaxis and mating. The behavior and sensory neuroanatomy of three such mutants, representing three distinct genetic loci, have been determined and compared with wild-type strain. Morphological abnormalities in afferent nerve endings were detected in each mutant. Both amphid and outer labial sensilla are affected in the mutant CB1377 (daf-6)X, while another mutant, CB1387 (daf-10)IV, is abnormal in amphidial cells and in the tips of the cephalic neurons. The most pleitropic mutant, CB1379 (che-3)I, exhibits gross abnormalities in the tips of virtually all anterior and posterior sensory neurons. The primary structural defect in CB1377 appears to be in the nonneuronal amphidial sheath cells. The disruption of neural organization in CB1377 is much greater in the adult than in the L2 stage. Of all the anterior sense organs examined, only the amphids are morphologically affected in all three mutants. Thus, one or more of the amphidial neurons may mediate the sensory signals for entry into the dauer larva stage in normal animals. Using temperature-sensitive mutants we determined that the same defects which block entry into the dauer stage also prevent recovery of dauer larvae.

Animals↗

PubMed2000

Transhemispheric cortical reorganization in rat SmI and involvement of central noradrenergic system.

Responses of single units in the hindpaw representational area of the left primary somatosensory cortex to electrical stimulation of both hindpaws and the right forepaw were recorded under urethane anaesthesia in three groups of adult male rats: a control group and two groups in which the right hindpaw representational area had been ablated 3-4 weeks previously, immediately after intraperitoneal injection of saline vehicle or DSP4, to destroy cortical noradrenergic terminals arising from the locus coeruleus. The lesion increased the overall number of neurones responding within 500 ms after the stimulation of the contralateral hindpaw (from 64 to 91%), and the proportion exhibiting short-latency response increased from 41 to 61%. Interestingly, the proportion of neurones with bilateral representation increased from 3 to 10% after the cortical lesioning. The changes were prevented by injection of DSP4 prior to lesioning and therefore depended on an intact central noradrenergic system. The increase in bilateral representation could not have been due to direct interhemispheric connections between corresponding representational areas because it occurred after lesioning of the homologous area in the contralateral hemisphere. The phenomenon was termed 'transhemispheric reorganization' and because it was somatotopically oriented (e.g. to either hindpaw); its function may be to ensure that when a sensory cortical area is damaged, its basic sensory functions are 'taken over' by the corresponding contralateral area.

Animals↗

PubMed1999

Comparison of different modalities for detection of small fiber neuropathy.

OBJECTIVES: In general, large fiber sensory function is easier to assess than small fiber function both clinically and electrophysiologically. Therefore, small fiber sensory neuropathies are more difficult to diagnose. The relative sensitivities of different electrodiagnostic tests for small fiber neuropathy are not known. We sought to determine and compare the sensitivities of quantitative thermal sensory testing (QST), quantitative sudomotor axon reflex testing (QSART), and cardiovascular autonomic testing for diagnosis in patients with clinically suspected small fiber neuropathy. METHODS: 15 adult patients with clinically suspected small fiber sensory neuropathy underwent neurologic examination, QST, and QSART. Twelve also underwent cardiovascular autonomic testing. RESULTS: 80% had an abnormal neurologic examination consistent with small fiber neuropathy, while 93% had at least one abnormal quantitative test. QSART was most sensitive with 12 of 15 (80%) having abnormal studies while 10 of 15 (67%) had abnormal thermal thresholds by QST. Abnormal heart rate with deep breathing was detected in 9 of 12 (75%) patients. CONCLUSION: Of the modalities tested, QSART was most sensitive in confirming the clinical suspicion of a small fiber neuropathy. Autonomic cardiovascular abnormalities were also common in our patients. Clinical examination and QSART may be optimal for screening patients for small fiber neuropathy.

Adult↗

PubMed2000

Low-level hydrocarbon solvent exposure and neurobehavioural effects.

Studies of workers exposed to hydrocarbon solvents are reviewed in order to address the question, 'Does long-term human exposure to hydrocarbon solvents at concentrations around occupational exposure limits result in clinically important neurobehavioural effects?' Studies selected evaluated exposure-response (E-R) trends with some control of potential confounders. Tests of neurobehavioural performance were classified into specific functional categories, within those of cognitive, psychomotor and sensory functions to increase specificity and power to detect patterns of effect. The weight-of-evidence was evaluated with respect to criteria for determining causality. The temporality criterion was met as latency was adequate for the occurrence of chronic effects. There were few significant associations, and when present, were consistently weak even in the most-exposed workers. Exposure response showed no consistent or significant pattern for any tests of functional mortality. The weight of evidence suggests that exposure to hydrocarbon solvents at current limits does not appear to cause adverse neurobehavioural effects.

Air Pollutants, Occupational↗

PubMed1997

Diagnosis of sensory impairment in people with intellectual disability in general practice.

The present authors have participated in the development of a Dutch consensus on the early detection, diagnosis and treatment of hearing and visual impairment in children and adults with intellectual disability. They argue that the early detection of sensory impairment in babies and children with intellectual disability should primarily be a responsibility of paediatricians and youth health physicians. General practitioners should be aware of the necessity of screening and should check whether this has been done when children visit the surgery. It is stressed that the general practitioner should play a more active role in the detection of age-related sensory loss in older adults with intellectual disability, and the assessment of younger adults whose sensory functions have never or incompletely been evaluated. Annual sensory screening is certainly not necessary, but annual otoscopy to detect impacted earwax or unidentified middle ear infection, as well as checks of the proper use of glasses and hearing aids, are suggested. Most adults with mild or moderate intellectual disability can be assessed with methods that are normally used by general practitioners. Uncooperative people should be referred for screening with specialized methods. A low-threshold referral system (e.g. via district expert teams) has been outlined.

Adolescent↗

PubMed2006

Predicting driving cessation over 5 years in older adults: psychological well-being and cognitive competence are stronger predictors than physical health.

OBJECTIVES: To examine psychological, medical, and sensorimotor risk factors that predict driving cessation in older adults. DESIGN: Prospective cohort study including five waves of data collected in 1992, 1993, 1994, 1995, and 1997. SETTING: The Australian Longitudinal Study of Aging. PARTICIPANTS: One thousand four hundred sixty-six men and women aged 70 and older drawn from the electoral roll and including 753 drivers at baseline. MEASUREMENTS: Interviews, including assessments of self-rated health (indicating general well-being); medical conditions; driving status; and clinical assessments of vision, hearing, cognitive function, and grip strength, were conducted in 1992 (baseline) and 1994. Information on current driving status was obtained at baseline and four subsequent waves (1993, 1994, 1995, and 1997). Drivers and nondrivers were compared at baseline. Risk factors for driving cessation were identified using logistic regression. RESULTS: Drivers were younger and more likely to be male and had better self-rated health, vision, hearing, and cognitive performance than nondrivers at baseline. Seventeen percent of drivers in the study had vision of 6/18 or worse, and 7.3% were classified as possibly cognitively impaired. In those identified as drivers at baseline, subsequent cessation was associated with increasing age, low grip strength, poorer cognitive performance, and poorer self-rated health. CONCLUSION: Self-rated health and cognitive function were more important than medical conditions or sensory function for predicting driving cessation.

Age Factors↗

PubMed2004

Regulation of brain proteolytic activity is necessary for the in vivo function of NMDA receptors.

Serine proteases are considered to be involved in plasticity-related events in the nervous system, but their in vivo targets and the importance of their control by endogenous inhibitors are still not clarified. Here, we demonstrate the crucial role of a potent serine protease inhibitor, protease nexin-1 (PN-1), in the regulation of activity-dependent brain proteolytic activity and the functioning of sensory pathways. Neuronal activity regulates the expression of PN-1, which in turn controls brain proteolytic activity. In PN-1-/- mice, absence of PN-1 leads to increased brain proteolytic activity, which is correlated with an activity-dependent decrease in the NR1 subunit of the NMDA receptor. Correspondingly, reduced NMDA receptor signaling is detected in their barrel cortex. This is coupled to decreased sensory evoked potentials in the barrel cortex and impaired whisker-dependent sensory motor function. Thus, a tight control of serine protease activity is critical for the in vivo function of the NMDA receptors and the proper function of sensory pathways.

Amyloid beta-Protein Precursor↗

PubMed1988

Update on peripheral nerve injuries.

Experimental work relating to factors affecting nerve regeneration is reviewed. There is increasing evidence that the nerve sprouts are preprogrammed for their peripheral reinnervation; old endoneurial tubes being discarded. Fascicular suture shows no significant improvement in function compared with epineural suture. The importance for sensory re-education and the need for repeatable sensory function tests is emphasized. Recent experimental work on the mechanisms of causalgia is reviewed and management of painful peripheral nerve disorders discussed. Striking advances have been made in the diagnosis, surgical treatment and rehabilitation of traction lesions of the brachial plexus. These are discussed with special reference to electrodiagnosis, functional splinting and management of pain. Surgery for obstetric palsies is now being undertaken and similar lesions to those in the adult being repaired with success. Reconstructive procedures for permanent paralysis are reviewed. Postirradiation plexus lesions present a formidable challenge but surgery can sometimes alleviate pain.

Brachial Plexus↗