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PubMed1992

General and specific cognitive dysfunctions in patients with Alzheimer's disease.

The purpose of the present study was to investigate the effect of Alzheimer's disease (AD) on general and specific neuropsychological function. Thirty-five subjects diagnosed with AD were compared to 30 medically normal aging control subjects using measures from the Halstead-Reitan Battery (HRB). All AD subjects were classified as "probable" AD (NINCDS-ADRDA) and found to be in the "late confusional" to "early dementia" stages of the disease (Global Deterioration Scale, GDS = 4-5). The AD group performed significantly worse than the controls on all measures of general neuropsychological function and almost all measures of specific functions. However, no differences were found between groups on motor abilities or many simple sensory functions. The findings demonstrate dramatic brain-behavior changes involving both general and specific cognitive functions which go beyond memory dysfunction even in the earlier stages of the disease. The neuropsychological pattern found may be the basis of a useful clinical-behavioral AD pattern in the earlier stages of the disease.

Journal Article↗

PubMed1990

[The effectiveness of selected surgical methods in the treatment of zygomatico-maxillary fractures].

In a period of 3 years, from 1984 to 1986 in the Department of Maxillofacial Surgery, Institute of Stomatology, Medical Academy in Warsaw 442 patients were treated for zygomatico-maxillary fractures, in 101 cases the treatment was conservative, and 341 were treated surgically by various operative methods. The aim of the study was assessment of late effectiveness of the surgical methods used most frequently in zygomatico-maxillary fractures with reposition of skeletal fragments either with one-pronged hook introduced percutaneously or from the side of the lumen of the maxillary sinus. The criterion of effectiveness of both methods was accepted to be functional assessment of the visual system and the stomatognathic system, and the condition of sensory function in the area of innervation by the suborbital nerve. Control examinations were done 2-5 years after operations confirming the both methods were successful in 90% of the treated group. A more detailed analysis of these methods is not possible since the qualification for these operations differentiated essentially both groups of patients.

Follow-Up Studies↗

PubMed1980

[The condition of long-term survivors and patients cured of childhood neoplasms].

Throughout the past years, permanent cure has become the realistic goal of treatment in a great number of children with cancer. As therapy is aggressive, various late effects of treatment have to be considered. The long-term survivors of 668 children with cancer treated at the Dept. of Pediatrics, University of Mainz, were analyzed for: their present clinical and neurological status, sensory function, impaired skeletal growth, risk of cardiomyopathies, renal functions after treatment for Wilms' tumors, chronic hepatitis, endocrine disorders, electroencephalographic abnormalities, motor and sensory nerve conduction velocities, death as a late consequence of tumor therapy, risk of second malignant neoplasias, and their psychosocial and intellectual situation. As a general result, the number of possible late consequences is great. Cancer treatment of children should be restricted to specialized teams at pediatric tumor centers. This is important concerning an optimal therapy as well as long-term care in view of prevention and early detection and treatment of late sequelae of tumors and treatment.

Actuarial Analysis↗

PubMed2002

Early psychological stress after forearm nerve injuries: a predictor for long-term functional outcome and return to productivity.

Forearm and wrist injuries can result in a nonfunctional hand caused by loss of motor and sensory functions. Psychological stress is known to accompany traumatic hand injuries and may therefore affect functional outcome. The authors conducted a retrospective study of 107 patients diagnosed with a median, ulnar, or combined median-ulnar nerve injury (79% response rate) who completed a questionnaire package consisting of the Impact of Event Scale (IES); Disabilities of Arm, Shoulder, and Hand; and a questionnaire concerning return to work and time off work. In an outpatient setting, motor and sensory recovery were examined. Ninety-four percent of those studied experienced early psychological stress. Thirty-six percent of patients reported sufficient symptoms 1 month postoperatively to be classified as in need for psychological treatment (IES score > 30 points). Combined median-ulnar nerve injuries (mean, 35.0 +/- 20.3 points [standard deviation]) were accompanied by a higher psychological stress compared with single nerve injuries (median injuries: mean, 24.2 +/- 20.6 points; ulnar injuries: mean, 22.6 +/- 19.5 points; p = 0.049 and p = 0.021 respectively). Multiple linear regression adjusting for age, gender, and severity of the trauma revealed an association between the IES score and the functional symptom score (beta = 0.51; 95% confidence interval [CI], 0.35-0.65), mean time off work (beta = 0.44; 95% CI, 0.25-0.75), and motor recovery (grip: beta = 0.37; 95% CI, 0.09-0.65; tip-pinch: beta = 0.46; 95% CI, 0.13-0.80). Patients with higher scores on the IES were found to be at increased risk for incapacity for work (odds ratio, 3.32; 95% CI, 1.60-6.91). Higher education was found to be a protecting variable for posttraumatic psychopathology (beta = -0.23; 95% CI, -6.05--0.246). This study demonstrated a high level of early posttraumatic psychological stress after forearm and wrist nerve injuries. These data provide evidence that functional outcome and work resumption are influenced negatively by early psychological stress, independent from severity of the somatic trauma. This indicates that outcome after upper extremity nerve injuries may be influenced positively by psychological intervention.

Adolescent↗

PubMed1992

Functional innervation of cultured skin grafts.

The aims of the present study were to determine 1) if grafts of cultured skin become innervated; and 2) whether tactile function of these grafts could be improved by implanting target tissue into them. Autologous skin equivalents were generated in vitro (30 d) for individual adult Sprague-Dawley rats. Some animals received pure skin equivalent grafts; others had target tissue consisting of 2-mm punch biopsies (normal skin or touch domes) inserted into their skin equivalents at the time of grafting. After 83 d, physiologic recordings were obtained from afferent nerves innervating the grafts. Tissue was processed for histology at various intervals. Silver staining of the tissues demonstrated many isolated nerve fibers in the dermis of cultured areas of skin as well as in implant zones. When grafts were rubbed with a glass rod or pinched with watchmaker forceps, impulses were evoked in nerves innervating both implant and cultured regions. In contrast, the afferent response to gently stroking grafts with a camel hair brush was severely reduced in cultured areas but was vigorous in implanted skin. Neuronal activity characteristic of type I neurons innervating touch domes was only found in cutaneous nerves innervating implants originally possessing domal tissue. Furthermore, grafts with good takes had better return of sensory function than grafts undergoing episodes of crusting. These results suggest that structural components or trophic factors present in implants enhanced the return of neural function related to the sensory modality of light touch; and this was also affected by the engraftment quality.

Action Potentials↗

PubMed2001

Gamma response of the brain: a multifunctional oscillation that represents bottom-up with top-down processing.

This paper deals with the functional correlates of the gamma response of the brain. A critical review of the literature findings reveals the existence of two types of gamma responses: an early gamma that fulfills sensory functions and a late gamma that fulfills perceptual-cognitive functions. However, even the early gamma shows individual differences. Such a finding points to the existence of top-down influences on sensory processes and to a parallel-processing model for brain function.

Brain↗

PubMed2004

Effects of the immunophilin ligand FK506 on nerve regeneration in collagen guides seeded with Schwann cells in rats.

We assessed the effects of FK506 administration on regeneration after 5-mm gap repair with a collagen guide seeded with syngeneic Schwann cells in the rat sciatic nerve. Functional reinnervation was evaluated by non-invasive methods to determine recovery of motor and sensory functions in the hindpaw over 4 months postoperation. Histological analysis of the regenerated nerves was performed at the end of follow-up. Treatment with FK506 (1 mg/kg for the first 2 months) resulted in significant improvement of the onset and the degree of reinnervation. The numbers of myelinated fibers in the distal regenerated nerve were similar between treated and control groups. In conclusion, FK506 improves functional recovery after repair with collagen guides seeded with syngeneic Schwann cells.

Animals↗

PubMed1996

In utero repair of experimental myelomeningocele saves neurological function at birth.

In a previous series of fetal sheep experiments, the authors demonstrated that midgestational exposure of the normal spinal cord to the amniotic space leads to a myelomeningocele (MMC) at birth that closely resembles human MMC phenotypes in terms of morphology and functional deficit. The present study tested whether delayed in utero repair of such evolving experimental MMC lesions spares neurological function. In 12 sheep fetuses, a spina bifida-type lesion with exposure of the lumbar spinal cord was created at 75 days' gestation (full term, 150 days). Four weeks later, the developing MMC lesions were repaired in utero for seven fetuses (five fetuses died before this time). Of those that had repair, three were delivered near term by cesarean section, and four died in utero or were aborted. All survivors had healed skin wounds and near-normal neurological function. Despite mild paraparesis, they were able to stand, walk, and perform demanding motor tests. Sensory function of the hindlimbs was present clinically and confirmed electrophysiologically. No signs of incontinence were detected. Histologically, the exposed and then covered spinal cord showed significant deformation, but the anatomic hallmarks as well as the cytoarchitecture of the spinal cord essentially were preserved. These findings show that timely in utero repair of developing experimental MMC stops the otherwise ongoing process of spinal cord destruction and "rescues" neurological function by the time of birth. Because there is evidence that a similar secondary damage to the exposed neural tissue also occurs in human MMC, we propose that in utero repair of selected human fetuses might reduce the neurological disaster commonly encountered after birth.

Animals↗

PubMed2001

The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs.

This study describes the development and validation of a novel tool for identifying patients in whom neuropathic mechanisms dominate their pain experience. The Leeds assessment of neuropathic symptoms and signs (LANSS) Pain Scale is based on analysis of sensory description and bedside examination of sensory dysfunction, and provides immediate information in clinical settings. It was developed in two populations of chronic pain patients. In the first (n = 60), the use of sensory descriptors and questions were compared in patients with nociceptive and neuropathic pain, combined with an assessment of sensory function. This data was used to derive a seven item pain scale, consisting of grouped sensory description and sensory examination with a simple scoring system. The LANSS Pain Scale was validated in a second group of patients (n = 40) by assessing discriminant ability, internal consistency and agreement by independent raters. Clinical and research applications of the LANSS Pain Scale are discussed.

Female↗

PubMed2003

Molecular mechanisms in endothelial regulation of cardiac function.

Endothelium is now recognized as a massive, regionally specific, multifunctional organ. Given its strategic anatomic location between the circulating blood components and the vascular smooth muscle or the cardiac muscle, it is a biologically significant interface whose dysfunction can be a critical factor in various pathological conditions. Two types of endothelial cells are recognized in the heart, the endocardial endothelial (EE) cells and the microvascular endothelial cells (MVE). Both produce common autacoids and share similar roles in signal transduction induced by neurotransmitters, hormones or mechanical stimuli. They are however two distinct cell populations with dissimilar embryological origin, cytoskeletal organization, receptor mediated functions and electrophysiological properties. Both the MVE and EE are modulators of cardiac performance. Myocardial contraction may be modulated by cardioactive agents such as nitric oxide, prostanoids, endothelin, natriuretic peptides, angiotensin II, kinins, reactive oxygen species and adenyl purines released from the cardiac endothelium. Two mechanisms have been proposed for the signal transduction from EE to the underlying myocytes: stimulus-secretion-contraction coupling and blood-heart barrier. Nitric oxide, bradykinin and myofilament desensitizing agent are probably important in short-term regulation of myocardial functions. Endothelin and Angiotensin II are probably involved in long-term regulation. Besides its sensory function and paracrine modulation of myocardial performance, EE as a blood-heart barrier could be of significance for the ionic homeostasis of the cardiac interstitium. In cardiac diseases, the damage to EE or MVE leading to failure of the endothelial cells to perform its regulatory and modulator functions may have serious consequences. A better understanding of the endothelial signaling pathways in cardiac physiology and pathophysiology may lead to the development of novel therapeutic strategies.

Animals↗

PubMed1990

Visual function with presbyopic contact lens correction.

All forms of ophthalmic correction for presbyopia require compromises in viewing flexibility and visual function. The unique effects on vision of contact lenses used in managing presbyopia are especially intriguing and potentially problematic. Bifocal contact lenses produce unique changes in the nature and quality of the retinal image. In monovision (MV) correction, anisometropia is intentionally created by fitting one eye to see clearly at optical infinity and the other eye to see clearly at the near working distance. Our review of the literature indicates that most visual functions are affected by these departures from the conventional optical correction strategies used on nonpresbyopes. Sensory functions such as contrast sensitivity and stereoacuity are affected most, whereas motor functions such as convergence and accommodation are not noticeably impaired. MV appears to produce a more widely acceptable visual compromise than currently available bifocal contact lenses for most patients.

Adaptation, Ocular↗

PubMed2005

Menstrual cycle affects bladder pain sensation in subjects with interstitial cystitis.

PURPOSE: Using psychophysical methods we compared the effect of the menstrual cycle on bladder sensation in subjects with the diagnosis of interstitial cystitis (IC) and in controls. MATERIALS AND METHODS: Female participants with normal menstrual cycles, including 7 with IC and 8 healthy controls, were recruited into this study. They completed daily diaries related to bladder pain and other body pain, and tracked daily micturition frequency. In a subset formal psychophysical testing of thermal and ischemic pain was performed at 2 times of the menstrual cycle, corresponding to the luteal and follicular phases. Cystometrograms were performed at the same time. RESULTS: Subjects with IC had higher pain scores and frequency than controls throughout the entire menstrual cycle. Pain scores were highest in the perimenstrual period in subjects with IC and controls. Micturition frequency was highest in the perimenstrual period in subjects with IC. Cystometric evaluation of a first need to void and the evocation of bladder pain demonstrated that lower intravesical volume and pressure were necessary to evoke bladder pain during the follicular period than during the luteal period in subjects with IC, although there was no effect on the first need to void. CONCLUSIONS: These findings are consistent with clinical lore that suggests a perimenstrual flare in pain in subjects with IC. To our knowledge it also demonstrates for the first time a menstrual cycle effect on bladder sensory function in subjects with IC. This suggests a potential role of gonadal hormones on bladder sensory processing and, therefore, a potential role for hormonal modulation as a therapeutic modality in this patient population.

Age Distribution↗

PubMed1992

Methylprednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up data. Results of the second National Acute Spinal Cord Injury Study.

The 1-year follow-up data of a multicenter randomized controlled trial of methylprednisolone (30 mg/kg bolus and 5.4 mg/kg/hr for 23 hours) or naloxone (5.4 mg/kg bolus and 4.0 mg/kg/hr for 23 hours) treatment for acute spinal cord injury are reported and compared with placebo results. In patients treated with methylprednisolone within 8 hours of injury, increased recovery of neurological function was seen at 6 weeks and at 6 months and continued to be observed 1 year after injury. For motor function, this difference was statistically significant (p = 0.030), and was found in patients with total sensory and motor loss in the emergency room (p = 0.019) and in those with some preservation of motor and sensory function (p = 0.024). Naloxone-treated patients did not show significantly greater recovery. Patients treated after 8 hours of injury recovered less motor function if receiving methylprednisolone (p = 0.08) or naloxone (p = 0.10) as compared with those given placebo. Complication and mortality rates were similar in either group of treated patients as compared with the placebo group. The authors conclude that treatment with the study dose of methylprednisolone is indicated for acute spinal cord trauma, but only if it can be started within 8 hours of injury.

Acute Disease↗

PubMed2001

Gait and balance dysfunction: a model of the interaction of age and disease.

This article reviews age-associated changes in gait, balance, and sensorimotor function and contrasts them to the changes that occur as a result of disease. Strength peaks in the mid-20s but declines only modestly until the fifth decade, after which there is rapid decline. All aspects of sensory function diminish with age, resulting in modest sensory changes in older patients. Gait speed is stable until the seventh decade and thereafter slows modestly. Age-related changes in the balance of older persons result in an effective response that meets routine needs but may be ineffective under demanding circumstances capable of producing response. Thus, these modest age-related decrements may be an element in the increased incidence of falls in older people. The loss of function caused by disease is of greater magnitude as well as being superimposed on that caused by age and thus may lead to a failure of mobility. Neurologic diseases that impair sensorimotor function compromise mobility in a manner consistent with the deficits that they produce. In mobility dysfunction caused by white matter lesions, the gait/balance abnormalities may not have unique clinical features, making diagnosis difficult. We used quantitative MRI to study the brains of older subjects with mobility impairment. The volume of white matter lesions in mobility-impaired subjects was double that of controls and was unrelated to increasing age, suggesting that white matter lesions are a disease-related rather than an age-related occurrence. We also used stance perturbation evoked potentials to demonstrate delayed conduction in some mobility-impaired older subjects. Prolonged sensory conduction may contribute to maladaptive balance and thus may be useful for diagnosis. Contemporary imaging and neurophysiology thus provides insight into the pathophysiology of mobility impairment and allows for more accurate diagnosis.

Aging↗

PubMed1987

Effects of ketamine anesthesia on the rat brain-stem auditory evoked potential as a function of dose and stimulus intensity.

Because ketamine is both an abused substance and a commonly used veterinary anesthetic, its effects on brain and sensory functions are of interest. The present study examined the dose-dependent effects of ketamine anesthesia in the rat, using the brain-stem auditory evoked potential (BAEP) as an objective, quantitative measure of this substance's acute effects on brain and sensory electrophysiology. The animal subjects were 11 young adult female Long-Evans rats. BAEPs were recorded from skull screw electrodes during a baseline period as well as after saline and ketamine treatments. Ketamine was administered (i.p.) in 2 serial doses. The first dose (100 mg/kg) was followed 30-40 min later by a second dose (also 100 mg/kg). Equal volumes of normal saline were also injected serially. An interval of 1-2 weeks occurred between the saline and ketamine treatments, with treatment order counterbalanced. Normothermia was maintained to control for possible temperature-related effects. Ketamine produced prolongations in the latencies of all BAEP components (P1 through P6) that were statistically significant relative to baseline values. These latency shifts were progressively greater for waves P1 through P4 (shifts in P5 and P6 approximated the P4 shift). The effect of the second ketamine injection was to nearly double the latency shifts. Ketamine also had significant and complex effects on BAEP amplitudes that were dependent on dose and stimulus intensity. The results of the present study challenge the belief that the BAEP is resistant to the effects of anesthetics and suggest that the BAEP is useful in characterizing the CNS and sensory effects of these pharmacological agents.

Animals↗

PubMed1982

Brain stimulation in the study of neuronal functions for conscious sensory experiences.

Some features of cerebral neuronal functions that are uniquely related to generation of conscious sensory responses, have been discovered. Included are two temporal factors: (1) Substantial delays, of up to about 0.5 sec, before achieving cerebral "neuronal adequacy" appear to be required for eliciting a sensory experience. This includes the demonstration that a cortical stimulus (C) can retroactively modify a skin (S)-induced sensation even when C stimulus begins up to 500 msec after S stimulus. (2) However, there appears to be a subjective referral of the experience back to the time of the cortical primary evoked response to S; subjectively the skin sensation would thus appear to have no delay. Stimuli that are inadequate for eliciting conscious sensory experience can nevertheless evoke considerable neuronal activity, including that represented in direct cortical responses or in primary (early) components of evoked potentials. Virtually all the qualities of somatic sensation (except pain) can be elicited by stimuli at post-central gyrus, when intensities of suitable trains of pulses are kept down to liminal levels. Some additional implications, for the manner in which mental and neural events are related, are discussed.

Arousal↗

PubMed1984

Birth palsy: natural recovery course and combined root avulsion.

Seventy-six patients with birth palsy were reviewed for type of palsy and mode of delivery. High incidences of root avulsion associated with lesser birth weight were identified in patients of breech deliveries. In 15 patients with serial neurological assessment for more than 5 years, the natural recovery course was evaluated, based on the assessment of particular key muscle and dermatomes mainly innervated by single nerve roots. Rapid and useful motor recovery was observed in upper-type palsy and the upper root levels (C5 and C6) of whole-type palsy, while poor prognosis of motor function was demonstrated in the lower root levels (C8 and D1) of whole-type palsy. Recovery of sensory function was far more predominant than recovery of motor function. Of 12 patients with root avulsion, 10 patients (27 avulsed roots) over 5 years of age were neurologically assessed. Of avulsed roots, 70.4% had useful sensory recovery and 33.3% had useful motor recovery. The patho-mechanism of those with a good prognosis in root avulsion of birth palsy is discussed, based on the findings of this series.

Birth Weight↗

PubMed2000

Spinal nerve root repair and reimplantation of avulsed ventral roots into the spinal cord after brachial plexus injury.

OBJECT: The authors review the first series of 10 cases in which injured intraspinal brachial plexus were surgically repaired. They describe the technique of spinal cord implantation or repair of ruptured nerve roots, as well as patient outcome. METHODS: Spinal root repair/implantation was performed from 10 days to 9 months postinjury. There were nine male patients and one female patient. Postoperatively in most cases, regeneration of motor neurons from the spinal cord to denervated muscles could be demonstrated. The first signs of regeneration were noted approximately 9 to 12 months postoperatively. Useful function with muscle power of at least Medical Research Council Grade 3 occurred in three of 10 cases. Magnetic brain stimulation studies revealed a normal amplitude and latency from the cortex to reinnervated muscles on surgically treated and control sides. A certain degree of cocontraction between antagonistic muscles (for example, biceps-triceps) compromised function. With time there was a reduction of cocontractions, probably due to spinal cord plasticity. In these cases there was also, surprisingly, a return of sensory function, although the mechanism by which this occurred is uncertain. Sensory stimulation (thermal and mechanical) within the avulsed dermatomes was perceived abnormally and/or experienced at remote sites. There was some return of patients' sense of joint position. CONCLUSIONS: A short time lag between the accident and the surgery was recognized as a significant factor for a successful outcome. Reimplantation of avulsed nerve roots may be combined with other procedures such as nerve transfers in severe cases of brachial plexus injury.

Adult↗