Regulation of bladder and colon--rectum in patients with spinal lesions

Parasympathetic cholinergic stimulation is excitatory for bladder and colon--rectum, normal as well as uninhibited. This is documented by pharmacological and neuroanatomical studies in man. The bladder and the left half of colon and rectum have motor supply in common as demonstrated by surgical intervention on sacral nerves. More detailed studies can be performed by electrical stimulation of sacral roots or rootlets. Sympathectomy may cause alteration of voiding pattern, but often only temporarily, and generally with no alteration of defecation habits. The sympathetic innervation is sparse in the human bladder, but alpha- and beta-adrenergic receptors have been demonstrated. The alpha-adrenergic blocking agent thymoxamine is able to cause a shift in the cystometrogram to the right, and to relax the spastic pelvic sphincters by i.v. administration. Like other alpha-adrenergic blocking agents, it can relax the proximal part of the urethra. The effect of other stimulating and blocking adrenergic compounds are reported, but further studies are needed. No simultaneous reactions are generally recorded in the uninhibited bladder and rectum, and no correlation was found between the hyperactivity of the uninhibited neurogenic bladder and colon.

Immunological parameters in multiple sclerosis patients with special reference to the herpes virus group

A group of multiple sclerosis (MS) patients (n = 50), most of them in a stable or slightly progressive phase was studied together with a group of neurological control (NC) patients with CNS lesions (n = 38) comparable in age and disability and an age matched group of healthy persons (n = 46). On stimulation of lymphocytes with herpes simplex virus (HSV), cytomegalovirus (CMV) and varicella zoster virus (VZV) a significantly lower interferon production was found in MS patients compared with the NC patients and the healthy controls; when the NC patients were compared with the healthy controls a significantly lower production was also found. The lymphocyte transformation reaction in seropositive MS patients was significantly lower than that seen in the seropositive control groups when HSV was used as antigen. Lower responses, although insignificant, were found when CMV and VZV were used as antigens. There were no differences among the three groups when Con A was used as mitogen in three different concentrations. Likewise spontaneous lymphocyte transformations were equal. The lower interferon production and the lower transformation reactions in MS patients could not be correlated to age, duration of disease, disability, disease activity or impairment. No significant differences in humoral immunity to HSV, CMV and VZV were found in the three groups, a few MS patients were 'true' seronegative to HSV type 1 and 2. Suppressor cell activity induced by Con A and measles virus was comparable in the three groups, although a few MS patients in an active relapsing phase were found to have low suppressor cell activity. Natural killer cell activity against two different cell lines was found equal in the three groups, and there was no difference in the potentiating effect of interferon.

The acute effect of the GABA-agonist, THIP, on proprioceptive and flexor reflexes in spastic patients

THIP (Lu 2-030) is pharmacologically a specific and potent GABA-receptor-agonist which in animal studies depresses monosynaptic and, to a smaller extent, polysynaptic spinal reflexes. 5 spastic patients were investigated by means of neurophysiological tests comparing the acute effect of a single oral dose of THIP (15-25 mg) to "the test situation without drug administration" with an interval of 2 days. The neurophysiological tests included quantitative studies of proprioceptive reflexes (T-reflex, vibratory inhibition of the T-reflex, resistance to passive movement of a spastic muscle and clonus) and of the flexor reflex (threshold and latency). The voluntary power was measured by a static technique. THIP clearly reduced the monosynaptic T-reflex and reinforced vibratory inhibition of the IA monosynaptic pathway. The flexor reflex threshold was slightly increased during THIP administration, but the changes were not significant. Flexor reflex latency, resistance to passive movement, clonus and voluntary power were unchanged.

Anal sphincter responses after perianal electrical stimulation

By perianal electrical stimulation and EMG recording from the external anal sphincter three responses were found with latencies of 2-8, 13-18 and 30-60 ms, respectively. The two first responses were recorded in most cases. They were characterised by constant latency and uniform pattern, were not fatigued by repeated stimulation, were most dependent on placement of stimulating and recording electrodes, and always had a higher threshold than the third response. The third response was constantly present in normal subjects. It had the longest EMG response and the latency decreased with increasing stimulation to a minimum of 30-60 ms. This response represented the clinical observable spinal reflex, "the classical anal reflex". The latencies of the two first responses were so short that they probably do not represent spinal reflexes. This was further supported by the effect of epidural anaesthesia which left the first responses unaffected but abolished the classical anal reflex. The origin of the two first responses is discussed and models involving antidromal impulse propagation in the efferent fibre as the afferent limbs of the responses are proposed.

Familial progressive myoclonic epilepsy. A clinical, genetical, biochemical and patho-anatomical study of a family with a 6-year follow-up

Six siblings, including 4 cases of myoclonic epilepsy, their parents and 2 grandmothers were subjected to systematic investigation, and the patients were followed-up. The genetic studies revealed in the mother's family a patient with Lafora bodies demonstrated at autopsy. No chromosome abnormalities were found nor any linkage to the HLA system. The affected family members were characterized biochemically by an increased excretion of total glycosaminoglycans and/or an abnormal electrophoretic pattern of urinary glycosaminoglycans with an increased proportion of low-sulfated glycosaminoglycans. In the healthy family members this pattern of electrophoresis could also be demonstrated in the father and the paternal grandmother. Based on the biochemical results and the genetic studies it is suggested that the family members with progressive familial myoclonic epilepsy present a combination of at least 2 hereditary defects. The course of the disease has been relatively benign and treatment with sodium valproate, baclofen and clonazepam has shown quite satisfying results. In consequence of the biochemical findings combined treatment with A and E vitamins has been initiated.

Effect of symptomatic therapy on motor difficulties in quantitative measurements of voluntary power

Thirty-one multiple sclerosis patients in a stable phase were given intensive symptomatic therapy. Isometric and isokinetic measurements of voluntary power were used to assess the effect of the treatment. Twenty-one of the patients were improved, six unchanged and four aggravated. The relative improvement was on the average 35%, best in the weakest patients. Isokinetic measurements revealed a particularly good progress for the fastest movements, probably reflecting reduction of spasticity. The optimum effect of treatment was found on an average after three weeks. Such tests seem to be useful in following and analysing the training and possibly in establishing treatment models.

The origin of cerebrospinal fluid somatostatin: hypothalamic or disperse central nervous system secretion?

The present study deals with the origin of somatostatin in cerebrospinal fluid. Two groups of experiments were performed: (1) Diagnostic lumbar puncture was performed in 37 patients admitted for various neurological diseases. Immunological determination of albumin and gamma-globulin, and radioimmunological analysis of somatostatin in successive cerebrospinal fluid taps demonstrated that while the protein concentration was approximately 20% lower in the 11th ml compared to the 1st ml drawn, the somatostatin concentration was constant. (2) Intravenous arginine infusion (30 G/30 min) induced identical patterns of plasma growth hormone in 8 patients with multiple sclerosis in relapse, in 6 patients with multiple sclerosis in the stable phase, and in 7 patients in whom no neurological disease was eventually diagnosed. Cerebrospinal fluid somatostatin was significantly lower in the patients with multiple sclerosis in relapse than in the two other groups, while cerebrospinal fluid growth hormone concentration was identical. There was no correlation between basal or arginine provoked plasma growth hormone and the cerebrospinal fluid content of somatostatin. The results indicate that cerebrospinal fluid somatostatin is released dispersely from the central nervous system including the spinal cord - and that it offers no indication of the activity or tone of hypothalamic growth hormone release inhibiting control of the pituitary gland.

Standardisation of the electrical elicitation of the human flexor reflex

The threshold and latency of the human flexor reflex were recorded by different kinds of electrical stimuli in order to find the optimal stimulus, defined as the lowest amount of currency and the shortest possible duration. Stimulation was given over the posterior tibial nerve of the foot. The reflex response was recorded from the tibialis anterior muscle and the number and duration of the pulses and the inter-phase interval were varied. A train of five square wave pulses with a duration of 0.5 ms separated by 1 ms were found most suitable in quantitative studies of the reflex. Twenty-four normal persons were investigated in this way as a basis for normal values. The day-to-day variations of the reflex were small in normal subjects.

A new electronic device for quantitation of EMG activity

A description is given of a new electronic device capable of analysing and converting the EMG response in a small volume of muscle in such a way that two output signals are obtained: one as an analogue voltage proportional to the instantaneous firing rate, the other as a number of impulses counted in a preselectable measurement-time window. The method thus allows quantitative measurements of reflex responses and has proved its value, especially in the investigation of reflex reactions in the pelvic sphincters.

Low somatostatin content in cerebrospinal fluid in multiple sclerosis. An indicator of disease activity?

In 27 patients with multiple sclerosis (MS), and in 10 control subjects of comparable age, percent ideal body weight and sex ratio, the cerebrospinal fluid (CSF) content of somatostatin was measured by radioimmunoassay. The results showed that the group of patients in relapse (n = 16) had significantly lower somatostatin content in CSF (95 +/- 4.1 (SEM) pg/ml) than both the control group (142 +/- 8.4 pg/ml) and the group of MS patients (n = 11), who had been in a clinical stable phase for more than 6 months (131 +/- 3.2 pg/ml). Duration of the disease and degree of neurological impairment were apparently without relation to the reduction of somatostatin content in the CSF. There was no relationship between CSF content of somatostatin and the content of total protein or IgG, neither of which showed any relationship to the activity of the disease.

Effect of the alpha-adrenergic blocking agent thymoxamine on the neurogenic bladder and urethra

The effect of the alpha-adrenergic blocking agent thymoxamine by intravenous administration was studied in 25 patients with spastic paraplegia and uninhibited neurogenic bladder. By cystometry a shift to the right of the first desire to void, the threshold of the first uninhibited contraction and a reduction of the pressures of the uninhibited contractions was found, but the bladder capacity was unchanged. The urethral pressure profile studied in 10 patients showed reduction in most and the peak value in all the patients. EMG from the external urethral sphincter in five patients showed damping of anal reflexes in all cases and in basic activity and cough reflexes when appropriate for studies. The site of action on the bladder is most likely adrenergic receptors in the bladder and the unchanged bladder capacity may be related to a too-short duration of the effect of thymoxamine. The effect on the spastic striated pelvic sphincters may be central, whereas the effect on the smooth muscle may be peripheral. Feedback from the drug relaxed proximal part of the urethra to the bladder might also be of importance.

Counting of flexor spasms

A method is described which is able to convert muscular contraction to a top, which can be counted electronically or visually. Such contractions are found much more frequently in patients with flexor spasms than in normal subjects during studies over 6-9 hours during the night. The method is of value in long-term recording, in evaluating antispastic therapy and in analyzing factors influencing flexor spasms.

Mode of action of dantrolene sodium in spasticity

The mode of action of dantrolene sodium was studied in 11 multiple sclerosis patients with spastic paresis of the legs by measurements of changes in electromyographic and mechanomyographic proprioceptive reflex responses and in voluntary power. Dantrolene sodium 0.5 mg per kg body weight given intravenously clearly reduced monosynaptic reflex twitch tension, but voluntary power only moderately so. The electromyographic reflex responses were unchanged or slightly increased. The mode of action of the drug on spindle function is discussed on the basis of the present findings and the literature. It is concluded that dantrolene sodium does not reduce spindle stretch sensitivity, but probably reduces activity in group II and tonic 1a afferent fibers.

Hodgkin's disease in patients with previous infectious mononucleosis

Patients with a positive reaction to the Paul-Bunnell test in the period 1961-72 were identified at nine different laboratories in Norway and matched against cases of malignant lymphoma registered at the Cancer Registry of Norway in the period 1961-75. Among 5,840 patients having a positive Paul-Bunnell test a total of six developed malignant lymphoma, three of these more than 1 year after the positive Paul-Bunnell test. The expected number of malignant lymphoma was 2.04. Of the six lymphoma cases, five were classified as Hodgkin's disease (HD). The present investigation agrees well with the findings of other epidemiological studies. There seems to be a small excess in incidence of HD among patients with previous infectious mononucleosis (IM), but both diagnostic problems and possible confounding factors must be taken into account before a possible causal association is considered.

The respiratory disease questionnaire: use of a self-administered version

A re-designed and simplified respiratory disease questionnaire was self-completed by 245 coke oven workers who previously were interviewed using the Standardized Medical Research Council/National Heart and Lung Institute form. The self-completion survey yielded significantly greater numbers of positive responses to various questions; nearly twice as many men were classified as having chronic bronchitis based on responses to the self-administered questionnaire. The severity of symptoms correlated with various factors such as the worker's smoking history; family history of lung disease, and job history. We suggest that, when compared with an interview using the British Medical Research Council/National Heart and Lung Institute respiratory disease questionnaire, a simplified, self-completion form may serve as a less expensive, more sensitive, and equally uniform and selective epidemiological tool. Self-completion forms deserve the attention and study previously afforded the interview process.

Human anal reflexes

By perianal electrical stimulation and EMG recording from the external anal sphincter the anal reflex was constantly present in normal subjects. The latency decreased within certain limits with increasing stimulation to an average minimum latency of 50 ms (SD 10.5). There was no difference between the minimum latency in normal subjects and patients with suprasegmental lesions of the CNS. The latency may be prolonged in patients with lesion of the reflex arc. By stimulation over the posterior tibial nerve behind the medial malleolus a reflex reaction could be picked up constantly from the anal sphincter in normal subjects. This reflex had a longer latency but a lower threshold than the reflex reaction from the tibialis anterior muscle. The average minimum latency from the anal sphincter was 93 ms (SD 21.1) and from the tibialis anterior muscle 64 ms (SD 7.9). In the absence of the anal reflex it may be possible to localise the defect to the afferent or efferent parts of the reflex by using types of stimulation. Preliminary studies of spinal shock revealed a perianally elicited anal reflex in all cases, but also a response to peripheral stimulation in some of the cases, more frequently found in the anal sphincter than in the tibialis anterior muscle.

Effect of dantrolene sodium on the spastic external urethral sphincter recorded by sphincterometry

An improved method of sphincterometry is described, which is easy to perform in men and also may be used in women. It gives reproducible results in the individual patient. The maximum pressure was found by radiographic and reflexological examinations of the external urethral sphincter. When 0.5 mg./kg. body weight dantrolene sodium was injected intravenously the resistance of the external urethral sphincter was found to be reduced significantly, presumably reflecting a reduction of reflex activity.

Stimulation frequency and visually evoked scalp potentials with brief flashes of light

Recording of the visually evoked scalp potential (VESP) elicited with flash stimulation was completed in six subjects presenting with normal vision. From the four separate signals recorded over the visual cortex, it was concluded that stimulation frequency affects some of the components of the VESP. Accordingly, in studies of the VESP character, the influence of stimulation frequency is a critical factor which must be taken into account when analyzing the resultant activity.

Studies on the effect and mode of action of flavoxate in human urinary bladder and sphincter

Flavoxate, a smooth muscle relaxant, compared with propantheline showed no significant difference in clinical effect on voiding disturbances in hyperactive neurogenic bladders, but fewer side effects. Both drugs increased bladder capacity significantly, but flavoxate did not increase residual urine in contrast to propantheline.

Clonus depression by propranolol

Propranolol administered i.v. to spastic patients was found to be capable of depressing clonus. The drug exerts its action on the spinal cord but does not influence dynamic spindle activity or alpha-motoneurone activity as tested by the T (Achilles tendon) and H reflexes. It may disinhibit the tonic stretch reflex. Thus, clonus is dependent not only on dynamic spindle activity but also on another, probably inhibitory, mechanism.