151
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Brown EN, Purdon PL, Van Dort CJ. General anesthesia and altered states of arousal: a systems neuroscience analysis. Annu Rev Neurosci 2011; 34:601-28. [PMID: 21513454 PMCID: PMC3390788 DOI: 10.1146/annurev-neuro-060909-153200] [Citation(s) in RCA: 348] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Placing a patient in a state of general anesthesia is crucial for safely and humanely performing most surgical and many nonsurgical procedures. How anesthetic drugs create the state of general anesthesia is considered a major mystery of modern medicine. Unconsciousness, induced by altered arousal and/or cognition, is perhaps the most fascinating behavioral state of general anesthesia. We perform a systems neuroscience analysis of the altered arousal states induced by five classes of intravenous anesthetics by relating their behavioral and physiological features to the molecular targets and neural circuits at which these drugs are purported to act. The altered states of arousal are sedation-unconsciousness, sedation-analgesia, dissociative anesthesia, pharmacologic non-REM sleep, and neuroleptic anesthesia. Each altered arousal state results from the anesthetic drugs acting at multiple targets in the central nervous system. Our analysis shows that general anesthesia is less mysterious than currently believed.
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Affiliation(s)
- Emery N. Brown
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - Patrick L. Purdon
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - Christa J. Van Dort
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
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152
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Vonsattel JPG, Keller C, Cortes Ramirez EP. Huntington's disease - neuropathology. HANDBOOK OF CLINICAL NEUROLOGY 2011; 100:83-100. [PMID: 21496571 DOI: 10.1016/b978-0-444-52014-2.00004-5] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
An expansion of a trinucleotide CAG repeat on chromosome 4 causes Huntington disease. The abnormal elongation of the CAG increases the polyglutamine stretch of huntingtin, which becomes proportionally toxic. The mutated huntingtin is ubiquitous in somatic tissues, yet the pathologic changes are apparently restricted to the brain. The degree of the abnormal expansion of the CAG repeats governs the gradually diffuse atrophy of the brain. However, the brunt of the degenerative process involves the striatum. The onset of symptoms is insidious, but the longer the CAG expansion, the earlier their occurrence. They include psychiatric, motor, and cognitive disorders. Patients with adult onset of symptoms are more prone to exhibit choreic movements whereas those with juvenile onset tend to develop parkinsonism or rigidity. Brains from patients with juvenile onset are usually more atrophic than those with adult onset. Brains from patients with late onset of symptoms might show changes occurring in usual aging in addition to those characteristically observed in Huntington disease. Despite recent important discoveries, the pathogenesis of Huntington disease is still not elucidated. Many possible mechanisms underlying the relative selective vulnerability of neurons are being explored. In particular, factors promoting apoptosis, and phenomena causing the toxic aggregation of proteins, or the blockage of trophic factors, or mitochondria dysfunction, and excitoxicity have been studied.
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Affiliation(s)
- Jean Paul G Vonsattel
- Department of Pathology, Presbyterian Hospital and Columbia University, New York, NY 10032, USA.
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153
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Shah RS, Chang SY, Min HK, Cho ZH, Blaha CD, Lee KH. Deep brain stimulation: technology at the cutting edge. J Clin Neurol 2010; 6:167-82. [PMID: 21264197 PMCID: PMC3024521 DOI: 10.3988/jcn.2010.6.4.167] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 09/16/2010] [Accepted: 09/16/2010] [Indexed: 01/15/2023] Open
Abstract
Deep brain stimulation (DBS) surgery has been performed in over 75,000 people worldwide, and has been shown to be an effective treatment for Parkinson's disease, tremor, dystonia, epilepsy, depression, Tourette's syndrome, and obsessive compulsive disorder. We review current and emerging evidence for the role of DBS in the management of a range of neurological and psychiatric conditions, and discuss the technical and practical aspects of performing DBS surgery. In the future, evolution of DBS technology may depend on several key areas, including better scientific understanding of its underlying mechanism of action, advances in high-spatial resolution imaging and development of novel electrophysiological and neurotransmitter microsensor systems. Such developments could form the basis of an intelligent closed-loop DBS system with feedback-guided neuromodulation to optimize both electrode placement and therapeutic efficacy.
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Affiliation(s)
- Rahul S Shah
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
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154
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Cantuti-Castelvetri I, Hernandez LF, Keller-McGandy CE, Kett LR, Landy A, Hollingsworth ZR, Saka E, Crittenden JR, Nillni EA, Young AB, Standaert DG, Graybiel AM. Levodopa-induced dyskinesia is associated with increased thyrotropin releasing hormone in the dorsal striatum of hemi-parkinsonian rats. PLoS One 2010; 5:e13861. [PMID: 21085660 PMCID: PMC2978093 DOI: 10.1371/journal.pone.0013861] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Accepted: 10/07/2010] [Indexed: 11/25/2022] Open
Abstract
Background Dyskinesias associated with involuntary movements and painful muscle contractions are a common and severe complication of standard levodopa (L-DOPA, L-3,4-dihydroxyphenylalanine) therapy for Parkinson's disease. Pathologic neuroplasticity leading to hyper-responsive dopamine receptor signaling in the sensorimotor striatum is thought to underlie this currently untreatable condition. Methodology/Principal Findings Quantitative real-time polymerase chain reaction (PCR) was employed to evaluate the molecular changes associated with L-DOPA-induced dyskinesias in Parkinson's disease. With this technique, we determined that thyrotropin releasing hormone (TRH) was greatly increased in the dopamine-depleted striatum of hemi-parkinsonian rats that developed abnormal movements in response to L-DOPA therapy, relative to the levels measured in the contralateral non-dopamine-depleted striatum, and in the striatum of non-dyskinetic control rats. ProTRH immunostaining suggested that TRH peptide levels were almost absent in the dopamine-depleted striatum of control rats that did not develop dyskinesias, but in the dyskinetic rats, proTRH immunostaining was dramatically up-regulated in the striatum, particularly in the sensorimotor striatum. This up-regulation of TRH peptide affected striatal medium spiny neurons of both the direct and indirect pathways, as well as neurons in striosomes. Conclusions/Significance TRH is not known to be a key striatal neuromodulator, but intrastriatal injection of TRH in experimental animals can induce abnormal movements, apparently through increasing dopamine release. Our finding of a dramatic and selective up-regulation of TRH expression in the sensorimotor striatum of dyskinetic rat models suggests a TRH-mediated regulatory mechanism that may underlie the pathologic neuroplasticity driving dopamine hyper-responsivity in Parkinson's disease.
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Affiliation(s)
- Ippolita Cantuti-Castelvetri
- Neurology Department, MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
- * E-mail:
| | - Ledia F. Hernandez
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Christine E. Keller-McGandy
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Lauren R. Kett
- Neurology Department, MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Alex Landy
- Neurology Department, MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Zane R. Hollingsworth
- Neurology Department, MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Esen Saka
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Jill R. Crittenden
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Eduardo A. Nillni
- Division of Endocrinology, Department of Medicine, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Anne B. Young
- Neurology Department, MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - David G. Standaert
- Center for Neurodegeneration and Experimental Therapeutics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Ann M. Graybiel
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
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155
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Redgrave P, Rodriguez M, Smith Y, Rodriguez-Oroz MC, Lehericy S, Bergman H, Agid Y, DeLong MR, Obeso JA. Goal-directed and habitual control in the basal ganglia: implications for Parkinson's disease. Nat Rev Neurosci 2010; 11:760-72. [PMID: 20944662 PMCID: PMC3124757 DOI: 10.1038/nrn2915] [Citation(s) in RCA: 695] [Impact Index Per Article: 49.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Progressive loss of the ascending dopaminergic projection in the basal ganglia is a fundamental pathological feature of Parkinson's disease. Studies in animals and humans have identified spatially segregated functional territories in the basal ganglia for the control of goal-directed and habitual actions. In patients with Parkinson's disease the loss of dopamine is predominantly in the posterior putamen, a region of the basal ganglia associated with the control of habitual behaviour. These patients may therefore be forced into a progressive reliance on the goal-directed mode of action control that is mediated by comparatively preserved processing in the rostromedial striatum. Thus, many of their behavioural difficulties may reflect a loss of normal automatic control owing to distorting output signals from habitual control circuits, which impede the expression of goal-directed action.
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Affiliation(s)
- Peter Redgrave
- Neuroscience Research Unit, Department of Psychology, University of Sheffield, UK.
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156
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Abstract
The substantia nigra pars reticulata (SNr) is a key basal ganglia output nucleus critical for movement control. A hallmark of the SNr gamma-aminobutyric acid (GABA)-containing projection neurons is their depolarized membrane potential, accompanied by rapid spontaneous spikes. Parkinsonian movement disorders are often associated with abnormalities in SNr GABA neuron firing intensity and/or pattern. A fundamental question is the molecular identity of the ion channels that drive these neurons to a depolarized membrane potential. Recent data show that SNr GABA projection neurons selectively express type 3 canonical transient receptor potential (TRPC3) channels. Such channels are tonically active and mediate an inward, Na(+)-dependent current, leading to a substantial depolarization and ensuring appropriate firing intensity and pattern in SNr GABA projection neurons. Equally important, TRPC3 channels in SNr GABA neurons are up-regulated by dopamine (DA) released from neighboring nigral DA neuron dendrites. Co-activation of D1 and D5 DA receptors leads to a TRPC3 channel-mediated inward current and increased firing in SNr GABA neurons, whereas D1-like receptor blockade reduces SNr GABA neuron firing frequency and increases their firing irregularity. TRPC3 channels serve as the effector channels mediating an ultra-short SNc-->SNr DA pathway that regulates the firing intensity and pattern of the basal ganglia output neurons.
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Affiliation(s)
- Fu-Ming Zhou
- Department of Pharmacology, University of Tennessee College of Medicine, Memphis TN 38163, USA.
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157
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Schiff SJ. Towards model-based control of Parkinson's disease. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2010; 368:2269-308. [PMID: 20368246 PMCID: PMC2944387 DOI: 10.1098/rsta.2010.0050] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Modern model-based control theory has led to transformative improvements in our ability to track the nonlinear dynamics of systems that we observe, and to engineer control systems of unprecedented efficacy. In parallel with these developments, our ability to build computational models to embody our expanding knowledge of the biophysics of neurons and their networks is maturing at a rapid rate. In the treatment of human dynamical disease, our employment of deep brain stimulators for the treatment of Parkinson's disease is gaining increasing acceptance. Thus, the confluence of these three developments--control theory, computational neuroscience and deep brain stimulation--offers a unique opportunity to create novel approaches to the treatment of this disease. This paper explores the relevant state of the art of science, medicine and engineering, and proposes a strategy for model-based control of Parkinson's disease. We present a set of preliminary calculations employing basal ganglia computational models, structured within an unscented Kalman filter for tracking observations and prescribing control. Based upon these findings, we will offer suggestions for future research and development.
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Affiliation(s)
- Steven J Schiff
- Center for Neural Engineering, Department of Neurosurgery, Pennsylvania State University, University Park, PA 16802, USA.
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158
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Cannabinoid-dopamine interaction in the pathophysiology and treatment of CNS disorders. CNS Neurosci Ther 2010; 16:e72-91. [PMID: 20406253 DOI: 10.1111/j.1755-5949.2010.00144.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Endocannabinoids and their receptors, mainly the CB(1) receptor type, function as a retrograde signaling system in many synapses within the CNS, particularly in GABAergic and glutamatergic synapses. They also play a modulatory function on dopamine (DA) transmission, although CB(1) receptors do not appear to be located in dopaminergic terminals, at least in the major brain regions receiving dopaminergic innervation, e.g., the caudate-putamen and the nucleus accumbens/prefrontal cortex. Therefore, the effects of cannabinoids on DA transmission and DA-related behaviors are generally indirect and exerted through the modulation of GABA and glutamate inputs received by dopaminergic neurons. Recent evidence suggest, however, that certain eicosanoid-derived cannabinoids may directly activate TRPV(1) receptors, which have been found in some dopaminergic pathways, thus allowing a direct regulation of DA function. Through this direct mechanism or through indirect mechanisms involving GABA or glutamate neurons, cannabinoids may interact with DA transmission in the CNS and this has an important influence in various DA-related neurobiological processes (e.g., control of movement, motivation/reward) and, particularly, on different pathologies affecting these processes like basal ganglia disorders, schizophrenia, and drug addiction. The present review will address the current literature supporting these cannabinoid-DA interactions, with emphasis in aspects dealing with the neurochemical, physiological, and pharmacological/therapeutic bases of these interactions.
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159
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Miman O, Kusbeci OY, Aktepe OC, Cetinkaya Z. The probable relation between Toxoplasma gondii and Parkinson's disease. Neurosci Lett 2010; 475:129-31. [PMID: 20350582 DOI: 10.1016/j.neulet.2010.03.057] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 02/16/2010] [Accepted: 03/21/2010] [Indexed: 12/31/2022]
Abstract
Parkinson's disease (PD), a chronic progressive neurodegenerative disorder, has a mainly unknown multifactorial etiology. Neuroinflammatory mechanisms might contribute to the cascade of events leading to neuronal degeneration. Toxoplasmosis can be associated with various neuropsychiatric disorders. The most commonly affected central nervous system (CNS) region in toxoplasmosis is the cerebral hemisphere, followed by the basal ganglia, cerebellum and brain stem. Therefore, in this study, we aimed to investigate the possible association between Toxoplasma infection and PD by evaluating the serum anti-Toxoplasma gondii IgG antibodies. There were no difference between the socioeconomic status of the patients and control subjects and magnetic resonance images of the patients were normal. Serum anti-T. gondii IgG levels were measured using ELISA. There was no statistically significant differences among the patients and control subjects with respect to age (66.01+/-12.14 years, 62.42+/-5.93 years, p=0.089; respectively) and gender. The sero-positivity rate for anti-T. gondii IgG antibodies in PD patients and control groups were 42.3 and 22.5%, respectively, and they were statistically significant (p=0.006). These results suggest that Toxoplasma infection may be involved in the pathogenetic mechanisms of PD. If confirmed, this hypothesis would represent a valuable advancement in care of patients with Parkinson's disease.
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Affiliation(s)
- Ozlem Miman
- Afyon Kocatepe University, Faculty of Medicine, Department of Microbiology, Izmir Street, 5 km, Afyonkarahisar, Turkey.
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160
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Juri C, Rodriguez-Oroz M, Obeso JA. The pathophysiological basis of sensory disturbances in Parkinson's disease. J Neurol Sci 2009; 289:60-5. [PMID: 19758602 DOI: 10.1016/j.jns.2009.08.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The diagnosis of Parkinson's disease (PD) is still based on the recognition of the cardinal motor features. However, it is now recognized that non-motor manifestations (NMM) may actually precede the emergence of motor manifestations. NMM are very frequently present in the overall population of PD patients and are a major determinant of their quality of life. In this article we discuss the origin of sensory manifestations in PD, particularly focus on pain mechanisms, which is the most frequent and better studied NMM. Analysis of experimental and clinical data reveals that the basal ganglia (BG) indeed have an anatomo-functional organization which sustains sensory functions. In addition, the dopaminergic system is also engaged in the modulation and integration of sensory information and the response to pain. In patients with PD, pain is often related with motor fluctuations and dyskinesias induced by dopaminergic treatments, which suggest some common mechanisms with the origin of motor complications in PD. Clinically, sensory manifestations are often disturbing and poorly treated and may occasionally become a major cause of disability for PD patients. Thus, more clinical and basic studies are warranted to clarify pain mechanisms in PD, with the aim of achieving better treatments.
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Affiliation(s)
- Carlos Juri
- Departments of Neurology, Neurophysiology and Neurosurgery, Clinica Universitaria and Medical School, Neuroscience Centre, Center for Applied Medical Research, University of Navarra, Pamplona, Spain
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161
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Brain metabolic correlates of dopaminergic degeneration in de novo idiopathic Parkinson’s disease. Eur J Nucl Med Mol Imaging 2009; 37:537-44. [DOI: 10.1007/s00259-009-1259-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Accepted: 08/06/2009] [Indexed: 10/20/2022]
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162
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163
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Hartman R, Lekic T, Rojas H, Tang J, Zhang JH. Assessing functional outcomes following intracerebral hemorrhage in rats. Brain Res 2009; 1280:148-57. [PMID: 19464275 DOI: 10.1016/j.brainres.2009.05.038] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 05/05/2009] [Accepted: 05/08/2009] [Indexed: 11/18/2022]
Abstract
Translational neuroprotective and drug development studies need to be gauged against well-characterized functional outcomes, including motor, sensory and cognitive domains. Since intracerebral hemorrhage (ICH) causes dramatic neurological and cognitive deficits in humans, we hypothesized that ICH would result in prolonged motor-sensory and learning/memory deficits in rats. Neurological tests of sensorimotor functions were performed before ICH, 1-3 days and 10 weeks after ICH. Water maze, open field, and rotarod performance was tested 2 and 8 weeks after ICH. Early neurological evaluations revealed significant deficits, with almost full recovery by 10 weeks. The water maze revealed significant learning (but not motor) deficits at 2 weeks, but by 8 weeks, the learning deficits had diminished and significant motor deficits had emerged, coinciding with a drop in activity. The injured hemisphere showed significant atrophy at sacrifice. Therefore, ICH produced detectable cognitive and motor deficits in rats that evolved over a 10-week period, and thereby provides a suitable baseline for analysis of future therapeutic interventions following hemorrhagic stroke.
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Affiliation(s)
- Richard Hartman
- Department of Psychology, Loma Linda University Medical Center, Loma Linda, California, USA.
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164
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Multiple roles for nicotine in Parkinson's disease. Biochem Pharmacol 2009; 78:677-85. [PMID: 19433069 DOI: 10.1016/j.bcp.2009.05.003] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 04/30/2009] [Accepted: 05/01/2009] [Indexed: 01/11/2023]
Abstract
There exists a remarkable diversity of neurotransmitter compounds in the striatum, a pivotal brain region in the pathology of Parkinson's disease, a movement disorder characterized by rigidity, tremor and bradykinesia. The striatal dopaminergic system, which is particularly vulnerable to neurodegeneration in this disorder, appears to be the major contributor to these motor problems. However, numerous other neurotransmitter systems in the striatum most likely also play a significant role, including the nicotinic cholinergic system. Indeed, there is an extensive anatomical overlap between dopaminergic and cholinergic neurons, and acetylcholine is well known to modulate striatal dopamine release both in vitro and in vivo. Nicotine, a drug that stimulates nicotinic acetylcholine receptors (nAChRs), influences several functions relevant to Parkinson's disease. Extensive studies in parkinsonian animals show that nicotine protects against nigrostriatal damage, findings that may explain the well-established decline in Parkinson's disease incidence with tobacco use. In addition, recent work shows that nicotine reduces l-dopa-induced abnormal involuntary movements, a debilitating complication of l-dopa therapy for Parkinson's disease. These combined observations suggest that nAChR stimulation may represent a useful treatment strategy for Parkinson's disease for neuroprotection and symptomatic treatment. Importantly, only selective nAChR subtypes are present in the striatum including the alpha4beta2*, alpha6beta2* and alpha7 nAChR populations. Treatment with nAChR ligands directed to these subtypes may thus yield optimal therapeutic benefit for Parkinson's disease, with a minimum of adverse side effects.
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