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Riberto M, Frances JA, Chueire R, Amorim ACFG, Xerez D, Chung TM, Mercuri LHC, Lianza S, Rocha ECDM, Maisonobe P, Cuperman-Pohl T, Khan P. Post Hoc Subgroup Analysis of the BCause Study Assessing the Effect of AbobotulinumtoxinA on Post-Stroke Shoulder Pain in Adults. Toxins (Basel) 2022; 14:toxins14110809. [PMID: 36422983 PMCID: PMC9692702 DOI: 10.3390/toxins14110809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/30/2022] [Accepted: 10/25/2022] [Indexed: 11/22/2022] Open
Abstract
Botulinum toxin type A is approved for the focal treatment of spasticity; however, the effectiveness of abobotulinumtoxinA (aboBoNT-A) in patients with shoulder pain who have set reduced pain as a treatment goal is understudied. In addition, some patients encounter delays in accessing treatment programs; therefore, the suitability of aboBoNT-A for pain reduction in this population requires investigation. These factors were assessed in aboBoNT-A-naive Brazilian patients in a post hoc analysis of data from BCause, an observational, multicenter, prospective study (NCT02390206). Patients (N = 49, n = 25 female; mean (standard deviation) age of 60.3 (9.1) years; median (range) time since onset of spasticity of 16.1 (0-193) months) received aboBoNT-A injections to shoulder muscles in one or two treatment cycles (n = 47). Using goal attainment scaling (GAS), most patients achieved their goal of shoulder pain reduction after one treatment cycle (72.1%; 95% confidence interval: 57.2-83.4%). Improvements in GAS T-score from baseline, clinically meaningful reductions in pain score at movement, and clinically meaningful increases in passive shoulder abduction angle further improved with repeated treatment more than 4 months later, despite treatment starting at a median of 16.1 months after the onset of spasticity. These findings support the further investigation of aboBoNT-A injections in chronic post-stroke shoulder pain.
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Affiliation(s)
- Marcelo Riberto
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo 14049-900, Brazil
| | - João Amaury Frances
- Hospital Bettina Ferro de Souza, Campus IV da Universidade Federal do Pará, Belém 66075-110, Brazil
| | - Regina Chueire
- Faculdade de Medicina de São José do Rio Preto, Autarquia Estadual 15090-000, Brazil
| | | | - Denise Xerez
- Serviço de Medicina Física e Reabilitação, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-590, Brazil
| | - Tae Mo Chung
- Complexo Hospital das Clinicas, Instituto de Medicina Fisica e Reabilitação, São Paulo 04116-030, Brazil
| | | | - Sérgio Lianza
- Hospital Alemão Oswaldo Cruz, São Paulo 01323-020, Brazil
| | | | | | | | - Patricia Khan
- Centro Catarinense de Reabilitação, Florianópolis, Santa Catarina 88025-301, Brazil
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Bakalkin G. The left-right side-specific endocrine signaling in the effects of brain lesions: questioning of the neurological dogma. Cell Mol Life Sci 2022; 79:545. [PMID: 36219330 PMCID: PMC9553812 DOI: 10.1007/s00018-022-04576-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/25/2022]
Abstract
Each cerebral hemisphere is functionally connected to the contralateral side of the body through the decussating neural tracts. The crossed neural pathways set a basis for contralateral effects of brain injury such hemiparesis and hemiplegia as it has been already noted by Hippocrates. Recent studies demonstrated that, in addition to neural mechanisms, the contralateral effects of brain lesions are mediated through the humoral pathway by neurohormones that produce either the left or right side-specific effects. The side-specific humoral signaling defines whether the left or right limbs are affected after a unilateral brain injury. The hormonal signals are released by the pituitary gland and may operate through their receptors that are lateralized in the spinal cord and involved in the side-specific control of symmetric neurocircuits innervating the left and right limbs. Identification of features and a proportion of neurological deficits transmitted by neurohormonal signals vs. those mediated by neural pathways is essential for better understanding of mechanisms of brain trauma and stroke and development of new therapies. In a biological context, the left–right side-specific neuroendocrine signaling may be fundamental for the control of the left- and right-sided processes in bilaterally symmetric animals.
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Affiliation(s)
- Georgy Bakalkin
- Department of Pharmaceutical Biosciences, Uppsala University, Box 591, SE-751 24, Uppsala, Sweden.
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Watanabe H, Nosova O, Sarkisyan D, Storm Andersen M, Carvalho L, Galatenko V, Bazov I, Lukoyanov N, Maia GH, Hallberg M, Zhang M, Schouenborg J, Bakalkin G. Left-Right Side-Specific Neuropeptide Mechanism Mediates Contralateral Responses to a Unilateral Brain Injury. eNeuro 2021; 8:ENEURO.0548-20.2021. [PMID: 33903183 PMCID: PMC8152370 DOI: 10.1523/eneuro.0548-20.2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/14/2021] [Accepted: 04/01/2021] [Indexed: 12/19/2022] Open
Abstract
Neuropeptides are implicated in control of lateralized processes in the brain. A unilateral brain injury (UBI) causes the contralesional sensorimotor deficits. To examine whether opioid neuropeptides mediate UBI induced asymmetric processes we compared effects of opioid antagonists on the contralesional and ipsilesional hindlimb responses to the left-sided and right-sided injury in rats. UBI induced hindlimb postural asymmetry (HL-PA) with the contralesional hindlimb flexion, and activated contralesional withdrawal reflex of extensor digitorum longus (EDL) evoked by electrical stimulation and recorded with EMG technique. No effects on the interossei (Int) and peroneaus longus (PL) were evident. The general opioid antagonist naloxone blocked postural effects, did not change EDL asymmetry while uncovered cryptic asymmetry in the PL and Int reflexes induced by UBI. Thus, the spinal opioid system may either mediate or counteract the injury effects. Strikingly, effects of selective opioid antagonists were the injury side-specific. The μ-antagonist β-funaltrexamine (FNA) and κ-antagonist nor-binaltorphimine (BNI) reduced postural asymmetry after the right but not left UBI. In contrast, the δ-antagonist naltrindole (NTI) inhibited HL-PA after the left but not right-side brain injury. The opioid gene expression and opioid peptides were lateralized in the lumbar spinal cord, and coordination between expression of the opioid and neuroplasticity-related genes was impaired by UBI that together may underlie the side-specific effects of the antagonists. We suggest that mirror-symmetric neural circuits that mediate effects of left and right brain injury on the contralesional hindlimbs are differentially controlled by the lateralized opioid system.
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Affiliation(s)
- Hiroyuki Watanabe
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden, 751 24
| | - Olga Nosova
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden, 751 24
| | - Daniil Sarkisyan
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden, 751 24
| | | | - Liliana Carvalho
- Departamento de Biomedicina da Faculdade de Medicina da Universidade do Porto, Instituto de Investigação e Inovação em Saúde, Instituto de Biologia Molecular e Celular, Porto, Portugal, 4200-135
| | - Vladimir Galatenko
- Faculty of Mechanics and Mathematics, Lomonosov Moscow State University, Moscow, Russia, 119991
| | - Igor Bazov
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden, 751 24
| | - Nikolay Lukoyanov
- Departamento de Biomedicina da Faculdade de Medicina da Universidade do Porto, Instituto de Investigação e Inovação em Saúde, Instituto de Biologia Molecular e Celular, Porto, Portugal, 4200-135
- Medibrain, Vila do Conde, Porto, Portugal, 4480-807
- Brain Research Institute, Porto, Portugal, 4200-135
| | - Gisela H Maia
- Medibrain, Vila do Conde, Porto, Portugal, 4480-807
- Brain Research Institute, Porto, Portugal, 4200-135
- Departamento de Biomedicina da Faculdade de Medicina da Universidade do Porto, Instituto de Investigação e Inovação em Saúde, Instituto de Biologia Molecular e Celular, Porto, Portugal, 4200-135
| | - Mathias Hallberg
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden, 751 24
| | - Mengliang Zhang
- Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark, 5230
- Neuronano Research Center, Department of Experimental Medical Science, Lund University, Lund, Sweden, 223 81
| | - Jens Schouenborg
- Neuronano Research Center, Department of Experimental Medical Science, Lund University, Lund, Sweden, 223 81
| | - Georgy Bakalkin
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden, 751 24
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Zhang M, Watanabe H, Sarkisyan D, Andersen MS, Nosova O, Galatenko V, Carvalho L, Lukoyanov N, Thelin J, Schouenborg J, Bakalkin G. Hindlimb motor responses to unilateral brain injury: spinal cord encoding and left-right asymmetry. Brain Commun 2020; 2:fcaa055. [PMID: 32954305 PMCID: PMC7425521 DOI: 10.1093/braincomms/fcaa055] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/02/2020] [Accepted: 04/07/2020] [Indexed: 12/26/2022] Open
Abstract
Mechanisms of motor deficits (e.g. hemiparesis and hemiplegia) secondary to stroke and traumatic brain injury remain poorly understood. In early animal studies, a unilateral lesion to the cerebellum produced postural asymmetry with ipsilateral hindlimb flexion that was retained after complete spinal cord transection. Here we demonstrate that hindlimb postural asymmetry in rats is induced by a unilateral injury of the hindlimb sensorimotor cortex, and characterize this phenomenon as a model of spinal neuroplasticity underlying asymmetric motor deficits. After cortical lesion, the asymmetry was developed due to the contralesional hindlimb flexion and persisted after decerebration and complete spinal cord transection. The asymmetry induced by the left-side brain injury was eliminated by bilateral lumbar dorsal rhizotomy, but surprisingly, the asymmetry after the right-side brain lesion was resistant to deafferentation. Pancuronium, a curare-mimetic muscle relaxant, abolished the asymmetry after the right-side lesion suggesting its dependence on the efferent drive. The contra- and ipsilesional hindlimbs displayed different musculo-articular resistance to stretch after the left but not right-side injury. The nociceptive withdrawal reflexes evoked by electrical stimulation and recorded with EMG technique were different between the left and right hindlimbs in the spinalized decerebrate rats. On this asymmetric background, a brain injury resulted in greater reflex activation on the contra- versus ipsilesional side; the difference between the limbs was higher after the right-side brain lesion. The unilateral brain injury modified expression of neuroplasticity genes analysed as readout of plastic changes, as well as robustly impaired coordination of their expression within and between the ipsi- and contralesional halves of lumbar spinal cord; the effects were more pronounced after the left side compared to the right-side injury. Our data suggest that changes in the hindlimb posture, resistance to stretch and nociceptive withdrawal reflexes are encoded by neuroplastic processes in lumbar spinal circuits induced by a unilateral brain injury. Two mechanisms, one dependent on and one independent of afferent input may mediate asymmetric hindlimb motor responses. The latter, deafferentation resistant mechanism may be based on sustained muscle contractions which often occur in patients with central lesions and which are not evoked by afferent stimulation. The unusual feature of these mechanisms is their lateralization in the spinal cord.
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Affiliation(s)
- Mengliang Zhang
- Department of Experimental Medical Science, Neuronano Research Center, Lund University, 221 00 Lund, Sweden
- Department of Molecular Medicine, University of Southern Denmark, DK-5000 Odense, Denmark
| | - Hiroyuki Watanabe
- Department of Pharmaceutical Biosciences, Uppsala University, 751 24 Uppsala, Sweden
| | - Daniil Sarkisyan
- Department of Pharmaceutical Biosciences, Uppsala University, 751 24 Uppsala, Sweden
| | - Marlene Storm Andersen
- Department of Molecular Medicine, University of Southern Denmark, DK-5000 Odense, Denmark
| | - Olga Nosova
- Department of Pharmaceutical Biosciences, Uppsala University, 751 24 Uppsala, Sweden
| | - Vladimir Galatenko
- Faculty of Mechanics and Mathematics, Lomonosov Moscow State University, 119234 Moscow, Russia
| | - Liliana Carvalho
- Departamento de Biomedicina da Faculdade de Medicina da Universidade do Porto, Instituto de Investigação e Inovação em Saúde, Instituto de Biologia Molecular e Celular, 4200-319 Porto, Portugal
| | - Nikolay Lukoyanov
- Departamento de Biomedicina da Faculdade de Medicina da Universidade do Porto, Instituto de Investigação e Inovação em Saúde, Instituto de Biologia Molecular e Celular, 4200-319 Porto, Portugal
| | - Jonas Thelin
- Department of Experimental Medical Science, Neuronano Research Center, Lund University, 221 00 Lund, Sweden
| | - Jens Schouenborg
- Department of Experimental Medical Science, Neuronano Research Center, Lund University, 221 00 Lund, Sweden
| | - Georgy Bakalkin
- Department of Pharmaceutical Biosciences, Uppsala University, 751 24 Uppsala, Sweden
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