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Yan Y, Tennekoon K, Eubanks A, Herekar A, Shimoga D, Ayyala D, McLeod C, Kurek JA, Morgan JC, Rao SSC, Sharma A. Evaluation of bidirectional gut-brain axis and anorectal function in Parkinson's disease with constipation. Neurogastroenterol Motil 2024; 36:e14728. [PMID: 38105462 DOI: 10.1111/nmo.14728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/08/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Parkinson's disease (PD) is a neurodegenerative movement disorder with prodromal and highly prevalent gastrointestinal (GI) symptoms, especially constipation. Although PD models suggest gut-brain axis dysfunction, the mechanistic underpinnings and their correlation with GI symptoms are poorly understood. AIM To examine the bidirectional gut-brain axis function in PD and correlate it with constipation severity, PD duration, and severity. METHODS Rectal sensory thresholds and afferent cortical evoked potentials (CEP) were assessed using a 4-ring EMG electrode probe. Efferent anal and rectal motor evoked potentials (MEPs) were obtained following transcranial and lumbosacral magnetic stimulation. Bowel symptoms were assessed by prospective stool diary. The CEP and MEP latencies, rectal sensory thresholds, and anorectal sensorimotor data were compared between PD subjects and age-adjusted healthy subjects. KEY RESULTS Twenty-five PD subjects with constipation (F/M = 6/19) and 20 healthy subjects (F/M = 14/6) were enrolled. The first and pain sensation thresholds were higher in PD subjects than healthy subjects (p < 0.002) but lost significance after adjustment for age. Age-adjusted rectal CEP and right-sided cortico-anal MEP latencies were prolonged in PD subjects compared to healthy subjects (p < 0.04). Also, half (4 of 8) age-adjusted spino-anal and rectal MEP latencies in PD subjects were significantly longer. In multivariate linear analysis, first rectal sensation and right-sided MEP latencies showed moderate correlation with constipation severity. CONCLUSIONS & INFERENCES Parkinson's disease is associated with significant bidirectional gut-brain axis dysfunction as evidenced by prolonged afferent and efferent neuronal signaling. Constipation severity in PD is correlated to abnormal rectal sensation and lateralized disturbance of efferent brain-gut signaling.
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Affiliation(s)
- Yun Yan
- Digestive Clinical Research Center, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Karunaratne Tennekoon
- Digestive Clinical Research Center, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Audrey Eubanks
- Digestive Clinical Research Center, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Anam Herekar
- Digestive Clinical Research Center, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Dhanush Shimoga
- Digestive Clinical Research Center, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Deepak Ayyala
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Colin McLeod
- Department of Neurology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Julie A Kurek
- Department of Neurology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - John C Morgan
- Department of Neurology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Satish S C Rao
- Digestive Clinical Research Center, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Amol Sharma
- Digestive Clinical Research Center, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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Wang RL, Chang RB. The Coding Logic of Interoception. Annu Rev Physiol 2024; 86:301-327. [PMID: 38061018 PMCID: PMC11103614 DOI: 10.1146/annurev-physiol-042222-023455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2024]
Abstract
Interoception, the ability to precisely and timely sense internal body signals, is critical for life. The interoceptive system monitors a large variety of mechanical, chemical, hormonal, and pathological cues using specialized organ cells, organ innervating neurons, and brain sensory neurons. It is important for maintaining body homeostasis, providing motivational drives, and regulating autonomic, cognitive, and behavioral functions. However, compared to external sensory systems, our knowledge about how diverse body signals are coded at a system level is quite limited. In this review, we focus on the unique features of interoceptive signals and the organization of the interoceptive system, with the goal of better understanding the coding logic of interoception.
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Affiliation(s)
- Ruiqi L Wang
- Department of Neuroscience and Department of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, Connecticut, USA;
| | - Rui B Chang
- Department of Neuroscience and Department of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, Connecticut, USA;
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Yan Y, Shimoga D, Sharma A. Parkinson's Disease and Diabetes Mellitus: Synergistic Effects on Pathophysiology and GI Motility. Curr Gastroenterol Rep 2023; 25:106-113. [PMID: 37067721 DOI: 10.1007/s11894-023-00868-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE OF REVIEW Parkinson's disease and diabetes affect an increasing proportion of the aging global population. Both conditions extensively affect gastrointestinal (GI) motility with similar and differing clinical symptoms. Nonetheless, GI symptoms in Parkinson's disease and diabetes pose significant morbidity and impairment of quality of life. Their pathophysiology is poorly understood, and therefore, effective treatment options are lacking. RECENT FINDINGS Parkinson's disease patients have oropharyngeal dysphagia and constipation. They also have mild or absent upper GI symptoms associated with delayed gastric emptying, which is prevalent in 70% of patients. Delayed gastric emptying in Parkinson's disease leads to erratic medication absorption and fluctuating motor symptoms. Half of diabetics have upper GI symptoms, which correlate to gastric emptying and changes in brain activity of the insular cortex. The majority of diabetics also have constipation. Diabetics have an increased risk for developing Parkinson's disease and anti-diabetic medications are associated with risk reduction of developing Parkinson's disease. Hyperglycemia is associated with advanced glycated end products formation and acceleration of α-synuclein aggregation. GLP-1 receptor agonists have also demonstrated efficacy in improving motor symptoms and cognition in Parkinson's disease patients with diabetes. Parkinson's disease and diabetes are pan-enteric disorders with significant GI symptoms and impairment of gut motility. Both conditions have synergistic pathophysiologies that propagate neurodegenerative changes. Treatment options for GI symptoms in diabetic and Parkinson's disease patients are lacking. Anti-diabetic treatment improves motor symptoms in Parkinson's disease, however, its effect on GI symptoms is unclear.
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Affiliation(s)
- Yun Yan
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Georgia, Augusta University, 1120 15th Street, AD 2226, Augusta, GA, 30912, USA
| | - Dhanush Shimoga
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Georgia, Augusta University, 1120 15th Street, AD 2226, Augusta, GA, 30912, USA
| | - Amol Sharma
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Georgia, Augusta University, 1120 15th Street, AD 2226, Augusta, GA, 30912, USA.
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4
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Abstract
Gastrointestinal (GI) pain - a form of visceral pain - is common in some disorders, such as irritable bowel syndrome, Crohn's disease and pancreatitis. However, identifying the cause of GI pain frequently represents a diagnostic challenge as the clinical presentation is often blurred by concomitant autonomic and somatic symptoms. In addition, GI pain can be nociceptive, neuropathic and associated with cancer, but in many cases multiple aetiologies coexist in an individual patient. Mechanisms of GI pain are complex and include both peripheral and central sensitization and the involvement of the autonomic nervous system, which has a role in generating the symptoms that frequently accompany pain. Treatment of GI pain depends on the precise type of pain and the primary disorder in the patient but can include, for example, pharmacological therapy, cognitive behavioural therapies, invasive surgical procedures, endoscopic procedures and lifestyle alterations. Owing to the major differences between organ involvement, disease mechanisms and individual factors, treatment always needs to be personalized and some data suggest that phenotyping and subsequent individual management of GI pain might be options in the future.
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Sharma A, Kurek J, Morgan JC, Wakade C, Rao SSC. Constipation in Parkinson's Disease: a Nuisance or Nuanced Answer to the Pathophysiological Puzzle? Curr Gastroenterol Rep 2018; 20:1. [PMID: 29350301 DOI: 10.1007/s11894-018-0609-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Chronic constipation is a common, nonmotor, and prodromal symptom in Parkinson's disease (PD). Its underlying neuropathology may provide pathophysiological insight into PD. Here, we critically review what is currently known about the neuroanatomical and brain-gut interactions, and the origin and progression of Lewy pathology (LP) at three levels-brain/brainstem, spinal cord, and enteric nervous system. RECENT FINDINGS Many recent studies have illustrated the challenges of examining LP in tissues obtained from colon biopsies of PD patients. Large-scale epidemiological studies have not confirmed the widely accepted Braakpostula. In this review, we propose an alternative origin and route of spread of LP in PD. We describe novel, noninvasive neurophysiological testing that could advance the understanding of LP and complex bidirectional brain-pelvic floor neural pathways in PD-a true disease model of a neurogastrointestinal disorder. This review may provide the impetus for future studies investigating gut and brain interaction and constipation in PD.
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Affiliation(s)
- Amol Sharma
- Division of Gastroenterology/Hepatology, Medical College of Georgia, Augusta University Medical Center, 1120 15th Street, AD-2226, Augusta, GA, 30912, USA.
| | - Julie Kurek
- Parkinson's Foundation Center of Excellence, Movement Disorders Program, Department of Neurology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - John C Morgan
- Parkinson's Foundation Center of Excellence, Movement Disorders Program, Department of Neurology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Chandramohan Wakade
- Department of Physical Therapy, College of Allied Health Sciences, Augusta University & Charlie Norwood VAMC, Augusta, GA, USA
| | - Satish S C Rao
- Division of Gastroenterology/Hepatology, Medical College of Georgia, Augusta University Medical Center, 1120 15th Street, AD-2226, Augusta, GA, 30912, USA
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De Ridder D, Manning P, Leong SL, Ross S, Sutherland W, Horwath C, Vanneste S. The brain, obesity and addiction: an EEG neuroimaging study. Sci Rep 2016; 6:34122. [PMID: 27658351 PMCID: PMC5034231 DOI: 10.1038/srep34122] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 09/07/2016] [Indexed: 01/16/2023] Open
Abstract
Obesity is among the greatest challenges facing healthcare systems with 20% of the world’s population afflicted. Great controversy exists whether obesity can be regarded as an addictive disorder or not. Recently the Yale Food Addiction Scale questionnaire has been developed as a tool to identify individuals with traits of addiction towards food. Using clinical and source localized EEG data we dichotomize obesity. Brain activity in food-addicted and non-food-addicted obese people is compared to alcohol-addicted and non-addicted lean controls. We show that food addiction shares common neural brain activity with alcohol addiction. This ‘addiction neural brain activity’ consists of the dorsal and pregenual anterior cingulate cortex, parahippocampal area and precuneus. Furthermore, common neural obesity neural brain activity exists as well. The ‘obesity neural brain activity’ consists of dorsal and pregenual anterior cingulate cortex, posterior cingulate extending into the precuneus/cuneus as well as the parahippocampal and inferior parietal area. However food-addicted differ from non-food-addicted obese people by opposite activity in the anterior cingulate gyrus. This food addiction and non-food-addiction obesity dichotomy demonstrates there is at least 2 different kinds of obesity with overlapping network activity, but different in anterior cingulate cortex activity.
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Affiliation(s)
- Dirk De Ridder
- Section of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, New Zealand
| | - Patrick Manning
- Section of Endocrinology, Department of Medicine, Dunedin School of Medicine, University of Otago, New Zealand
| | - Sook Ling Leong
- Section of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, New Zealand
| | - Samantha Ross
- Section of Endocrinology, Department of Medicine, Dunedin School of Medicine, University of Otago, New Zealand
| | - Wayne Sutherland
- Section of Endocrinology, Department of Medicine, Dunedin School of Medicine, University of Otago, New Zealand
| | - Caroline Horwath
- Department of Human Nutrition, Dunedin School of Medicine, University of Otago, New Zealand
| | - Sven Vanneste
- School of Behavioral and Brain Sciences, University of Texas at Dallas, USA
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Brock C, McCallum RW, Gyawali CP, Farmer AD, Frøkjaer JB, McMahon BP, Drewes AM. Neurophysiology and new techniques to assess esophageal sensory function: an update. Ann N Y Acad Sci 2016; 1380:78-90. [DOI: 10.1111/nyas.13175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/10/2016] [Accepted: 06/15/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Christina Brock
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital and Clinical Institute; Aalborg University; Aalborg Denmark
| | - Richard W. McCallum
- Department of Internal Medicine; Texas Tech University Health Sciences Center; El Paso Texas
| | - C. Prakash Gyawali
- Division of Gastroenterology; Washington University School of Medicine; St. Louis Missouri
| | - Adam D. Farmer
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital and Clinical Institute; Aalborg University; Aalborg Denmark
- Centre for Digestive Diseases, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry; Queen Mary University of London; London United Kingdom
- Department of Gastroenterology; University Hospitals of North Midlands; Stoke on Trent United Kingdom
| | - Jens Brøndum Frøkjaer
- Mech-Sense, Department of Radiology, Aalborg University Hospital and Clinical Institute; Aalborg University; Aalborg Denmark
| | - Barry P. McMahon
- Department of Medical Physics and Clinical Engineering; Tallaght Hospital and Trinity College; Dublin Ireland
| | - Asbjørn Mohr Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital and Clinical Institute; Aalborg University; Aalborg Denmark
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Hubbard CS, Becerra L, Heinz N, Ludwick A, Rasooly T, Wu R, Johnson A, Schechter NL, Borsook D, Nurko S. Abdominal Pain, the Adolescent and Altered Brain Structure and Function. PLoS One 2016; 11:e0156545. [PMID: 27244227 PMCID: PMC4886967 DOI: 10.1371/journal.pone.0156545] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/16/2016] [Indexed: 12/22/2022] Open
Abstract
Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disorder of unknown etiology. Although relatively common in children, how this condition affects brain structure and function in a pediatric population remains unclear. Here, we investigate brain changes in adolescents with IBS and healthy controls. Imaging was performed with a Siemens 3 Tesla Trio Tim MRI scanner equipped with a 32-channel head coil. A high-resolution T1-weighted anatomical scan was acquired followed by a T2-weighted functional scan. We used a surface-based morphometric approach along with a seed-based resting-state functional connectivity (RS-FC) analysis to determine if groups differed in cortical thickness and whether areas showing structural differences also showed abnormal RS-FC patterns. Patients completed the Abdominal Pain Index and the GI Module of the Pediatric Quality of Life Inventory to assess abdominal pain severity and impact of GI symptoms on health-related quality of life (HRQOL). Disease duration and pain intensity were also assessed. Pediatric IBS patients, relative to controls, showed cortical thickening in the posterior cingulate (PCC), whereas cortical thinning in posterior parietal and prefrontal areas were found, including the dorsolateral prefrontal cortex (DLPFC). In patients, abdominal pain severity was related to cortical thickening in the intra-abdominal area of the primary somatosensory cortex (SI), whereas HRQOL was associated with insular cortical thinning. Disease severity measures correlated with cortical thickness in bilateral DLPFC and orbitofrontal cortex. Patients also showed reduced anti-correlations between PCC and DLPFC compared to controls, a finding that may reflect aberrant connectivity between default mode and cognitive control networks. We are the first to demonstrate concomitant structural and functional brain changes associated with abdominal pain severity, HRQOL related to GI-specific symptoms, and disease-specific measures in adolescents with IBS. It is possible such changes will be responsive to therapeutic intervention and may be useful as potential markers of disease progression or reversal.
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Affiliation(s)
- Catherine S. Hubbard
- Center for Pain and the Brain, Boston Children’s Hospital, Waltham, Massachusetts, United States of America
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Lino Becerra
- Center for Pain and the Brain, Boston Children’s Hospital, Waltham, Massachusetts, United States of America
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Nicole Heinz
- Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Allison Ludwick
- Center for Pain and the Brain, Boston Children’s Hospital, Waltham, Massachusetts, United States of America
| | - Tali Rasooly
- Center for Pain and the Brain, Boston Children’s Hospital, Waltham, Massachusetts, United States of America
| | - Rina Wu
- Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Adriana Johnson
- Center for Pain and the Brain, Boston Children’s Hospital, Waltham, Massachusetts, United States of America
| | - Neil L. Schechter
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, United States of America
| | - David Borsook
- Center for Pain and the Brain, Boston Children’s Hospital, Waltham, Massachusetts, United States of America
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Samuel Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
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Irimia A, Labus JS, Torgerson CM, Van Horn JD, Mayer EA. Altered viscerotopic cortical innervation in patients with irritable bowel syndrome. Neurogastroenterol Motil 2015; 27:1075-81. [PMID: 25952540 PMCID: PMC4520752 DOI: 10.1111/nmo.12586] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 04/14/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Studies have demonstrated the existence of regional gray matter and white matter (WM) alterations in the brains of patients with irritable bowel syndrome (IBS), but the extent to which altered anatomical connectivity between brain regions is altered in IBS remains incompletely understood. METHODS In this study, magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) were used to identify significant brain connectivity differences between IBS patients and healthy control (HC) subjects. Based on MRI and DTI volumes acquired from 66 IBS patients and 23 HC subjects, multivariate regression was used to investigate whether subject age, sex, cortical thickness, or the mean fractional anisotropy (FA) of WM connections innervating each location on the cortex could predict IBS diagnosis. KEY RESULTS HC and IBS subjects were found to differ significantly within both left and right viscerotopic portions of the primary somatosensory cortex (S1), with the mean FA of WM bundles innervating S1 being the predictor variable responsible for these significant differences. CONCLUSIONS & INFERENCES These preliminary findings illustrate how a chronic visceral pain syndrome and brain structure are related in the cohort examined, and because of their indication that IBS diagnosis is associated with anatomic neuropathology of potential neurological relevance in this patient sample.
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Affiliation(s)
- Andrei Irimia
- Laboratory of Neuro Imaging, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA
| | - Jennifer S. Labus
- Oppenheimer Family Center for Neurobiology of Stress, Pain and Interoception Network (PAIN), David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Carinna M. Torgerson
- Laboratory of Neuro Imaging, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA
| | - John D. Van Horn
- Laboratory of Neuro Imaging, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA
| | - Emeran A. Mayer
- Oppenheimer Family Center for Neurobiology of Stress, Pain and Interoception Network (PAIN), David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
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10
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Brock C, Brokjaer A, Drewes AM, Farmer AD, Frøkjaer JB, Gregersen H, Lottrup C. Neurophysiology of the esophagus. Ann N Y Acad Sci 2015; 1325:57-68. [PMID: 25266015 DOI: 10.1111/nyas.12515] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The following, from the 12th OESO World Conference: Cancers of the Esophagus, includes commentaries on the methods and characteristics of esophageal afferents in humans; the pitfalls in characterization of mechanosensitive afferents; the sensitization of esophageal afferents in human studies; the brain source modeling in the understanding of the esophagus-brain axis; the use of evoked brain potentials in the esophagus; and measuring descending inhibition in animal and human studies.
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Affiliation(s)
- Christina Brock
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
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11
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Haas S, Brock C, Krogh K, Gram M, Nissen TD, Lundby L, Laurberg S, Drewes AM. Cortical evoked potentials in response to rapid balloon distension of the rectum and anal canal. Neurogastroenterol Motil 2014; 26:862-73. [PMID: 24750321 DOI: 10.1111/nmo.12341] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/11/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Neurophysiological evaluation of anorectal sensory function is hampered by a paucity of methods. Rapid balloon distension (RBD) has been introduced to describe the cerebral response to rectal distension, but it has not successfully been applied to the anal canal. METHODS Nineteen healthy women received 30 RBDs in the rectum and the anal canal at intensities corresponding to sensory and unpleasantness thresholds, and response was recorded as cortical evoked potentials (CEPs) in 64-channels. The anal canal stimulations at unpleasantness level were repeated after 4 min to test the within-day reproducibility. CEPs were averaged, and to overcome latency variation related to jitter the spectral content of single sweeps was also computed. KEY RESULTS Repeated stimulation of the anal canal generated CEPs with similar latencies but smaller amplitudes compared to those from the rectum. Due to latency jitter, reproducibility of averaged CEPs was lower than what was found in the rectum. The most reproducible feature was N2P2 peak-to-peak amplitude with intra-class correlation coefficient (ICC) of 0.7 and coefficient of variation (CV) of 18%. Spectral content of the single sweeps showed reproducibility with ICCs for all bands >0.8 and corresponding CVs <7%. CONCLUSIONS & INFERENCES Cortical potentials evoked from the anal canal are challenged by latency jitter likely related to variability in muscle tone due to the distensions. Using single-sweep analysis, anal CEPs proved to be reproducible and should be used in future evaluation of the anal function.
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Affiliation(s)
- S Haas
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
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12
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Do patients with functional chest pain have neuroplastic reorganization of the pain matrix? A diffusion tensor imaging study. Scand J Pain 2014; 5:85-90. [DOI: 10.1016/j.sjpain.2013.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 11/25/2013] [Indexed: 02/08/2023]
Abstract
Abstract
Background and aims
In functional chest pain (FCP) of presumed esophageal origin central nervous system hyperexcitability is generally believed to play an important role in pain pathogenesis. However, this theory has recently been challenged. Using magnetic resonance diffusion tensor imaging, the aim was to characterize any microstructural reorganization of the pain neuromatrix in FCP patients.
Methods
13 FCP patients and 20 matched healthy controls were studied in a 3T MR scanner. Inclusion criteria were relevant chest pain, normal coronary angiogram and normal upper gastrointestinal evaluation. Apparent diffusion coefficient (ADC) (i.e. mean diffusivity of water) and fractional anisotropy (FA) (i.e. directionality of water diffusion as a measure of fiber organization) values were assessed in the secondary sensory cortex, cingulate cortex, insula, prefrontal cortex, and amygdala.
Results
Overall, including all regions, no difference in ADC and FA values was found between the patients and controls (P = 0.79 and P = 0.23, respectively). Post-hoc tests revealed no difference in ADC and FA values of the individual regions. However, a trend of patients having increased ADC in the mid insula grey matter and increased FA in the mid insula white matter was observed (both P = 0.065).
Conclusions
This explorative study suggests that microstructural reorganization of the central pain neuromatrix may not be present in well-characterized FCP patients.
Implications
This finding, together with recent neurophysiologal evidence, challenges the theory of visceral hypersensitivity due to changes in the central nervous system in FCP patients.
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13
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Zhang Q, Ni M, Zhou HF, Ding SQ, Fan ZM. Value of evoked potential in study of functional bowel disorders. Shijie Huaren Xiaohua Zazhi 2014; 22:184-189. [DOI: 10.11569/wcjd.v22.i2.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In recent years, the development of neurogastroenterology and the application of neurophysiologic examinations have gradually revealed the association of gastrointestinal activity with cortical activity through the efferent and afferent pathways. The state of nerve conduction pathway between the brain and gastrointestinal tract is closely related with specific functions of the anus and rectum. Scholars have put forward the "brain gut axis" and "brain gut interaction" theories to explain the bidirectional interaction between the gastrointestinal tract and central nervous system. Evoked potentials have an important role in the diagnosis and research of electrophysiological changes in various parts of the neural system, which provides practical information for the study of the brain-gut pathway, promotes the diagnosis and understanding of diseases related to the brain-gut axis abnormalities, and provides the basis for developing new treatment methods. In this paper, we summarize the roles of various evoked potential techniques in the study of functional bowel disorders.
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Søfteland E, Brock C, Frøkjær JB, Simrén M, Drewes AM, Dimcevski G. Rectal sensitivity in diabetes patients with symptoms of gastroparesis. J Diabetes Res 2014; 2014:784841. [PMID: 25136644 PMCID: PMC4130227 DOI: 10.1155/2014/784841] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/07/2014] [Indexed: 02/07/2023] Open
Abstract
In a clinical setting, diabetic autonomic complications (cardiac, gastrointestinal, urogenital, etc.) are often handled as separate entities. We investigated rectal sensitivity to heat, mechanical distension, and electrical stimulations in 20 patients with diabetes and symptoms of gastroparesis, to evaluate the extent of visceral neuronal damage. Furthermore, to evaluate the relation between the nervous structures we examined gastric emptying and cardiac autonomic function with the hypothesis being an association between these. We found that 60% of patients had delayed gastric empting. Rectal hyposensitivity was a general finding as they tolerated 67% higher thermal, 42% more mechanical, and 33% higher electrical current intensity compared to healthy controls. In patients, most heart rate variability parameters were reduced; they reported significantly more gastrointestinal symptoms and a reduced quality of life in all SF-36 domains. Shortened RR interval correlated with reduced rectal temperature sensitivity, and gastric retention rate was negatively associated with symptoms of nausea and vomiting. To conclude, in these patients with signs and symptoms of diabetic gastroparesis, rectal sensitivity was reduced, and heart rate variability was impaired. Thus, we suggest regarding diabetic autonomic neuropathy as a diffuse disorder. Symptoms of widespread autonomic dysfunction and sensory disorders should be expected and treated in these patients.
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Affiliation(s)
- Eirik Søfteland
- Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway
- Department of Clinical Medicine, University of Bergen, 5020 Bergen, Norway
- *Eirik Søfteland:
| | - Christina Brock
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Jens B. Frøkjær
- Mech-Sense, Department of Radiology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Magnus Simrén
- Institute of Medicine, Department of Internal Medicine & Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden
| | - Asbjørn M. Drewes
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, 9000 Aalborg, Denmark
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, 9000 Aalborg, Denmark
| | - Georg Dimcevski
- Department of Clinical Medicine, University of Bergen, 5020 Bergen, Norway
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, 5020 Bergen, Norway
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Lelic D, Brock C, Simrén M, Frøkjaer JB, Søfteland E, Dimcevski G, Gregersen H, Drewes AM. The brain networks encoding visceral sensation in patients with gastrointestinal symptoms due to diabetic neuropathy. Neurogastroenterol Motil 2014; 26:46-58. [PMID: 24050116 DOI: 10.1111/nmo.12222] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 08/02/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Increasing evidence points to association between long-term diabetes mellitus and abnormal brain processing. The aim of this study was to investigate central changes due to electrical stimulation in esophagus in patients with upper gastrointestinal (GI) symptoms due to diabetic neuropathy. METHODS Twenty-three diabetes patients with upper GI symptoms and 27 healthy controls were included. A standard ambulatory 24-h electrocardiography was carried out. 122-channel esophageal evoked brain potentials to electrical stimulation were acquired. Brain source/network analysis was performed. Gastroparesis Cardinal Symptom Index was used to evaluate upper GI symptoms and SF-36 questionnaire was utilized to assess patients' quality of life (QOL). KEY RESULTS Diabetes patients with GI symptoms showed modifications in three brain networks: (i) brainstem/operculum/frontal cortex, (ii) operculum/cingulate, and (iii) mid-cingulate/anterior-cingulate/operculum/deep limbic structures. Operculum brain source in patients was localized deeper and more anterior in all three networks. The shift of operculum source was correlated with the severity of upper GI symptoms, decreased heart beat-to-beat interval, and decreased SD of the intervals. The activation of the first network was delayed in patients. Operculum source had higher activity than cingulate in the second network in patients, and this was correlated with decreased physical QOL. Deep limbic source was localized deeper in patients, which also correlated with decreased physical QOL. CONCLUSIONS & INFERENCES This study indicates involvement of central nervous system in diabetes. Reorganization within opercular cortex was correlated with GI symptoms suggesting that operculo-cingulate cortex could contribute to development and maintenance of GI symptoms in diabetes patients.
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Affiliation(s)
- D. Lelic
- Mech-Sense; Department of Gastroenterology and Hepatology; Aalborg Hospital; Aarhus University; Aalborg Denmark
| | - C. Brock
- Mech-Sense; Department of Gastroenterology and Hepatology; Aalborg Hospital; Aarhus University; Aalborg Denmark
| | - M. Simrén
- Institute of Medicine; Department of Internal Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - J. B. Frøkjaer
- Mech-Sense; Department of Radiology; Aalborg Hospital; Aarhus University Hospital; Aalborg Denmark
| | - E. Søfteland
- Department of Medicine; Haukeland University Hospital; Bergen Norway
- Institute of Medicine; University of Bergen; Bergen Norway
| | - G. Dimcevski
- Department of Medicine; Haukeland University Hospital; Bergen Norway
- Institute of Medicine; University of Bergen; Bergen Norway
| | - H. Gregersen
- Department of Medicine; GIOME and Sino-Danish Centre for Education and Research; Aarhus Denmark
| | - A. M. Drewes
- Mech-Sense; Department of Gastroenterology and Hepatology; Aalborg Hospital; Aarhus University; Aalborg Denmark
- Department of Health Science and Technology; Center for Sensory-Motor Interactions (SMI); Aalborg University; Aalborg Denmark
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Kristiansen FL, Olesen AE, Brock C, Gazerani P, Petrini L, Mogil JS, Drewes AM. The Role of Pain Catastrophizing in Experimental Pain Perception. Pain Pract 2013; 14:E136-45. [DOI: 10.1111/papr.12150] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 10/07/2013] [Indexed: 12/14/2022]
Affiliation(s)
- Frederik L. Kristiansen
- Mech-Sense; Department of Gastroenterology and Hepatology; Aalborg University Hospital; Aalborg Denmark
- Center for Sensory-Motor Interaction (SMI); Department of Health Science and Technology; Aalborg University; Aalborg Denmark
| | - Anne E. Olesen
- Mech-Sense; Department of Gastroenterology and Hepatology; Aalborg University Hospital; Aalborg Denmark
| | - Christina Brock
- Mech-Sense; Department of Gastroenterology and Hepatology; Aalborg University Hospital; Aalborg Denmark
| | - Parisa Gazerani
- Center for Sensory-Motor Interaction (SMI); Department of Health Science and Technology; Aalborg University; Aalborg Denmark
| | - Laura Petrini
- Center for Sensory-Motor Interaction (SMI); Department of Health Science and Technology; Aalborg University; Aalborg Denmark
| | - Jeffrey S. Mogil
- Department of Psychology and Alan Edwards Centre for Research on Pain; McGill University; Montreal Quebec Canada
| | - Asbjørn M. Drewes
- Mech-Sense; Department of Gastroenterology and Hepatology; Aalborg University Hospital; Aalborg Denmark
- Center for Sensory-Motor Interaction (SMI); Department of Health Science and Technology; Aalborg University; Aalborg Denmark
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Hoff DAL, Krarup AL, Lelic D, Olesen SS, Dimcevski G, Hansen TM, Brock C, Hatlebakk JG, Drewes AM. Central response to painful electrical esophageal stimulation in well-defined patients suffering from functional chest pain. Neurogastroenterol Motil 2013; 25:e718-27. [PMID: 23965033 DOI: 10.1111/nmo.12196] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 07/03/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Functional chest pain (FCP) of presumed esophageal origin is considered a common cause for chest pain in which central nervous system hyperexcitability is thought to play an important role. We aimed to compare cerebral responses with painful esophageal stimuli between FCP patients and healthy subjects (HS). METHODS Thirteen patients with FCP (seven females, mean age 50.4 ± 7.5 years) and 15 HS (eight females, mean age 49.1 ± 12.9 years) were enrolled. Inclusion criteria consisted of typical chest pain, normal coronary angiogram, and normal upper gastrointestinal evaluation. Electrical stimulations evoking the pain threshold were applied in the distal esophagus, while cortical evoked potentials were recorded from the scalp. Pain scores, resting electroencephalogram (EEG), evoked potential characteristics and brain electrical sources to pain stimulation were compared between groups. KEY RESULTS No differences were seen between patients and HS regarding (i) pain thresholds (patients: 20.1 ± 7.4 mA vs HS: 22.4 ± 8.3 mA, all P > 0.05), (ii) resting-EEG (P > 0.05), (iii) evoked brain potential latencies (N2: patients 181.7 ± 25.7 mS vs HS 182.2 ± 25.8 mS, all P > 0.05) and amplitudes (N2P2: patients 8.2 ± 7.2 μV vs HS: 10.1 ± 3.4 μV, all P > 0.05), (iv) topography (P > 0.05), and (v) brain source location (P > 0.05). CONCLUSIONS & INFERENCES No differences in activation of brain areas to painful esophageal stimulation were seen in this group of well characterized patients with FCP compared with sex- and age-matched HS. The mechanism of pain in FCP and whether it originates in the esophagus remains unsolved.
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Affiliation(s)
- D A L Hoff
- Department of Medicine, Division of Gastroenterology and Hepatology, Aalesund Hospital, Aalesund, Norway
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Woodland P, Sifrim D, Krarup AL, Brock C, Frøkjaer JB, Lottrup C, Drewes AM, Swanstrom LL, Farmer AD. The neurophysiology of the esophagus. Ann N Y Acad Sci 2013; 1300:53-70. [DOI: 10.1111/nyas.12238] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Philip Woodland
- Neurogastroenterology Group, Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London United Kingdom
| | - Daniel Sifrim
- Neurogastroenterology Group, Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London United Kingdom
| | - Anne Lund Krarup
- Mech-Sense, Department of Gastroenterology; Aalborg Hospital; Aarhus University; Aarhus Denmark
| | - Christina Brock
- Mech-Sense, Department of Gastroenterology; Aalborg Hospital; Aarhus University; Aarhus Denmark
| | - Jens Brøndum Frøkjaer
- Mech-Sense, Department of Gastroenterology; Aalborg Hospital; Aarhus University; Aarhus Denmark
| | - Christian Lottrup
- Mech-Sense, Department of Gastroenterology; Aalborg Hospital; Aarhus University; Aarhus Denmark
| | - Asbjørn Mohr Drewes
- Mech-Sense, Department of Gastroenterology; Aalborg Hospital; Aarhus University; Aarhus Denmark
| | | | - Adam D. Farmer
- Department of Gastroenterology, Shrewsbury & Telford Hospitals NHS Trust; Princess Royal Hospital; Apley Castle Telford Shropshire United Kingdom
- Neurogastroenterology Group, Blizard Institute of Cell & Molecular Science; Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry; Queen Mary University of London; London United Kingdom
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Burgell RE, Lelic D, Carrington EV, Lunniss PJ, Olesen SS, Surguy S, Drewes AM, Scott SM. Assessment of rectal afferent neuronal function and brain activity in patients with constipation and rectal hyposensitivity. Neurogastroenterol Motil 2013; 25:260-7, e167-8. [PMID: 23240734 DOI: 10.1111/nmo.12047] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Blunted rectal sensation (rectal hyposensitivity: RH) is present in almost one-quarter of patients with chronic constipation. The mechanisms of its development are not fully understood, but in a proportion, afferent dysfunction is likely. To determine if, in patients with RH, alteration of rectal sensory pathways exists, rectal evoked potentials (EPs) and inverse modeling of cortical dipoles were examined. METHODS Rectal EPs (64 channels) were recorded in 13 patients with constipation and RH (elevated thresholds to balloon distension) and 11 healthy controls, in response to electrical stimulation of the rectum at 10 cm from the anal verge using a bipolar stimulating electrode. Stimuli were delivered at pain threshold. Evoked potential peak latencies and amplitudes were analyzed, and inverse modeling was performed on traces obtained to determine the location of cortical generators. KEY RESULTS Pain threshold was higher in patients than controls [median 59 (range 23-80) mA vs 24 (10-55) mA; P = 0.007]. Median latency to the first negative peak was 142 (±24) ms in subjects compared with 116 (±15) ms in controls (P = 0.004). There was no difference in topographic analysis of EPs or location of cortical activity demonstrated by inverse modeling between groups. CONCLUSIONS & INFERENCES This study is the first showing objective evidence of alteration in the rectal afferent pathway of individuals with RH and constipation. Prolonged latencies suggest a primary defect in sensory neuronal function, while cerebral processing of visceral sensory information appears normal.
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Affiliation(s)
- R E Burgell
- Academic Surgical Unit (GI Physiology Unit), Blizard Institute, Barts, UK
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20
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Frøkjær JB, Andersen LW, Brock C, Simrén M, Ljungberg M, Søfteland E, Dimcevski G, Yavarian Y, Gregersen H, Drewes AM. Altered brain microstructure assessed by diffusion tensor imaging in patients with diabetes and gastrointestinal symptoms. Diabetes Care 2013; 36:662-8. [PMID: 23139372 PMCID: PMC3579353 DOI: 10.2337/dc12-1131] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In patients with long-standing diabetes mellitus (DM), there is increasing evidence for abnormal processing of gastrointestinal sensations in the central nervous system. Using magnetic resonance diffusion tensor imaging, we characterized brain microstructure in areas involved in visceral sensory processing and correlated these findings to clinical parameters. RESEARCH DESIGN AND METHODS Twenty-six patients with DM and gastrointestinal symptoms and 23 healthy control subjects were studied in a 3T scanner. The apparent diffusion coefficient (i.e., diffusivity of water) and fractional anisotropy (FA) (i.e., organization of fibers) were assessed in the "sensory matrix" (cingulate cortex, insula, prefrontal and secondary sensory cortex, amygdala, and corona radiata) and in corpus callosum. RESULTS Patients had decreased FA values compared with control subjects in 1) all areas (P = 0.025); 2) anterior (P < 0.001), mid- (P = 0.001), and posterior (P < 0.001) cingulate cortex; 3) prefrontal cortex gray matter (P < 0.001); 4) corona radiata (P < 0.001); 5) secondary sensory cortex (P = 0.008); and 6) anterior white matter (P = 0.045), anterior gray matter (P = 0.002), and posterior gray matter (P = 0.002) insula. No difference was found in corpus callosum (P > 0.05). The microstructural changes in some areas correlated with clinical parameters such as bloating (anterior insula), mental well-being (anterior insula, prefrontal cortex, and mid-cingulated and corona radiata), autonomic function based on electrocardiographic results (posterior insula and anterior cingulate), and presence of gastroparesis (anterior insula). CONCLUSIONS The findings of this explorative study indicate that microstructural changes of brain areas involved in visceral sensory processing are associated with autonomic dysfunction and therefore may be involved in the pathogenesis of gastrointestinal symptoms in DM patients.
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Affiliation(s)
- Jens Brøndum Frøkjær
- Department of Radiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
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21
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Brock C, Graversen C, Frøkjaer JB, Søfteland E, Valeriani M, Drewes AM. Peripheral and central nervous contribution to gastrointestinal symptoms in diabetic patients with autonomic neuropathy. Eur J Pain 2012; 17:820-31. [PMID: 23239083 DOI: 10.1002/j.1532-2149.2012.00254.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Long-term diabetes mellitus (DM) has been associated with neuronal changes in the enteric, peripheral and/or central nervous system. Moreover, abnormal visceral sensation and gastrointestinal (GI) symptoms are seen in up to 75% of patients. To explore the role of diabetic autonomic neuropathy (DAN) in patients with long-standing DM, we investigated psychophysical responses and neuronal activity recorded as evoked brain potentials and dipolar source modelling. METHODS Fifteen healthy volunteers and 14 type-1 DM patients with DAN were assessed with a symptom score index characterizing upper GI abnormalities. Multichannel (62) electroencephalography was recorded during painful electrical stimulation of the lower oesophagus. Brain activity to painful stimulations was modelled using Brain Electrical Source Analysis (besa). RESULTS Diabetic patients had higher stimulus intensities to evoke painful sensation (p ≤ 0.001), longer latencies of N2 and P2 components (both p ≤ 0.001), and lower amplitudes of P1-N2 and N2-P2 complexes (p ≤ 0.001; p = 0.02). Inverse modelling of brain sources showed deeper bilateral insular dipolar source localization (p = 0.002). Symptom score index was negatively correlated with the depth of insular activity (p = 0.004) and positively correlated with insular dipole strength (p = 0.03). CONCLUSION DM patients show peripheral and central neuroplastic changes. Moreover, the role of abnormal insular processing may explain the appearance and persistence of GI symptoms related to DAN. This enhanced understanding of DAN may have future clinical and therapeutical implications.
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Affiliation(s)
- C Brock
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
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22
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Baumgärtner U, Greffrath W, Treede RD. Contact heat and cold, mechanical, electrical and chemical stimuli to elicit small fiber-evoked potentials: Merits and limitations for basic science and clinical use. Neurophysiol Clin 2012; 42:267-80. [DOI: 10.1016/j.neucli.2012.06.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 06/05/2012] [Accepted: 06/25/2012] [Indexed: 12/13/2022] Open
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Frøkjær JB, Bouwense SAW, Olesen SS, Lundager FH, Eskildsen SF, van Goor H, Wilder-Smith OHG, Drewes AM. Reduced cortical thickness of brain areas involved in pain processing in patients with chronic pancreatitis. Clin Gastroenterol Hepatol 2012; 10:434-8.e1. [PMID: 22155560 DOI: 10.1016/j.cgh.2011.11.024] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 10/30/2011] [Accepted: 11/18/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patients with painful chronic pancreatitis (CP) might have abnormal brain function. We assessed cortical thickness in brain areas involved in visceral pain processing. METHODS We analyzed brain morphologies of 19 patients with painful CP and compared them with 15 healthy individuals (controls) by using a 3T magnetic resonance scanner. By using an automated method with surface-based cortical segmentation, we assessed cortical thickness of the primary (SI) and secondary (SII) somatosensory cortex; prefrontal cortex (PFC); frontal cortex (FC); anterior (ACC), mid (MCC), and posterior (PCC) cingulate cortex; and insula. The occipital middle sulcus was used as a control area. The pain score was determined on the basis of the average daily amount of pain during 1 week. RESULTS Compared with controls, patients with CP had reduced overall cortical thickness (P = .0012), without effects of modification for diabetes, alcoholic etiologies, or opioid treatment (all P values >.05). In patients with CP, the cortical thickness was decreased in SII (P = .002, compared with controls), PFC (P = .046), FC (P = .0003), MCC (P = .001), and insula (P = .002). There were no differences in cortical thickness between CP patients and controls in the control area (P = .20), SI (P = .06), ACC (P = .95), or PCC (P = .42). Cortical thickness in the affected areas correlated with pain score (r = 0.47, P = .003). CONCLUSIONS In patients with CP, brain areas involved in pain processing have reduced cortical thickness. As a result of long-term, ongoing pain input to the neuromatrix, cortical thickness might serve as a measure for overall pain system dysfunction, as observed in other diseases characterized by chronic pain.
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Affiliation(s)
- Jens Brøndum Frøkjær
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
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Brain activity in rectosigmoid pain: Unravelling conditioning pain modulatory pathways. Clin Neurophysiol 2012; 123:829-37. [DOI: 10.1016/j.clinph.2011.07.047] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 07/08/2011] [Accepted: 07/09/2011] [Indexed: 12/18/2022]
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Lelic D, Olesen SS, Valeriani M, Drewes AM. Brain source connectivity reveals the visceral pain network. Neuroimage 2011; 60:37-46. [PMID: 22178813 DOI: 10.1016/j.neuroimage.2011.12.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 11/30/2011] [Accepted: 12/02/2011] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Several brain structures have been consistently found to be involved in visceral pain processing. However, recent research questions the specificity of these regions and it has been suggested that it is not singular activations of brain areas, but their cross-communication that results in perception of pain. Moreover, frequency at which neurons are firing could be what separates pain from other sensory modalities which otherwise involve the same anatomical locations. In this test/retest study, we identified the network of sources and their frequencies following visceral pain. METHODS 62-channel evoked potentials following electrical stimulation in oesophagus were recorded in twelve healthy volunteers on two separate days. Multichannel matching pursuit (MMP) and dipolar source localisation were used. Multiple sources responsible for one MMP component were considered to act synchronously as each MMP component is mono-frequency and has a single topography. We first identified components that were reproducible within subjects over recording sessions. These components were then analysed across subjects. RESULTS MMP and source localisation showed three main brain networks; an early network at ~8.3 Hz and ~3.5 Hz involving brainstem, operculum, and pre-frontal cortex peaking at ~77 ms. This was followed by an operculum, amygdale, mid-cingulate, and anterior-cingulate network at ~4.5 Hz. Finally, there was an operculum and mid-cingulate network that persisted over the entire time interval, peaking at 245.5±51.4 ms at ~2.1 Hz. CONCLUSION This study gives evidence of operculum's central integrative role for perception of pain and shows that MMP is a reliable method to study upstream brain activity.
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Affiliation(s)
- Dina Lelic
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg Hospital, Aarhus University, Denmark.
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26
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Olesen SS, Graversen C, Olesen AE, Frøkjaer JB, Wilder-Smith O, van Goor H, Valeriani M, Drewes AM. Randomised clinical trial: pregabalin attenuates experimental visceral pain through sub-cortical mechanisms in patients with painful chronic pancreatitis. Aliment Pharmacol Ther 2011; 34:878-87. [PMID: 21848870 DOI: 10.1111/j.1365-2036.2011.04802.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pregabalin has a broad spectrum of analgesic and antihyperalgesic activity in both basic and clinical studies. However, its mechanisms and sites of action have yet to be determined in humans. AIMS To assess the antinociceptive effect of pregabalin on experimental gut pain in patients with visceral hyperalgesia due to chronic pancreatitis and to reveal putative changes in corresponding central pain processing as assessed by evoked brain potentials. METHODS Thirty-one patients were randomly assigned to receive increasing doses of pregabalin or placebo for three consecutive weeks. Perceptual thresholds to electrical stimulation of the sigmoid with recording of corresponding evoked brain potentials were obtained at baseline and study end. The brain source localisations reflecting direct neuronal activity were fitted by a five-dipole model projected to magnetic resonance imaging of the individuals' brains. RESULTS As compared to placebo, pregabalin significantly increased the pain threshold to electrical gut stimulation from baseline (P=0.02). No differences in evoked brain potential characteristics were seen, neither after pregabalin nor placebo treatment (all P>0.05). In agreement with this, brain source locations remained stable during study treatment (all P>0.05). CONCLUSION Pregabalin was superior to placebo for attenuation of experimental visceral pain in chronic pancreatitis patients. We suggest its antinociceptive effects to be mediated primarily through sub-cortical mechanisms.
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Affiliation(s)
- S S Olesen
- Mech-Sense, Department of Gastroenterology, Aalborg Hospital, Aarhus University Hospital, Denmark.
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Frøkjær JB, Olesen SS, Graversen C, Andresen T, Lelic D, Drewes AM. Neuroimaging of the human visceral pain system–A methodological review. Scand J Pain 2011; 2:95-104. [DOI: 10.1016/j.sjpain.2011.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 02/25/2011] [Indexed: 12/13/2022]
Abstract
Abstract
During the last decades there has been a tremendous development of non-invasive methods for assessment of brain activity following visceral pain. Improved methods for neurophysiological and brain imaging techniques have vastly increased our understanding of the central processing of gastrointestinal sensation and pain in both healthy volunteers as well as in patients suffering from gastrointestinal disorders. The techniques used are functional magnetic resonance imaging (fMRI), positron emission tomography (PET), electroencephalography (EEG)/evoked brain potentials (EPs), magnetoencephalography (MEG), single photon emission computed tomography (SPECT), and the multimodal combinations of these techniques. The use of these techniques has brought new insight into the complex brain processes underlying pain perception, including a number of subcortical and cortical regions, and paved new ways in our understanding of acute and chronic pain. The pathways are dynamic with a delicate balance between facilitatory and inhibitory pain mechanisms, and with modulation of the response to internal or external stressors with a high degree of plasticity. Hence, the ultimate goal in imaging of pain is to follow the stimulus response throughout the neuraxis.
Brain activity measured by fMRI is based on subtracting regional changes in blood oxygenation during a resting condition from the signal during a stimulus condition, and has high spatial resolution but low temporal resolution. SPECT and PET are nuclear imaging techniques where radiolabeled molecules are injected with visualization of the distribution, density and activity of receptors in the brain allowing not only assessment of brain activity but also study of receptor sites. EEG is based on assessment of electrical activity in the brain, and recordings of the resting EEG and evoked potentials following an external stimulus are used to study normal visceral pain processing, alterations of pain processing in different patient groups and the effect of pharmacological intervention. EEG has high temporal resolution, but relative poor spatial resolution, which however to some extent can be overcome by applying inverse modelling algorithms and signal decomposition procedures. MEG is based on recording the magnetic fields produced by electrical currents in the brain, has high spatial resolution and is especially suitable for the study cortical activation.
The treatment of chronic abdominal pain is often ineffective and dissapointing, which leads to search for optimized treatment achieved on the basis of a better understanding of underlying pain mechanisms. Application of the recent improvements in neuroimaging on the visceral pain system may likely in near future contribute substantially to our understanding of the functional and structural pathophysiology underlying chronic visceral pain disorders, and pave the road for optimized individual and mechanism based treatments.
The purpose of this review is to give a state-of-the-art overview of these methods, with focus on EEG, and especially the advantages and limitations of the single methods in clinical gastrointestinal pain esearch including examples from relevant studies.
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Affiliation(s)
- Jens Brøndum Frøkjær
- Mech-Sense , Department of Gastroenterology , Aalborg Hospital , Aarhus University Hospital , Aalborg , Denmark
- Department of Radiology , Aalborg Hospital , Aarhus University Hospital , Aalborg , Denmark
| | - Søren Schou Olesen
- Mech-Sense , Department of Gastroenterology , Aalborg Hospital , Aarhus University Hospital , Aalborg , Denmark
| | - Carina Graversen
- Mech-Sense , Department of Gastroenterology , Aalborg Hospital , Aarhus University Hospital , Aalborg , Denmark
| | - Trine Andresen
- Mech-Sense , Department of Gastroenterology , Aalborg Hospital , Aarhus University Hospital , Aalborg , Denmark
| | - Dina Lelic
- Mech-Sense , Department of Gastroenterology , Aalborg Hospital , Aarhus University Hospital , Aalborg , Denmark
| | - Asbjørn Mohr Drewes
- Mech-Sense , Department of Gastroenterology , Aalborg Hospital , Aarhus University Hospital , Aalborg , Denmark
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Staahl C, Krarup AL, Olesen AE, Brock C, Graversen C, Drewes AM. Is Electrical Brain Activity a Reliable Biomarker for Opioid Analgesia in the Gut? Basic Clin Pharmacol Toxicol 2011; 109:321-7. [DOI: 10.1111/j.1742-7843.2011.00727.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Murray E, Wise S, Rhodes S. What Can Different Brains Do with Reward? NEUROBIOLOGY OF SENSATION AND REWARD 2011. [DOI: 10.1201/b10776-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Remes-Troche JM, Tantiphlachiva K, Attaluri A, Valestin J, Yamada T, Hamdy S, Rao SSC. A bi-directional assessment of the human brain-anorectal axis. Neurogastroenterol Motil 2011; 23:240-8, e117-8. [PMID: 20964791 PMCID: PMC3035753 DOI: 10.1111/j.1365-2982.2010.01619.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Brain-gut dysfunction has been implicated in gastrointestinal disorders but a comprehensive test of brain-gut axis is lacking. We developed and tested a novel method for assessing both afferent anorectal-brain function using cortical evoked potentials (CEP), and efferent brain-anorectal function using motor evoked potentials (MEP). METHODS Cortical evoked potentials was assessed following electrical stimulations of anus and rectum with bipolar electrodes in 26 healthy subjects. Anorectal MEPs were recorded following transcranial magnetic stimulation (TMS) over paramedian motor cortices bilaterally. Anal and rectal latencies/amplitudes for CEP and MEP responses and thresholds for first sensation and pain (mA) were analyzed and compared. Reproducibility and interobserver agreement of responses were examined. KEY RESULTS Reproducible polyphasic rectal and anal CEPs were recorded in all subjects, without gender differences, and with negative correlation between BMI and CEP amplitude (r -0.66, P=0.001). Transcranial magnetic stimulation evoked triphasic rectal and anal MEPs, without gender differences. Reproducibility for CEP and MEP was excellent (CV <10%). The inter-rater CV for anal and rectal MEPs was excellent (ICC 97-99), although there was inter-subject variation. CONCLUSIONS & INFERENCES Combined CEP and MEP studies offer a simple, inexpensive and valid method of examining bidirectional brain-anorectal axes. This comprehensive method could provide mechanistic insights into lower gut disorders.
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Affiliation(s)
- J M Remes-Troche
- Division of Neurogastroenterology and Motility, Department of Internal Medicine and Clinical Translational Research Center, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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31
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Multichannel matching pursuit validation and clustering—A simulation and empirical study. J Neurosci Methods 2011; 196:190-200. [DOI: 10.1016/j.jneumeth.2010.12.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 12/17/2010] [Accepted: 12/20/2010] [Indexed: 11/21/2022]
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Olesen SS, Frøkjær JB, Lelic D, Valeriani M, Drewes AM. Pain-associated adaptive cortical reorganisation in chronic pancreatitis. Pancreatology 2011; 10:742-51. [PMID: 21273802 DOI: 10.1159/000321644] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 09/28/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIMS In various chronic pain conditions cortical reorganisation seems to play a role in the symptomatology. The aims of this study were to investigate cortical reorganisation in patients with pain caused by chronic pancreatitis (CP) and to correlate putative cortical reorganisation to clinical pain scores. METHODS 24 patients suffering from CP and 14 healthy volunteers were included. Patients' daily experience of pain was recorded in a pain diary. The sigmoid was stimulated electrically with simultaneous recording of evoked brain potentials (EPs). The brain source localisations reflecting direct neuronal activity were fitted by a five-dipole model projected to magnetic resonance imaging of the individual brains. RESULTS Patients showed prolonged latencies of the EPs confined to the frontal region of the brain (p < 0.01). The corresponding brain sources were located in the bilateral insula, cingulate gyrus and bilateral secondary somatosensory area. The insular dipoles were localised more posterior in the patients than in healthy subjects (p < 0.01). The shift in insular dipole localisation was negatively correlated with the patients' clinical pain scores (p < 0.05). CONCLUSIONS The findings indicate that sustained pain in CP leads to functional reorganisation of the insular cortex. We suggest its physiological correlate to be an adaptive response to chronic pain. and IAP.
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Affiliation(s)
- Søren Schou Olesen
- Mech-Sense, Department of Gastroenterology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
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Doenlen R, Krügel U, Wirth T, Riether C, Engler A, Prager G, Engler H, Schedlowski M, Pacheco-López G. Electrical activity in rat cortico-limbic structures after single or repeated administration of lipopolysaccharide or staphylococcal enterotoxin B. Proc Biol Sci 2010; 278:1864-72. [PMID: 21106598 DOI: 10.1098/rspb.2010.2040] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Immune-to-brain communication is essential for an individual to aptly respond to challenging internal and external environments. However, the specificity by which the central nervous system detects or 'senses' peripheral immune challenges is still poorly understood. In contrast to post-mortem c-Fos mapping, we recorded neural activity in vivo in two specific cortico-limbic regions relevant for processing visceral inputs and associating it with other sensory signalling, the amygdala (Am) and the insular cortex (IC). Adult rats were implanted with deep-brain monopolar electrodes and electrical activity was monitored unilaterally before and after administration of two different immunogens, the T-cell-independent antigen lipopolysaccharide (LPS) or the T-cell-dependent antigen staphylococcal enterotoxin B (SEB). In addition, the neural activity of the same individuals was analysed after single as well as repeated antigen administration, the latter inducing attenuation of the immune response. Body temperature and circulating cytokine levels confirmed the biological activity of the antigens and the success of immunization and desensitization protocols. More importantly, the present data demonstrate that neural activity of the Am and IC is not only specific for the type of immune challenge (LPS versus SEB) but seems to be also sensitive to the different immune state (naive versus desensitization). This indicates that the forebrain expresses specific patterns of electrical activity related to the type of peripheral immune activation as well as to the intensity of the stimulation, substantiating associative learning paradigms employing antigens as unconditioned stimuli. Overall, our data support the view of an intensive immune-to-brain communication, which may have evolved to achieve the complex energetic balance necessary for mounting effective immunity and improved individual adaptability by cognitive functions.
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Affiliation(s)
- Raphael Doenlen
- Swiss Federal Institute of Technology (ETH), Zurich 8092, Switzerland
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Gastrointestinal symptoms in type-1 diabetes: is it all about brain plasticity? Eur J Pain 2010; 15:249-57. [PMID: 20813568 DOI: 10.1016/j.ejpain.2010.08.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2010] [Revised: 06/22/2010] [Accepted: 08/06/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Autonomic neuropathy seems to play a central role in the development of gastrointestinal symptoms in diabetes. In order to explore the neuronal mechanisms behind the symptoms we evaluated the brain processing of painful visceral stimuli. METHODS Evoked brain potentials were recorded to assess the response to painful oesophageal electrical stimuli in 15 healthy volunteers and 14 type-1 diabetes patients with autonomic neuropathy and related gastrointestinal symptoms. Source reconstruction analysis (fixed Multiple Signal Classification (MUSIC) algorithm) was applied to estimate the location of the evoked electrical activity in the brain. RESULTS The patients had increased oesophageal sensory thresholds compared to the controls (P=0.004). The latencies of the evoked brain potentials at vertex (Cz) were increased (P=0.007) and amplitudes reduced (P=0.011) in diabetics. Compared with controls the patients had a posterior shift of the electrical sources in the anterior cingulate cortex at 54 ms, and additional sources close to the posterior insula at 95 ms and in medial frontal gyrus at 184 ms. CONCLUSIONS There is evidence of altered central processing to visceral stimulation, and both peripheral and central mechanisms seem involved. Central neuronal reorganisation may contribute to our understanding of the gastrointestinal symptoms in patients with diabetic autonomic neuropathy and this may guide development and evaluation of new treatment modalities.
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Kanazawa M, Hamaguchi T, Watanabe S, Terui T, Mine H, Kano M, Fukudo S. Site-specific differences in central processing of visceral stimuli from the rectum and the descending colon in men. Neurogastroenterol Motil 2010; 22:173-80, e53. [PMID: 19825012 DOI: 10.1111/j.1365-2982.2009.01417.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND It has been reported that different brain activation areas are demonstrated during somatosensory and visceral stimulation. However, no study thus far has investigated how activated patterns in the human brain differ during visceral stimulation of different sites of the digestive tracts. The aim of this study was to determine possible site-specific differences in brain responses and perceptions during visceral stimulation of two different sites, the intraluminal distentions of the rectum and descending colon. METHODS Regional cerebral blood flow was assessed in 32 healthy right-handed male subjects using H(2)(15)O positron emission tomography during distention of the rectum (R group, n = 16) or descending colon (DC group, n = 16) at 40 or 20 mmHg. KEY RESULTS R group reported significantly higher scores of abdominal pain (P < 0.05) and urge to defecate (P < 0.001) during the application of stimulus at 40 mmHg compared with DC group but not of abdominal bloating or anxiety. In comparisons of response to the 40-mmHg stimulus, R group showed significantly greater activation in posterior midcingulate cortex (MCC) and right anterior and posterior insula, whereas DC group showed greater activation in subgenual anterior cingulate cortex (ACC), perigenual ACC and left orbitofrontal and superior temporal cortices. CONCLUSIONS & INFERENCES These findings suggest that central projections of painful visceral stimulation from the rectum and descending colon differ in affective, cognitive and nociceptive processing in the brain, which may result in different perceptions of visceral stimulation from different sites.
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Affiliation(s)
- M Kanazawa
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
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Moisset X, Bouhassira D, Denis D, Dominique G, Benoit C, Sabaté JM. Anatomical connections between brain areas activated during rectal distension in healthy volunteers: a visceral pain network. Eur J Pain 2009; 14:142-8. [PMID: 19473859 DOI: 10.1016/j.ejpain.2009.04.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Revised: 03/11/2009] [Accepted: 04/28/2009] [Indexed: 02/07/2023]
Abstract
Diffusion Tensor Imaging (DTI) is a promising new imaging method allowing in vivo mapping of anatomical connections in the living human brain. We combined DTI with functional magnetic resonance imaging (fMRI) to investigate the anatomical relationships between areas involved in visceral sensations in humans. Non-painful and moderately painful rectal distensions were performed in 11 healthy women (38.4+/-3.1years). fMRI was used to analyse the changes in brain activity during both types of distension. Then, DTI was applied for tracking fibers between the main activated regions. Non-painful distension bilaterally activated the PreFrontal Cortex (PFC), the Anterior Cingulate Cortex (ACC) and the right insula. Painful distension bilaterally activated the primary (S1) and secondary (S2) somatosensory cortices, the motor cortex, the frontal inferior gyrus, the thalamus, the insula, the striatum and the cerebellum. DTI revealed direct connections between insula, and the four areas more frequently activated in this study, i.e. ACC, thalamus, S1, S2 and PFC. The combined use of fMRI and DTI in healthy subjects during rectal distension revealed a neural network of visceral sensory perception involving the insula, thalamus, somatosensory cortices, ACC and PFC.
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Affiliation(s)
- Xavier Moisset
- INSERM U792, Physiopathologie et pharmacologie clinique de la douleur, Hôpital Ambroise Paré, 92100 Boulogne, France
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Schulz A, Lass-Hennemann J, Nees F, Blumenthal TD, Berger W, Schachinger H. Cardiac modulation of startle eye blink. Psychophysiology 2009; 46:234-40. [PMID: 19207206 DOI: 10.1111/j.1469-8986.2008.00768.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
As an alternative to interoceptive paradigms that depend on the participants' active cooperation, two studies are presented to show that startle methodology may be employed to study visceral afferent processing. The first study of 38 volunteers showed that startle responses were smaller when elicited during cardiac systole as compared to diastole. In the second study, 31 diabetic patients were divided into two groups, having normal or diminished (<6 ms/mmHg) baroreflex sensitivity (BRS). Patients with normal BRS showed the same results found in healthy volunteers. Diabetic patients with diminished BRS did not show this pattern. Because diminished BRS is an indicator of impaired baro-afferent signal transmission, it is concluded that cardiac modulation of startle is associated with intact baro-afferent feedback. Thus, pre-attentive startle methodology is feasible to study visceral afferent processing originating from the cardiovascular system.
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Affiliation(s)
- André Schulz
- Division of Clinical Physiology, Institute of Psychobiology, University of Trier, Trier, Germany
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Gosselin RD, Gibney S, O'Malley D, Dinan TG, Cryan JF. Region specific decrease in glial fibrillary acidic protein immunoreactivity in the brain of a rat model of depression. Neuroscience 2008; 159:915-25. [PMID: 19000745 DOI: 10.1016/j.neuroscience.2008.10.018] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Revised: 10/03/2008] [Accepted: 10/09/2008] [Indexed: 12/11/2022]
Abstract
A growing body of evidence from human postmortem and animal studies suggests that deficits in glial cell (particularly astrocytes) density and function, in limbic regions of the brain contribute to the etiology of depressive disorders. Despite the widespread use of Wistar-Kyoto (WKY) rat strain as a model of depression and stress susceptibility, there is a paucity of data examining whether alterations in brain astrocytic population are present in the model. In the present study, we investigated the expression of the astrocytic markers glial fibrillary acidic protein (GFAP) in various brain regions in WKY rats in comparison to Sprague-Dawley rats. A significant deficit in GFAP-immunoreactive cells was found in the prefrontal cortex region (infralimbic, prelimbic and anterior cingulate cortex), in the basolateral amygdala as well as in the hippocampus (CA3 and dentate gyrus) in WKY rat brain. No statistical difference was found in the other brain regions analyzed (insular cortex, somatosensory cortex, CA1 and callosal white matter). No difference was found in the total density of astrocytes (assessed by s-100beta immunoreactivity), neurons (determined by NeuN expression) or in the total number of cells in the regions of interest. A slight increase in the intensity of s-100beta immunoreactivity was observed. The lower expression of GFAP in WKY rats was further confirmed by Western-blot analysis. These results suggest that specific astrocytic deficits in GFAP expression in corticolimbic circuits may be a general correlate of depressive-like behavior in animal models in addition to human major depression. Moreover, they suggest that glial physiology may become a therapeutic target in depression and other stress-related conditions.
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Affiliation(s)
- R-D Gosselin
- Laboratory of Neurogastroenterology, Alimentary Pharmabiotic Centre, University College Cork, Cork, Ireland
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Abstract
Neurophysiological tests of anorectal function can provide useful information regarding the integrity of neuronal innervation, as well as neuromuscular function. This information can give insights regarding the pathophysiological mechanisms that lead to several disorders of anorectal function, particularly fecal incontinence, pelvic floor disorders and dyssynergic defecation. Currently, several tests are available for the neurophysiological evaluation of anorectal function. These tests are mostly performed on patients referred to tertiary care centers, either following negative evaluations or when there is lack of response to conventional therapy. Judicious use of these tests can reveal significant and new understanding of the underlying mechanism(s) that could pave the way for better management of these disorders. In addition, these techniques are complementary to other modalities of investigation, such as pelvic floor imaging. The most commonly performed neurophysiological tests, along with their indications and clinical utility are discussed. Several novel techniques are evolving that may reveal new information on brain-gut interactions.
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Affiliation(s)
- Jose M Remes-Troche
- Digestive Physiology and Motility Department, Medical-Biological Research Institute, University of Veracruz, Veracruz, Mexico, Tel.: +52 229 202 1231, Fax: +52 229 202 1231
| | - Satish SC Rao
- Section of Neuro gastroenterology, Division of Gastroenterology–Hepatology, Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, IA 52242, USA, Tel.: +1 319 353 6602, Fax: +1 319 353 6399
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Lerner A, Bagic A, Hanakawa T, Boudreau EA, Pagan F, Mari Z, Bara-Jimenez W, Aksu M, Sato S, Murphy DL, Hallett M. Involvement of insula and cingulate cortices in control and suppression of natural urges. Cereb Cortex 2008; 19:218-23. [PMID: 18469316 DOI: 10.1093/cercor/bhn074] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The physiology of control and suppression of natural urges is not well understood. We used [(15)O]H(2)O positron-emission tomography imaging to identify neural circuits involved in suppression of spontaneous blinking as a model of normal urges. Suppression of blinking was associated with prominent activation of bilateral insular-claustrum regions, right more than left; activation was also found in bilateral anterior cingulate cortex (ACC), supplementary motor areas, and the face area of the primary motor cortex bilaterally. These results suggest a central role for the insula possibly together with ACC in suppression of blinking.
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Affiliation(s)
- Alicja Lerner
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA.
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Dimcevski G, Sami SAK, Funch-Jensen P, Le Pera D, Valeriani M, Arendt-Nielsen L, Drewes AM. Pain in chronic pancreatitis: the role of reorganization in the central nervous system. Gastroenterology 2007; 132:1546-56. [PMID: 17408654 DOI: 10.1053/j.gastro.2007.01.037] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2006] [Accepted: 01/04/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS In various chronic pain conditions cortical reorganization seems to play a role in the manifestations. The aim of this study was to investigate cortical reorganization in patients with pain caused by chronic pancreatitis. METHODS Twelve healthy subjects and 10 patients with chronic pancreatitis were included. The esophagus, stomach, and duodenum were stimulated electrically at the pain threshold using a nasal endoscope. The electroencephalogram was recorded from 64 surface electrodes and event-related brain potentials (EPs) were obtained. RESULTS As compared with healthy subjects, the patient group showed decreased latencies of the early EP components (N1, P < .001; P1, P = .02), which is thought to reflect the exogenous brain pain processing specifically. Source analysis showed that the dipolar activities corresponding to the early EPs were located consistently in the bilateral insula, in the anterior cingulate gyrus, and in the bilateral secondary somatosensory area. The bilateral insular dipoles were localized more medial in the patient group than in the healthy subjects after stimulation of all 3 gut segments (P < .01). There also were changes in the cingulate cortex where the neuronal source was more posterior in patients than in controls to stimulation of the esophagus (P < .05). CONCLUSIONS The findings indicate that pain in chronic pancreatitis leads to changes in cortical projections of the nociceptive system. Such findings also have been described in somatic pain disorders, among them neuropathic pain. Taken together with the clinical data this suggests a neuropathic component in pancreatic pain, which may influence the approach to treatment.
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Affiliation(s)
- Georg Dimcevski
- Center for Visceral Biomechanics and Pain, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
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Murrell JC, Mitchinson SL, Johnstone AC, Johnson CB, Barnes GRG. Is it possible to generate cerebral evoked potentials with a mechanical stimulus from the duodenum in rats? J Neurosci Methods 2007; 162:215-21. [PMID: 17320970 DOI: 10.1016/j.jneumeth.2007.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Revised: 01/17/2007] [Accepted: 01/20/2007] [Indexed: 11/16/2022]
Abstract
The study aim was to develop a model to generate cerebral evoked potentials (CEPs) by mechanical distention of the duodenum in rats. Twenty Sprague-Dawley rats were anaesthetized and the EEG recorded from the left and right somatosensory cortices (S1L, S1R). A balloon catheter was implanted into the duodenum. A pneumatic device, triggered by data acquisition software, inflated the balloon for 200 ms every 3s to deliver a repeatable noxious stimulus. EEG was recorded for 100 ms before and 500 ms after onset of inflation and the response to 512 stimuli averaged to generate a CEP. Two CEPs were generated in each animal and data summed to calculate a single CEP for each channel. Data were excluded when the signal to noise ratio was < 2, therefore data are presented from 11 animals. A repeatable CEP was identified in waveforms recorded from S1L. The mean (S.D.) CEP comprised a triphasic waveform (P1, N1, P2) with latencies of 246.0 (24.7), 289.3 (12.8) and 321.5 (13.2)ms, respectively. We are the first group to have generated and characterized a CEP following mechanical stimulation of the duodenum. This model can be applied to further elucidate the mechanisms leading to visceral pain perception.
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Affiliation(s)
- Joanna C Murrell
- Institute of Veterinary Animal and Biomedical Sciences, College of Sciences, Massey University, Private Bag 11 222, Palmerston North, New Zealand.
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