Diagnosis and treatment of multifocal motor neuropathy

Physiology and pathophysiology of myelinated nerve fibers

The chief role of the axon is that of impulse conduction, which depends on the electrical cable structure and voltage-dependent ion channels of the axonal membrane. Over recent decades, the development of specialized techniques such as patch clamping and site-directed mutagenesis have established the contribution of neuronal ion channel function to the processes of impulse conduction in myelinated nerves. Recently, these insights from in vitro studies have been translated into the clinical realm. In keeping with this progress, clinical axonal excitability techniques have been developed to provide information related to the activity of a variety of ion channels, energy-dependent pumps, and ion exchange processes activated during impulse conduction in peripheral axons. These noninvasive techniques have been extensively applied to the study of the biophysical properties of human peripheral nerves in vivo and have provided important insights into axonal ion channel function in health and neurological disease, particularly in relation to the pathophysiological mechanisms that underlie neuropathy.

Amyotrophic lateral sclerosis: A 40-year personal perspective

Amyotrophic lateral sclerosis (ALS) or motor neuron disease (MND) shares with other neurodegenetrative disorders of the aging nervous system a polygenic, multifactorial aetiology. Less than 10% are familial and these too probably are associated with several interactive genes. The onset of ALS predates development of clinical symptoms by an unknown interval which may extend several years. The cause of neurodegeneration remains unknown but a common end-point is protein misfolding which in turn causes cell function failure. The complex nature of ALS has hindered therapeutic advances. In recent years longer survival is attributable largely to institution of non-invasive ventilation with BiPAP and timely implementation of percutaneous endoscopic gastrostomy (PEG) feeding. Symptomatic treatment has advanced improving quality of life. Several encouraging avenues of therapy for ALS are beginning to be emerge raising hope for real benefit. They include protective autoimmunity, vaccines against misfolded protein epitopes and other deleterious species, new drug delivery systems employing nanotechnology and the potential of stem cell therapy.