The effects of 4-aminopyridine on the spinal cord: rhythmic discharges recorded from the peripheral nerves

Candidate Interneurons Mediating the Resetting of the Locomotor Rhythm by Extensor Group I Afferents in the Cat

Sensory information arising from limb movements controls the spinal locomotor circuitry to adapt the motor pattern to demands of the environment. Stimulation of extensor group (gr) I afferents during fictive locomotion in decerebrate cats prolongs the ongoing extension, and terminates ongoing flexion with an initiation of the subsequent extension, i. e. "resetting to extension". Moreover, instead of the classical Ib non-reciprocal inhibition, stimulation of extensor gr I afferents produces a polysynaptic excitation in extensor motoneurons with latencies (∼3.5-4.0 ms) compatible with 3 interposed interneurons. We assume that some interneurons in this pathway actually belong to the rhythm-generating layer of the locomotor Central Pattern Generator (CPG), since their activity was correlated to a resetting of the rhythm. In the present work fictive locomotion was (mostly) induced by i.v. injection of nialamide followed by l-DOPA in paralyzed cats following decerebration and spinalization at C1 level. In some experiments, we extended previous observations during fictive locomotion on the emergence and locomotor state-dependence of polysynaptic excitatory postsynaptic potentials from extensor gr I afferents to ankle extensor motoneurons. However, the main focus was to record location and properties of interneurons (n = 62) that (i) were active during the extensor phase of fictive locomotion and (ii) received short-latency excitation (mono-, di- or polysynaptic) from extensor gr I afferents. We conclude that the interneurons recorded fulfill the characteristics to belong to the neuronal pathway activated by extensor gr I afferents during locomotion, and may contribute to the 'resetting to extension' as part of the locomotor CPG.

Current Principles of Motor Control, with Special Reference to Vertebrate Locomotion

The vertebrate control of locomotion involves all levels of the nervous system from cortex to the spinal cord. Here, we aim to cover all main aspects of this complex behavior, from the operation of the microcircuits in the spinal cord to the systems and behavioral levels and extend from mammalian locomotion to the basic undulatory movements of lamprey and fish. The cellular basis of propulsion represents the core of the control system, and it involves the spinal central pattern generator networks (CPGs) controlling the timing of different muscles, the sensory compensation for perturbations, and the brain stem command systems controlling the level of activity of the CPGs and the speed of locomotion. The forebrain and in particular the basal ganglia are involved in determining which motor programs should be recruited at a given point of time and can both initiate and stop locomotor activity. The propulsive control system needs to be integrated with the postural control system to maintain body orientation. Moreover, the locomotor movements need to be steered so that the subject approaches the goal of the locomotor episode, or avoids colliding with elements in the environment or simply escapes at high speed. These different aspects will all be covered in the review.

Specificity of intramuscular activation during rhythms produced by spinal patterning systems in the in vitro neonatal rat with hindlimb attached preparation

In intact adult vertebrates, muscles can be activated with a high degree of specificity, so that even within a single traditionally defined muscle, groups of motor units can be differentially activated. Such differential activation might reflect detailed control by descending systems, potentially resulting from postnatal experience such that activation of motor units is precisely tailored to their mechanical actions. Here we examine the degree to which such specific activation can be seen in the rhythmic patterns produced by isolated spinal motor systems in neonates. We examined motor output produced by the in vitro neonatal rat spinal cord with hindlimb attached. We recorded the activity of different regions within the posterior portion of biceps femoris (BFp; i.e., excluding the anterior/vertebral head). We found that in the rhythms evoked by bath application of serotonin/N-methyl-d-aspartate (5-HT/NMDA), all regions of BFp were active during extension. However, the regions of BFp were activated in a specific sequence, with the activation of rostral regions consistently preceding those of more caudal regions in both afferented and deafferented preparations. In the rhythms evoked by cauda equina (CE) stimulation, rostral and middle regions of BFp remained active in extension, but the caudal region of BFp was usually active in flexion. Stimulation of L5 and S2 dorsal roots typically evoked rhythms with all regions of BFp active during extension; although the same rostral to caudal sequence of activation observed in 5-HT/NMDA evoked rhythms could also be observed in these rhythms, we also observed cases with reversed sequences, with activity proceeding from caudal to rostral. S2 dorsal root stimulation occasionally evoked rhythms with flexor activity in caudal BFp, similar to CE-evoked rhythms. Taken together, these results suggest a high degree of individuated control of muscles by spinal pattern generating networks, even at birth.

The use of 4-aminopyridine (fampridine) in demyelinating disorders

4-Aminopyridine (4-AP or fampridine) is a potassium channel-blocking agent that has been shown to restore conduction in focally demyelinated axons. A sustained-release matrix tablet form of 4-AP (fampridine-SR) is currently undergoing multicenter clinical trials in patients with multiple sclerosis or chronic spinal cord injury. This review describes the pharmacology and mechanisms of action of 4-AP, its pharmacokinetics in human subjects, and the outcomes of clinical trials employing either immediate-release or sustained-release formulations of the drug. The randomized clinical trials that have been completed to date indicate that K+ channel blockade may prove to be a useful strategy for ameliorating central conduction deficits due to demyelination. Diverse neurological gains have been reported for both motor and sensory domains. At the present time, however, the clinical trials have not provided sufficiently robust or definitive evidence of efficacy to gain regulatory approval for the symptomatic management of patients with either multiple sclerosis or spinal cord injury.

Coordination and localization in spinal motor systems

We review here experiments examining the hypothesis that vertebrate spinal motor systems produce movement through the flexible combination of a small number of units of motor output. Using a variety of preparations and techniques, these experiments provide evidence for such spinally generated units and for the localization of the networks responsible for producing them within different regions of the spinal cord. Such an organization might help to simplify the production of movement, reducing the degrees of freedom that need to be specified by providing a set of units involved in regulating features common to a range of behaviors.

Depression of muscle and cutaneous afferent-evoked monosynaptic field potentials during fictive locomotion in the cat

1. Monosynaptic extracellular field potentials evoked by electrical stimulation of ipsilateral hindlimb nerves carrying muscle group I, II and cutaneous afferents were examined during fictive locomotion. Fifty-eight field potentials were recorded in the dorsal and intermediate laminae throughout the mid-lumbar to first sacral segments and fictive locomotion was evoked by mesencephalic locomotor region (MLR) stimulation in paralysed decerebrate cats. 2. The majority (96 %) of group I, II and cutaneous-evoked field potentials were decreased during fictive locomotion. Group I, cutaneous and dorsal group II potentials were reduced on average to about 80 % of control values. Group II field potentials recorded in the intermediate laminae were reduced to a mean of 49 % of control values. Cyclic variations in field potential amplitude between the flexion and extension phases were observed in 24 of 45 cases analysed. Of those 24 field potentials, the two group I and four cutaneous field potentials were smaller during the flexion phase. All eleven group II and the remaining seven cutaneous fields were smaller during extension. In all but two cases, these cyclic variations were smaller than the tonic depression upon which they were superimposed. 3. In 7/9 group II field potentials examined, reductions (on average to 85 % of control) began with the onset of MLR stimulation that produced tonic activity in the motor nerves before the onset of rhythmic alternating, locomotor discharges. In six of the seven cases the field potential depression increased with the establishment of fictive locomotion. This observation and the cyclic modulation of field potentials during fictive locomotion suggests that the depression was strongly linked to the operation of the spinal locomotor circuitry. 4. Depression of the monosynaptic components of the field potentials suggests a reduction in synaptic transmission from primary afferents to first-order spinal interneurones during fictive locomotion. Accordingly, the larger depression of intermediate group II field potentials may indicate a preferential reduction in transmission from group II afferents to interneurones located in intermediate spinal laminae. 5. Flexion reflexes evoked by group II and cutaneous afferents were also depressed during MLR-evoked fictive locomotion. The possibility that this depression results from a reduction in transmission from primary afferents, and in particular from group II afferents, ending on interneurones in the intermediate laminae is discussed.

Effects of 4-aminopyridine on motor evoked potentials in patients with spinal cord injury

The potassium (K+) channel-blocking agent 4-aminopyridine (4-AP) is currently being investigated for its potential therapeutic value in patients with spinal cord injury (SCI). The present study was designed to test the hypothesis that 4-AP ameliorates central motor conduction deficits in individuals with SCI. Oral 4-AP (10 mg) was administered to 19 (n = 19) SCI subjects with stable neurological deficits. Their response to the drug was monitored using motor evoked potentials (MEPs) following transcranial magnetic stimulation of motor cortex and various measures of segmental or peripheral reflex activity (F-waves, H-reflex, and M-response) recorded from lower limb muscles. The mean MEP amplitude in the extensor digitorum brevis muscle (left) was significantly (p < .05) increased from x = .25 +/- .42 mV to x = .59 +/- 1.04 mV at 2 h after drug administration, and the cortical stimulation threshold was reduced (p < .05) by 5.8%. Similar results were obtained in all subjects exhibiting MEPs (n = 13) and in all muscles (n = 6) studied. These changes were maintained at 4 h postdrug. MEP latencies were reduced in all subjects who initially exhibited abnormally prolonged MEP latencies relative to control group (n = 13) values. F-wave, H-reflex, and M-response values (latency and amplitude) were not systematically altered by 4-AP, leading to the conclusion that it was central motor conduction that was enhanced. This interpretation was supported by observed reductions in central motor conduction time (CMCT) in the majority of SCI subjects from whom CMCT measurements were obtained, two of whom anecdotally reported improved motor control after 4-AP, and by increased MEP:M-wave amplitude ratios. The MEP:M-wave ratios indicated that the magnitude of the effect of 4-AP on motoneuron recruitment was not large, in absolute terms (<4% motoneuron pool), but was appreciable relative to the initial level of motoneuron recruitment. These results provide the first statistically significant, objective evidence of improved functioning of the neuromuscular system in chronically injured SCI subjects receiving 4-AP and suggest that the improvements are mediated through enhanced central conduction. The results further support the emerging view that pharmaceutical management of central conduction deficits may prove to be a useful therapeutic strategy for some patients with long-standing SCI.

Glutamate receptor-mediated synaptic excitation in axons of the lamprey

1. Spontaneous and evoked synaptic inputs were recorded in vitro in the axons of lamprey reticulospinal neurones. After isolation of the axon from its somata, synaptic inputs were recorded using microelectrode and whole-cell patch clamp recording techniques. 2. Single stimuli applied to the spinal cord elicited Ca(2+)-dependent synaptic potentials with short latencies in reticulospinal axons. These synaptic inputs are capable of summation and generate sufficient depolarization to raise the membrane potential beyond threshold to initiate action potentials. Action potential initiation in the absence of the cell body indicates that these axons show synaptic integration. 3. Both evoked and spontaneous responses comprise at least two components of synaptic drive: a slow component (rise time of 9.6 +/- 2.1 ms) with a reversal potential of -53 +/- 19 mV and a fast component (rise time as fast as 0.85 ms) with a reversal potential of 0.3 +/- 9.1 mV. The responses are Ca2+ dependent, and are blocked by the substitution of Ba2+ for Ca2+ in the saline solution. 4. The slow component of synaptic input was blocked by the gamma-aminobutyric acidA (GABAA) receptor antagonist bicuculline (5 microM). The fast component was blocked by the alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor antagonist 6-cyano-7-nitroqinoxaline-2,3-dione (CNQX; 10 microM) in Ringer solution containing physiological concentrations of Mg2+. Following removal of Mg2+ from the superfusate a further excitatory component was identified that was blocked by application of the N-methyl-D-aspartate (NMDA) receptor antagonist 2-amino-5-phosphonopentanoate (AP5; 100 microM). 5. Comparison of the kinetic properties and the voltage sensitivity of the isolated components of evoked and spontaneous synaptic activity indicate that these responses are mediated by similar synaptic inputs. 6. These results suggest that axons and presynaptic terminals receive excitatory and inhibitory ionotropic receptor-mediated inputs. Summation of these inputs is possible indicating that the axons act as sites of synaptic integration similar to the role previously attributed only to neuronal dendrites and somata.

Spinal pattern generation

Recent research in the field of spinal pattern generation has concentrated on three main areas: the effects of various transmitters on spinal rhythmic patterns in reduced preparations (neonatal rats, chick embryos, tadpole embryos, lampreys); the changes in membrane properties of different elements of the generating circuits; and the interactions between central generating mechanisms and afferent inputs. The important message is that new properties of neural membranes, as well as new reflex responses, have been identified that could not have been predicted in the absence of such rhythmic activity.

Spinal cord stimulation-induced locomotion in the adult cat

Epidural and subdural stimulation of the dorsal surface of the spinal cord was found to elicit locomotion in the decerebrate cat in the active and fictive locomotion preparations. Stimulation of the cervical enlargement induced stepping in all four limbs, while stimulation of the lumbosacral enlargement induced hindlimb stepping. Lumbosacral enlargement stimulation induced hindlimb locomotion starting four hours following an acute midthoracic spinal cord transection. The preservation of the overall locomotor pattern and relationships between muscle groups, and of coordination between hindlimbs following transection, suggests that lumbar enlargement stimulation may be activating an intrinsically organized system. These findings suggest a method which may be applied clinically for the induction of limb alternation following epidural stimulation of the spinal cord.

Extracellular potassium activity and axonal conduction in spinal cord of the myelin-deficient mutant rat

We recorded somatosensory evoked potentials SEPs), extracellular K+ ionic activity ([K+]e), and K+ clearance rates in the spinal cords of 14 myelin-deficient mutant rats and 16 normal male littermates at 16-41 days after birth. Tested under pentobarbital anesthesia (25 mg/kg ip) and hypothermic conditions (32-34 degrees C), myelin-deficient rats had longer cortical SEP latencies (67 +/- 20 ms) compared to those in normal siblings (48 +/- 15 ms; P less than 0.05). Mean baseline [K+]e levels were 2.6 +/- 0.5 mM in myelin-deficient rats and 2.6 +/- 0.8 mM in normal siblings. Clearance times of KCl solutions injected into the spinal cord were biphasic and exponential. The mean initial and secondary exponential half-times were 1.0 +/- 0.5 and 2.7 +/- 1.7 min for myelin-deficient rats and 0.8 +/- 0.4 and 3.8 +/- 3.2 min for normal siblings. Repetitive sciatic nerve stimulation (2-20 Hz, 2- to 6-s trains) produced 1-3 mM transient [K+]e rises in thoracic and lumbar cords of myelin-deficient rats. The [K+]e rises were largest in the dorsal spinal cord at 200-500 microns depth. The normal siblings had smaller or no stimulus-induced [K+]e rises. In myelin-deficient rats, injection of 1 mM 4-aminopyridine (4-AP) solution into the thoracic spinal cord completely suppressed the stimulus-induced [K+]e and markedly increased spinal and cortical SEP amplitudes for several hours. In the normal siblings, the 4-AP injections transiently blocked spinal conduction for 20-30 min but thereafter enhanced cortical SEP amplitudes for 2-3 h. We conclude that sciatic nerve stimulation produces spinal cord [K+]e rises in myelin-deficient rat larger than those in the normal siblings, that the [K+]e transients represent increased K+ release rather than impaired K+ clearance, and that the K+ ions come from 4-AP blockable sources.

Unitary discharges in dorsal and ventral roots after the administration of 4-aminopyridine in the cat

The administration of 4-aminopyridine (4-AP) in decerebrate paralyzed cats induces centrifugal rhythmic discharges in both ventral and dorsal roots. This study describes the mode of discharge of individual primary afferents as well as some ventral root fibers. Several patterns of antidromic discharge have been observed in primary afferents after the administration of 4-AP. A large proportion of the units (n = 96; 53%) showed rhythmic bursts of discharge related (n = 41) or not (n = 55) to the ongoing rhythmic activity in the peripheral nerves. Other units (n = 86; 47%) discharged either tonically, sporadically or had no antidromic activity at all. The conduction velocity of the non-bursting units was significantly higher (89.7 +/- 18.4 m/s) than that of the bursting units (70.6 +/- 15.4 m/s; P less than 0.01). Ventral roots showed rhythmic activity although less intense than that of the dorsal roots. As in dorsal roots, some fibers showed a rhythmical pattern of discharge related to the mass activity recorded from whole dorsal roots or peripheral nerves, while other units were not related. It is concluded that bursting activity which occurs in peripheral nerves after the administration of 4-AP is mainly the result of the antidromic activation of medium to small size primary afferent fibers.

The effects of 4-aminopyridine on the cat spinal cord: rhythmic antidromic discharges recorded from the dorsal roots

In a previous paper, we have reported that 4-aminopyridine (4-AP, i.v., 10 mg/kg) induces in decerebrate spinal and paralyzed cats, a sustained rhythmic activity (2.5-8.5 Hz) in various muscle nerves. We describe here that similar discharges are recorded from the proximal stump of cut cutaneous nerves. The latter rhythmic activity arises from intense antidromic discharges in the dorsal roots. The rhythmic discharges are recorded from dorsal roots of both spinal cord enlargements as well as from thoracic roots. The rhythmic activity is highly synchronous among adjacent dorsal roots. Bilateral activity is also highly cross-correlated, but may be dissociated by unilateral stimulation of one dorsal root. It is not yet possible to determine the precise site where the antidromic discharges recorded from the dorsal roots are generated. 4-AP could act directly at the terminal level of the primary afferents or could activate interneurons impinging upon the terminals.

Comparison of vestibular and auditory startle responses in the rat and cat

Cats, humans, and many other animals show stereotyped EMG responses in limb and axial muscles if suddenly dropped into free-fall. In cats, these free-fall responses (FFR) consist of highly synchronized bursts in most limb and axial muscles at 18-22 ms. We have used FFR to evaluate descending motor function and recovery in chronic spinal injured cats. Here FFR are compared with auditory evoked startle reflexes (ASR) in the hindlimb muscles of the rat and cat to determine whether they are related, and whether they could be used to evaluate descending motor function in the rat. ASR and FFR in the two species were similar except that the earliest components for both responses occurred around 9 ms in the rat versus 18-20 ms in the cat. Also, FFR in cats were usually more consistent and greater in amplitude during repeated drops than in rats, while the converse was true for ASR. Rat FFR amplitudes increased significantly after administering ketamine or 4-aminopyridine (4-AP), especially with both drugs together, while ASR amplitudes did not. FFR in cats recorded under ketamine analgesia were not normally improved by 4-AP. Finally, both FFR and ASR were suppressed by pentobarbital, chloralose, or motor activity. These data suggest that: (1) FFR appears to be a vestibular evoked startle reflex; (2) in the rat, ASR should be useful as a test of descending motor function following spinal injury, and (3) the combination of ketamine and 4-AP may be useful in revealing the presence of functional spinal pathways after CNS trauma.