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Cruz R, Tramontin AF, Oliveira AS, Caputo F, Denadai BS, Greco CC. Ischemic preconditioning increases spinal excitability and voluntary activation during maximal plantar flexion contractions in men. Scand J Med Sci Sports 2024; 34:e14591. [PMID: 38429941 DOI: 10.1111/sms.14591] [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] [Received: 10/18/2023] [Revised: 01/29/2024] [Accepted: 02/21/2024] [Indexed: 03/03/2024]
Abstract
The enigmatic benefits of acute limb ischemic preconditioning (IP) in enhancing muscle force and exercise performance have intrigued researchers. This study sought to unravel the underlying mechanisms, focusing on increased neural drive and the role of spinal excitability while excluding peripheral factors. Soleus Hoffmann (H)-reflex /M-wave recruitment curves and unpotentiated supramaximal responses were recorded before and after IP or a low-pressure control intervention. Subsequently, the twitch interpolation technique was applied during maximal voluntary contractions to assess conventional parameters of neural output. Following IP, there was an increase in both maximum normalized force and voluntary activation (VA) for the plantar flexor group, with negligible peripheral alterations. Greater benefits were observed in participants with lower VA levels. Despite greater H-reflex gains, soleus volitional (V)-wave and sEMG amplitudes remained unchanged. In conclusion, IP improves muscle force via enhanced neural drive to the muscles. This effect appears associated, at least in part, to reduced presynaptic inhibition and/or increased motoneuron excitability. Furthermore, the magnitude of the benefit is inversely proportional to the skeletal muscle's functional reserve, making it particularly noticeable in under-recruited muscles. These findings have implications for the strategic application of the IP procedure across diverse populations.
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Affiliation(s)
- Rogério Cruz
- Human Performance Laboratory, São Paulo State University (UNESP), Biosciences Institute, Campus Rio Claro, Brazil
- Human Performance Research Group, Santa Catarina State University, Florianópolis, Brazil
| | | | | | - Fabrizio Caputo
- Human Performance Research Group, Santa Catarina State University, Florianópolis, Brazil
| | - Benedito Sérgio Denadai
- Human Performance Laboratory, São Paulo State University (UNESP), Biosciences Institute, Campus Rio Claro, Brazil
| | - Camila Coelho Greco
- Human Performance Laboratory, São Paulo State University (UNESP), Biosciences Institute, Campus Rio Claro, Brazil
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Tankisi H, Bostock H, Grafe P. A test to determine the site of abnormal neuromuscular refractoriness. Clin Neurophysiol Pract 2022; 7:1-6. [PMID: 34984248 PMCID: PMC8693356 DOI: 10.1016/j.cnp.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/18/2021] [Accepted: 11/07/2021] [Indexed: 10/26/2022] Open
Abstract
Objective The relative refractory period (RRP) of motor axons is an important parameter in nerve excitability tests of the recovery cycle (RC). Abnormalities may have a site in the axonal membrane, the neuromuscular junction, or in a dysfunction of the muscle. We aimed in this study to determine the site of abnormality, using a modified protocol of the conventional RC test, whereby an additional supramaximal stimulus is added at the same interstimulus interval as in RC recordings (RCSM). Methods Twenty-four healthy subjects aged 37.8 ± 2.4 years (mean ± SE) were examined with median nerve excitability testing using RC and RCSM protocols at normal temperature (34.1 ± 0.2 °C). The recordings were repeated in 12 subjects after selective cooling of the thenar muscle (25.2 ± 0.7 °C) and in 12 subjects after cooling the nerve trunk at the wrist (24.9 ± 0.3 °C). Results After cooling the nerve, RRP measured with RC and RCSM were prolonged similarly (medians by 1.8 ms, and 2.1 ms respectively). In contrast, cooling the muscle prolonged RRP measured with RC (by 1.3 ms), but did not significantly prolong RRP measured with RCSM. RRPs measured by RC and RCSM were significantly different when cooling was at the muscle (P = 5.10-4), but not when cooling was at the nerve (P = 0.57). Conclusions A difference between RC and RCSM indicates abnormal excitability distal to the axonal membrane under the stimulating electrode. Significance Combining RCSM with the conventional RC protocol should help to localize the site of abnormal neuromuscular refractoriness.
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Affiliation(s)
- Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hugh Bostock
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Peter Grafe
- Institute of Physiology, Ludwig-Maximilians University Munich, Germany
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3
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Bennedsgaard K, Ventzel L, Grafe P, Tigerholm J, Themistocleous AC, Bennett DL, Tankisi H, Finnerup NB. Cold aggravates abnormal excitability of motor axons in oxaliplatin-treated patients. Muscle Nerve 2020; 61:796-800. [PMID: 32133655 PMCID: PMC7318596 DOI: 10.1002/mus.26852] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 02/26/2020] [Accepted: 02/29/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Cold allodynia is often seen in the acute phase of oxaliplatin treatment, but the underlying pathophysiology remains unclear. METHODS Patients scheduled for adjuvant oxaliplatin for colorectal cancer were examined with quantitative sensory testing and nerve excitability tests at baseline and after the second or third oxaliplatin cycle at different skin temperatures. RESULTS Seven patients were eligible for examination. All patients felt evoked pain and tingling when touching something cold after oxaliplatin infusion. Oxaliplatin decreased motor nerve superexcitability (P < .001), increased relative refractory period (P = .011), and caused neuromyotonia-like after-activity. Cooling exacerbated these changes and prolonged the accommodation half-time. DISCUSSION The findings suggest that a combined effect of oxaliplatin and cooling facilitates nerve excitability changes and neuromyotonia-like after-activity in peripheral nerve axons. A possible mechanism is the slowing in gating of voltage-dependent fast sodium and slow potassium channels, which results in symptoms of cold allodynia.
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Affiliation(s)
- Kristine Bennedsgaard
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lise Ventzel
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Peter Grafe
- Institute of Physiology, Ludwig-Maximilians University, Munich, Germany
| | - Jenny Tigerholm
- Center of Neuroplasticity and Pain, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | - David L Bennett
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Hatice Tankisi
- Department of Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - Nanna B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Yeh WZ, Dyck PJ, van den Berg LH, Kiernan MC, Taylor BV. Multifocal motor neuropathy: controversies and priorities. J Neurol Neurosurg Psychiatry 2020; 91:140-148. [PMID: 31511307 DOI: 10.1136/jnnp-2019-321532] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/14/2019] [Accepted: 08/31/2019] [Indexed: 12/11/2022]
Abstract
Despite 30 years of research there are still significant unknowns and controversies associated with multifocal motor neuropathy (MMN) including disease pathophysiology, diagnostic criteria and treatment. Foremost relates to the underlying pathophysiology, specifically whether MMN represents an axonal or demyelinating neuropathy and whether the underlying pathophysiology is focused at the node of Ranvier. In turn, this discussion promotes consideration of therapeutic approaches, an issue that becomes more directed in this evolving era of precision medicine. It is generally accepted that MMN represents a chronic progressive immune-mediated motor neuropathy clinically characterised by progressive asymmetric weakness and electrophysiologically by partial motor conduction block. Anti-GM1 IgM antibodies are identified in at least 40% of patients. There have been recent developments in the use of neuromuscular ultrasound and MRI to aid in diagnosing MMN and in further elucidation of its pathophysiological mechanisms. The present Review will critically analyse the knowledge accumulated about MMN over the past 30 years, culminating in a state-of-the-art approach to therapy.
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Affiliation(s)
- Wei Zhen Yeh
- Department of Neurology, Royal Hobart Hospital, Hobart, Tasmania, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - P James Dyck
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Leonard H van den Berg
- UMC Utrecht Brain Center, Department of Neurology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Matthew C Kiernan
- Bushell Chair of Neurology, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Bruce V Taylor
- Department of Neurology, Royal Hobart Hospital, Hobart, Tasmania, Australia .,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Hugosdottir R, Mørch CD, Jørgensen CK, Nielsen CW, Olsen MV, Pedersen MJ, Tigerholm J. Altered excitability of small cutaneous nerve fibers during cooling assessed with the perception threshold tracking technique. BMC Neurosci 2019; 20:47. [PMID: 31481024 PMCID: PMC6724327 DOI: 10.1186/s12868-019-0527-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a need for new approaches to increase the knowledge of the membrane excitability of small nerve fibers both in healthy subjects, as well as during pathological conditions. Our research group has previously developed the perception threshold tracking technique to indirectly assess the membrane properties of peripheral small nerve fibers. In the current study, a new approach for studying membrane excitability by cooling small fibers, simultaneously with applying a slowly increasing electrical stimulation current, is evaluated. The first objective was to examine whether altered excitability during cooling could be detected by the perception threshold tracking technique. The second objective was to computationally model the underlying ionic current that could be responsible for cold induced alteration of small fiber excitability. The third objective was to evaluate whether computational modelling of cooling and electrical simulation can be used to generate hypotheses of ionic current changes in small fiber neuropathy. RESULTS The excitability of the small fibers was assessed by the perception threshold tracking technique for the two temperature conditions, 20 °C and 32 °C. A detailed multi-compartment model was developed, including the ionic currents: NaTTXs, NaTTXr, NaP, KDr, KM, KLeak, KA, and Na/K-ATPase. The perception thresholds for the two long duration pulses (50 and 100 ms) were reduced when the skin temperature was lowered from 32 to 20 °C (p < 0.001). However, no significant effects were observed for the shorter durations (1 ms, p = 0.116; 5 ms p = 0.079, rmANOVA, Sidak). The computational model predicted that the reduction in the perception thresholds related to long duration pulses may originate from a reduction of the KLeak channel and the Na/K-ATPase. For short durations, the effect cancels out due to a reduction of the transient TTX resistant sodium current (Nav1.8). Additionally, the result from the computational model indicated that cooling simultaneously with electrical stimulation, may increase the knowledge regarding pathological alterations of ionic currents. CONCLUSION Cooling may alter the ionic current during electrical stimulation and thereby provide additional information regarding membrane excitability of small fibers in healthy subjects and potentially also during pathological conditions.
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Affiliation(s)
- Rosa Hugosdottir
- Center of Neuroplasticity and Pain, SMI®, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7D3, 9220, Aalborg, Denmark
| | - Carsten Dahl Mørch
- Center of Neuroplasticity and Pain, SMI®, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7D3, 9220, Aalborg, Denmark
| | - Cecilia Klitgaard Jørgensen
- Center of Neuroplasticity and Pain, SMI®, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7D3, 9220, Aalborg, Denmark
| | - Camilla Winther Nielsen
- Center of Neuroplasticity and Pain, SMI®, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7D3, 9220, Aalborg, Denmark
| | - Mathias Vassard Olsen
- Center of Neuroplasticity and Pain, SMI®, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7D3, 9220, Aalborg, Denmark
| | - Mads Jozwiak Pedersen
- Center of Neuroplasticity and Pain, SMI®, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7D3, 9220, Aalborg, Denmark
| | - Jenny Tigerholm
- Center of Neuroplasticity and Pain, SMI®, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7D3, 9220, Aalborg, Denmark.
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Sleutjes BTHM, Kovalchuk MO, Durmus N, Buitenweg JR, van Putten MJAM, van den Berg LH, Franssen H. Simulating perinodal changes observed in immune-mediated neuropathies: impact on conduction in a model of myelinated motor and sensory axons. J Neurophysiol 2019; 122:1036-1049. [PMID: 31291151 DOI: 10.1152/jn.00326.2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Immune-mediated neuropathies affect myelinated axons, resulting in conduction slowing or block that may affect motor and sensory axons differently. The underlying mechanisms of these neuropathies are not well understood. Using a myelinated axon model, we studied the impact of perinodal changes on conduction. We extended a longitudinal axon model (41 nodes of Ranvier) with biophysical properties unique to human myelinated motor and sensory axons. We simulated effects of temperature and axonal diameter on conduction and strength-duration properties. We then studied effects of impaired nodal sodium channel conductance and paranodal myelin detachment by reducing periaxonal resistance, as well as their interaction, on conduction in the 9 middle nodes and enclosed paranodes. Finally, we assessed the impact of reducing the affected region (5 nodes) and adding nodal widening. Physiological motor and sensory conduction velocities and changes to axonal diameter and temperature were observed. The sensory axon had a longer strength-duration time constant. Reducing sodium channel conductance and paranodal periaxonal resistance induced progressive conduction slowing. In motor axons, conduction block occurred with a 4-fold drop in sodium channel conductance or a 7.7-fold drop in periaxonal resistance. In sensory axons, block arose with a 4.8-fold drop in sodium channel conductance or a 9-fold drop in periaxonal resistance. This indicated that motor axons are more vulnerable to developing block. A boundary of block emerged when the two mechanisms interacted. This boundary shifted in opposite directions for a smaller affected region and nodal widening. These differences may contribute to the predominance of motor deficits observed in some immune-mediated neuropathies.NEW & NOTEWORTHY Immune-mediated neuropathies may affect myelinated motor and sensory axons differently. By the development of a computational model, we quantitatively studied the impact of perinodal changes on conduction in motor and sensory axons. Simulations of increasing nodal sodium channel dysfunction and paranodal myelin detachment induced progressive conduction slowing. Sensory axons were more resistant to block than motor axons. This could explain the greater predisposition of motor axons to functional deficits observed in some immune-mediated neuropathies.
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Affiliation(s)
- Boudewijn T H M Sleutjes
- Department of Neurology, Brain Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maria O Kovalchuk
- Department of Neurology, Brain Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Naric Durmus
- Biomedical Signals and Systems, MIRA, Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.,Department of Clinical Neurophysiology, University of Twente, Enschede, The Netherlands
| | - Jan R Buitenweg
- Biomedical Signals and Systems, MIRA, Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Michel J A M van Putten
- Department of Clinical Neurophysiology, University of Twente, Enschede, The Netherlands.,Department of Neurology and Clinical Neurophysiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Leonard H van den Berg
- Department of Neurology, Brain Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hessel Franssen
- Department of Neurology, Brain Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
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Kiernan MC, Bostock H, Park SB, Kaji R, Krarup C, Krishnan AV, Kuwabara S, Lin CSY, Misawa S, Moldovan M, Sung J, Vucic S, Wainger BJ, Waxman S, Burke D. Measurement of axonal excitability: Consensus guidelines. Clin Neurophysiol 2019; 131:308-323. [PMID: 31471200 DOI: 10.1016/j.clinph.2019.07.023] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 07/17/2019] [Accepted: 07/24/2019] [Indexed: 12/12/2022]
Abstract
Measurement of axonal excitability provides an in vivo indication of the properties of the nerve membrane and of the ion channels expressed on these axons. Axonal excitability techniques have been utilised to investigate the pathophysiological mechanisms underlying neurological diseases. This document presents guidelines derived for such studies, based on a consensus of international experts, and highlights the potential difficulties when interpreting abnormalities in diseased axons. The present manuscript provides a state-of-the-art review of the findings of axonal excitability studies and their interpretation, in addition to suggesting guidelines for the optimal performance of excitability studies.
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Affiliation(s)
- Matthew C Kiernan
- Brain and Mind Centre, University of Sydney and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney 2006, Australia.
| | - Hugh Bostock
- UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom
| | - Susanna B Park
- Brain and Mind Centre, University of Sydney and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney 2006, Australia
| | - Ryuji Kaji
- National Utano Hospital, 8-Narutaki Ondoyamacho, Ukyoku, Kyoto 616-8255, Japan
| | - Christian Krarup
- Department of Neuroscience, University of Copenhagen and Department of Clinical Neurophysiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Arun V Krishnan
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | - Cindy Shin-Yi Lin
- Brain and Mind Centre, University of Sydney and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney 2006, Australia
| | - Sonoko Misawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | - Mihai Moldovan
- Department of Neuroscience, University of Copenhagen and Department of Clinical Neurophysiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jiaying Sung
- Taipei Medical University, Wanfang Hospital, Taipei, Taiwan
| | - Steve Vucic
- Department of Neurology, Westmead Hospital, Western Clinical School, University of Sydney, Australia
| | - Brian J Wainger
- Department of Neurology and Anesthesiology, Critical Care & Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Stephen Waxman
- Department of Neurology, Yale Medical School, New Haven, CT 06510, USA; Neurorehabilitation Research Center, Veterans Affairs Hospital, West Haven, CT 06516, USA
| | - David Burke
- Brain and Mind Centre, University of Sydney and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney 2006, Australia
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Kovalchuk MO, Franssen H, Scheijmans FEV, Van Schelven LJ, Van Den Berg LH, Sleutjes BTHM. Warming nerves for excitability testing. Muscle Nerve 2019; 60:279-285. [PMID: 31241195 DOI: 10.1002/mus.26621] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 06/21/2019] [Accepted: 06/23/2019] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The aim of this study was to find the best method of warming the median nerve before excitability testing to a standard temperature. METHODS In 5 healthy subjects, the forearm and hand were warmed for 1 h to 37°C by infrared lamp, water blanket, or water bath. Recordings were performed before and during warming every 10 min. Excitability indices were fitted by exponential relations, thereby calculating the time needed to reach 95% of their asymptotic end value. RESULTS Distal motor latency, refractory period, and superexcitability at 10 ms changed exponentially with time. Warming by water bath took the shortest time (24 min); this was followed by warming by infrared lamp (34 min) and water blanket (35 min). CONCLUSIONS Warming by water bath is the quickest way. The other methods took only moderately more time. Future studies need to specify both warming method and warming time before excitability testing. Muscle Nerve, 2019.
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Affiliation(s)
- Maria O Kovalchuk
- Department of Neurology, University Medical Center Utrecht, Brain Center, Utrecht University, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Hessel Franssen
- Department of Neurology, University Medical Center Utrecht, Brain Center, Utrecht University, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Féline E V Scheijmans
- Department of Neurology, University Medical Center Utrecht, Brain Center, Utrecht University, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Leonard J Van Schelven
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, The Netherlands
| | - Leonard H Van Den Berg
- Department of Neurology, University Medical Center Utrecht, Brain Center, Utrecht University, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Boudewijn T H M Sleutjes
- Department of Neurology, University Medical Center Utrecht, Brain Center, Utrecht University, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
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Physiology of Myelinated Nerve Conduction and Pathophysiology of Demyelination. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1190:85-106. [DOI: 10.1007/978-981-32-9636-7_7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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10
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McCorquodale D, Smith AG. Clinical electrophysiology of axonal polyneuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2019; 161:217-240. [PMID: 31307603 DOI: 10.1016/b978-0-444-64142-7.00051-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Axonal neuropathies encompass a wide range of acquired and inherited disorders with electrophysiologic characteristics that arise from the unique neurophysiology of the axon. Accurate interpretation of nerve conduction studies and electromyography requires an in-depth understanding of the pathophysiology of the axon. Here we review the unique neurophysiologic properties of the axon and how they relate to clinical electrodiagnostic features. We review the length-dependent Wallerian or "dying-back" processes as well as the emerging body of literature from acquired axonal neuropathies that highlights the importance of axonal disease at the nodes of Ranvier. Neurophysiologic features of individual inherited and acquired axonal diseases, including primary nerve disease as well as systemic immune mediated, metabolic, and toxic diseases involving the peripheral nerve, are reviewed. This comprehensive review of electrodiagnostic findings coupled with the current understanding of pathophysiology will aid the clinician in the evaluation of axonal polyneuropathies.
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Affiliation(s)
- Donald McCorquodale
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, United States
| | - A Gordon Smith
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, United States.
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Hageman S, Kovalchuk MO, Sleutjes BTHM, van Schelven LJ, van den Berg LH, Franssen H. Sodium-potassium pump assessment by submaximal electrical nerve stimulation. Clin Neurophysiol 2018; 129:809-814. [PMID: 29477980 DOI: 10.1016/j.clinph.2018.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/15/2017] [Accepted: 01/07/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Sodium-potassium pump dysfunction in peripheral nerve is usually assessed by determining axonal hyperpolarization following maximal voluntary contraction (MVC) or maximal electrical nerve stimulation. As MVC may be unreliable and maximal electrical stimulation too painful, we assessed if hyperpolarization can also be induced by submaximal electrical nerve stimulation. METHODS In 8 healthy volunteers different submaximal electrical stimulus trains were given to the median nerve at the wrist, followed by 5 min assessment of thresholds for compound muscle action potentials of 20%, 40% or 60% of maximal. RESULTS Threshold increase after submaximal electrical nerve stimulation was most prominent after an 8 Hz train of at least 5 min duration evoking submaximal CMAPs of 60%. It induced minimal discomfort and was not painful. Threshold increase after MVC was not significantly higher than this stimulus train. CONCLUSIONS Submaximal electrical stimulation evokes activity dependent hyperpolarization in healthy test subjects without causing significant discomfort. SIGNIFICANCE Sodium-potassium pump function may be assessed using submaximal electrical stimulation.
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Affiliation(s)
- Steven Hageman
- Brain Centre Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Centre Utrecht, The Netherlands
| | - Maria O Kovalchuk
- Brain Centre Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Centre Utrecht, The Netherlands
| | - Boudewijn T H M Sleutjes
- Brain Centre Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Centre Utrecht, The Netherlands
| | - Leonard J van Schelven
- Department of Medical Technology & Clinical Physics, University Medical Centre Utrecht, The Netherlands
| | - Leonard H van den Berg
- Brain Centre Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Centre Utrecht, The Netherlands
| | - Hessel Franssen
- Brain Centre Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Centre Utrecht, The Netherlands.
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12
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Kovalchuk MO, Franssen H, Van Schelven LJ, Sleutjes BTHM. Comparing excitability at 37°C versus at 20°C: Differences between motor and sensory axons. Muscle Nerve 2017; 57:574-580. [DOI: 10.1002/mus.25960] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Maria O. Kovalchuk
- Department of Neurology and Neurosurgery, Brain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht The Netherlands
| | - Hessel Franssen
- Department of Neurology and Neurosurgery, Brain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht The Netherlands
| | - Leonard J. Van Schelven
- Department of Medical Technology and Clinical PhysicsUniversity Medical Center UtrechtUtrecht the Netherlands
| | - Boudewijn T. H. M. Sleutjes
- Department of Neurology and Neurosurgery, Brain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht The Netherlands
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13
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Uncini A, Kuwabara S. Nodopathies of the peripheral nerve: an emerging concept. J Neurol Neurosurg Psychiatry 2015; 86:1186-95. [PMID: 25699569 DOI: 10.1136/jnnp-2014-310097] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 01/31/2015] [Indexed: 12/17/2022]
Abstract
Peripheral nerve diseases are traditionally classified as demyelinating or axonal. It has been recently proposed that microstructural changes restricted to the nodal/paranodal region may be the key to understanding the pathophysiology of antiganglioside antibody mediated neuropathies. We reviewed neuropathies with different aetiologies (dysimmune, inflammatory, ischaemic, nutritional, toxic) in which evidence from nerve conductions, excitability studies, pathology and animal models, indicate the involvement of the nodal region in the pathogenesis. For these neuropathies, the classification in demyelinating and axonal is inadequate or even misleading, we therefore propose a new category of nodopathy that has the following features: (1) it is characterised by a pathophysiological continuum from transitory nerve conduction block to axonal degeneration; (2) the conduction block may be due to paranodal myelin detachment, node lengthening, dysfunction or disruption of Na(+) channels, altered homeostasis of water and ions, or abnormal polarisation of the axolemma; (3) the conduction block may be promptly reversible without development of excessive temporal dispersion; (4) axonal degeneration, depending on the specific disorder and its severity, eventually follows the conduction block. The term nodopathy focuses to the site of primary nerve injury, avoids confusion with segmental demyelinating neuropathies and circumvents the apparent paradox that something axonal may be reversible and have a good prognosis.
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Affiliation(s)
- Antonino Uncini
- Department of Neuroscience, Imaging and Clinical Sciences, University "G d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Franssen H. Relation between symptoms and pathophysiology in inflammatory neuropathies: Controversies and hypotheses. Neurosci Lett 2015; 596:84-9. [PMID: 25483620 DOI: 10.1016/j.neulet.2014.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 11/11/2014] [Accepted: 12/02/2014] [Indexed: 10/24/2022]
Abstract
This review attempts to explain the symptoms experienced by patients with inflammatory neuropathies by pathophysiological events. The emphasis is not on the primary events that may cause a particular illness but on downstream events taking place in peripheral nerves or muscles. Symptoms that will be discussed include sensory predominance, motor predominance, activity-induced weakness, heat paresis, and cold paresis. Each symptom is associated with, but not limited to, particular neuropathies.
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Affiliation(s)
- Hessel Franssen
- Brain Center Rudolf Magnus, Section Neuromuscular Disorders, Department of Neurology F02.230, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, Netherlands.
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15
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Franssen H. The Node of Ranvier in Multifocal Motor Neuropathy. J Clin Immunol 2014; 34 Suppl 1:S105-11. [DOI: 10.1007/s10875-014-0023-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 03/19/2014] [Indexed: 01/07/2023]
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16
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Franssen H, Straver DCG. Pathophysiology of immune-mediated demyelinating neuropathies--Part II: Neurology. Muscle Nerve 2013; 49:4-20. [PMID: 24037667 DOI: 10.1002/mus.24068] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2013] [Indexed: 12/13/2022]
Abstract
In the second part of this review we deal with the clinical aspects of immune-mediated demyelinating neuropathies. We describe the relationship between pathophysiology and symptoms and discuss the pathophysiology of specific disease entities, including Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, multifocal motor neuropathy, anti-myelin-associated glycoprotein neuropathy, and POEMS syndrome.
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Affiliation(s)
- Hessel Franssen
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX Utrecht, The Netherlands
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17
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Hofmeijer J, Franssen H, van Schelven LJ, van Putten MJAM. Why are sensory axons more vulnerable for ischemia than motor axons? PLoS One 2013; 8:e67113. [PMID: 23840596 PMCID: PMC3688630 DOI: 10.1371/journal.pone.0067113] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 05/14/2013] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE In common peripheral neuropathies, sensory symptoms usually prevail over motor symptoms. This predominance of sensory symptoms may result from higher sensitivity of sensory axons to ischemia. METHODS We measured median nerve compound sensory action potentials (CSAPs), compound muscle action potentials (CMAPs), and excitability indices in five healthy subjects during forearm ischemia lasting up to disappearance of both CSAPs and CMAPs. RESULTS ISCHEMIA INDUCED: (1) earlier disappearance of CSAPs than CMAPs (mean ± standard deviation 30±5 vs. 46±6 minutes), (2) initial changes compatible with axonal depolarization on excitability testing (decrease in threshold, increase in strength duration time constant (SDTC) and refractory period, and decrease in absolute superexcitability) which were all more prominent in sensory than in motor axons, and (3) a subsequent decrease of SDTC reflecting a decrease in persistent Na(+) conductance during continuing depolarisation. INTERPRETATION Our study shows that peripheral sensory axons are more vulnerable for ischemia than motor axons, with faster inexcitability during ischemia. Excitability studies during ischemia showed that this was associated with faster depolarization and faster persistent Na(+) channel inactivation in sensory than in motor axons. These findings might be attributed to differences in ion channel composition between sensory and motor axons and may contribute to the predominance of sensory over motor symptoms in common peripheral neuropathies.
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Affiliation(s)
- Jeannette Hofmeijer
- Clinical Neurophysiology, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
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18
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Abstract
Multifocal motor neuropathy (MMN) is a rare disorder in which the symptoms are caused by persistent conduction block lesions. The mononeuropathy multiplex progresses over time with increasing axonal loss. The cause of the conduction blocks and axonal loss are not completely understood but immune mechanisms are involved and response to intravenous immunoglobulin has been established. The importance of MMN goes beyond its clinical incidence as the increasing understanding of the pathogenesis of this disorder has implications for other peripheral nerve diseases and for our knowledge of peripheral nerve biology.
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Affiliation(s)
- Ximena Arcila-Londono
- Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA
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Nodera H, Spieker A, Sung M, Rutkove S. Neuroprotective effects of Kv7 channel agonist, retigabine, for cisplatin-induced peripheral neuropathy. Neurosci Lett 2011; 505:223-7. [DOI: 10.1016/j.neulet.2011.09.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 09/09/2011] [Accepted: 09/11/2011] [Indexed: 10/17/2022]
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20
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Examining the effects of age, sex, and body mass index on normative median motor nerve excitability measurements. Clin Neurophysiol 2011; 122:2081-8. [DOI: 10.1016/j.clinph.2011.03.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 03/09/2011] [Accepted: 03/24/2011] [Indexed: 11/17/2022]
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Straver DCG, van Asseldonk JTH, Notermans NC, Wokke JHJ, van den Berg LH, Franssen H. Cold paresis in multifocal motor neuropathy. J Neurol 2010; 258:212-7. [PMID: 20803025 PMCID: PMC3036831 DOI: 10.1007/s00415-010-5712-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 08/09/2010] [Accepted: 08/11/2010] [Indexed: 10/25/2022]
Abstract
Increased weakness during cold (cold paresis) was reported in single cases of multifocal motor neuropathy (MMN). This was unexpected because demyelination is a feature of MMN and symptoms of demyelination improve, rather than worsen, in cold. It was hypothesized that cold paresis in MMN does not reflect demyelination only, but may indicate the existence of inflammatory nerve lesions with permanently depolarized axons that only just conduct at normal temperature, but fail at lower temperatures. We investigated symptoms of cold paresis in 50 MMN patients, 48 chronic inflammatory demyelinating polyneuropathy (CIDP) patients, 35 progressive spinal muscular atrophy (PSMA) patients, and 25 chronic idiopathic axonal polyneuropathy patients. We also investigated symptoms of increased weakness during warmth (heat paresis). Cold paresis was reported more often than heat paresis. Cold paresis was most frequently reported in MMN. Multivariate analysis indicated that MMN patients had a 4- to 6-fold higher risk of reporting cold paresis than CIDP or PSMA patients. Because cold paresis is not consistent with demyelination, the lesions in MMN may involve other mechanisms than demyelination only. In conclusion, symptoms of cold paresis are common in peripheral nervous system disorders, particularly in MMN. This supports the above-described hypothesis.
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Affiliation(s)
- Dirk C G Straver
- Neuromuscular Disease Group, Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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