1
|
Ha EJ, Phi JH, Lee JY, Koh EJ, Kim KH, Wang KC, Cho BK, Kim SK. Long-Term Surgical Outcome of Indirect Bypass Surgery in Young Children With Moyamoya Disease. Neurosurgery 2023; 93:901-909. [PMID: 37561505 DOI: 10.1227/neu.0000000000002489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/13/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND The prognosis of moyamoya disease (MMD) in young children (younger than 4 years) is worse than that of older adults. The effectiveness of surgery is still inconclusive. OBJECTIVE To evaluate long-term outcomes after indirect bypass in young children with MMD. METHODS A total of 1417 MMD children underwent indirect bypass from August 1988 to October 2020. This study included 135 patients who were younger than 4 years at the time of surgery. The clinical features and surgical outcomes of these patients were assessed. We analyzed the long-term outcome of 102 children who were followed up for more than 5 years (mean: 18.8 years, range: 5-27.3 years). Cross-sectional analysis was performed to evaluate overall outcomes based on the Lansky Play Performance Scale (LPS). The annual risk of symptomatic stroke after surgery was calculated with a person-year method, and the event-free survival rate was evaluated using the Kaplan-Meier method. RESULTS The overall clinical outcome was favorable (LPS ≥ 80) in 88% of the patients. The overall postoperative adverse event rate was 15%, including 1 death. At the last follow-up, 86% of patients who had seizures at diagnosis were seizure-free. During the follow-up, there were 3 symptomatic infarctions on the operated hemisphere (postoperative 3, 3, and 10 months each). There was no hemorrhagic event. The annual infarction rate was 0.16% per person-year. The 20-year event-free survival rates for symptomatic infarction were 97%. CONCLUSION Indirect bypass could provide a satisfactory long-term outcome and prevent recurrent stroke in young children with MMD.
Collapse
Affiliation(s)
- Eun Jin Ha
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul , Republic of Korea
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul , Republic of Korea
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul , Republic of Korea
| | - Ji Hoon Phi
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul , Republic of Korea
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul , Republic of Korea
| | - Ji Yeoun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul , Republic of Korea
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul , Republic of Korea
- Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul , Republic of Korea
| | - Eun Jung Koh
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul , Republic of Korea
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul , Republic of Korea
| | - Kyung Hyun Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul , Republic of Korea
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul , Republic of Korea
| | - Kyu-Chang Wang
- Center for Rare Cancers, National Cancer Center, Goyang , Gyeonggi-do , Republic of Korea
| | - Byung-Kyu Cho
- Department of Neurosurgery, Armed Forces Capital Hospital, Seongnam , Gyeonggi-do , Republic of Korea
| | - Seung-Ki Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul , Republic of Korea
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul , Republic of Korea
| |
Collapse
|
2
|
Higo N. Motor Cortex Plasticity During Functional Recovery Following Brain Damage. JOURNAL OF ROBOTICS AND MECHATRONICS 2022. [DOI: 10.20965/jrm.2022.p0700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Although brain damage causes functional impairment, it is often followed by partial or total recovery of function. Recovery is believed to occur primarily because of brain plasticity. Both human and animal studies have significantly contributed to uncovering the neuronal basis of plasticity. Recent advances in brain imaging technology have enabled the investigation of plastic changes in living human brains. In addition, animal experiments have revealed detailed changes at the neural and genetic levels. In this review, plasticity in motor-related areas of the cerebral cortex, which is one of the most well-studied areas of the neocortex in terms of plasticity, is reviewed. In addition, the potential of technological interventions to enhance plasticity and promote functional recovery following brain damage is discussed. Novel neurorehabilitation technologies are expected to be established based on the emerging research on plasticity from the last several decades.
Collapse
|
3
|
Sporer ME, Aman M, Bergmeister KD, Depisch D, Scheuba KM, Unger E, Podesser BK, Aszmann OC. Experimental nerve transfer model in the neonatal rat. Neural Regen Res 2021; 17:1088-1095. [PMID: 34558537 PMCID: PMC8552847 DOI: 10.4103/1673-5374.324851] [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] [Indexed: 11/25/2022] Open
Abstract
Clinically, peripheral nerve reconstructions in neonates are most frequently applied in brachial plexus birth injuries. Most surgical concepts, however, have investigated nerve reconstructions in adult animal models. The immature neuromuscular system reacts differently to the effects of nerve lesion and surgery and is poorly investigated due to the lack of reliable experimental models. Here, we describe an experimental forelimb model in the neonatal rat, to study these effects on both the peripheral and central nervous systems. Within 24 hours after birth, three groups were prepared: In the nerve transfer group, a lesion of the musculocutaneous nerve was reconstructed by selectively transferring the ulnar nerve. In the negative control group, the musculocutaneous nerve was divided and not reconstructed and in the positive control group, a sham surgery was performed. The animal´s ability to adapt to nerve lesions and progressive improvement over time were depict by the Bertelli test, which observes the development of grooming. Twelve weeks postoperatively, animals were fully matured and the nerve transfer successfully reinnervated their target muscles, which was indicated by muscle force, muscle weight, and cross sectional area evaluation. On the contrary, no spontaneous regeneration was found in the negative control group. In the positive control group, reference values were established. Retrograde labeling indicated that the motoneuron pool of the ulnar nerve was reduced following nerve transfer. Due to this post-axotomy motoneuron death, a diminished amount of motoneurons reinnervated the biceps muscle in the nerve transfer group, when compared to the native motoneuron pool of the musculocutaneous nerve. These findings indicate that the immature neuromuscular system behaves profoundly different than similar lesions in adult rats and explains reduced muscle force. Ultimately, pathophysiologic adaptations are inevitable. The maturing neuromuscular system, however, utilizes neonatal capacity of regeneration and seizes a variety of compensation mechanism to restore a functional extremity. The above described neonatal rat model demonstrates a constant anatomy, suitable for nerve transfers and allows all standard neuromuscular analyses. Hence, detailed investigations on the pathophysiological changes and subsequent effects of trauma on the various levels within the neuromuscular system as well as neural reorganization of the neonatal rat may be elucidated. This study was approved by the Ethics Committee of the Medical University of Vienna and the Austrian Ministry for Research and Science (BMWF-66.009/0187-WF/V/3b/2015) on March 20, 2015.
Collapse
Affiliation(s)
- Matthias E Sporer
- Christian Doppler Laboratory for the Restoration of Extremity Function; Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria; Division of Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Martin Aman
- Christian Doppler Laboratory for the Restoration of Extremity Function, Department of Surgery; Division of Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Konstantin D Bergmeister
- Christian Doppler Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna; Department of Plastic, Aesthetic and Reconstructive Surgery, University Hospital of St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria
| | - Dieter Depisch
- Christian Doppler Laboratory for the Restoration of Extremity Function; Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Katharina M Scheuba
- Christian Doppler Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Ewald Unger
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Bruno K Podesser
- Division of Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Oskar C Aszmann
- Christian Doppler Laboratory for the Restoration of Extremity Function; Clinical Laboratory for Bionic Extremity Reconstruction, Department of Surgery; Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
4
|
Cassel JC, Ferraris M, Quilichini P, Cholvin T, Boch L, Stephan A, Pereira de Vasconcelos A. The reuniens and rhomboid nuclei of the thalamus: A crossroads for cognition-relevant information processing? Neurosci Biobehav Rev 2021; 126:338-360. [PMID: 33766671 DOI: 10.1016/j.neubiorev.2021.03.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 01/29/2023]
Abstract
Over the past twenty years, the reuniens and rhomboid (ReRh) nuclei, which constitute the ventral midline thalamus, have received constantly growing attention. Since our first review article about the functional contributions of ReRh nuclei (Cassel et al., 2013), numerous (>80) important papers have extended anatomical knowledge, including at a developmental level, introduced new and very original electrophysiological insights on ReRh functions, and brought novel results on cognitive and non-cognitive implications of the ReRh. The current review will cover these recent articles, more on Re than on Rh, and their contribution will be approached according to their affiliation with work before 2013. These neuroanatomical, electrophysiological or behavioral findings appear coherent and point to the ReRh nuclei as two major components of a multistructural system supporting numerous cognitive (and non-cognitive) functions. They gate the flow of information, perhaps especially from the medial prefrontal cortex to the hippocampus and back, and coordinate activity and processing across these two (and possibly other) brain regions of major cognitive relevance.
Collapse
Affiliation(s)
- Jean-Christophe Cassel
- Laboratoire de Neurosciences Cognitives et Adaptatives, Université de Strasbourg, F-67000 Strasbourg, France; LNCA, UMR 7364 - CNRS, F-67000 Strasbourg, France.
| | - Maëva Ferraris
- Aix Marseille Université, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Pascale Quilichini
- Aix Marseille Université, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Thibault Cholvin
- Institute for Physiology I, University Clinics Freiburg, 79104 Freiburg, Germany
| | - Laurine Boch
- Laboratoire de Neurosciences Cognitives et Adaptatives, Université de Strasbourg, F-67000 Strasbourg, France; LNCA, UMR 7364 - CNRS, F-67000 Strasbourg, France
| | - Aline Stephan
- Laboratoire de Neurosciences Cognitives et Adaptatives, Université de Strasbourg, F-67000 Strasbourg, France; LNCA, UMR 7364 - CNRS, F-67000 Strasbourg, France
| | - Anne Pereira de Vasconcelos
- Laboratoire de Neurosciences Cognitives et Adaptatives, Université de Strasbourg, F-67000 Strasbourg, France; LNCA, UMR 7364 - CNRS, F-67000 Strasbourg, France
| |
Collapse
|
5
|
Williams MD, Lascelles BDX. Early Neonatal Pain-A Review of Clinical and Experimental Implications on Painful Conditions Later in Life. Front Pediatr 2020; 8:30. [PMID: 32117835 PMCID: PMC7020755 DOI: 10.3389/fped.2020.00030] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/20/2020] [Indexed: 12/13/2022] Open
Abstract
Modern health care has brought our society innumerable benefits but has also introduced the experience of pain very early in life. For example, it is now routine care for newborns to receive various injections or have blood drawn within 24 h of life. For infants who are sick or premature, the pain experiences inherent in the required medical care are frequent and often severe, with neonates requiring intensive care admission encountering approximately fourteen painful procedures daily in the hospital. Given that much of the world has seen a steady increase in preterm births for the last several decades, an ever-growing number of babies experience multiple painful events before even leaving the hospital. These noxious events occur during a critical period of neurodevelopment when the nervous system is very vulnerable due to immaturity and neuroplasticity. Here, we provide a narrative review of the literature pertaining to the idea that early life pain has significant long-term effects on neurosensory, cognition, behavior, pain processing, and health outcomes that persist into childhood and even adulthood. We refer to clinical and pre-clinical studies investigating how early life pain impacts acute pain later in life, focusing on animal model correlates that have been used to better understand this relationship. Current knowledge around the proposed underlying mechanisms responsible for the long-lasting consequences of neonatal pain, its neurobiological and behavioral effects, and its influence on later pain states are discussed. We conclude by highlighting that another important consequence of early life pain may be the impact it has on later chronic pain states-an area of research that has received little attention.
Collapse
Affiliation(s)
- Morika D. Williams
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
- Translational Research in Pain Program, North Carolina State University, Raleigh, NC, United States
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC, United States
| | - B. Duncan X. Lascelles
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
- Translational Research in Pain Program, North Carolina State University, Raleigh, NC, United States
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC, United States
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Center for Translational Pain Medicine, Duke University, Durham, NC, United States
| |
Collapse
|
6
|
Zhang Q, Ge P, Ma Y, Zhang D, Wang R, Zhang Y, Wang S, Cao Y, Zhao M, Zhao J. Clinical Features and Surgical Outcomes of Patients With Moyamoya Disease and the Homozygous RNF213 p.R4810K Variant. J Child Neurol 2019; 34:793-800. [PMID: 31290353 DOI: 10.1177/0883073819858264] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The ring-finger protein 213 (RNF213) gene is a major susceptibility gene for moyamoya disease. The homozygote of the p.R4810K variant on RNF213 exhibits an early onset age and severe form of moyamoya disease. We report 4 unrelated pediatric moyamoya disease cases with the homozygous p.R4810K variant and the long-term surgical outcomes. Published reports on surgical outcome of moyamoya disease case with the homozygous p.R4810K variant were reviewed. Cerebral angiography revealed classic angiographic findings of moyamoya disease in 7 hemispheres of the 4 children. All patients underwent successful indirect revascularization. Abundant collateral blood flow from the external carotid arteries to the internal carotid arteries was observed in all bypass procedures by angiography. Improvements in symptoms and cerebral blood volume were observed in all patients at long-term follow-up. This report is the first case series in the literature on the surgical management of these patients. These cases highlight the effectiveness of indirect revascularization for moyamoya disease patients with the homozygous p.R4810K variant. Early diagnosis and treatment are crucial to avoid irreversible neurologic deficits in these patients.
Collapse
Affiliation(s)
- Qian Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Peicong Ge
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yonggang Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Meng Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| |
Collapse
|
7
|
Aversive learning-induced plasticity throughout the adult mammalian olfactory system: insights across development. J Bioenerg Biomembr 2018; 51:15-27. [PMID: 30171506 DOI: 10.1007/s10863-018-9770-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
Abstract
Experiences, such as sensory learning, are known to induce plasticity in mammalian sensory systems. In recent years aversive olfactory learning-induced plasticity has been identified at all stages of the adult olfactory pathway; however, the underlying mechanisms have yet to be identified. Much of the work regarding mechanisms of olfactory associative learning comes from neonates, a time point before which the brain or olfactory system is fully developed. In addition, pups and adults often express different behavioral outcomes when subjected to the same olfactory aversive conditioning paradigm, making it difficult to directly attribute pup mechanisms of plasticity to adults. Despite the differences, there is evidence of similarities between pups and adults in terms of learning-induced changes in the olfactory system, suggesting at least some conserved mechanisms. Identifying these conserved mechanisms of plasticity would dramatically increase our understanding of how the brain is able to alter encoding and consolidation of salient olfactory information even at the earliest stages following aversive learning. The focus of this review is to systematically examine literature regarding olfactory associative learning across developmental stages and search for similarities in order to build testable hypotheses that will inform future studies of aversive learning-induced sensory plasticity in adults.
Collapse
|
8
|
Promoting neuroregeneration after perinatal arterial ischemic stroke: neurotrophic factors and mesenchymal stem cells. Pediatr Res 2018; 83:372-384. [PMID: 28949952 DOI: 10.1038/pr.2017.243] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/19/2017] [Indexed: 01/02/2023]
Abstract
Newborns suffering from perinatal arterial ischemic stroke (PAIS) are at risk of neurodevelopmental problems. Current treatment options for PAIS are limited and mainly focus on supportive care, as presentation of PAIS is beyond the time window of current treatment strategies. Therefore, recent focus has shifted to interventions that stimulate regeneration of damaged brain tissue. From animal models, it is known that the brain increases its neurogenic capability after ischemic injury, by promoting neural cell proliferation and differentiation. However, neurogenesis is not maintained at the long term, which consequently impedes full repair leading to adverse consequences later in life. Boosting neuroregeneration of the newborn brain using treatment with neurotrophic factors and/or mesenchymal stem cells (MSCs) may be promising novel therapeutic strategies to improve neurological prospects and quality of life of infants with PAIS. This review focuses on effectiveness of neurotrophic growth factors, including erythropoietin, brain-derived neurotrophic factor, vascular endothelial growth factor, glial-derived neurotrophic factor, and MSC therapy, in both experimental neonatal stroke studies and first clinical trials for neonatal ischemic brain injury.
Collapse
|
9
|
Spinal Plasticity and Behavior: BDNF-Induced Neuromodulation in Uninjured and Injured Spinal Cord. Neural Plast 2016; 2016:9857201. [PMID: 27721996 PMCID: PMC5046018 DOI: 10.1155/2016/9857201] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/27/2016] [Accepted: 08/10/2016] [Indexed: 12/26/2022] Open
Abstract
Brain-derived neurotrophic factor (BDNF) is a member of the neurotrophic factor family of signaling molecules. Since its discovery over three decades ago, BDNF has been identified as an important regulator of neuronal development, synaptic transmission, and cellular and synaptic plasticity and has been shown to function in the formation and maintenance of certain forms of memory. Neural plasticity that underlies learning and memory in the hippocampus shares distinct characteristics with spinal cord nociceptive plasticity. Research examining the role BDNF plays in spinal nociception and pain overwhelmingly suggests that BDNF promotes pronociceptive effects. BDNF induces synaptic facilitation and engages central sensitization-like mechanisms. Also, peripheral injury-induced neuropathic pain is often accompanied with increased spinal expression of BDNF. Research has extended to examine how spinal cord injury (SCI) influences BDNF plasticity and the effects BDNF has on sensory and motor functions after SCI. Functional recovery and adaptive plasticity after SCI are typically associated with upregulation of BDNF. Although neuropathic pain is a common consequence of SCI, the relation between BDNF and pain after SCI remains elusive. This article reviews recent literature and discusses the diverse actions of BDNF. We also highlight similarities and differences in BDNF-induced nociceptive plasticity in naïve and SCI conditions.
Collapse
|
10
|
Babini M, Giulioni M, Galassi E, Marucci G, Martinoni M, Rubboli G, Volpi L, Zucchelli M, Nicolini F, Marliani AF, Michelucci R, Calbucci F. Seizure outcome of surgical treatment of focal epilepsy associated with low-grade tumors in children. J Neurosurg Pediatr 2013; 11:214-23. [PMID: 23215740 DOI: 10.3171/2012.11.peds12137] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECT Low-grade tumor (LGT) is an increasingly recognized cause of focal epilepsies, particularly in children and young adults, and is frequently associated with cortical dysplasia. The optimal surgical treatment of epileptogenic LGTs in pediatric patients has not been fully established. METHODS In the present study, the authors retrospectively reviewed 30 patients (age range 3-18 years) who underwent surgery for histopathologically confirmed LGTs, in which seizures were the only clinical manifestation. The patients were divided into 2 groups according to the type of surgical treatment: patients in Group A (20 cases) underwent only tumor removal (lesionectomy), whereas patients in Group B (11 cases) underwent removal of the tumor and the adjacent epileptogenic zone (tailored surgery). One of the patients, who underwent 2 operations, is included in both groups. Follow-up ranged from 1 to 17 years. RESULTS Sixteen (80%) of 20 patients in Group A had an Engel Class I outcome. In this group, 3 of 4 patients who were in Engel Classes II and III had temporomesial lesions. All patients in Group B had temporomesial tumors and were seizure free (Engel Class I). In this series, in temporolateral and extratemporal tumor locations, lesionectomy yielded a good seizure outcome. In addition, a young age at seizure onset (in particular < 4 years) was associated with a poor seizure outcome. CONCLUSIONS Tailored resection in temporomesial LGTs was associated with excellent seizure outcome, indicating that an adequate presurgical evaluation including extensive neurophysiological evaluation (long-term videoelectroencephalography monitoring) to plan appropriate surgical strategy is advised.
Collapse
Affiliation(s)
- Micol Babini
- Divisions of Neurosurgery, Bellaria Hospital, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Narberhaus A, Lawrence E, Allin MP, Walshe M, McGuire P, Rifkin L, Murray R, Nosarti C. Neural substrates of visual paired associates in young adults with a history of very preterm birth: Alterations in fronto-parieto-occipital networks and caudate nucleus. Neuroimage 2009; 47:1884-93. [PMID: 19376244 DOI: 10.1016/j.neuroimage.2009.04.036] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 04/01/2009] [Accepted: 04/08/2009] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ana Narberhaus
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Abstract
Non-human primates have been used to model psychiatric disease for several decades. The success of this paradigm has issued from comparable cognitive skills, brain morphology, and social complexity in adult monkeys and humans. Recently, interest in biological psychiatry has focused on similar brain, social, and emotional developmental processes in monkeys. In part, this is related to evidence that early postnatal experiences in human development may have profound implications for subsequent mental health. Non-human primate studies of postnatal phenomenon have generally fallen into three basic categories: experiential manipulation (largely manipulations of rearing), pharmacological manipulation (eg drug-induced psychosis), and anatomical localization (defined by strategic surgical damage). Although these efforts have been very informative each of them has certain limitations. In this review we highlight general findings from the non-human primate postnatal developmental literature and their implications for primate models in psychiatry. We argue that primates are uniquely capable of uncovering interactions between genes, environmental challenges, and development resulting in altered risk for psychopathology.
Collapse
|
13
|
Maton B, Jayakar P, Resnick T, Morrison G, Ragheb J, Duchowny M. Surgery for medically intractable temporal lobe epilepsy during early life. Epilepsia 2008; 49:80-7. [PMID: 17868049 DOI: 10.1111/j.1528-1167.2007.01315.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Temporal lobe epilepsy (TLE) in early life is often a catastrophic disorder with pharmacoresistant seizures and secondary neurological deterioration. there is little data available regarding epilepsy surgery performed in infants and young children and no prior study has focused on tle. METHODS We analyzed the results of temporal resection for epilepsy as the primary indication in children less than age 5 years who had at least 2 years of follow-up. RESULTS 20 children (14 males) were identified with a mean age at surgery of 26 months and a mean age at seizure onset of 12 months. Clinical presentation was diverse. Typical psychomotor seizures (n = 4; mean age at surgery 37 months) were followed by prominent motor changes (n = 7; 30 months) and were occasionally isolated (n = 3; 23 months). Epileptic spasms were noted in six patients and were frequently associated with lateralizing features. The interictal EEG was lateralizing in 15 patients and the ictal EEG was lateralizing in 18 patients. Brain MRI provided localizing value in 16 patients, ictal SPECT was concordant in 4/8 cases. Invasive EEG was employed in six cases. At mean follow-up of 5.5 years, 65% of the children were seizure-free and 15% had >90% seizure reduction. Morbidity included infection and hydrocephalus in one case and stroke-related hemiparesis in two cases. Cortical dysplasia was identified in eight children, tumors in eight including two DNET, two ganglioglioma, and four malignant tumors. Hippocampal sclerosis was present in four cases, always as dual pathology. CONCLUSION TLE presents in early life with varied and severe manifestations. Excisional procedures in this age group are associated with favorable seizure reduction similar to older children and in adults.
Collapse
MESH Headings
- Age Factors
- Age of Onset
- Brain Mapping
- Cerebral Cortex/abnormalities
- Child, Preschool
- Drug Resistance
- Electroencephalography
- Epilepsy, Complex Partial/diagnosis
- Epilepsy, Complex Partial/epidemiology
- Epilepsy, Complex Partial/surgery
- Epilepsy, Temporal Lobe/diagnosis
- Epilepsy, Temporal Lobe/epidemiology
- Epilepsy, Temporal Lobe/surgery
- Female
- Florida/epidemiology
- Functional Laterality/physiology
- Humans
- Infant
- Magnetic Resonance Imaging
- Male
- Predictive Value of Tests
- Preoperative Care
- Stereotaxic Techniques
- Temporal Lobe/surgery
- Tomography, Emission-Computed, Single-Photon
- Tomography, X-Ray Computed
- Treatment Outcome
Collapse
Affiliation(s)
- Bruno Maton
- The Brain Institute, Miami Children's Hospital, Miami, Florida, USA
| | | | | | | | | | | |
Collapse
|
14
|
von der Ohe CG, Darian-Smith C, Garner CC, Heller HC. Ubiquitous and temperature-dependent neural plasticity in hibernators. J Neurosci 2006; 26:10590-8. [PMID: 17035545 PMCID: PMC6674705 DOI: 10.1523/jneurosci.2874-06.2006] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2006] [Revised: 08/17/2006] [Accepted: 08/29/2006] [Indexed: 12/29/2022] Open
Abstract
Hibernating mammals are remarkable for surviving near-freezing brain temperatures and near cessation of neural activity for a week or more at a time. This extreme physiological state is associated with dendritic and synaptic changes in hippocampal neurons. Here, we investigate whether these changes are a ubiquitous phenomenon throughout the brain that is driven by temperature. We iontophoretically injected Lucifer yellow into several types of neurons in fixed slices from hibernating ground squirrels. We analyzed neuronal microstructure from animals at several stages of torpor at two different ambient temperatures, and during the summer. We show that neuronal cell bodies, dendrites, and spines from several cell types in hibernating ground squirrels retract on entry into torpor, change little over the course of several days, and then regrow during the 2 h return to euthermia. Similar structural changes take place in neurons from the hippocampus, cortex, and thalamus, suggesting a global phenomenon. Investigation of neural microstructure from groups of animals hibernating at different ambient temperatures revealed that there is a linear relationship between neural retraction and minimum body temperature. Despite significant temperature-dependent differences in extent of retraction during torpor, recovery reaches the same final values of cell body area, dendritic arbor complexity, and spine density. This study demonstrates large-scale and seemingly ubiquitous neural plasticity in the ground squirrel brain during torpor. It also defines a temperature-driven model of dramatic neural plasticity, which provides a unique opportunity to explore mechanisms of large-scale regrowth in adult mammals, and the effects of remodeling on learning and memory.
Collapse
Affiliation(s)
- Christina G von der Ohe
- Department of Biological Sciences, Stanford University, Stanford, California 94305-5020, USA.
| | | | | | | |
Collapse
|
15
|
Abstract
The aim of this review is to summarize our knowledge about Dandy-Walker malformation (DWM) and introduce recent notions about its prognosis. DWM is a malformation associating hypoplasia of the vermis, pseudocystic fourth ventricle, upward displacement of the tentorium, torcular and lateral sinuses and anterio-posterior enlargement of the posterior fossa. It is frequently associated with genetic anomalies, brain malformations (anomalies of gyration, grey matter heterotopias, meningoceles, corpus callosum agenesis...) or systemic malformations (heart, orthopedic, intestinal, urogenital and facial anomalies). It is also part of many syndromes. Its rarity, the difficulty of its diagnosis, the fact that the malformation is mainly known through hospitalized patients, mainly from neurosurgical departments, have made its definition variable and prevents us from having an accurate knowledge of its natural history and prognosis. Hydrocephalus, so frequent in neurosurgical series that some have included it in the definition, is actually rare as has been seen in prenatal series. Treatment, when necessary, is still controversial, the main options remaining cyst fenestration, ventriculo- and/or cystoperitoneal shunts and more recently endoscopic third ventriculostomy. The prognosis, commonly said to be unpredictable, is actually foreseeable after scrutinous observation of the brain anatomy, and mainly of the vermis. A cerebellar vermis with three groups of lobes and two main fissures, as identified on MRI T2 sagittal views, not only has the greatest chance to not be associated with other malformation but also to have a favorable neurocognitive outcome. On the contrary, a deeply dysgenetic vermis with only two or one recognizable lobes is not only constantly associated with other brain malformation but also with poor prognosis. This is a recent advance that may be important for those involved in prenatal counselling.
Collapse
Affiliation(s)
- O Klein
- Unité de Neurochirurgie Pédiatrique, Département de Neurochirurgie, Hôpital Central, 29, avenue Maréchal-de-Lattre-de-Tassigny, 54035 Nancy Cedex.
| | | |
Collapse
|
16
|
Centeno RS, Yacubian EM, Sakamoto AC, Ferraz AFP, Junior HC, Cavalheiro S. Pre-surgical evaluation and surgical treatment in children with extratemporal epilepsy. Childs Nerv Syst 2006; 22:945-59. [PMID: 16832668 DOI: 10.1007/s00381-006-0145-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This review summarizes some patterns of pre-surgical evaluation and surgical treatment of extratemporal epilepsy in pediatric patients with medically refractory seizures, whose ictal behavior is variable. The most effective treatment for intractable partial epilepsy is a focal cortical resection with excision of the epileptogenic zone (the area of ictal onset and initial seizure propagation). This might be risky, though, in the case of a widespread lesion, sometimes encroaching one or more lobes, given the risk to the functional cerebral cortex. An anterior temporal lobectomy might prove more effective then in preventing seizures with fewer potential complications. If partial extratemporal epilepsy is associated with pharmaco-resistant seizures, the preoperative evaluation and operative strategy are determined according to the epileptogenic zone and to the relationship between a substrate-directed disorder and eloquent areas. The pediatric treatment of extratemporal epilepsy is aimed at controlling the seizures, avoiding morbidity, and improving the patient's quality of life through psychosocial integration. Since the immature brain is more plastic than when mature, the recovery of functions after surgery is greater in children than in adults. RECOMMENDATION Early surgery is recommended for children with intractable epilepsy, and is now accepted as an important therapeutic modality also for children with chronic epilepsy. CONCLUSION Technological advances in the last two decades, mainly in neuroimaging, have led many medical centers to consider surgical treatment of epilepsy, accuracy being granted by MRI-based neuronavigation systems-an interface between the lesion seen in the preoperative magnetic resonance imaging (MRI) and the operative field, often invisible to the surgeon.
Collapse
Affiliation(s)
- Ricardo Silva Centeno
- Universidade Federal de São Paulo, Departamento de Neurologia/Neurocirurgia, Disciplina de Neurocirurgia. Rua Napoleão de Barros, 715-6 andar Vila Clementino 04024-002, São Paulo, SP, Brazil
| | | | | | | | | | | |
Collapse
|
17
|
Heller SL, Heier LA, Watts R, Schwartz TH, Zelenko N, Doyle W, Devinsky O. Evidence of cerebral reorganization following perinatal stroke demonstrated with fMRI and DTI tractography. Clin Imaging 2005; 29:283-7. [PMID: 15967322 DOI: 10.1016/j.clinimag.2004.09.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2004] [Accepted: 09/14/2004] [Indexed: 11/17/2022]
Abstract
A 44-year-old man with a left perinatal stroke and recurrent refractory epilepsy underwent functional MRI (fMRI) for motor and language mapping to determine if further epilepsy surgery could be performed without loss of language. Language was activated excessively in the right hemisphere, with only small areas of left hemisphere activation. This suggests bilateral language dominance acquired secondary to the perinatal stroke with the right hemisphere activation resulting from neonatal neuronal reorganization. Functional data were overlaid onto 3D diffusion tensor tractography, providing a unique image of the right hemisphere language recruitment.
Collapse
|
18
|
Abstract
Perinatal brain damage following a hypoxic-ischemic episode has been considered for a long time as an irreversible phenomenon. However, recent studies have shown that various insults may induce de novo neurogenesis in the adult rodent brain. The present study tested the hypothesis that acute hypoxia may trigger neurogenesis in the developing brain. In vitro, the influence of transient hypoxia was analyzed on the outcome of embryonic rat neurons in culture. In vivo, the temporal profile of brain damage was monitored at the level of the CA1 layer of the hippocampus after the exposure to hypoxia of 1-day-old rats. The extent of cell loss and regeneration was evaluated after staining with DAPI. The characterization of newly generated cells was performed in the subventricular zone at 20 days postexposure by immunohistochemistry. Following hypoxia for 6 hours, neuronal viability in the culture dishes was reduced by 36% at 96 hours, with a significant number of cell nuclei showing apoptosis features. In contrast, a 3-hour hypoxia apparently did not damage cultured neurons whose number increased by 14%. The Bax/Bcl-2 ratio tended to increase after 6-hour hypoxia and to decrease after 3-hour hypoxia. In vivo, hypoxia induced cell damage in the CA1 subfield of the hippocampus, where the total number of cells was reduced by 27% at days 6-7 postreoxygenation, with histopathological hallmarks of apoptosis. This cell deficit was followed by a gradual recovery observable from day 20, suggesting a repair mechanism. Brain incorporation of BrdU in the subventricular zone revealed an accumulation of proliferating cells expressing the neuronal marker NeuroD. The present data demonstrate that a posthypoxic neurogenesis does occur during development and may account for brain protection.
Collapse
Affiliation(s)
- Jean-Luc Daval
- Laboratoire de Biochimie, INSERM EMI 0014, Faculté de Médecine de Nancy, France.
| | | |
Collapse
|
19
|
Abstract
Uncontrolled epilepsy is associated with progressive cortical and hippocampal atrophy, substantial cognitive and psychosocial morbidity, and increased mortality. Seizure freedom is required to reverse such morbidity and mortality. Surgery is vastly superior to medical therapy for patients with chronic, refractory temporal lobe seizures, and is now the standard of care for these patients. On the other hand, the concept of early surgery requires further exploration and definition. Although there is no robust, direct evidence to support early epilepsy surgery, case series and cohort studies report an association between earlier surgery and better outcomes. The evidence for earlier epilepsy surgery is reviewed.
Collapse
Affiliation(s)
- Samuel Wiebe
- London Health Sciences Centre, University Campus, 339 Windermere Road, London, ON N6A 5A5, Canada.
| |
Collapse
|
20
|
Kim SK, Seol HJ, Cho BK, Hwang YS, Lee DS, Wang KC. Moyamoya Disease among Young Patients: Its Aggressive Clinical Course and the Role of Active Surgical Treatment. Neurosurgery 2004; 54:840-4; discussion 844-6. [PMID: 15046649 DOI: 10.1227/01.neu.0000114140.41509.14] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2003] [Accepted: 11/18/2003] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The prognosis for moyamoya disease (MMD) among young patients is known to be worse than that among older patients. The aim of this study was to investigate the clinical features and treatment outcomes of young patients with MMD. METHODS A total of 204 patients with MMD who underwent encephaloduroarteriosynangiosis, with or without bifrontal encephalogaleosynangiosis, were categorized into three groups according to their ages at the time of surgery, i.e., Group A (n = 23, <3 yr of age), Group B (n = 50, 3-6 yr of age), and Group C (n = 131, >6 yr of age). For each group, patterns of presentation and the occurrence of subsequent preoperative or surgery-related infarctions were assessed. Clinical outcomes and postoperative hemodynamic status were analyzed. RESULTS At initial presentation, infarctions were significantly more frequent in Group A (87%) and Group B (58%) than in Group C (46%). Subsequent preoperative infarctions occurred significantly more frequently in Group A (39%) than in Group B (6%) or Group C (0.8%). The median interval between the onset of symptoms and a subsequent preoperative infarction was 3 months (range, 1-14 mo). No significant difference in the rates of surgery-related infarctions among the three groups was observed. The rate of favorable clinical outcomes was significantly lower in Group A (58%) than in Group B (84%) or Group C (86%), although the rates of postoperative hemodynamic improvements were similar among the groups. The poor clinical outcomes for Group A were caused mainly by preoperative infarctions. CONCLUSION Young-age MMD demonstrates rapid disease progression and results in poor clinical outcomes. These findings indicate the necessity of early surgery for young patients with MMD; however, the actual benefits should be verified with additional controlled studies, with long-term follow-up monitoring.
Collapse
Affiliation(s)
- Seung-Ki Kim
- Division of Pediatric Neurosurgery and Laboratory for Fetal Medicine Research, Clinical Research Institute, Seoul National University Children's Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea
| | | | | | | | | | | |
Collapse
|
21
|
Boddaert N, Klein O, Ferguson N, Sonigo P, Parisot D, Hertz-Pannier L, Baraton J, Emond S, Simon I, Chigot V, Schmit P, Pierre-Kahn A, Brunelle F. Intellectual prognosis of the Dandy-Walker malformation in children: the importance of vermian lobulation. Neuroradiology 2003; 45:320-4. [PMID: 12682795 DOI: 10.1007/s00234-003-0980-6] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2002] [Accepted: 01/21/2003] [Indexed: 10/20/2022]
Abstract
Half of patients with the Dandy-Walker malformation (DWM) have normal intellectual development. We aimed to identify feature on MRI associated with good intellectual prognosis. We reviewed 20 patients with DWM diagnosed on MRI, mean age 14.6+/-9.9 years. We assessed their intellectual development and related it to the MRI features. We found two groups with a statistically different intellectual outcome. All 14 patients with normal intellectual development had a normal lobulation of the vermis, without supratentorial anomalies. Of the six patients with mental retardation, three had an abnormal vermis, together with dysgenesis of the corpus callosum. In the other three, there were normal vermian anatomy with associated anomalies. Normal lobulation of the vermis, in the absence of any supratentorial anomaly, appears to be a good prognostic factor in DWM. Preservation of cerebrocerebellar pathways and neonatal plasticity could explain the normal intellectual development. These findings might be useful in prenatal diagnosis.
Collapse
Affiliation(s)
- N Boddaert
- Paediatric Radiology Department, Hopital Necker Enfants-Malades, 149 rue de Sèvres, 75015 Paris, France.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Chen CY, Bonham AC, Schelegle ES, Gershwin LJ, Plopper CG, Joad JP. Extended allergen exposure in asthmatic monkeys induces neuroplasticity in nucleus tractus solitarius. J Allergy Clin Immunol 2001; 108:557-62. [PMID: 11590381 DOI: 10.1067/mai.2001.118132] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Extended exposure to allergen exacerbates asthma symptoms, in part via complex interactions between inflammatory cells and mediators. One consequence of these interactions is the triggering of local and central nervous system (CNS) neuronal activity that might further exacerbate the asthma-like symptoms by causing bronchoconstriction, mucous secretion, increased microvascular leak, and cough. One CNS region that might be particularly important is the caudomedial nucleus tractus solitarius (NTS). NTS neurons not only integrate primary afferent inputs from lung sensory nerve fibers but also have direct exposure to inhaled allergens and allergen-induced blood-borne inflammatory mediators via a deficient blood-brain barrier. Given the capacity of CNS neurons to undergo plasticity, allergen-induced changes in NTS neuronal properties could contribute to the exaggerated respiratory responses to extended allergen exposure. OBJECTIVE In a recently developed rhesus monkey model of allergic asthma, we tested the hypothesis that extended exposure to allergen increases the intrinsic excitability of NTS neurons. METHODS Three adult monkeys were sensitized and then repeatedly exposed to aerosols of house dust mite allergen; 4 monkeys served as controls. Whole-cell current-clamp recordings were made to measure 3 indices of excitability: resting membrane potential, input resistance, and number of action potentials evoked by current injections. RESULTS Extended allergen exposure depolarized the resting membrane potential by 14% and increased the number of action potentials evoked by current injections (5-fold). CONCLUSION The finding that NTS neurons in a primate model of allergic asthma undergo intrinsic increases in excitability suggests that CNS mechanisms might contribute to the exaggerated symptoms in asthmatic individuals exposed to allergen.
Collapse
Affiliation(s)
- C Y Chen
- Department of Internal Medicine, School of Medicine, University of California at Davis, Sacramento, 95817, USA
| | | | | | | | | | | |
Collapse
|
23
|
Abstract
Neonatal intensive care exposes preterm neonates to a series of repeated, randomly occurring invasive procedures and handling, resulting in acute pain, chronic pain, and prolonged stress during a critical window associated with epochal brain development. Characteristics of the immature pain system in preterm neonates (such as a low pain threshold, prolonged periods of windup, overlapping receptive fields, immature descending inhibition) predisposes them to greater clinical and behavioral sequelae from inadequately treated pain than older age groups. Evidence for developmental plasticity in the neonatal brain suggests that repetitive painful experiences during this period or prolonged exposure to analgesic drugs may alter neuronal and synaptic organization permanently. Traditionally, clinicians have chosen the perspective that routine use of analgesic or sedative drugs in preterm neonates may create more problems than minimal therapy. However, the immediate and long-term consequences of inadequately treated pain have forced them to reconsider the risk-benefit ratios for such therapy. Whereas the short-term consequences of prolonged analgesic therapy in human neonates are well-known (tolerance, withdrawal, ventilator dependency), long-term consequences are relatively unknown. Advances in the study of repetitive pain associated with routine NICU care have challenged the perspective that prolonged pain and stress were inevitable consequences of premature birth.
Collapse
Affiliation(s)
- K J Anand
- Pain Neurobiology Laboratory, University of Arkansas for Medical Sciences, Little Rock, USA.
| |
Collapse
|
24
|
Asikainen I, Nybo T, Muller K, Sarna S, Kaste M. Speed performance and long-term functional and vocational outcome in a group of young patients with moderate or severe traumatic brain injury. Eur J Neurol 1999; 6:179-85. [PMID: 10053230 DOI: 10.1111/j.1468-1331.1999.tb00011.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We studied specific aspects of speed performance in neuropsychological tests and functional and vocational long-term outcome among moderate or severe traumatic brain injury (TBI) patients admitted to a rehabilitation programme. A group of 140 patients with mild, moderate or severe TBI was followed up for a minimum of 5 years in a rehabilitation programme. Severity of TBI was estimated using the Glasgow Coma Scale (GCS) scores on emergency hospital admission. The patients, grouped by age at injury into the categories: 7 or younger, 8-16 and 17 years of age or older, were tested five or more years post-injury with comprehensive neuropsychological tests, including a speed performance test with the Stroop material, the Purdue Pegboard (PB) test and simple visual and auditive reaction times. The outcome variables were functional outcome, as measured by the Glasgow Outcome Scale (GOS) score, and capacity for employment at the end of follow-up, i.e. on average 12 years post-injury. The patients with mild TBI were excluded from further analysis of outcome. The study was carried out at the Kauniala outpatient neurological clinic. In the Stroop test, patients with a GOS score of 3 and patients who were incapable of employment were slower (P = 0.0046 and P = 0.0015, respectively) than those with a GOS score of 1 or 2 and those capable of independent or subsidized employment, respectively. The PB test also differentiated significantly between the patients with a GOS score of 3 and those with a GOS score of 1 or 2 at the end of follow-up (P = 0.0413), and predicted incapacity for employment (P = 0.032), those with worse outcome being slower. Simple reaction times did not differ significantly between the GOS scores at the end of follow-up, and neither did they predict capacity or incapacity for employment. Our data suggest that the Stroop and PB tests can help estimate functional outcome, as measured by the GOS, among patients with initially moderate or severe TBI and who were referred to a rehabilitation programme. The same tests could also be useful in predicting long-term vocational outcome.
Collapse
Affiliation(s)
- I Asikainen
- Department of Neurology, Kauniala Hospital, Kauniainen, Finland
| | | | | | | | | |
Collapse
|
25
|
Beni-Adani L, Flores I, Spektor S, Umansky F, Constantini S. Epidural hematoma in infants: a different entity? THE JOURNAL OF TRAUMA 1999; 46:306-11. [PMID: 10029038 DOI: 10.1097/00005373-199902000-00018] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Epidural hematoma (EDH) in infants may be difficult to diagnose. The mechanism of injury and the clinical presentation are different from those in older children. We characterized the clinical and radiologic parameters of EDH in infants and correlated them with outcome. Because there are no optimal prognostic tools or clear guidelines to perform computed tomography in this unique population, a new approach of neurotrauma scoring is suggested. METHODS Eleven infants (<2 years old) operated on for EDH were studied. Children's Glasgow Coma Scale (CCS) score was applied, and diagnosis was confirmed by computed tomography. RESULTS Age was 13+/-5 months. Seven infants (63.6%) fell from less than 1 m. CCS score on admission was 10.7+/-3.9. Five infants (45%) were unconscious, yet two (18.2%) had CCS scores of 15. Pupillary abnormalities were found in two infants and lateralizing signs in five infants. Eight infants (72.7%) had subgaleal hematomas. Mortality and morbidity were 9% each. CONCLUSION We suggest that a Trauma Infant Neurologic Score be used when dealing with EDH in infants. Lateralizing signs, pupillary abnormalities, mechanism of trauma, and scalp injuries should be included because these are objective relevant parameters.
Collapse
Affiliation(s)
- L Beni-Adani
- Department of Neurosurgery, Hadassah University Hospital, Ein-Karem, Jerusalem, Israel.
| | | | | | | | | |
Collapse
|
26
|
Peña-de-Ortiz S, Jamieson GA. Molecular cloning and brain localization of HZF-2 alpha, a new member of the Rev-erb subfamily of orphan nuclear receptors. JOURNAL OF NEUROBIOLOGY 1997; 32:341-58. [PMID: 9058325 DOI: 10.1002/(sici)1097-4695(199703)32:3<341::aid-neu7>3.0.co;2-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We have isolated a novel cDNA homologous to the family of nuclear hormone receptors which we have designated hippocampal zinc finger-2 alpha (HZF-2 alpha). HZF-2 alpha encodes a protein 494 amino acids in length and predicted molecular size of 56 kD. HZF-2 alpha shares sequence similarities with orphan nuclear receptors related to thyroid hormone and retinoic acid receptors. An additional HZF-2 cDNA clone, HZF-2 beta, was isolated. HZF-2 beta differs from HZF-2 alpha in a nine-amino-acid region carboxyl to the DNA-binding domain thought to participate in enhancing the interaction of nuclear receptors with DNA. Northern blot analysis with a probe homologous to both HZF-2 alpha and beta identified two transcripts, sizes 4.4 and 5.5 kb in several rat tissues. HZF-2 alpha/beta mRNA levels are low in embryonic rat brain, increase during neonatal brain development and remain elevated in the adult rat brain. In situ hybridization analyses localized HZF-2 alpha/beta mRNA expression to all hippocampal subfields. Within the hippocampus heaviest expression was observed within the dentate gyrus. High levels of HZF-2 alpha/beta mRNA were also detected in Purkinje cells and the granular cell layer of the cerebellum. In summary, HZF-2 alpha/beta are novel orphan nuclear receptors which may play an important role in hormone-dependent aspects of developmental processes modulating hippocampal and cerebellar plasticity.
Collapse
Affiliation(s)
- S Peña-de-Ortiz
- Department of Environmental Health, University of Cincinnati College of Medicine, Ohio 45267-0056, USA
| | | |
Collapse
|
27
|
Abstract
Although most children with epilepsy have a good prognosis, a small but significant minority have seizures that either do not respond to conventional antiepileptic drugs (AEDs) or have significant adverse reactions to AEDs. Many children may benefit from epilepsy surgery. Surgical treatment of epilepsy is becoming a well-established therapy for infants and young children with severe, medically intractable seizures. As in older children and adults, the presurgical evaluations of possible surgical candidates typically consist of a detailed history, neurologic and neuropsychologic examination, and anatomic and functional neuroimaging. The "gold standard" test, however, is the recording of ictal events by using simultaneous EEG and videomonitoring. Although temporal lobe resection is the most commonly performed surgery in older children and adults, nontemporal lobe resection, corpus callosotomy, and hemispherectomy are commonly performed in younger children. Efficacy of surgery in children compares favorably with results from adult patients. In addition, because the immature brain is more plastic than the mature brain, recovery of function is often greater after surgery in children than in adults. Early surgery in children with intractable epilepsy is recommended.
Collapse
Affiliation(s)
- G L Holmes
- Department of Neurology, Harvard Medical School, Children's Hospital, Boston, Massachusetts 02115, USA
| |
Collapse
|
28
|
|