Clinical and MRI features of Japanese patients with multiple sclerosis positive for NMO-IgG

This study investigates the relation between the serological status of NMO (neuromyelitis optica)-IgG and the clinical and MRI features in Japanese patients with multiple sclerosis. Serum NMO-IgG was tested in 35 Japanese patients diagnosed with multiple sclerosis, including 19 with the optic-spinal form of multiple sclerosis (OSMS), three with the spinal form of multiple sclerosis (SMS), and 13 with the conventional form of multiple sclerosis (CMS), which affects the brain. NMO-IgG was detected in 14 patients, 12 with OSMS and 2 with CMS. In these patients, longitudinally extensive (> 3 vertebral segments) spinal cord lesions (93% v 57%) and permanent, complete blindness (no perception of light) in at least one eye (50% v 0%) were the noticeable features as compared with NMO-IgG-negative OSMS. The two patients having CMS with NMO-IgG had unusual brain lesions, but in other respects had features suggesting OSMS. NMO-IgG was detected in more than half the number of patients with OSMS and in some patients with CMS. This newly discovered serum autoantibody was markedly associated with longitudinally extensive spinal cord lesions and with complete blindness, suggesting severe optic-spinal disease.

Absence of IgG1 response in the cerebrospinal fluid of relapsing neuromyelitis optica

The authors studied immunoglobulin (Ig) G subclasses in the CSF and sera of patients with relapsing neuromyelitis optica (RNMO) and typical multiple sclerosis (MS). Although the total IgG concentrations were elevated in the CSF of patients with RNMO and MS, IgG1% and IgG1 index were significantly elevated only in patients with MS. The absence of the CSF IgG1 responses in the patients with RNMO may suggest less Th1 immunity and may also explain the rarity of oligoclonal IgG bands in patients with this disease.

[Successful treatment of emotional disturbances following non-herpetic limbic encephalitis by serotonergic agents. A case report]

We report a 19-year-old woman who developed refractory status epilepticus due to non-herpetic limbic encephalitis. Because ordinary anti-epileptics were ineffective, general anesthesia under mechanical ventilation was begun with pentobarbital, midazolam, and propofol. After 4 months, we could finally discontinue the intravenous anesthetics. Then, she gradually became conscious and several weeks later, could communicate verbally. Simultaneously, she began to manifest psychomotor agitation and emotional incontinence mimicking Klüver-Bucy syndrome. Brain MRI revealed cortical atrophy in the fronto-temporal lobes and dilated anterior and inferior horns of the lateral ventricles. Dopamine blockers and benzodiazepines failed to resolve these emotional symptoms. Oral tandospirone (30 mg/day dose) was initiated and a partial regression was observed. The following administration of fluvoxamine (started with 12.5 mg/day and maintained with 75 mg/day) resulted in a dramatic improvement of her symptoms within 3 days. This clinical course suggests that impaired serotonergic neurotransmission plays a key role in her emotional disturbances and that its modulation by serotonergic agents is useful to relieve such symptoms.

In vivo patch-clamp analysis of IPSCs evoked in rat substantia gelatinosa neurons by cutaneous mechanical stimulation

To know a functional role of inhibitory synaptic responses in transmitting noxious and innoxious information from the periphery to the rat spinal dorsal horn, we examined inhibitory postsynaptic currents (IPSCs) elicited in substantia gelatinosa (SG) neurons by mechanical stimuli applied to the skin using the newly developed in vivo patch-clamp technique. In the majority (80%) of SG neurons examined, a brush stimulus applied to the ipsilateral hind limb produced a barrage of IPSCs that persisted during the stimulus, while a pinch stimulus evoked IPSCs only at its beginning and end. The pinch-evoked IPSCs may have been caused by a touch that occurs at the on/off time of the pinch. The evoked IPSCs were blocked by either a glycine-receptor antagonist, strychnine (4 microM), or a GABA(A)-receptor antagonist, bicuculline (20 microM). All SG neurons examined received inhibitory inputs from a wide area throughout the thigh and lower leg. When IPSCs were examined together with excitatory postsynaptic currents (EPSCs) in the same neurons, a brush evoked a persistent activity of both IPSCs and EPSCs during the stimulus while a pinch evoked such an activity of EPSCs but not IPSCs. It is suggested that innoxious mechanical stimuli activate a GABAergic or glycinergic circuitry in the spinal dorsal horn. This inhibitory transmission may play an important role in the modulation of noxious information in the SG.

Responsiveness of rat substantia gelatinosa neurones to mechanical but not thermal stimuli revealed by in vivo patch-clamp recording

1. Synaptic responses of 46 substantia gelatinosa (SG) neurones in the spinal dorsal horn to cutaneous mechanical and/or thermal stimuli were investigated in an in vivo rat preparation with whole-cell patch-clamp recordings. The clamped neurones were identified as being in the SG based on either their morphological features by intrasomatic injection of biocytin or the depth of the neurones from the surface of the spinal cord. 2. In all SG neurones examined where spontaneous EPSCs occurred, pinch (noxious) and air (innocuous) stimuli applied to the ipsilateral hindlimb elicited a barrage of EPSCs (some of which initiated an action potential under current-clamp conditions), which subsided just after cessation of the stimuli without any residual slow current (or after-discharge). The spontaneous and evoked EPSCs were reversibly abolished by a non-N-methyl-D-aspartate (non-NMDA) receptor antagonist, CNQX (20 microM). 3. Noxious (>= 45 C) or innocuous (<= 40 C) thermal stimuli did not elicit any synaptic responses in all 18 SG neurones tested which were sensitive to mechanical stimuli. Noxious cold stimulation (<= 10 C) also failed to produce any responses (n = 6). 4. It is concluded that both noxious and innocuous mechanical information to SG neurones are transmitted primarily by activation of non-NMDA receptors, probably without any involvement of slow synaptic transmission, and that thermal information is conveyed to areas of the dorsal horn other than SG.

Crossing inputs of the superior laryngeal nerve afferents to medullary swallowing-related neurons in the cat

To understand the neural mechanism for generation of synchronous activity on both sides during swallowing, we examined the convergence of inputs from the bilateral superior laryngeal nerves (SLNs) in the urethane-anesthetized cat medulla and we also examined the changes in swallowing outputs after a longitudinal brain-stem split in decerebrate cats. Twenty-six (31%) of 84 swallowing-related neurons (SRNs) that were oligosynaptically activated by ipsilateral SLN stimulation and recorded mostly in the reticular formation received contralateral inputs, which were confirmed by orthodromic spike responses (n = 16) or were detected as subliminal facilitatory or inhibitory inputs (n = 10) using conditioning-test stimuli. The rate of convergence of inputs from bilateral SLNs in these SRNs was significantly higher than that (4%) in the SRNs that were regarded as sensory-relay neurons in the nucleus tractus solitarius (NTS). The SRNs receiving signals from the contralateral SLN were located diffusely from the NTS and the adjacent reticular formation to the nucleus ambiguus (NA) and the reticular formation dorso-medial to the NA. A midsagittal split from 3 mm caudal to 6 mm rostral to the obex could change symmetrical swallowing to unilateral swallowing. Thus the crossing projections to the contralateral SRNs appear to contribute to symmetrical swallowing.

Ten-year longitudinal clinical evaluation of a visible light cured posterior composite resin

Using modified USPHS criteria, we evaluated annually for ten years 91 cases restored with visible light cured posterior composite resin LFP (Base resin: UDMA; filler: micro crushed type, alumino-silicate, barium glass and silica, 85 wt%, 74 vol%). The 91 cases restored with LFP decreased to 68 in ten years. Of the 23 cases that were lost, one resulted from a pulpal reaction immediately following restoration, four were extracted owing to periodontal disease or extrusion of third molars, two became abutments owing to loss of an adjacent tooth, eight had recurrent caries, and eight were lost owing to caries on a surface having no relationship to the composite resin restoration. Because we observed comparatively little wear, good marginal adaptability, and no discoloration, we concluded that the ten-year clinical success of LFP was on the whole very good, and that this resin has adequate clinical merit as a restorative material for posterior teeth when restricted to restorations covering comparatively small areas.