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Niemeyer CS, Harlander-Locke M, Bubak AN, Rzasa-Lynn R, Birlea M. Trigeminal Postherpetic Neuralgia: From Pathophysiology to Treatment. Curr Pain Headache Rep 2024; 28:295-306. [PMID: 38261232 PMCID: PMC10940365 DOI: 10.1007/s11916-023-01209-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE OF REVIEW Trigeminal postherpetic neuralgia (TG-PHN) is a neuropathic pain condition complicating herpes zoster (HZ) attributed to the trigeminal nerve. It poses significant challenges due to its persistent and debilitating nature. This review explores the clinical characteristics of TG-PHN, analyzes its pathophysiological underpinnings, and addresses existent and potential therapies. RECENT FINDINGS TG-PHN is one of the most common and complex PHN locations. It has distinguishing clinical and pathophysiological characteristics, starting with viral triggered injuries to the trigeminal ganglion (TG) and peripheral tissue and involving the ascending and descending brain modulation pathways. Current therapies include vaccines, oral and topical medications, and interventional approaches, like nerve blocks and neurostimulation. This review covers TG-PHN's clinical and physiological components, treatment options, and potential future targets for improved management. By exploring the complexities of this condition, we aim to contribute to developing more effective and targeted therapies for patients suffering from trigeminal PHN.
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Affiliation(s)
- Christy S Niemeyer
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael Harlander-Locke
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew N Bubak
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rachael Rzasa-Lynn
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marius Birlea
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Bliwise DL, Trotti LM. Forced-choice lavender discrimination in Parkinson's disease. Parkinsonism Relat Disord 2024; 121:106035. [PMID: 38402774 DOI: 10.1016/j.parkreldis.2024.106035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/02/2024] [Accepted: 02/09/2024] [Indexed: 02/27/2024]
Affiliation(s)
- Donald L Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Lynn Marie Trotti
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
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Lambert GA, Zagami AS. Effects of somatostatin, a somatostatin agonist, and an antagonist, on a putative migraine trigger pathway. Neuropeptides 2024; 103:102399. [PMID: 38118293 DOI: 10.1016/j.npep.2023.102399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 11/15/2023] [Accepted: 12/04/2023] [Indexed: 12/22/2023]
Abstract
OBJECTIVE To determine whether somatostatin (SST) could be a cortico-brainstem neurotransmitter involved in producing the headache of migraine. BACKGROUND There is evidence to support the idea that a cortico-brainstem-trigeminal nucleus neuraxis might be responsible for producing migraine headache; we have suggested that SST may be one of the neurotransmitters involved. METHODS Rats were anesthetised and prepared for recording neurons in either the periaqueductal gray matter (PAG) or nucleus raphe magnus (NRM), as well as the trigeminal nucleus caudalis (TNC). The dura mater and facial skin were stimulated electrically or mechanically. SST, the SST agonist L054264 and the SST antagonist CYN54806 were injected intravenously, by microinjection, or by iontophoresis into the PAG or NRM. Cortical neuronal activity was provoked by cortical spreading depression (CSD) or light flash (LF) and was monitored by recording cortical blood flow (CBF). RESULTS Intravenous injection of SST: (a) selectively decreased the responses of TNC neurons to stimulation of the dura, but not skin, for up to 5 h; (b) decreased the ongoing discharge rate of TNC neurons while simultaneously increasing the discharge rate of neurons in either brainstem nucleus and; (c) prevented, or reversed, the effect of CSD and LF on brainstem and trigeminal neuron discharge rates. CSD and LF decreased the discharge rate of neurons in both brainstem nuclei and increased the discharge rate of TNC neurons. These effects were reversed by L054264 and mimicked by CYN54806. Injections of L054264 into the PAG or NRM reduced the response of TNC neurons to dural stimulation and skin stimulation differentially, depending on the nucleus injected. Injections of CYN54806 into either brainstem nucleus potentiated the responses of TNC neurons to dural and skin stimulation, but without a marked differential effect. CONCLUSIONS These results imply that SST could be a neurotransmitter in a pathway responsible for migraine pain.
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Affiliation(s)
- Geoffrey A Lambert
- School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Australia.
| | - Alessandro S Zagami
- School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Australia; Institute of Neurological Sciences, Prince of Wales Hospital, Randwick, NSW 2031, Australia
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Weir EM, Exten C, Gerkin RC, Munger SD, Hayes JE. Transient loss and recovery of oral chemesthesis, taste and smell with COVID-19: A small case-control series. Physiol Behav 2023; 271:114331. [PMID: 37595820 PMCID: PMC10591985 DOI: 10.1016/j.physbeh.2023.114331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 08/07/2023] [Accepted: 08/15/2023] [Indexed: 08/20/2023]
Abstract
Transient loss of smell is a common symptom of influenza and other upper respiratory infections. Loss of taste is possible but rare with these illnesses, and patient reports of 'taste loss' typically arise from a taste / flavor confusion. Thus, initial reports from COVID-19 patients of loss of taste and chemesthesis (i.e., chemical somatosensation like warming or cooling) were met with skepticism until multiple studies confirmed SARS-CoV-2 infections could disrupt these senses. Many studies have been based on self-report or on single time point assessments after acute illness was ended. Here, we describe intensive longitudinal data over 28 days from adults aged 18-45 years recruited in early 2021 (i.e., prior to the Delta and Omicron SARS-CoV-2 waves). These individuals were either COVID-19 positive or close contacts (per U.S. CDC criteria at the time of the study) in the first half of 2021. Upon enrollment, all participants were given nose clips, blinded samples of commercial jellybeans (Sour Cherry and Cinnamon), and scratch-n-sniff odor identification test cards (ScentCheckPro), which they used for daily assessments. In COVID-19 cases who enrolled on or before Day 10 of infection, Gaussian Process Regression showed two distinct measures of function - odor identification and odor intensity - declined relative to controls (exposed individuals who never developed COVID-19). Because enrollment began upon exposure, some participants became ill only after enrollment, which allowed us to capture baseline ratings, onset of loss, and recovery. Data from these four cases and four age- and sex- matched controls were plotted over 28 days to create panel plots. Variables included mean orthonasal intensity of four odors (ScentCheckPro), perceived nasal blockage, oral burn (Cinnamon jellybeans), and sourness and sweetness (Sour Cherry jellybeans). Controls exhibited stable ratings over time. By contrast, COVID-19 cases showed sharp deviations over time. Changes in odor intensity or odor identification were not explained by nasal blockage. No single pattern of taste loss or recovery was apparent, implying different taste qualities might recover at different rates. Oral burn was transiently reduced for some before recovering quickly, suggesting acute loss may be missed in datasets collected only after illness ends. Collectively, intensive daily testing shows orthonasal smell, oral chemesthesis and taste were each altered by acute SARS-CoV-2 infection. This disruption was dyssynchronous for different modalities, with variable loss and recovery rates across both modalities and individuals.
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Affiliation(s)
- Elisabeth M Weir
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA, 16802, United States of America; Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA, 16802, United States of America
| | - Cara Exten
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA, 16802, United States of America
| | - Richard C Gerkin
- School of Life Sciences, Arizona State University, Tempe, AZ, 85287, United States of America
| | - Steven D Munger
- Department of Pharmacology and Therapeutics, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America; Center for Smell and Taste, University of Florida, Gainesville, FL, 32610, United States of America; Department of Otolaryngology, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America
| | - John E Hayes
- Sensory Evaluation Center, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA, 16802, United States of America; Department of Food Science, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA, 16802, United States of America.
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Szabo E, Ashina S, Melo-Carrillo A, Bolo NR, Borsook D, Burstein R. Peripherally acting anti-CGRP monoclonal antibodies alter cortical gray matter thickness in migraine patients: A prospective cohort study. Neuroimage Clin 2023; 40:103531. [PMID: 37866119 PMCID: PMC10623369 DOI: 10.1016/j.nicl.2023.103531] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 10/24/2023]
Abstract
Migraine is underpinned by central nervous system neuroplastic alterations thought to be caused by the repetitive peripheral afferent barrage the brain receives during the headache phase (cortical hyperexcitability). Calcitonin gene-related peptide monoclonal antibodies (anti-CGRP-mAbs) are highly effective migraine preventative treatments. Their ability to alter brain morphometry in treatment-responders vs. non-responders is not well understood. Our aim was to determine the effects of the anti-CGRP-mAb galcanezumab on cortical thickness after 3-month treatment of patients with high-frequency episodic or chronic migraine. High-resolution magnetic resonance imaging was performed pre- and post-treatment in 36 migraine patients. In this group, 19 patients were classified responders (≥50 % reduction in monthly migraine days) and 17 were considered non-responders (<50 % reduction in monthly migraine days). Following cross-sectional processing to analyze the baseline differences in cortical thickness, two-stage longitudinal processing and symmetrized percent change were conducted to investigate treatment-related brain changes. At baseline, no significant differences were found between the responders and non-responders. After 3-month treatment, decreased cortical thickness (compared to baseline) was observed in the responders in regions of the somatosensory cortex, anterior cingulate cortex, medial frontal cortex, superior frontal gyrus, and supramarginal gyrus. Non-responders demonstrated decreased cortical thickness in the left dorsomedial cortex and superior frontal gyrus. We interpret the cortical thinning seen in the responder group as suggesting that reduction in head pain could lead to changes in neural swelling and dendritic complexity and that such changes reflect the recovery process from maladaptive neural activity. This conclusion is further supported by our recent study showing that 3 months after treatment initiation, the incidence of premonitory symptoms and prodromes that are followed by headache decreases but not the incidence of the premonitory symptoms or prodromes themselves (that is, cortical thinning relates to reductions in the nociceptive signals in the responders). We speculate that a much longer recovery period is required to allow the brain to return to a more 'normal' functioning state whereby prodromes and premonitory symptoms no longer occur.
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Affiliation(s)
- Edina Szabo
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Anaesthesiology, Harvard Medical School, Boston, MA 02215, USA
| | - Sait Ashina
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Anaesthesiology, Harvard Medical School, Boston, MA 02215, USA; Comprehensive Headache Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Agustin Melo-Carrillo
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Anaesthesiology, Harvard Medical School, Boston, MA 02215, USA
| | - Nicolas R Bolo
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - David Borsook
- Department of Anaesthesiology, Harvard Medical School, Boston, MA 02215, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02215, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Anaesthesiology, Harvard Medical School, Boston, MA 02215, USA; Comprehensive Headache Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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Acevedo-González JC, Taub-Krivoy A. Modification to the Hartel Route Radiofrequency Technique for the Treatment of Trigeminal Neuralgia: A Technical Note. World Neurosurg 2023; 178:14-19. [PMID: 37393995 DOI: 10.1016/j.wneu.2023.06.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE To evaluate a modification to the classical Hartel technique for the treatment of trigeminal neuralgia. METHODS Intraoperative radiographs of 30 patients with trigeminal neuralgia treated with radiofrequency were retrospectively reviewed. The distance between the needle and the anterior edge of the temporomandibular joint (TMJ) was measured on strict lateral skull radiographs. Surgical time was reviewed, and clinical outcomes were evaluated. RESULTS All patients showed clinical improvement in pain (Visual Analog Scale). In all radiographs, the measurement between the needle and the anterior edge of the TMJ ranged from 10 mm to 22 mm. None of the measurements were below 10 mm or above 22 mm. In most cases, this distance was 18 mm (9 patients), followed by 16 mm in 5 patients. CONCLUSIONS Considering the inclusion of the oval foramen in a Cartesian coordinate system with axes X, Y, and Z is useful. Directing the needle to a point located 1 cm from the anterior edge of the TMJ, avoiding the medial aspect of the upper jaw ridge, allows for a safer and faster procedure.
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Affiliation(s)
- Juan Carlos Acevedo-González
- Department of Neurosurgery, Functional Neurosurgery, Pain Management, and Spasticity, San Ignacio University Hospital, Pontifical Xaverian University, Bogotá, Colombia
| | - Alex Taub-Krivoy
- Medical Student and Director of the Neurosurgery Research Group at San Ignacio University Hospital, Pontifical Xaverian University, Bogotá, Colombia.
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Labastida-Ramírez A, Caronna E, Gollion C, Stanyer E, Dapkute A, Braniste D, Naghshineh H, Meksa L, Chkhitunidze N, Gudadze T, Pozo-Rosich P, Burstein R, Hoffmann J. Mode and site of action of therapies targeting CGRP signaling. J Headache Pain 2023; 24:125. [PMID: 37691118 PMCID: PMC10494408 DOI: 10.1186/s10194-023-01644-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/01/2023] [Indexed: 09/12/2023] Open
Abstract
Targeting CGRP has proved to be efficacious, tolerable, and safe to treat migraine; however, many patients with migraine do not benefit from drugs that antagonize the CGRPergic system. Therefore, this review focuses on summarizing the general pharmacology of the different types of treatments currently available, which target directly or indirectly the CGRP receptor or its ligand. Moreover, the latest evidence regarding the selectivity and site of action of CGRP small molecule antagonists (gepants) and monoclonal antibodies is critically discussed. Finally, the reasons behind non-responders to anti-CGRP drugs and rationale for combining and/or switching between these therapies are addressed.
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Affiliation(s)
- Alejandro Labastida-Ramírez
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE1 1UL, UK
| | - Edoardo Caronna
- Headache Unit, Neurology Department, Vall d'Hebron Universitary Hospital, Barcelona, Spain
- Headache Research Group, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cédric Gollion
- Department of Neurology, University Hospital of Toulouse, Toulouse, France
| | - Emily Stanyer
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE1 1UL, UK
- Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | | | - Diana Braniste
- Institute of Neurology and Neurosurgery, Diomid Gherman, Chișinău, Moldova
- State University of Medicine and Pharmacy, Nicolae Testemițanu, Moldova
| | - Hoda Naghshineh
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Science, Tehran, Iran
| | - Liga Meksa
- Headache Unit, Neurology and Neurosurgery Department, Riga East University Hospital Gailezers, Riga, Latvia
| | | | - Tamari Gudadze
- Department of Neurology, Christian Hospital Unna, Unna, Germany
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron Universitary Hospital, Barcelona, Spain
- Headache Research Group, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Anesthesia, Harvard Medical School, Boston, MA, USA
- Center for Life Science, Room 649, 3 Blackfan Circle, Boston, MA, 02215, USA
| | - Jan Hoffmann
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE1 1UL, UK.
- NIHR-Wellcome Trust King's Clinical Research Facility/SLaM Biomedical Research Centre, King's College Hospital, London, UK.
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Tsutsumi Y, Morita Y, Sato F, Furuta T, Uchino K, Sohn J, Haque T, Bae YC, Niwa H, Tachibana Y, Yoshida A. Cerebellar Nuclei Receiving Orofacial Proprioceptive Signals through the Mossy Fiber Pathway from the Supra trigeminal Nucleus in Rats. Cerebellum 2023:10.1007/s12311-023-01602-9. [PMID: 37682386 DOI: 10.1007/s12311-023-01602-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/09/2023]
Abstract
Proprioception from muscle spindles is necessary for motor function executed by the cerebellum. In particular, cerebellar nuclear neurons that receive proprioceptive signals and send projections to the lower brainstem or spinal cord play key roles in motor control. However, little is known about which cerebellar nuclear regions receive orofacial proprioception. Here, we investigated projections to the cerebellar nuclei from the supratrigeminal nucleus (Su5), which conveys the orofacial proprioception arising from jaw-closing muscle spindles (JCMSs). Injections of an anterograde tracer into the Su5 resulted in a large number of labeled axon terminals bilaterally in the dorsolateral hump (IntDL) of the cerebellar interposed nucleus (Int) and the dorsolateral protuberance (MedDL) of the cerebellar medial nucleus. In addition, a moderate number of axon terminals were ipsilaterally labeled in the vestibular group Y nucleus (group Y). We electrophysiologically detected JCMS proprioceptive signals in the IntDL and MedDL. Retrograde tracing analysis confirmed bilateral projections from the Su5 to the IntDL and MedDL. Furthermore, anterograde tracer injections into the external cuneate nucleus (ECu), which receives other proprioceptive input from forelimb/neck muscles, resulted in only a limited number of ipsilaterally labeled terminals, mainly in the dorsomedial crest of the Int and the group Y. Taken together, the Su5 and ECu axons almost separately terminated in the cerebellar nuclei (except for partial overlap in the group Y). These data suggest that orofacial proprioception is differently processed in the cerebellar circuits in comparison to other body-part proprioception, thus contributing to the executive function of orofacial motor control.
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Affiliation(s)
- Yumi Tsutsumi
- Department of Systematic Anatomy and Neurobiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yayoi Morita
- Department of Dental Anesthesiology, Osaka University Graduate School of Dentistry, Suita, Osaka, 565-0871, Japan
| | - Fumihiko Sato
- Department of Systematic Anatomy and Neurobiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takahiro Furuta
- Department of Systematic Anatomy and Neurobiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Katsuro Uchino
- Department of Acupuncture, Faculty of Health Care Sciences, Takarazuka University of Medical and Health Care, Takarazuka, Hyogo, 666-0162, Japan
| | - Jaerin Sohn
- Department of Systematic Anatomy and Neurobiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tahsinul Haque
- Department of Preventive Sciences, College of Dentistry, Dar Al Uloom University, Riyadh, 13314, Saudi Arabia
| | - Yong Chul Bae
- Department of Anatomy and Neurobiology, School of Dentistry, Kyungpook National University, Daegu, 700-412, Korea
| | - Hitoshi Niwa
- Department of Dental Anesthesiology, Osaka University Graduate School of Dentistry, Suita, Osaka, 565-0871, Japan
| | - Yoshihisa Tachibana
- Division of Physiology and Cell Biology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki, Chuo, Kobe, Hyogo, 650-0017, Japan.
| | - Atsushi Yoshida
- Department of Systematic Anatomy and Neurobiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan.
- Department of Oral Health Sciences, Faculty of Health Care Sciences, Takarazuka University of Medical and Health Care, Takarazuka, Hyogo, 666-0162, Japan.
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Hernandez AK, Walke A, Haehner A, Cuevas M, Hummel T. Correlations between gustatory, trigeminal, and olfactory functions and nasal airflow. Eur Arch Otorhinolaryngol 2023; 280:4101-4109. [PMID: 37129608 PMCID: PMC10153028 DOI: 10.1007/s00405-023-07962-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/01/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE To determine the relationship of chemosensory screening and nasal airflow tests among the same set of participants, and to determine other factors that are related to the outcomes of these tests. METHODS Participants had no chemosensory complaints. Structured medical history was taken. Participants underwent 5 screening tests: q-sticks (orthonasal olfaction), q-powders (retronasal olfaction), trigeminal lateralization test, taste sprays, and peak nasal inspiratory flow (PNIF). Ratings of smell/taste ability and nasal airflow were obtained using visual analogue scales (VAS). Composite sinusitis symptoms and significance of olfaction questionnaire scores were also determined. RESULTS Four hundred participants were included in the study, 156 men, 244 women; aged 18-82 years (mean: 46). The q-powders and taste spray scores were weakly positively correlated with all the other chemosensory tests and PNIF. However, chemosensory test scores were not correlated with VAS, composite sinusitis symptoms, and significance of olfaction questionnaire scores. Various tests showed significant decrease starting at specific ages (in years, PNIF and trigeminal lateralization: 40, q-powders: 60, and q-sticks: 70). CONCLUSION Chemosensory screening tests and self-rated chemosensory function showed no correlation in participants without chemosensory complaints. In addition, gustatory function appeared to be correlated with olfactory and trigeminal function but also with nasal airflow, and nasal airflow was related not only to olfactory but also to trigeminal and taste function. Over all, the results suggest that chemosensory functions (orthonasal olfactory, trigeminal, retronasal olfactory, gustatory) and nasal airflow are correlated with each other, which we propose may be possibly mediated, at least in part, through central nervous system interactions.
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Affiliation(s)
- Anna Kristina Hernandez
- Department of Otorhinolaryngology, Smell and Taste Clinic, TU Dresden, Haus 5, Fetscherstrasse 74, 01307, Dresden, Germany.
- Department of Otolaryngology - Head and Neck Surgery, Philippine General Hospital, University of the Philippines - Manila, Manila, Philippines.
- Department of Otolaryngology - Head and Neck Surgery, Asian Hospital and Medical Center, Muntinlupa, Philippines.
| | - Antje Walke
- Department of Otorhinolaryngology, Smell and Taste Clinic, TU Dresden, Haus 5, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Antje Haehner
- Department of Otorhinolaryngology, Smell and Taste Clinic, TU Dresden, Haus 5, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Mandy Cuevas
- Department of Otorhinolaryngology, Smell and Taste Clinic, TU Dresden, Haus 5, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Thomas Hummel
- Department of Otorhinolaryngology, Smell and Taste Clinic, TU Dresden, Haus 5, Fetscherstrasse 74, 01307, Dresden, Germany
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Benoit J, Norton LA, Jirah S. The maxillary canal of the titanosuchid Jonkeria (Synapsida, Dinocephalia). Naturwissenschaften 2023; 110:27. [PMID: 37272962 PMCID: PMC10241669 DOI: 10.1007/s00114-023-01853-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/13/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023]
Abstract
The maxillary canal of the titanosuchid dinocephalian Jonkeria is described based on digitised serial sections. We highlight that its morphology is more like that of the tapinocephalid Moschognathus than that of Anteosaurus. This is unexpected given the similarities between the dentition of Jonkeria and Anteosaurus (i.e., presence of a canine) and the fact that the branching pattern of the maxillary canal in synapsids usually co-varies with dentition. Hypotheses to account for similarities between Jonkeria and Moschognathus (common ancestry, function in social signalling or underwater sensing) are discussed. It is likely that the maxillary canal carries a strong phylogenetic signal, here supporting the clade Tapinocephalia.
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Affiliation(s)
- Julien Benoit
- Evolutionary Studies Institute, University of the Witwatersrand, Johannesburg, South Africa.
| | - Luke A Norton
- Evolutionary Studies Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Sifelani Jirah
- Evolutionary Studies Institute, University of the Witwatersrand, Johannesburg, South Africa
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Mignot C, Faria V, Hummel T, Frost M, Michel CM, Gossrau G, Haehner A. Migraine with aura: less control over pain and fragrances? J Headache Pain 2023; 24:55. [PMID: 37198532 DOI: 10.1186/s10194-023-01592-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/04/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Accumulating data emphasizes the importance of olfaction in migraine pathophysiology. However, there are only a few studies evaluating how the migraine brain processes olfactory stimulation, and virtually no studies comparing patients with and without aura in this context. METHODS This cross-sectional study recorded event-related potentials from 64 electrodes during a pure olfactory or pure trigeminal stimulus in females with episodic migraine with aura (n = 13) and without aura (n = 15), to characterize the central nervous processing of these intranasal stimuli. Patients were tested in interictal state only. Data were analyzed in the time domain and in the time-frequency domain. Source reconstruction analysis was also performed. RESULTS Patients with aura had higher event-related potentials amplitudes for left-sided trigeminal and left-sided olfactory stimulations, and higher neural activity for right-sided trigeminal stimulation in brain areas related to trigeminal and visual processing. Following olfactory stimulations patients with aura displayed decreased neural activity in secondary olfactory structures compared to patients without aura. Oscillations in the low frequency bands (< 8 Hz) differed between patient groups. CONCLUSIONS Altogether this may reflect hypersensitivity to nociceptive stimuli in patients with aura relative to patients without aura. Patients with aura have a bigger deficit in engaging secondary olfactory-related structures, possibly leading to distorted attention and judgements towards odors. The cerebral overlap between trigeminal nociception and olfaction might explain these deficits.
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Affiliation(s)
- Coralie Mignot
- Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Smell & Taste Clinic, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Vanda Faria
- Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Smell & Taste Clinic, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- Department of Psychology, Uppsala University, 752 37, Uppsala, Sweden
- Brain and Eye Pain Imaging Lab, Pain and Affective Neuroscience Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, MA 02115, USA
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, MA 02115, USA
| | - Thomas Hummel
- Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Smell & Taste Clinic, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Marie Frost
- Comprehensive Pain Center, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christoph M Michel
- Department of Basic Neurosciences, University of Geneva, CH-1211, Geneva 4, Switzerland
- CIBM Center for Biomedical Imaging, 1015, Lausanne, Switzerland
| | - Gudrun Gossrau
- Comprehensive Pain Center, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Antje Haehner
- Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Smell & Taste Clinic, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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12
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Ashina S, Melo-Carrillo A, Toluwanimi A, Bolo N, Szabo E, Borsook D, Burstein R. Galcanezumab effects on incidence of headache after occurrence of triggers, premonitory symptoms, and aura in responders, non-responders, super-responders, and super non-responders. J Headache Pain 2023; 24:26. [PMID: 36927366 PMCID: PMC10018924 DOI: 10.1186/s10194-023-01560-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND The goal of this observational, open-label, cohort study was to determine whether prophylactic migraine treatment with galcanezumab, a peripherally acting drug, alters the incidence of premonitory symptoms, and/or occurrence of headache after exposure to triggers or aura episodes in treatment-responders (≥ 50% reduction in monthly migraine days [MMD]), super-responders (≥ 70%), non-responders (< 50%) and super non-responders (< 30%). METHODS Participants were administered electronic daily headache diaries to document migraine days and associated symptoms one month before and during the three months of treatment. Questionnaires were used to identify conscious prodromal and trigger events that were followed by headache prior to vs. after 3 months of treatment. RESULTS After 3 months of galcanezumab treatment, (a) the incidence of premonitory symptoms that were followed by headache decreased by 48% in the 27 responders vs. 28% in the 19 non-responders, and by 50% in the 11 super-responders vs. 12% in the 8 super non-responders; (b) the incidence of visual and sensory aura that were followed by headache was reduced in responders, non-responders, and super-responders, but not in super non-responders; (c) the number of triggers followed by headache decreased by 38% in responders vs. 13% in non-responders, and by 31% in super-responders vs. 4% in super non-responders; and (d) some premonitory symptoms (e.g., cognitive impairment, irritability, fatigue) and triggers (e.g., stress, sleeping too little, bright light, aura) were followed by headache only in super non-responders. CONCLUSIONS Mechanistically, these findings suggest that even a mild decrease in migraine frequency is sufficient to partially reverse the excitability and responsivity of neurons involved in the generation of certain triggers and potentially premonitory symptoms of migraine. TRIAL REGISTRATION ClinicalTrials.gov: NCT04271202. Registration date: February 10, 2020.
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Affiliation(s)
- Sait Ashina
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Anesthesia, Harvard Medical School, Boston, MA, USA.,Comprehensive Headache Center, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Agustin Melo-Carrillo
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Anesthesia, Harvard Medical School, Boston, MA, USA
| | - Ajayi Toluwanimi
- Clinical Research Center, Beth Israel Deaconess Medical Boston, Boston, MA, USA
| | - Nicolas Bolo
- Departments of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Edina Szabo
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Anesthesia, Harvard Medical School, Boston, MA, USA
| | - David Borsook
- Departments of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Departments of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. .,Department of Anesthesia, Harvard Medical School, Boston, MA, USA. .,Center for Life Science, Room 649, 3 Blackfan Circle, Boston, MA, 02215, USA.
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13
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Mansano AM, Frederico TN, Valentin REB, Carmona MJC, Ashmawi HA. Percutaneous Radiofrequency Ablation for Trigeminal Neuralgia Management: A Randomized, Double-Blinded, Sham-Controlled Clinical Trial. Pain Med 2023; 24:234-243. [PMID: 36029256 DOI: 10.1093/pm/pnac132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022]
Abstract
Trigeminal neuralgia, considered by many the worst pain that humankind can experience, has been called "the suicide disease." Neuroablative procedures are good options when conservative treatment fails to promote pain relief or in those whose side effects are unbearable. The objective was to compare the effectiveness and safety of trigeminal percutaneous radiofrequency ablation in classical refractory trigeminal neuralgia in a prospective, randomized, double-blind, sham-controlled clinical trial. We included 30 consecutive patients with classical trigeminal neuralgia who had failed to respond to drug treatment. The patients were randomly assigned into two groups: a thermal radiofrequency and a sham group. The thermal radiofrequency group were submitted to a 75°C lesion for 60 seconds after proper sensory and motor stimulation. All steps were carried out in the sham group except the thermal lesion. Patients were evaluated using the Numerical Rating Scale (NRS), the 36-Item Short-Form Health Survey questionnaire, and anticonvulsant dose. After 1 month, the mean NRS score decreased from 9.2 to 0.7 in the radiofrequency group and from 8.9 to 5.8 in the sham group. This significant reduction was measurable starting at day one after the procedure and remained significant throughout the first month. Changing groups was allowed after one month, after which the pain reduction was similar between the two groups. Percutaneous trigeminal radiofrequency ablation results in statistically and clinically significant greater pain relief than the sham procedure after 1 month of follow-up. These results support using radiofrequency nerve ablation as a treatment for refractory trigeminal neuralgia.
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Affiliation(s)
- André Marques Mansano
- Anesthesiology Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Thiago Nouer Frederico
- Interventional Pain Management, Hospita Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | | | - Hazem Adel Ashmawi
- Anesthesiology Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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14
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Venugopal S, Ghulam-Jhelani Z, Ahn IS, Yang X, Wiedau M, Simmons D, Chandler SH. Early deficits in GABA inhibition parallels an increase in L-type Ca 2+ currents in the jaw motor neurons of SOD1 G93A mouse model for ALS. Neurobiol Dis 2023; 177:105992. [PMID: 36623607 DOI: 10.1016/j.nbd.2023.105992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 12/21/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023] Open
Abstract
Amyotrophic Lateral Sclerosis (ALS) involves protracted pre-symptomatic periods of abnormal motor neuron (MN) excitability occurring in parallel with central and peripheral synaptic perturbations. Focusing on inhibitory control of MNs, we first compared longitudinal changes in pre-synaptic terminal proteins for GABA and glycine neurotransmitters around the soma of retrogradely identified trigeminal jaw closer (JC) MNs and ChAT-labeled midbrain extraocular (EO) MNs in the SOD1G93A mouse model for ALS. Fluorescence immunocytochemistry and confocal imaging were used to quantify GAD67 and GlyT2 synaptic bouton density (SBD) around MN soma at pre-symptomatic ages ∼P12 (postnatal), ∼P50 (adult) and near disease end-stage (∼P135) in SOD1G93A mice and age-matched wild-type (WT) controls. We noted reduced GAD67 innervation in the SOD1G93A trigeminal jaw closer MNs around P12, relative to age-matched WT and no significant difference around P50 and P135. In contrast, both GAD67 and GlyT2 innervation were elevated in the SOD1G93A EO MNs at the pre-symptomatic time points. Considering trigeminal MNs are vulnerable in ALS while EO MNs are spared, we suggest that upregulation of inhibition in the latter might be compensatory. Notable contrast also existed in the innate co-expression patterns of GAD67 and GlyT2 with higher mutual information (co-dependency) in EO MNs compared to JC in both SOD1G93A and WT mice, especially at adult stages (P50 and P135). Around P12 when GAD67 terminals expression was low in the mutant, we further tested for persistent GABA inhibition in those MNs using in vitro patch-clamp electrophysiology. Our results show that SOD1G93A JC MNs have reduced persistent GABA inhibition, relative to WT. Pharmacological blocking of an underlying tonically active GABA conductance using the GABA-α5 subunit inverse agonist, L-655-708, disinhibited WT JC MNs and lowered their recruitment threshold, suggesting its role in the control of intrinsic MN excitability. Quantitative RT-PCR in laser dissected JC MNs further supported a reduction in GABA-α5 subunit mRNA expression in the mutant. In light of our previous report that JC MNs forming putative fast motor units have lower input threshold in the SOD1G93A mice, we suggest that our present result on reduced GABA-α5 tonic inhibition provides for a mechanism contributing to such imbalance. In parallel with reduced GABA inhibition, we noted an increase in voltage-gated L-type Ca2+ currents in the mutant JC MNs around P12. Together these results support that, early modifications in intrinsic properties of vulnerable MNs could be an adaptive response to counter synaptic deficits.
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Affiliation(s)
- Sharmila Venugopal
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Neurology, University of California, Los Angeles, Los Angeles, CA 90095, USA.
| | - Zohal Ghulam-Jhelani
- Undergraduate Interdepartmental Program for Neuroscience, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - In Sook Ahn
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Xia Yang
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Martina Wiedau
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Dwayne Simmons
- Department of Biology, Baylor University, Waco, TX 76798, USA
| | - Scott H Chandler
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA 90095, USA.
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15
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Hosseini M, Asarzadegan F, Shafiee E, Alijanpour S. Trigeminal neuralgia: IncobotulinumtoxinA (Xeomin), can it decrease the pharmacological intervention? (A case series). Caspian J Intern Med 2023; 14:376-379. [PMID: 37223298 PMCID: PMC10201132 DOI: 10.22088/cjim.14.2.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/18/2021] [Accepted: 12/25/2021] [Indexed: 05/25/2023]
Abstract
Background Trigeminal neuralgia is one of the most disabling facial pain syndromes. In recent years' new therapeutic strategy, incobotulinumtoxin A has emerged. The aim of the current study was to determine the time and duration of pain in 3 cases with pharmacological treatment and incobotulinumtoxin A. Case presentation In three patients with different onsets, trigeminal neuralgia was diagnosed. Pain severity was assessed by the visual analogue scale. Patient demographics and clinical data were filled in a checklist. They were females with age ranging from 39 to 49 years. Two patients had normal MRI and one patient had no any recent MRI. One center and specialist injection Xeomin 50 units for one time. Despite long time oral treatment, their symptoms had no significant improvement, but after incobotulinumtoxin A injection, pain frequency, severity and duration decreased in patients. Conclusion Result showed that the frequency, severity and duration of pain attacks was efficiently decreased by incobotulinumtoxin A with low side-effects. Its complication and side-effect should be considered in the future.
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Affiliation(s)
- Meghdad Hosseini
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Asarzadegan
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Erfan Shafiee
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shayan Alijanpour
- Students Scientific Research Center, School of Nursing and Midwifery, Tehran University of Medical Science, Tehran, Iran
- Research and Planning Unite, Pre-hospital Emergency Organization and Emergency Medical Service Center, Babol University of Medical Sciences, Babol, Iran
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16
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Bram R, Choi JL, See AP, Atwal GS. A persistent trigeminal artery demonstrates cerebrovascular embryologic development. Surg Neurol Int 2023; 14:40. [PMID: 36895245 PMCID: PMC9990760 DOI: 10.25259/sni_950_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023] Open
Abstract
Background Cerebrovascular embryologic development is characterized by the presence of four well-described carotid-vertebrobasilar (VB) anastomoses. As the fetal hindbrain matures and the VB system develops, these connections involute, yet some may persist into adulthood. The persistent primitive trigeminal artery (PPTA) is the most common of these anastomoses. In this report, we describe a unique variant of the PPTA and a four-way division of the VB circulation. Case Description A female in her 70s presented with a Fisher Grade 4 subarachnoid hemorrhage. Catheter angiography revealed a fetal origin of the left posterior cerebral artery (PCA) giving rise to a left P2 aneurysm which was coiled. A PPTA arose from the left internal carotid artery and supplied the distal basilar artery (BA) including the superior cerebellar arteries bilaterally and the right but not left PCA. The mid-BA was atretic and the anterior inferior cerebellar artery-posterior inferior cerebellar artery complexes were fed solely from the right vertebral artery. Conclusion Our patient's cerebrovascular anatomy represents a unique variant of the PPTA not well described in the literature. This demonstrates how hemodynamic capture of the distal VB territory by a PPTA is sufficient to prevent fusion of the BA.
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Affiliation(s)
- Richard Bram
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, United States
| | - Jason L Choi
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, United States
| | - Alfred P See
- Department of Neurosurgery, Cerebrovascular Surgery and Interventions Center, Boston Children's Hospital, Harvard Medical School, Boston, United States
| | - Gursant S Atwal
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, United States
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17
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Tsutsumi Y, Sato F, Furuta T, Uchino K, Moritani M, Bae YC, Kato T, Tachibana Y, Yoshida A. The Cerebellar Cortex Receives Orofacial Proprioceptive Signals from the Supra trigeminal Nucleus via the Mossy Fiber Pathway in Rats. Cerebellum 2022:10.1007/s12311-022-01434-z. [PMID: 35781609 DOI: 10.1007/s12311-022-01434-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 06/15/2023]
Abstract
Proprioceptive sensory information from muscle spindles is essential for the regulation of motor functions. However, little is known about the motor control regions in the cerebellar cortex that receive proprioceptive signals from muscle spindles distributed throughout the body, including the orofacial muscles. Therefore, in this study, we investigated the pattern of projections in the rat cerebellar cortex derived from the supratrigeminal nucleus (Su5), which conveys orofacial proprioceptive information from jaw-closing muscle spindles (JCMSs). Injections of an anterograde tracer into the Su5 revealed that many bilateral axon terminals (rosettes) were distributed in the granular layer of the cerebellar cortex (including the simple lobule B, crus II and flocculus) in a various sized, multiple patchy pattern. We could also detect JCMS proprioceptive signals in these cerebellar cortical regions, revealing for the first time that they receive muscle proprioceptive inputs in rats. Retrograde tracer injections confirmed that the Su5 directly sends outputs to the cerebellar cortical areas. Furthermore, we injected an anterograde tracer into the external cuneate nucleus (ECu), which receives proprioceptive signals from the forelimb and neck muscle spindles, to distinguish between the Su5- and ECu-derived projections in the cerebellar cortex. The labeled terminals from the ECu were distributed predominantly in the vermis of the cerebellar cortex. Almost no overlap was seen in the terminal distributions of the Su5 and ECu projections. Our findings demonstrate that the rat cerebellar cortex receives orofacial proprioceptive input that is processed differently from the proprioceptive signals from the other regions of the body.
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Affiliation(s)
- Yumi Tsutsumi
- Department of Oral Anatomy and Neurobiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Fumihiko Sato
- Department of Oral Anatomy and Neurobiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takahiro Furuta
- Department of Oral Anatomy and Neurobiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Katsuro Uchino
- Faculty of Health Care Science, Takarazuka University of Medical and Health Care, Takarazuka, Hyogo, 666-0162, Japan
| | - Masayuki Moritani
- Department of Physical Therapy, Faculty of Health Science, Morinomiya University of Medical Sciences, Osaka, 559-8611, Japan
| | - Yong Chul Bae
- Department of Anatomy and Neurobiology, School of Dentistry, Kyungpook National University, Daegu, 700-412, Korea
| | - Takafumi Kato
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, Suita, Osaka, 565-0871, Japan
| | - Yoshihisa Tachibana
- Division of Physiology and Cell Biology, Kobe University Graduate School of Medicine, Kobe, Hyogo, 650-0017, Japan
| | - Atsushi Yoshida
- Department of Oral Anatomy and Neurobiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan.
- Faculty of Health Care Science, Takarazuka University of Medical and Health Care, Takarazuka, Hyogo, 666-0162, Japan.
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Karsan N, Nagaraj K, Goadsby PJ. Cranial autonomic symptoms: prevalence, phenotype and laterality in migraine and two potentially new symptoms. J Headache Pain 2022; 23:18. [PMID: 35093009 PMCID: PMC8903520 DOI: 10.1186/s10194-022-01389-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/12/2022] [Indexed: 11/12/2022] Open
Abstract
Background Whilst cranial autonomic symptoms (CAS) are typically associated with trigeminal autonomic cephalalgias (TAC’s), they have also been reported in migraine. Identification and understanding of these symptoms in migraine is important to ensure timely diagnosis and effective management. Methods Migraineurs seen in a tertiary headache service between 2014 and 2018 (n = 340): cohort one, and a separate cohort of headache patients seen between 2014-May 2021 reporting voice change, or throat swelling, or both, as CAS were selected (n = 64): cohort two. We performed a service evaluation of our records regarding age, sex, diagnosis, headache and CAS frequency and laterality as acquired from the first consultation, during which a detailed headache history is taken by a headache trained physician. Results Cohort 1: Mean age 43 (range 14–94, SD 15). The most common diagnosis was chronic migraine (78%). Median monthly headache frequency was 26 days (IQR 15–75). At least one CAS was reported in 74%, with a median of two (IQR 0–3). The most common were nasal congestion (32%), lacrimation (31%) and aural fullness (25%). Most patients reported their most common headache as unilateral (80%) and with it strictly unilateral CAS (64%). There was a positive association between headache and CAS laterality (χ21 = 20.7, P < 0.001), with a positive correlation between baseline headache frequency and number of CAS reported (r = 0.11, P = 0.047). Cohort two: mean age 49 (range 23–83, SD 14). Diagnoses were chronic migraine (50%), chronic cluster headache (11%), undifferentiated continuous lateralised headache (9%), SUNCT/SUNA (8%), hemicrania continua (8%), episodic migraine (8%), episodic cluster headache (3%) and trigeminal neuropathies (3%). Most (89%) described trigeminal distribution pain; 25% involving all three divisions. Throat swelling was reported by 54, voice change by 17, and both by 7. The most common CAS reported were lacrimation (n = 47), facial swelling (n = 45) and rhinorrhoea (n = 37). There was significant agreement between the co-reporting of throat swelling (χ21 = 7.59, P = 0.013) and voice change (χ21 = 6.49, P = 0.02) with aural fullness. Conclusions CAS are common in migraine, are associated with increasing headache frequency and tend to lateralise with headache. Voice change and throat swelling should be recognized as possible parasympathetically-mediated CAS. They may be co-associated and associated with aural fullness, suggesting a broadly somatotopic endophenotype.
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Affiliation(s)
- Nazia Karsan
- Headache Group, Division of Neuroscience, Wolfson Centre for Age Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley Biomedical Research Centre, King's College Hospital, London, UK
| | - Karthik Nagaraj
- Department of Neurology, Bangalore Medical College and Research Institute, Bangalore, India
| | - Peter J Goadsby
- Headache Group, Division of Neuroscience, Wolfson Centre for Age Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. .,South London and Maudsley Biomedical Research Centre, King's College Hospital, London, UK. .,Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA.
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19
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Kaya A, Kaya SY. A case of trigeminal neuralgia developing after a COVID-19 vaccination. J Neurovirol 2021; 28:181-182. [PMID: 34870807 PMCID: PMC8647511 DOI: 10.1007/s13365-021-01030-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/20/2021] [Accepted: 11/09/2021] [Indexed: 11/02/2022]
Abstract
In this case, we report a patient who developed acute trigeminal neuritis after using a Pfizer-BioNtech vaccination against SARS-CoV-2. The patient was completely recovered with steroid treatment.
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Affiliation(s)
- Abdurrahman Kaya
- Department of Infectious Disease, Istanbul Training and Research Hospital, Istanbul, Turkey.
| | - Sibel Yıldız Kaya
- Department of Infectious Disease, Sungurlu State Hospital, Sungurlu, Turkey
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20
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Martinez-Perez R, Aref M, Ramakhrisnan V, Youssef AS. Combined biportal unilateral endoscopic endonasal and endoscopic anterior transmaxillary approach for resection of lesions involving the infratemporal fossa. Acta Neurochir (Wien) 2021; 163:3439-45. [PMID: 34633545 DOI: 10.1007/s00701-021-04994-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Approaching tumors involving the infratemporal fossa (ITF) is technically challenging due to the complex relationships between several neurovascular structures and the deep-seated location of these lesions. METHODS The authors describe in detail a minimally invasive approach to the ITF, consisting on a single-nostril endoscopic endonasal transmaxillary approach aided by an anterior transmaxillary port (EEA-ATMa). Anatomical landmarks and surgical tenets of this approach are highlighted and reviewed with the goal to guarantee successful tumor resection and avoid operative complications. CONCLUSION The EEA-ATMa is technically feasible and offers excellent surgical exposure to the anterior and lateral aspect of ITF, without the need of transecting the Vidian nerve or performing a wide septectomy.
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Abstract
Aβ-afferents in maxillary or V2 trigeminal ganglion (TG) neurons are somatosensory neurons that may be involved in both non-nociceptive and nociceptive functions in orofacial regions. However, electrophysiological properties of these V2 trigeminal Aβ-afferent neurons have not been well characterized so far. Here, we used rat ex vivo trigeminal nerve preparations and applied patch-clamp recordings to large-sized V2 TG neurons to characterize their electrophysiological properties. All the cells recorded had afferent conduction velocities in the range of Aβ-afferent conduction speeds. However, these V2 trigeminal Aβ-afferent neurons displayed different action potential (AP) properties. APs showed fast kinetics in some cells but slow kinetics with shoulders in repolarization phases in other cells. Based on the derivatives of voltages in AP repolarization with time (dV/dt), we classified V2 trigeminal Aβ-afferent neurons into four types: type I, type II, type IIIa and type IIIb. Type I V2 trigeminal Aβ-afferent neurons had the largest dV/dt of repolarization, the fastest AP conduction velocities, the shortest AP and afterhyperpolarization (AHP) durations, and the highest AP success rates. In contrast, type IIIb V2 trigeminal Aβ-afferent neurons had the smallest dV/dt of AP repolarization, the slowest AP conduction velocities, the longest AP and AHP durations, and the lowest AP success rates. The type IIIb cells also had significantly lower voltage-activated K+ currents. For type II and type IIIa V2 trigeminal Aβ-afferent neurons, AP parameters were in the range between those of type I and type IIIb V2 trigeminal Aβ-afferent neurons. Our electrophysiological classification of V2 trigeminal Aβ-afferent neurons may be useful in future to study their non-nociceptive and nociceptive functions in orofacial regions.
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Affiliation(s)
- Yuya Okutsu
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Akihiro Yamada
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sotatsu Tonomura
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ryan J Vaden
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jianguo G Gu
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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22
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Bahia PK, Taylor-Clark TE. Differential sensitivity of cinnamaldehyde-evoked calcium fluxes to ruthenium red in guinea pig and mouse trigeminal sensory neurons. BMC Res Notes 2021; 14:127. [PMID: 33827677 PMCID: PMC8028702 DOI: 10.1186/s13104-021-05539-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/23/2021] [Indexed: 12/04/2022] Open
Abstract
Objective Transient receptor potential ankyrin 1 (TRPA1) is an excitatory ion channel expressed on a subset of sensory neurons. TRPA1 is activated by a host of noxious stimuli including pollutants, irritants, oxidative stress and inflammation, and is thought to play an important role in nociception and pain perception. TRPA1 is therefore a therapeutic target for diseases with nociceptive sensory signaling components. TRPA1 orthologs have been shown to have differential sensitivity to certain ligands. Cinnamaldehyde has previously been shown to activate sensory neurons via the selective gating of TRPA1. Here, we tested the sensitivity of cinnamaldehyde-evoked responses in mouse and guinea pig sensory neurons to the pore blocker ruthenium red (RuR). Results Cinnamaldehyde, the canonical TRPA1-selective agonist, caused robust calcium fluxes in trigeminal neurons dissociated from both mice and guinea pigs. RuR effectively inhibited cinnamaldehyde-evoked responses in mouse neurons at 30 nM, with complete block seen with 3 μM. In contrast, responses in guinea pig neurons were only partially inhibited by 3 μM RuR. We conclude that RuR has a decreased affinity for guinea pig TRPA1 compared to mouse TRPA1. This study provides further evidence of differences in ligand affinity for TRPA1 in animal models relevant for drug development.
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Affiliation(s)
- Parmvir K Bahia
- Molecular Pharmacology & Physiology, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Thomas E Taylor-Clark
- Molecular Pharmacology & Physiology, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA.
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Kim EHJ, Paredes D, Motoi L, Eckert M, Wadamori Y, Tartaglia J, Wade C, Green C, Hedderley DH, Morgenstern MP. Subthreshold chemesthetic stimulation can enhance flavor lastingness of a soft chewable candy. Food Res Int 2021; 140:109883. [PMID: 33648200 DOI: 10.1016/j.foodres.2020.109883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 10/23/2022]
Abstract
In addition to taste and aroma components of a flavor, FEMA GRAS approved chemesthetic flavor ingredients deliver a trigeminal experience or chemesthetic effect and provide a third dimension to overall flavor experience. In this study, we explored the impact of chemesthetic stimulation on dynamic flavor perception, acceptability and salivation, with two base flavors (mint, watermelon), using a soft chewable candy as a model food. Each base flavor was augmented with three increasing levels of a mixture of chemesthetic flavor ingredients, which provided a cooling sensation; subthreshold, detection threshold, and supra-threshold levels. Thirty-six panelists were asked to rate the perceived flavor intensity of each sample during eating and after swallowing using time intensity analysis. Lastingness after swallowing was measured as the time for the flavor intensity to drop below 25% of the maximum intensity perceived during chewing. Compared with the control, the addition of chemesthetic flavor ingredients increased the perceived flavor intensity during chewing and the flavor lastingness after swallowing for both mint and watermelon flavor. These effects started from the addition of subthreshold concentration of chemesthetic flavor ingredients and further increased with increasing the concentration of chemesthetic flavor ingredients added. By adding the subthreshold concentration of chemesthetic flavor ingredients, the flavor lastingness was increased by 32% for mint flavor and 22% for watermelon flavor. The acceptability of these weak-flavored soft chewable candy test samples was significantly increased towards 'just right' with increasing concentrations of chemesthetic flavor ingredients, even at subthreshold level. However, chew time and saliva flow rate were not affected by the addition of chemesthetic flavor ingredients. The increased flavor lastingness by the addition of chemesthetic flavor ingredients could therefore be explained by perceptual interaction between chemesthesis and flavor perception.
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Affiliation(s)
- Esther H-J Kim
- The New Zealand Institute for Plant and Food Research Limited, Lincoln, New Zealand.
| | - Dulce Paredes
- Takasago International Corporation (USA), Rockleigh, NJ, USA
| | - Lidia Motoi
- The New Zealand Institute for Plant and Food Research Limited, Lincoln, New Zealand
| | - Markus Eckert
- Takasago International Corporation (USA), Rockleigh, NJ, USA
| | - Yukiko Wadamori
- The New Zealand Institute for Plant and Food Research Limited, Lincoln, New Zealand
| | | | - Cath Wade
- The New Zealand Institute for Plant and Food Research Limited, Lincoln, New Zealand
| | - Carter Green
- Takasago International Corporation (USA), Rockleigh, NJ, USA
| | - Duncan H Hedderley
- The New Zealand Institute for Plant and Food Research Limited, Palmerston North, New Zealand
| | - Marco P Morgenstern
- The New Zealand Institute for Plant and Food Research Limited, Lincoln, New Zealand
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24
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Cornelison LE, Woodman SE, Durham PL. 5-HT3/7 and GABA B receptors mediate inhibition of trigeminal nociception by dietary supplementation of grape seed extract. Nutr Neurosci 2021; 25:1565-1576. [PMID: 33544064 PMCID: PMC8339147 DOI: 10.1080/1028415x.2021.1880211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Temporomandibular joint disorder is a prevalent orofacial pain condition involving sensitization and activation of trigeminal nociceptive neurons. Dietary supplementation with a proanthocyanin-enriched grape seed extract (GSE) was found to inhibit trigeminal nociception in a chronic TMD model. In this study, the cellular mechanisms by which GSE inhibits sustained trigeminal nociception in male and female Sprague Dawley rats were investigated.Methods: Some animals were supplemented with 0.5% GSE dissolved in their water one week prior to neck muscle inflammation induced by injection of complete Freund's adjuvant into the trapezius. To investigate the mechanism of GSE, some animals were injected intracisternally with antagonists of 5-HT3, 5-HT7, GABAA, or GABAB, receptor prior to jaw opening.Results: In males and females, trapezius inflammation prior to jaw opening resulted in sustained mechanical hypersensitivity of trigeminal nociceptors that was significantly inhibited by GSE. Further, GSE beginning 14 days post jaw opening also inhibited trigeminal nociception. Intracisternal injection of antagonists of the 5-HT3/7 and GABAB, but not GABAA receptors reduced the anti-nocifensive effect of GSE in both sexes. Neuronal expression of GABAB protein and mRNA in the spinal cord and trigeminal ganglion were detected.Conclusions: The inhibitory effect of GSE is mediated via activation of 5-HT3/7 receptors and GABAB to enhance central descending inhibitory pain pathways and suppress ongoing trigeminal nociception. Further, our findings support the use of GSE as a dietary supplement in the management of pain associated with TMD and other orofacial pain conditions involving central sensitization and dysfunction of descending pain modulation.
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Uddin O, Anderson M, Smith J, Masri R, Keller A. Parabrachial complex processes dura inputs through a direct trigeminal ganglion-to-parabrachial connection. Neurobiol Pain 2021; 9:100060. [PMID: 33537510 PMCID: PMC7840999 DOI: 10.1016/j.ynpai.2021.100060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/18/2020] [Accepted: 01/17/2021] [Indexed: 11/11/2022]
Abstract
Parabrachial complex (PB) neurons respond reliably to dura stimulation. Trigeminal ganglion (TG) neurons project directly to PB. TG neurons project to both dura and PB, demonstrating a direct connection.
Migraines cause significant disability and contribute heavily to healthcare costs. Irritation of the meninges’ outermost layer (the dura mater), and trigeminal ganglion activation contribute to migraine initiation. Maladaptive changes in central pain-processing regions are also important in maintaining pain. The parabrachial complex (PB) is a central region that mediates chronic pain. PB receives diverse sensory information, including a direct input from the trigeminal ganglion. We hypothesized that PB processes inputs from the dura. Using in vivo electrophysiology recordings from single units in anesthetized rats we identified 58 neurons in lateral PB that respond reliably and with short latency to electrical dura stimulation. After injecting tracer into PB, anatomical examination reveals retrogradely labeled cell bodies in the trigeminal ganglion. Neuroanatomical tract-tracing revealed a population of neurons in the trigeminal ganglion that innervate the dura and project directly to PB. These findings indicate that PB is strategically placed to process dura inputs and suggest that it is directly involved in the pathogenesis of migraine headaches.
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Affiliation(s)
- Olivia Uddin
- Department of Anatomy and Neurobiology, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, MD 21201, United States
| | - Michael Anderson
- Department of Anatomy and Neurobiology, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, MD 21201, United States
| | - Jesse Smith
- Department of Anatomy and Neurobiology, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, MD 21201, United States
| | - Radi Masri
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, United States
| | - Asaf Keller
- Department of Anatomy and Neurobiology, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, MD 21201, United States
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Cornelison LE, Hawkins JL, Woodman SE, Durham PL. Noninvasive vagus nerve stimulation and morphine transiently inhibit trigeminal pain signaling in a chronic headache model. Pain Rep 2020; 5:e881. [PMID: 33364541 DOI: 10.1097/PR9.0000000000000881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 12/02/2022] Open
Abstract
Noninvasive vagus nerve stimulation suppressed persistent trigeminal nociception in a chronic headache model similarly to morphine and may provide a safe, nonaddictive abortive therapy for chronic headache. Introduction: Chronic headache conditions are characterized by persistent sensitization of the trigeminal system, which involves dysfunction of descending pain modulation. We previously reported that noninvasive vagus nerve stimulation (nVNS) inhibits trigeminal nociception in models of episodic migraine through a mechanism involving enhanced serotonergic and GABAergic descending pain signaling. Objectives: The analgesic effectiveness of nVNS and morphine were investigated in an animal model of chronic headache mediated by the combination of the 3 migraine risk factors of neck muscle tension, paradoxical sleep deprivation, and pungent odors. Methods: Sprague–Dawley rats were injected with complete Freund's adjuvant in the trapezius and sleep deprived for 1 night to promote trigeminal sensitization. After 7 days, animals were exposed to a pungent odor, and mechanical nocifensive head withdrawal responses were determined using von Frey filaments. Beginning on day 3 after odor exposure, animals were treated daily with either nVNS or morphine for 7 days. Results: Exposure of animals sensitized by neck inflammation and sleep deprivation to a pungent odor resulted in a prolonged state of trigeminal nociception. Daily administration of nVNS or morphine significantly repressed the nocifensive response; however, cessation resulted in a return to heightened pretreatment nocifensive levels. Conclusions: The combination of reported migraine risk factors promotes a state of sustained trigeminal hypersensitivity characteristic of chronic headache. Daily nVNS was similarly effective as morphine in inhibiting nociception and may represent a safer, opioid-sparing therapeutic option for other chronic pain disorders involving sensitization of the trigeminal system by promoting descending pain modulation.
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Santoro G, Piccirilli M, Chiarella V, Greco N, Berra LV, Santoro A. Intracranial capillary hemangiomas: literature review in pediatric and adult population. Neurosurg Rev 2020; 44:1977-1985. [PMID: 33079288 DOI: 10.1007/s10143-020-01419-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/17/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
Capillary hemangiomas (CHs) of the central nervous system represent a rare diagnosed pathology. CHs are benign vascular tumors whose most common manifestations are dermal and mucous and mainly occur during childhood or adolescence, while the involvement of the central nervous system can occur in a wider age range. We conducted a PubMed research on literature published until March 2020. We only enrolled cases with histological documented presence of intracranial CH. For every case collected, we analyzed age, sex, localization, neuroimaging studies performed, the presence of extracranial CHs, symptoms, neurological deficits, extent of surgical resection (biopsy, partial or gross total), adjunct treatment received (radiotherapy, chemotherapy, Trans-Arterial Embolization TAE), and outcome. Up to March 2020, the literature review identified 52 cases to which we added the case of our personal experience. The mean age was 26 with slightly female prevalence (28 F, 25 M). The most common presenting symptom was headache (21 cases, 40%). The surgical treatment consisted of biopsy in 7 cases (13%), partial resection in 10 cases (19%), gross total resection in 31 cases (58.5%), biopsy followed by total resection in 2 cases (3%), and partial resection followed by total resection in 1 case (1.5%), and the diagnosis was obtained from an autopsy sample in 1 case (1.5%). For symptomatic lesions, surgery is a valid option to obtain histological characterization, neurological improvement, and where possible a total resection. Stereotactic radiotherapy can be used if the lesion is not surgically approachable or as an adjuvant treatment in case of partial resection, having shown good results in terms of long-term disease control.
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Affiliation(s)
- Giorgio Santoro
- Department of Human Neurosciences, Neurosurgery, Sapienza University, Rome, Italy
| | - Manolo Piccirilli
- Department of Human Neurosciences, Neurosurgery, Sapienza University, Rome, Italy
| | - Vito Chiarella
- Department of Human Neurosciences, Neurosurgery, Sapienza University, Rome, Italy.
| | - Nicoletta Greco
- Department of Biosciences, Biotechnologies and Biopharmaceutics, Aldo Moro University, Bari, Italy
| | | | - Antonio Santoro
- Department of Human Neurosciences, Neurosurgery, Sapienza University, Rome, Italy
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Larkin MB, North RY, Viswanathan A. Percutaneous Computed Tomography-Guided Radiofrequency Ablation of Spinal Trigeminal Tract and Nucleus Caudalis for Refractory Trigeminal Neuropathic Pain: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 19:E530-E531. [PMID: 32649751 DOI: 10.1093/ons/opaa188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/20/2020] [Indexed: 11/13/2022] Open
Abstract
This is a surgical video of a computed tomography (CT)-guided percutaneous radiofrequency ablation of the spinal trigeminal tract and nucleus caudalis for refractory trigeminal neuropathic pain.1,2 Many have contributed historically, among them, Sjoqvist3 in 1938 first described destruction of the descending medullary trigeminal tractus via open craniotomy.3-6 In 1967 and 1968, Crue7 and Hitchcock8 independently developed a percutaneous tractotomy technique. Although Kanpolat9,10 first described the use of CT imaging for percutaneous creation of a single tractotomy/nucleotomy lesion resulting in satisfactory pain relief for 85% of patients. The spinal trigeminal tract is a descending fiber pathway containing central processes of first-order afferent neurons from cranial nerves V, VII, IX, and X. The spinal trigeminal nucleus is the terminal projection of the spinal trigeminal tract comprised of 3 subnuclei: oralis, interpolaris, and caudalis. The nucleus caudalis is the most caudal of the 3 subdivisions of the spinal trigeminal nucleus and houses the cell bodies of second-order afferent neurons critical in nociception of the face. Lesioning of the spinal trigeminal tract and nucleus caudalis can provide pain relief without affecting facial sensation or trigeminal motor function.9,11-13 Percutaneous radiofrequency ablation is performed using anatomical landmarks, serial CT scans, impedance monitoring, and functional confirmation to ensure appropriate insertion of the probe to the target of interest prior to lesioning. This procedure remains uncommon in current practices even among functional neurosurgery pain specialists but offers a low-risk, minimally invasive treatment option for refractory facial pain.14 This procedure was done under Institutional Review Board guidance (H-41228: retrospective chart review of patients undergoing spine surgery for pain). The risks and benefits were explained, and the patient consented to videography/procedure. Images in the video used with permission from the following: Carter HV. Anatomy of the Human Body. Wikimedia Commons [Public Domain]. https://commons.wikimedia.org/wiki/File:Gray698.png. Published 1918. Accessed June 30, 2019; Carter HV. Anatomy of the Human Body. Wikimedia Commons [Public Domain]. https://commons.wikimedia.org/wiki/File:Gray784.png. Published 1918. Accessed June 30, 2019; Reprinted from Kanpolat Y, Kahilogullari G, Ugur HC, Elhan AH, CT-guided percutaneous trigeminal tractotomy-nucleotomy, Neurosurgery, 2008, 63(1 Suppl 1), ONS147-53; discussion ONS153-5, by permission of the Congress of Neurological Surgeons; Madhero88. Onion Distribution of Pain and Temperature Sense by Trigeminal Nerve. Wikimedia Commons [Creative Commons BY 3.0 license]. https://en.wikipedia.org/wiki/File:Onionskinddistribution.svg#/media/File:Onionskinddistribution.svg. Accessed June 30, 2019.
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Affiliation(s)
- M Benjamin Larkin
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Robert Y North
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
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Danioth L, Brotschi G, Croy I, Friedrich H, Caversaccio MD, Negoias S. Multisensory environmental sensitivity in patients with chronic tinnitus. J Psychosom Res 2020; 135:110155. [PMID: 32534321 DOI: 10.1016/j.jpsychores.2020.110155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 05/17/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The study aimed at investigating the sensitivity to noise and chemosensory environmental stressors as well as the relation to perceived stress, depression and anxiety in subjects with chronic tinnitus as compared to subjects without tinnitus. METHODS We included 75 subjects with chronic tinnitus and 75 age and sex-matched subjects without tinnitus. Standardized questionnaires assessing the level of distress and impairment of quality of life caused by tinnitus, perceived level of stress, anxiety and depression, environmental noise and chemosensory sensitivity were used. A subgroup of 27 subjects with chronic tinnitus and 20 age-matched subjects without tinnitus underwent testing of olfactory function with the Sniffin' Sticks test and testing of intranasal trigeminal function using CO2 thresholds. RESULTS Our data confirmed the increased environmental noise sensitivity (NSS) in patients with tinnitus. Furthermore, we observed an increased environmental chemosensory sensitivity (CSS), but no difference in measured chemosensory function. Subjects with tinnitus showed also significant higher levels of perceived stress, anxiety and depression and those symptoms partially correlated to CSS and NSS. Predictors of both NSS and CSS results were the presence / absence of tinnitus and high anxiety levels while neither stress nor depression were found as predicting variables. CONCLUSIONS The results suggest that chronic tinnitus is related to a multisensory environmental hypersensitivity. Anxiety seems to be a predictor of this environmental vulnerability.
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Affiliation(s)
- Laura Danioth
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Gladys Brotschi
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Ilona Croy
- Department of Psychotherapy and Psychosomatic Medicine, Technische Universität Dresden, Fetscherstraße 74, Dresden 01307, Germany
| | - Hergen Friedrich
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland; Department of Otorhinolaryngology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Marco-Domenico Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Simona Negoias
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland; Department of Otorhinolaryngology, Head and Neck Surgery, Basel University Hospital, University of Basel, Basel CH-4051, Switzerland.
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Fiedler LS, Machado LA, Costa YM, Conti PCR, Bonjardim LR. Influence of self-reported physical activity and sleep quality on conditioned pain modulation in the orofacial region. Clin Oral Investig 2020; 25:1195-1202. [PMID: 32643089 DOI: 10.1007/s00784-020-03424-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 06/19/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the influence of self-reported physical activity and sleep quality on conditioned pain modulation (CPM) in the orofacial region. MATERIALS AND METHODS Ninety healthy participants aged 18-50 years old were evenly distributed according to the level of physical activity into low, moderate, and high level. The classification of physical activity was based on modified criteria of the International Physical Activity Questionnaire (IPAQ), considering intensity, duration, and frequency of physical activity. The Pittsburgh Sleep Quality Index (PSQI) assessed sleep quality and the individuals were then classified as good or poor sleepers. CPM was assessed using the pressure pain threshold (PPT) of the anterior temporalis as test stimulus and hand immersion in hot water as conditioning stimulus. ANOVA was applied to the data and Tukey's posttest was applied when the main effects or interactions were significant (p < 0.050). RESULTS There was no significant main effect of neither physical activity nor sleep quality on pain modulation. However, individuals who reported high level of physical activity and good quality of sleep had a greater pain modulation (- 0.60 ± 0.34) when compared with those who reported moderate (- 0.10 ± 0.25) and low level of physical activity (- 0.10 ± 0.52) and good sleep quality (p < 0.028). CONCLUSIONS Pain modulation seems to be more efficient in individuals who report a good sleep quality and a high level of physical activity. CLINICAL RELEVANCE Conditioned pain modulation is highly variable in healthy people. Therefore, a multifactorial approach should be taken into consideration in the evaluation of the efficacy of endogenous analgesia.
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Affiliation(s)
- Leticia Soares Fiedler
- Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Laila Aguiar Machado
- Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Yuri Martins Costa
- Department of Biosciences, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | | | - Leonardo Rigoldi Bonjardim
- Department of Biological Sciences, Bauru School of Dentistry, University of Sao Paulo, Al. Octávio Pinheiro Brizolla 9-75 CEP Vila Universitária, Bauru, SP, 17012-901, Brazil.
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Herz RS, Van Reen E, Gredvig-Ardito CA, Carskadon MA. Insights into smell and taste sensitivity in normal weight and overweight-obese adolescents. Physiol Behav 2020; 221:112897. [PMID: 32259597 PMCID: PMC7222023 DOI: 10.1016/j.physbeh.2020.112897] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/14/2020] [Accepted: 03/30/2020] [Indexed: 11/28/2022]
Abstract
Research examining connections between BMI and smell and taste sensitivity in adolescents has been minimal, methodologically inconsistent, and inconclusive. We sought to address this issue with an exploratory study of smell and taste sensitivity in overweight-obese (high BMI) and normal BMI male and female adolescents (ages 12-16 years), using previously validated chemosensory testing measures (Sniffin' Sticks, Taste Strips, 6-n-propylthiouracil: PROP), and taking pubertal stage into account. Puberty was evaluated with the validated Pubertal Development Scale and participants were then classified as either "early" or "late" pubertal stage. We used the phenylethyl alcohol (PEA) version of the Sniffin' Sticks olfactory threshold test and found that high BMI adolescents had significantly greater olfactory sensitivity than normal BMI adolescents. This observation contradicts previous results in overweight adults tested with the n-butanol version of Sniffin' Sticks. We also found that participants in early puberty had significantly higher olfactory sensitivity than participants in late puberty. No significant findings for taste sensitivity were obtained, though there is a suggestion that puberty may affect salty taste thresholds. Our results illuminate a potentially important difference in sensitivity to pure olfactory versus olfactory-trigeminal stimuli as a function of BMI, which the PEA and n-butanol versions of the Sniffin' Sticks respectively assess; and for the first time demonstrate variation in chemosensory acuity in relation to pubertal stage. These findings have implications for eating behavior during adolescence.
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Affiliation(s)
- Rachel S Herz
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA; Department of Psychology and Neuroscience, Boston College, Newton, MA, USA.
| | | | | | - Mary A Carskadon
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA; E.P. Bradley Hospital Sleep Research Laboratory, Providence, RI, USA
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Benbow T, Ranjbar Ekbatan M, Cairns BE. α 1 adrenergic receptor activation has a dynamic effect on masticatory muscle afferent fibers. Neuropharmacology 2020; 175:108197. [PMID: 32544482 DOI: 10.1016/j.neuropharm.2020.108197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/28/2020] [Accepted: 06/09/2020] [Indexed: 12/14/2022]
Abstract
Temporomandibular Disorder (TMD) patients report amplification of pain in the masticatory muscles after psychological trauma or stressful conditions. The mechanisms underlying this phenomenon are yet to be elucidated. This study combined immunohistochemistry with single cell in vivo electrophysiology recordings of masticatory muscle afferent fibers to investigate the role of α1-adrenergic receptors in muscle nociception. It was found that a subset of trigeminal afferent fibers which innervate the masseter and temporal muscles expressed α1a, α1b and α1d receptors, including a smaller number of putative nociceptors which co-expressed TrpV1 receptors. Local injection of the selective α1 adrenergic receptor agonist phenylephrine into masticatory muscle decreased and increased the mechanical activation threshold of slow and fast conducting afferent fibers, respectively. This effect was reversed by co-administration of the α1 selective antagonist terazosin. To rule out the possibility that local ischemia was responsible for the observed effect of phenylephrine on masticatory muscle afferent fibers, additional experiments were conducted where blood flow to the masticatory muscle was reduced by common carotid artery occlusion. This investigation found that muscle blood flow occlusion increased the mechanical activation threshold of the majority of masticatory muscle afferent fibers unrelated to conduction velocity. These findings suggest that under conditions of increased sympathetic tone, such as those related to stress, noradrenaline may sensitize masticatory muscle nociceptors to increase pain and desensitize muscle proprioceptors to alter muscle tone, through activation of α1 receptors.
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Nguyen DA, Nguyen TH, Vo HL. Successful endoscopic endonasal surgery for very huge trigeminal schwannomas in nasopharynx. Br J Neurosurg 2020; 35:73-76. [PMID: 32410472 DOI: 10.1080/02688697.2020.1763257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We present a 60-year-old female diagnosed with a giant trigeminal tumor (5.2*6.4*8.2 cm) situated in the middle cranial fossa and nasopharyngeal area. The patient was operated on by endoscopic endonasal transmaxillary, transpterygoid and infratemporal approaches. Postoperatively she was stable, with no neurologic complication and no cerebrospinal fluid leakage. We review the literature on extremely large trigeminal schwannomas.
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Affiliation(s)
- Duc-Anh Nguyen
- Department of Neurosurgery, Bach Mai Hospital, Hanoi, Vietnam
| | - The-Hao Nguyen
- Department of Neurosurgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Hoang-Long Vo
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
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Abstract
Migraine is the most common disabling primary headache globally. Attacks typically present with unilateral throbbing headache and associated symptoms including, nausea, multisensory hypersensitivity, and marked fatigue. In this article, the authors address the underlying neuroanatomical basis for migraine-related headache, associated symptomatology, and discuss key clinical and preclinical findings that indicate that migraine likely results from dysfunctional homeostatic mechanisms. Whereby, abnormal central nervous system responses to extrinsic and intrinsic cues may lead to increased attack susceptibility.
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Affiliation(s)
- Peter J Goadsby
- Headache Group, Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Philip R Holland
- Headache Group, Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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35
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Adair D, Truong D, Esmaeilpour Z, Gebodh N, Borges H, Ho L, Bremner JD, Badran BW, Napadow V, Clark VP, Bikson M. Electrical stimulation of cranial nerves in cognition and disease. Brain Stimul 2020; 13:717-750. [PMID: 32289703 PMCID: PMC7196013 DOI: 10.1016/j.brs.2020.02.019] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 02/13/2020] [Accepted: 02/17/2020] [Indexed: 02/06/2023] Open
Abstract
The cranial nerves are the pathways through which environmental information (sensation) is directly communicated to the brain, leading to perception, and giving rise to higher cognition. Because cranial nerves determine and modulate brain function, invasive and non-invasive cranial nerve electrical stimulation methods have applications in the clinical, behavioral, and cognitive domains. Among other neuromodulation approaches such as peripheral, transcranial and deep brain stimulation, cranial nerve stimulation is unique in allowing axon pathway-specific engagement of brain circuits, including thalamo-cortical networks. In this review we amalgamate relevant knowledge of 1) cranial nerve anatomy and biophysics; 2) evidence of the modulatory effects of cranial nerves on cognition; 3) clinical and behavioral outcomes of cranial nerve stimulation; and 4) biomarkers of nerve target engagement including physiology, electroencephalography, neuroimaging, and behavioral metrics. Existing non-invasive stimulation methods cannot feasibly activate the axons of only individual cranial nerves. Even with invasive stimulation methods, selective targeting of one nerve fiber type requires nuance since each nerve is composed of functionally distinct axon-types that differentially branch and can anastomose onto other nerves. None-the-less, precisely controlling stimulation parameters can aid in affecting distinct sets of axons, thus supporting specific actions on cognition and behavior. To this end, a rubric for reproducible dose-response stimulation parameters is defined here. Given that afferent cranial nerve axons project directly to the brain, targeting structures (e.g. thalamus, cortex) that are critical nodes in higher order brain networks, potent effects on cognition are plausible. We propose an intervention design framework based on driving cranial nerve pathways in targeted brain circuits, which are in turn linked to specific higher cognitive processes. State-of-the-art current flow models that are used to explain and design cranial-nerve-activating stimulation technology require multi-scale detail that includes: gross anatomy; skull foramina and superficial tissue layers; and precise nerve morphology. Detailed simulations also predict that some non-invasive electrical or magnetic stimulation approaches that do not intend to modulate cranial nerves per se, such as transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS), may also modulate activity of specific cranial nerves. Much prior cranial nerve stimulation work was conceptually limited to the production of sensory perception, with individual titration of intensity based on the level of perception and tolerability. However, disregarding sensory emulation allows consideration of temporal stimulation patterns (axon recruitment) that modulate the tone of cortical networks independent of sensory cortices, without necessarily titrating perception. For example, leveraging the role of the thalamus as a gatekeeper for information to the cerebral cortex, preventing or enhancing the passage of specific information depending on the behavioral state. We show that properly parameterized computational models at multiple scales are needed to rationally optimize neuromodulation that target sets of cranial nerves, determining which and how specific brain circuitries are modulated, which can in turn influence cognition in a designed manner.
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Affiliation(s)
- Devin Adair
- Department of Biomedical Engineering, City College of New York, New York, NY, USA
| | - Dennis Truong
- Department of Biomedical Engineering, City College of New York, New York, NY, USA
| | - Zeinab Esmaeilpour
- Department of Biomedical Engineering, City College of New York, New York, NY, USA.
| | - Nigel Gebodh
- Department of Biomedical Engineering, City College of New York, New York, NY, USA
| | - Helen Borges
- Department of Biomedical Engineering, City College of New York, New York, NY, USA
| | - Libby Ho
- Department of Biomedical Engineering, City College of New York, New York, NY, USA
| | - J Douglas Bremner
- Department of Psychiatry & Behavioral Sciences and Radiology, Emory University School of Medicine, Atlanta, GA, USA; Atlanta VA Medical Center, Decatur, GA, USA
| | - Bashar W Badran
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Vitaly Napadow
- Martinos Center for Biomedical Imaging, Department of Radiology, MGH, Harvard medical school, Boston, MA, USA
| | - Vincent P Clark
- Psychology Clinical Neuroscience Center, Dept. Psychology, MSC03-2220, University of New Mexico, Albuquerque, NM, 87131, USA; Department of Psychology, University of New Mexico, Albuquerque, NM, 87131, USA; The Mind Research Network of the Lovelace Biomedical Research Institute, 1101 Yale Blvd. NE, Albuquerque, NM, 87106, USA
| | - Marom Bikson
- Department of Biomedical Engineering, City College of New York, New York, NY, USA.
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Magown P, Ko AL, Burchiel KJ. The Spectrum of Trigeminal Neuralgia Without Neurovascular Compression. Neurosurgery 2020; 85:E553-E559. [PMID: 31329945 DOI: 10.1093/neuros/nyz048] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 01/29/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In trigeminal neuralgia type 1 (TN1), neurovascular compression (NVC) is often assumed to be the pain initiating mechanism. NVC can be surgically addressed by microvascular decompression (MVD). However, some patients with TN1 present without NVC (WONVC). OBJECTIVE To characterize and analyze the clinical spectrum of a TN1 patient population WONVC. METHODS A retrospective chart review of patients presenting with TN1 between 2007 and 2017 was performed. Patients who were potential candidates for MVD surgery underwent high-resolution imaging with 3-dimensional (3D) reconstruction to address the presence, or absence, of NVC. Demographic data about the populations with NVC (WNVC) and WONVC were collected. RESULTS Of 242 patients with TN1, 32% did not have NVC. Patients WONVC were on average 10.6 yr younger than those WNVC. TN1 onset in patients WONVC was more frequent below 48.7 yr, and the opposite was found in patients WNVC. Compared to patients WNVC, those WONVC were predominantly female (odds ratio 4.8), on average were 4 yr younger at symptom onset (34.7 yr) and 7.8 yr younger at first clinic visit, and had a 3.7 yr shorter symptom duration. CONCLUSION Patients presenting with TN1 WONVC were predominantly females in their mid-30s with short symptom duration. In the absence of NVC, this subgroup of TN1 patients has limited surgical options, and potentially a longer condition duration that must be managed medically or surgically. This population WONVC might provide insights into the true pathophysiology of TN1.
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Affiliation(s)
- Philippe Magown
- Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrew L Ko
- Neurological Surgery, University of Washington Medical Center, Seattle, Washington
| | - Kim J Burchiel
- Neurological Surgery, Oregon Health & Science University, Portland, Oregon
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Artola A, Voisin D, Dallel R. PKCγ interneurons, a gateway to pathological pain in the dorsal horn. J Neural Transm (Vienna) 2020; 127:527-40. [PMID: 32108249 DOI: 10.1007/s00702-020-02162-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/13/2020] [Indexed: 12/21/2022]
Abstract
Chronic pain is a frequent and disabling condition that is significantly maintained by central sensitization, which results in pathological amplification of responses to noxious and innocuous stimuli. As such, mechanical allodynia, or pain in response to a tactile stimulus that does not normally provoke pain, is a cardinal feature of chronic pain. Recent evidence suggests that the dorsal horn excitatory interneurons that express the γ isoform of protein kinase C (PKCγ) play a critical role in the mechanism of mechanical allodynia during chronic pain. Here, we review this evidence as well as the main aspects of the development, anatomy, electrophysiology, inputs, outputs, and pathophysiology of dorsal horn PKCγ neurons. Primary afferent high-threshold neurons transmit the nociceptive message to the dorsal horn of the spinal cord and trigeminal system where it activates second-order nociceptive neurons relaying the information to the brain. In physiological conditions, low-threshold mechanoreceptor inputs activate inhibitory interneurons in the dorsal horn, which may control activation of second-order nociceptive neurons. During chronic pain, low-threshold mechanoreceptor inputs now activate PKCγ neurons that forward the message to second-order nociceptive neurons, turning thus tactile inputs into pain. Several mechanisms may contribute to opening this gate, including disinhibition, activation of local astrocytes, release of diffusible factors such as reactive oxygen species, and alteration of the descending serotoninergic control on PKCγ neurons through 5-HT2A serotonin receptors. Dorsal horn PKCγ neurons, therefore, appear as a relevant therapeutic target to alleviate mechanical allodynia during chronic pain.
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Cândido DNC, Rassi MS, Ceccato GHW, de Oliveira JG, Borba LAB. Microsurgical Resection of Trigeminal Schwannomas: 3-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 18:E18. [PMID: 31120116 DOI: 10.1093/ons/opz097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 01/13/2019] [Indexed: 11/12/2022] Open
Abstract
Trigeminal schwannomas are benign lesions arising from the Schwann cells of the trigeminal nerve. This is an unusual tumor that accounts for less than 0.4% of intracranial pathologies, even though they are the second most frequent schwannoma after the vestibular schwannoma. The tumor spreads along the natural course of the V nerve at its cisternal portion, along the ganglion inside Meckel's cave or through its peripheral division. Even though the tumor can reach great size and become multicompartmental. We present a 51-yr-old woman, with an history of 3 mo of incapacitating facial pain, that was found on examination to be on the territory of the third division of the trigeminal nerve on the right side. The MRI depicted a large homogeneous enhancing lesion at the base of the right middle fossa with extension through the petrous apex to the most superior and medial part of the posterior fossa. The patient was operated by the senior author, through a middle fossa approach, dissecting between the two layers of the middle fossa dura (the apparent inner and the true outer layer of the cavernous sinus), the so called middle fossa "peeling". We achieved total resection of the tumor, but the patient presented after surgery with facial nerve paresis. This is thought to be related to geniculate ganglion manipulation, as it was unprotect by bone at the middle fossa and the patient maintained lacrimal function (post-geniculate alteration). It resolved completely after 6 mo. The patient consented to publication of her images.
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Affiliation(s)
| | - Marcio S Rassi
- Department of Neurosurgery, Hospital Universitário Evangélico de Curitiba, Curitiba, Paraná, Brazil
| | | | - Jean Gonçalves de Oliveira
- Department of Neurosurgery, A. C. Camargo Cancer Center (ACCCC), São Paulo-SP, Brazil.,Division of Neurosurgery, Department of Surgery, Santa Casa de São Paulo School of Medical Sciences (FCMSCSP), São Paulo-SP, Brazil
| | - Luis A B Borba
- Department of Neurosurgery, Hospital Universitário Evangélico de Curitiba, Curitiba, Paraná, Brazil.,Department of Neurosurgery, Federal University of Parana, Curitiba, Paraná, Brazil
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Rimmele F, Maschke H, Großmann A, Jürgens TP. A case report: Numb Chin Syndrome due to thalamic infarction: a rare case. BMC Neurol 2019; 19:303. [PMID: 31783736 PMCID: PMC6884807 DOI: 10.1186/s12883-019-1525-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 11/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numb Chin Syndrome (NCS), which is also characterized as sensory neuropathy of the mental nerve, describes a mostly unilateral numbness of the chin and lower lip. Benign and malignant diseases are known to cause this circumscribed symptom, which can easily be overlooked or misdiagnosed. In this article we present the very rare case of a clinical NCS caused by thalamic lacunar infarction. As a pure sensory stroke it is a rare variant of the Cheiro-Oral Syndrome (COS). CASE PRESENTATION A 63-year-old male patient received an emergency referral to our department after the patient had noticed a feeling of numbness of the left lower lip and chin on the previous day. The neurological examination revealed an approximately 2 × 3 cm area of hypoesthesia in the area of the chin and left lower lip and the cranial MRI an acute ischemia in the right thalamus. CONCLUSIONS In this case report we introduce a patient who clinically shows an NCS. Various diseases may be responsible for NCS, including malignancies or even central neurological disorders such as multiple sclerosis. A lacunar thalamic ischemia as a cause of NCS is very rare and to our knowledge described in the literature only in the contex of a COS in three cases. We wish to remind the reader, through this case, of the purely descriptive and syndromal character of the NCS and the importance for detecting underlying diseases. Furthermore we give a brief overview of the NCS and causative disorders.
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Affiliation(s)
- Florian Rimmele
- Department of Neurology, Headache Center North-East, University Medical Center Rostock, Gehlsheimer Str. 20, 18147, Rostock, Germany.
| | - Henning Maschke
- Department of Radiology, University Medical Center Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Annette Großmann
- Department of Radiology, University Medical Center Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Tim P Jürgens
- Department of Neurology, Headache Center North-East, University Medical Center Rostock, Gehlsheimer Str. 20, 18147, Rostock, Germany
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Migneault-Bouchard C, Hsieh JW, Hugentobler M, Frasnelli J, Landis BN. Chemosensory decrease in different forms of olfactory dysfunction. J Neurol 2019; 267:138-143. [PMID: 31586261 DOI: 10.1007/s00415-019-09564-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/28/2019] [Accepted: 09/28/2019] [Indexed: 11/25/2022]
Abstract
The aim of this study is to investigate the effect of olfactory dysfunction (OD) on the two other chemical senses, namely gustation and the intranasal trigeminal system. Taste and trigeminal function were analyzed in a retrospective cross-sectional study of 178 participants with OD (n = 78 posttraumatic, n = 42 idiopathic, n = 27 post-infectious and n = 31 chronic rhinosinusitis (CRS) OD). All patients had been investigated for OD at our smell and taste outpatient clinic. Evaluation of olfaction was performed by means of the Sniffin' Sticks test (odor threshold, odor discrimination and odor identification), whereas gustatory function was assessed with the Taste Strips test and the intranasal trigeminal sensitivity by means of the lateralization task. The degree of olfactory impairment was found to depend on the cause of OD, but not on patients' age. Patients with posttraumatic OD showed lower olfactory function than patients with idiopathic, post-infectious and CRS OD (p = 0.01). Gustatory and trigeminal sensitivity in turn depended on age rather than the cause of olfactory dysfunction. Partial correlations between olfactory, gustatory, and trigeminal scores, with age as covariate, were significant, showing a decrease of taste and trigeminal function proportional to the OD (p < 0.05). The present data suggest that the three chemical senses are closely connected for humans underlining that in case of OD the remaining chemical senses (taste, trigeminal function) tend to decrease rather than compensate as this is seen for sensory loss in other modalities. This finding has direct clinical implications and importance when dealing with smell and taste disorders.
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Affiliation(s)
- Chloé Migneault-Bouchard
- Research Chair in Chemosensory Neuroanatomy, Department of Anatomy, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, QC, Canada
| | - Julien Wen Hsieh
- Department of Clinical Neuroscience, Geneva University Hospitals (HUG), Geneva, Switzerland.,Rhinology-Olfactology Unit, Department of Otorhinolaryngology, Head and Neck Surgery, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Marianne Hugentobler
- Rhinology-Olfactology Unit, Department of Otorhinolaryngology, Head and Neck Surgery, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Johannes Frasnelli
- Research Chair in Chemosensory Neuroanatomy, Department of Anatomy, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, QC, Canada.,Research Center of the Sacré-Coeur Hospital, Montreal, QC, Canada
| | - Basile Nicolas Landis
- Rhinology-Olfactology Unit, Department of Otorhinolaryngology, Head and Neck Surgery, Geneva University Hospitals (HUG), Geneva, Switzerland.
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Moayedi M, Hodaie M. Trigeminal nerve and white matter brain abnormalities in chronic orofacial pain disorders. Pain Rep 2019; 4:e755. [PMID: 31579849 PMCID: PMC6728001 DOI: 10.1097/pr9.0000000000000755] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/27/2019] [Accepted: 04/12/2019] [Indexed: 02/02/2023] Open
Abstract
Medial temporal lobe activity is investigated in meta-analyses of experimental and chronic pain. Abnormal hippocampal connectivity is found in patients with chronic low back pain. The orofacial region is psychologically important, given that it serves fundamental and important biological purposes. Chronic orofacial pain disorders affect the head and neck region. Although some have clear peripheral etiologies, eg, classic trigeminal neuralgia, others do not have a clear etiology (eg, muscular temporomandibular disorders). However, these disorders provide a unique opportunity in terms of elucidating the neural mechanisms of these chronic pain conditions: both the peripheral and central nervous systems can be simultaneously imaged. Diffusion-weighted imaging and diffusion tensor imaging have provided a method to essentially perform in vivo white matter dissections in humans, and to elucidate abnormal structure related to clinical correlates in disorders, such as chronic orofacial pains. Notably, the trigeminal nerve anatomy and architecture can be captured using diffusion imaging. Here, we review the trigeminal somatosensory pathways, diffusion-weighted imaging methods, and how these have contributed to our understanding of the neural mechanisms of chronic pain disorders affecting the trigeminal system. We also discuss novel findings indicating the potential for trigeminal nerve diffusion imaging to develop diagnostic and precision medicine biomarkers for trigeminal neuralgia. In sum, diffusion imaging serves both an important basic science purpose in identifying pain mechanisms, but is also a clinically powerful tool that can be used to improve treatment outcomes.
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Affiliation(s)
- Massieh Moayedi
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.,University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada.,Department of Dentistry, Mount Sinai Hospital, Toronto, ON, Canada
| | - Mojgan Hodaie
- University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada.,Division of Neurosurgery and Krembil Research Institute, Toronto Western Hospital, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Kim HK, Kim ME. Quantitative and qualitative sensory testing results are associated with numbness rather than neuropathic pain in patients with post-implant trigeminal neuropathy: a cross-sectional pilot study. Somatosens Mot Res 2019; 36:202-211. [PMID: 31366273 DOI: 10.1080/08990220.2019.1645000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: This study aimed to characterize the sensory profile of patients with post-implant trigeminal neuropathy and identify the association between subjective symptoms and objective signs including psychophysical testing and radiographic imaging. This study further evaluated to the association between quantitative sensory testing (QST)/qualitative sensory testing (QualST) and the severity of nerve injury graded by radiographic imaging. Materials and methods: This retrospective study included 34 patients diagnosed with post-implant trigeminal neuropathy. Data on the neuropathic pain symptom inventory (NPSI), thermal and electric QST, bedside QualST, and cone beam computed tomography (CBCT) was collected and the association between these variables were analysed. Results: Numbness was the most common subjective symptom and evoked pain was the most frequent neuropathic pain. There was no significant correlation between negative and positive symptoms. Spearman's rank correlation analyses indicated that objective findings including QST/QualST correlated with a sensory loss profile rather than a gain of function profile. Moderate positive correlations between some positive symptoms and the score of QualST were observed. The Mann-Whitney U test showed that subjective symptoms did not differ according to the severity of nerve damage according to CBCT, but the electric QST and QualST was discriminative. Conclusions: This study suggests that QST/QualST associated with the severity of nerve damage according to CBCT might be useful in assessing numbness in patients with negative and positive symptoms after implant surgery, but may be of marginal utility in the evaluation of neuropathic pain within the limitation of this cross-sectional study with small sample size.
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Affiliation(s)
- Hye-Kyoung Kim
- Department of Oral Medicine, College of Dentistry, Dankook University , Cheonan , South Korea
| | - Mee-Eun Kim
- Department of Oral Medicine, College of Dentistry, Dankook University , Cheonan , South Korea
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Ji Y, Rizk A, Voulalas P, Aljohani H, Akerman S, Dussor G, Keller A, Masri R. Sex differences in the expression of calcitonin gene-related peptide receptor components in the spinal trigeminal nucleus. Neurobiol Pain 2019; 6:100031. [PMID: 31223141 PMCID: PMC6565752 DOI: 10.1016/j.ynpai.2019.100031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND PURPOSE Calcitonin gene-related peptide (CGRP) plays an important role in migraine pathophysiology. CGRP acts primarily by activating a receptor composed of 3 proteins: calcitonin receptor-like receptor (CLR), receptor activity-modifying protein 1 (RAMP1), and receptor component protein (RCP). We tested the hypothesis that sex differences exist in protein levels of two key components of this CGRP receptor: CLR and RCP. METHODS We used specific antibodies to assess baseline protein levels of CLR and RCP in the spinal trigeminal nucleus caudalis (SpVc) and upper cervical spinal cord of both male and female rats. We also tested if manipulations that knock-down the expression of RCP in SpVc, using locally-mediated gene transfer of short hairpin RNA (shRNA), ameliorate pain in an animal model of intracranial migraine-like pain induced by chemical noxious stimulation of the meninges. To assess pain, we used tests of ongoing pain (rat face grimace test and freezing behavior) and tests of facial mechanical hypersensitivity and allodynia. RESULTS There was no difference in CLR levels between male and female animals (p > 0.11) in SpVc and the upper cervical cord. However, female animals exhibited greater baseline levels of RCP (up to 3-fold higher) compared to males (p < 0.002). The knock-down of RCP expression in SpVc attenuated mechanical facial allodynia induced by chemical noxious stimulation of the meninges, but had little effect on ongoing pain behaviors in female and male animals. CONCLUSIONS RCP is an integral component of the CGRP receptor and may play a key role in mediating CGRP induced central sensitization after noxious stimulation of the meninges. RCP expression in the SpVc and upper cervical cord is sexually dimorphic, with higher levels of expression in females. This dimorphism may be related to the increased incidence of migraines in females-a hypothesis that should be tested in the future.
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Affiliation(s)
- Yadong Ji
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
- Program in Neuroscience, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alexandra Rizk
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Pamela Voulalas
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
- Program in Neuroscience, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hanan Aljohani
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA
- Department of Oral Medicine and Diagnostics Sciences, King Saud University, School of Dentistry, Riyadh, Saudi Arabia
| | - Simon Akerman
- Department of Neural Sciences and Pain, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Gregory Dussor
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - Asaf Keller
- Program in Neuroscience, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Radi Masri
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
- Program in Neuroscience, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD, USA
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Abstract
Horses with trigeminal mediated headshaking (TMHS) have a decreased activation threshold of the trigeminal nerve and clinical signs are suspected to be a manifestation of trigeminal neuralgia. Electrical nerve stimulation (ENS) is used for management of neuralgia in humans and appears to work via gate control theory. Use of an equine specific percutaneous ENS program in over 130 TMHS horses has resulted in approximately 50% success return to previous work. Electroacupuncture may also be useful in the management TMHS. Optimization of ENS procedures for TMHS is likely to require a greater understanding of the etiopathogenesis of the aberrant neurophysiology.
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Affiliation(s)
- Kirstie Pickles
- Chine House Veterinary Hospital, 12 Cossington Road, Sileby, Leicestershire LE12 7RS, UK.
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45
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Vgontzas A, Rizzoli PB. Nonmigraine Headache and Facial Pain. Med Clin North Am 2019; 103:235-250. [PMID: 30704679 DOI: 10.1016/j.mcna.2018.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The vast majority of headache patients encountered in the outpatient general medicine setting will be diagnosed with a primary headache disorder, mostly migraine or tension-type headache. Other less common primary headaches and secondary headaches, related to or caused by another condition, are the topic of this article. Nonmigraine primary headaches include trigeminal autonomic cephalalgias, primarily cluster headache; facial pain, primarily trigeminal neuralgia; and miscellaneous headache syndromes, such as hemicrania continua and new daily persistent headache. Selected secondary headaches related to vascular disease, cerebrospinal fluid dynamics, and inflammatory conditions are also reviewed.
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Affiliation(s)
- Angeliki Vgontzas
- Department of Neurology, Brigham and Women's Hospital, John R. Graham Headache Center, Brigham and Women's Faulkner Hospital, Harvard Medical School, 1153 Centre Street, Suite 4H, Boston, MA 02130, USA
| | - Paul B Rizzoli
- Department of Neurology, Brigham and Women's Hospital, John R. Graham Headache Center, Brigham and Women's Faulkner Hospital, Harvard Medical School, 1153 Centre Street, Suite 4H, Boston, MA 02130, USA.
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46
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Samadian M, Omidbeigi M, Bakhtevari MH, Asaadi S, Jafari A, Rezaei O. Nerve-Sheath-Risen Neuroglial Cyst: A Case Report and Review of the Literature. World Neurosurg 2019:S1878-8750(19)30082-8. [PMID: 30660890 DOI: 10.1016/j.wneu.2018.12.203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/24/2018] [Accepted: 12/26/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Neuroglial cysts are rare intracranial lesions that are believed to originate from the sequestration of neural tube lining during embryogenesis. They can present anywhere within the neuraxis; however, their most common location is the frontal lobe. Cerebellopontine angle (CPA) neuroglial cysts are extremely rare and to the best of authors' knowledge, there are no previous reports of a neuroglial cyst arising from cranial nerves. CASE DESCRIPTION The current study presented a male adolescent with the reoccurrence of an intracranial cyst with symptoms of diplopia and facial numbness primarily treated as CPA arachnoid cyst with fenestration of the cyst 12 months prior to admission to our center. Different magnetic resonance imaging (MRI) sequences showed a thin-walled extra-axial cyst at the right CPA without gadolinium (Gd)-enhancement. Direct visualization of the lesion revealed a cyst arising from the 5th cranial nerve sheath compressing the surrounding structures. The cyst was fenestrated and a biopsy was taken from the cyst wall. The pathological analysis along with specified histological markers indicated the neuroglial nature of the cyst. CONCLUSION The rising of a neuroglial cyst from the nerve sheath is a finding that brings other possible origins of neuroglial cysts into consideration.
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Ptaszyńska-Sarosiek I, Dunaj J, Zajkowska A, Niemcunowicz-Janica A, Król M, Pancewicz S, Zajkowska J. Post-mortem detection of six human herpesviruses (HSV-1, HSV-2, VZV, EBV, CMV, HHV-6) in trigeminal and facial nerve ganglia by PCR. PeerJ 2019; 6:e6095. [PMID: 30643675 PMCID: PMC6330031 DOI: 10.7717/peerj.6095] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/10/2018] [Indexed: 12/14/2022] Open
Abstract
Background Among over 100 types of Herpesviridae viruses, eight can infect humans: herpes simplex viruses (HSV-1, HSV-2), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpesviruses 6, 7, and 8 (HHV-6, HHV-7, HHV-8). After initial infection, the viruses remain latent for the lifetime of the host. The aim of this study was to determine the distribution of six different herpesviruses: HSV-1, HSV-2, VZV, EBV, CMV, and HHV-6 in trigeminal and facial nerve ganglia among a random group of Polish population. Methods The studied group consisted of 47 individuals (40 male, seven female); mean age of 47.4 ± 16.5 years) who died of independent causes (suicide, traffic accident, and poisoning, among others). Bilateral trigeminal and facial nerve ganglia of each cadaver were collected during the autopsy. Herpesviruses were detected using multiplex polymerase chain reaction technique. Results Herpesviruses were found in trigeminal and/or facial ganglia in 30/47 (63.8%) of cadavers. HHV-6 was the most prevalent of the herpesviruses and was found in nearly half of cadavers (n = 22; 46.8%), followed by HSV-1 (n = 7; 14.9%), VZV (n = 4; 8.5%), EBV (n = 4; 8.5%), HSV-2 (n = 2; 4.3%), and CMV (n = 1; 2.1%). Facial nerve ganglia (n = 23; 48.9%) were more often infected than trigeminal ganglia (n = 13; 27.7%). Discussion The results of this study have revealed a common presence of the herpesviruses in trigeminal and facial nerve ganglia among a random group of Polish population. Furthermore, the data also demonstrate simultaneous infection of the ganglia with different herpesviruses. This study has contributed to the knowledge of prevalence and localization of herpesviruses in different structures of the nervous system.
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Affiliation(s)
| | - Justyna Dunaj
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Białystok, Poland
| | - Agata Zajkowska
- Department of Neurology, Medical University of Bialystok, Bialystok, Poland
| | | | - Monika Król
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Białystok, Poland
| | - Sławomir Pancewicz
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Białystok, Poland
| | - Joanna Zajkowska
- Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Białystok, Poland
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48
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Zhang L, Kunkler PE, Knopp KL, Oxford GS, Hurley JH. Role of intraganglionic transmission in the trigeminovascular pathway. Mol Pain 2019; 15:1744806919836570. [PMID: 30784351 PMCID: PMC6440047 DOI: 10.1177/1744806919836570] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 01/29/2019] [Accepted: 01/29/2019] [Indexed: 01/14/2023] Open
Abstract
Migraine is triggered by poor air quality and odors through unknown mechanisms. Activation of the trigeminovascular pathway by environmental irritants may occur via activation of transient receptor potential ankyrin 1 (TRPA1) receptors on nasal trigeminal neurons, but how that results in peripheral and central sensitization is unclear. The anatomy of the trigeminal ganglion suggests that noxious nasal stimuli are not being transduced to the meninges by axon reflex but likely through intraganglionic transmission. Consistent with this concept, we injected calcitonin gene-related peptide, adenosine triphosphate, or glutamate receptor antagonists or a gap junction channel blocker directly and exclusively into the trigeminal ganglion and blocked meningeal blood flow changes in response to acute nasal TRP agonists. Previously, we observed chronic sensitization of the trigeminovascular pathway after acrolein exposure, a known TRPA1 receptor agonist. To explore the mechanism of this sensitization, we utilized laser dissection microscopy to separately harvest nasal and meningeal trigeminal neuron populations in the absence or presence of acrolein exposure. mRNA levels of neurotransmitters important in migraine were then determined by reverse transcription polymerase chain reaction. TRPA1 message levels were significantly increased in meningeal cell populations following acrolein exposure compared to room air exposure. This was specific to TRPA1 message in meningeal cell populations as changes were not observed in either nasal trigeminal cell populations or dorsal root ganglion populations. Taken together, these data suggest an important role for intraganglionic transmission in acute activation of the trigeminovascular pathway. It also supports a role for upregulation of TRPA1 receptors in peripheral sensitization and a possible mechanism for chronification of migraine after environmental irritant exposure.
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Affiliation(s)
- LuJuan Zhang
- The Department of Biochemistry and Molecular Biology, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Phillip Edward Kunkler
- The Department of Biochemistry and Molecular Biology, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kelly L Knopp
- Lilly Research Laboratories, Eli Lilly & Company, Indianapolis, IN, USA
| | - Gerry Stephen Oxford
- Department of Pharmacology and Toxicology, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Joyce Harts Hurley
- Department of Medical and Molecular Genetics, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
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49
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Abstract
Many odors activate the intranasal chemosensory trigeminal system where they produce cooling and other somatic sensations such as tingling, burning, or stinging. Specific trigeminal receptors are involved in the mediation of these sensations. Importantly, the trigeminal system also mediates sensitivity to airflow. The intranasal trigeminal and the olfactory system are closely connected. With regard to central nervous processing, it is most interesting that trigeminal stimuli can activate the piriform cortex, which is typically viewed as the primary olfactory cortex. This suggests that interactions between the two systems may form at a relatively early stage of processing. For example, there is evidence showing that acquired olfactory loss leads to reduced trigeminal sensitivity, probably on account of the lack of interaction in the central nervous system. Decreased trigeminal sensitivity may also be responsible for changes in airflow perception, leading to the impression of congested nasal airways.
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Affiliation(s)
- Thomas Hummel
- Department of Otorhinolaryngology, Smell and Taste Clinic, Technische Universität Dresden, Dresden, Germany.
| | - Johannes Frasnelli
- Université du Québec à Trois-Rivières, Department of Anatomy, Trois-Rivières, QC, Canada
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50
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Abstract
Peptides released from trigeminal fibers fulfill well-understood functions in neuroinflammatory processes and in the modulation of nociceptive signal processing. In particular, calcitonin gene-related peptide (CGRP) and substance P (SP), released from afferent nerve terminals, exert paracrine effects on the surrounding tissue and this has been recently highlighted by the prominent parcrine role of CGRP in the development of headache and migraine. Some recent communications suggest that these sensory neuropeptides may also modulate the workings of sensory organs and influence afferent signals from nose, tongue, eyes and ears. Here, we briefly review the evidence for modulatory effects of CGRP and SP in the sensory periphery.
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Affiliation(s)
- Richard Carr
- Department of Experimental Pain Research, Medical Faculty Mannheim, University of Heidelberg, Ludolf-Krehl-Str. 13-17, 68167, Mannheim, Germany.
| | - Stephan Frings
- Department of Animal Physiology, Centre for Organismal Studies, University of Heidelberg, Heidelberg, Germany
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