-
Seminars in Neurology Apr 2015Despite well-described international variabilities in brain death practices, de facto there already exists a minimum international clinical standard for the diagnosis of... (Review)
Review
Despite well-described international variabilities in brain death practices, de facto there already exists a minimum international clinical standard for the diagnosis of brain death. This remains rooted in the Harvard criteria and based on the characteristics of a permanently nonfunctioning brain. Medicine is evolving toward a single unified determination of death based on the cessation of brain function subsequent to catastrophic brain injury or circulatory arrest. Clarity in lexicon could be established, including movement toward functional definitions and away from anatomically based terms such as cardiac and brain death that erroneously imply death of the organ. The cessation of clinical functions of the brain that will not resume is determined by the absence of capacity for consciousness, centrally mediated motor responses, brainstem reflexes, and capacity to breathe. A known proximate cause and the absence of confounding or reversible conditions must be confirmed. Regional medical, legal, cultural, religious, or socioeconomic factors may require testing beyond this minimal clinical standard.
Topics: Brain Death; Consensus; Humans; Practice Guidelines as Topic
PubMed: 25839725
DOI: 10.1055/s-0035-1547538 -
Clinical Neurophysiology : Official... Jun 2020Human research on the cremaster muscle (CM), cremasteric reflex (CMR) and genitofemoral nerve (GFN) and reports on their clinical applications using electrophysiological... (Review)
Review
OBJECTIVE
Human research on the cremaster muscle (CM), cremasteric reflex (CMR) and genitofemoral nerve (GFN) and reports on their clinical applications using electrophysiological and histological techniques are rare. We aimed to present a detailed review of the human CM and CMR based on our earlier publications and relevant literature.
METHODS
Electromyography (EMG) of the CM was recorded using disposable needle electrodes. CMR was obtained with tactile and/or electrical stimulation of the inner thigh. Transcranial magnetic stimulation (TMS) and magnetic stimulation of the upper lumbar roots were applied; GFN was stimulated using a surface electrode at the anterior superior iliac spine.
RESULTS
CM striated fibers comprised multiple motor end plates. CM needle EMG results were similar to those of the limb muscles in chronic neurogenic disorders. TMS produced clear-cut evoked motor responses from CM. GFN motor conduction time to CM was absent or delayed in patients with inguinal hernia. EMG of CM was abnormal in 40% of patients with premature ejaculation.
CONCLUSION
CM is different from other skeletal muscles both morphologically and physiologically. Intersegmental sacrolumbar reflexes are useful for evaluating ejaculatory dysfunction.
SIGNIFICANCE
CM is an important muscle for testis thermoregulation and sexual reflexes. Neurophysiological techniques are available for physiological and clinical studies.
Topics: Abdominal Muscles; Body Temperature Regulation; Electric Stimulation; Electromyography; Humans; Male; Reflex; Testis
PubMed: 32305856
DOI: 10.1016/j.clinph.2020.03.011 -
Autonomic Neuroscience : Basic &... May 2021Sepsis is a serious medical condition in which immune dysfunction plays a key role. Previous treatments focused on chemotherapy to control immune function; however, a... (Review)
Review
Sepsis is a serious medical condition in which immune dysfunction plays a key role. Previous treatments focused on chemotherapy to control immune function; however, a recognized effective compound or treatment has yet to be developed. Recent advances indicate that a neuromodulation approach with nerve stimulation allows developing a therapeutic strategy to control inflammation and improve organ functions in sepsis. As a quick, non-invasive technique of peripheral nerve stimulation, acupuncture has emerged as a promising therapy to provide significant advantages for immunomodulation in acute inflammation. Acupuncture obtains its regulatory effect by activating the somatic-autonomic-immune reflexes, including the somatic-sympathetic-splenic reflex, the somatic-sympathetic-adrenal reflex, the somatic-vagal-splenic reflex and the somatic-vagal-adrenal reflex, which produces a systemic effect. The peripheral nerve stimulation also induces local reflexes such as the somatic-sympathetic-lung-reflex, which then produces local effects. These mechanisms offer scientific guidance to design acupuncture protocols for immunomodulation and inflammation control, leading to an evidence-based comprehensive therapy recommendation.
Topics: Acupuncture Therapy; Autonomic Nervous System; Humans; Reflex; Sepsis; Sympathetic Nervous System
PubMed: 33684727
DOI: 10.1016/j.autneu.2021.102793 -
Journal of Korean Neurosurgical Society Mar 2021Spinal dysraphism often causes neurological impairment from direct involvement of lesions or from cord tethering. The conus medullaris and lumbosacral roots are most...
Spinal dysraphism often causes neurological impairment from direct involvement of lesions or from cord tethering. The conus medullaris and lumbosacral roots are most vulnerable. Surgical intervention such as untethering surgery is indicated to minimize or prevent further neurological deficits. Because untethering surgery itself imposes risk of neural injury, intraoperative neurophysiological monitoring (IONM) is indicated to help surgeons to be guided during surgery and to improve functional outcome. Monitoring of electromyography (EMG), motor evoked potential, and bulbocavernosus reflex (BCR) is essential modalities in IONM for untethering. Sensory evoked potential can be also employed to further interpretation. In specific, free-running EMG and triggered EMG is of most utility to identify lumbosacral roots within the field of surgery and filum terminale or non-functioning cord can be also confirmed by absence of responses at higher intensity of stimulation. The sacral nervous system should be vigilantly monitored as pathophysiology of tethered cord syndrome affects the sacral function most and earliest. BCR monitoring can be readily applicable for sacral monitoring and has been shown to be useful for prediction of postoperative sacral dysfunction. Further research is guaranteed because current IONM methodology in spinal dysraphism is still deficient of quantitative and objective evaluation and fails to directly measure the sacral autonomic nervous system.
PubMed: 32905697
DOI: 10.3340/jkns.2020.0124 -
Journal of Applied Behavior Analysis Feb 2019Experts in infant health and development consider the rooting reflex a cue of a baby's hunger and recommend feeding the infant when this reflex occurs. However, the...
Experts in infant health and development consider the rooting reflex a cue of a baby's hunger and recommend feeding the infant when this reflex occurs. However, the relation between rooting and infant feeding status has not been well established in the literature. In the current study, seven parents documented the occurrence of their newborns' rooting, crying, and a control reflex (palmar grasp) before, after, and between naturally occurring feedings. For all participants, rooting occurred during a greater percentage of reflex checks prior to feedings, whereas the palmar grasp occurred during a similar percentage of checks across these time periods. These results provide empirical support for the rooting reflex as a feeding cue. However, data for only one dyad suggested a high probability of the rooting reflex occurring without crying during prefeeding checks. Thus, our data do not provide evidence that feeding in response to the rooting reflex would preempt infant crying.
Topics: Crying; Cues; Feeding Behavior; Female; Humans; Infant; Infant Behavior; Infant Nutritional Physiological Phenomena; Infant, Newborn; Male; Reflex
PubMed: 30251406
DOI: 10.1002/jaba.512 -
Journal of Pain Research 2020Increasing evidence suggests that fibromyalgia most likely represents a neurological dysfunction. We previously hypothesized that at least some fibromyalgia cases may be...
PURPOSE
Increasing evidence suggests that fibromyalgia most likely represents a neurological dysfunction. We previously hypothesized that at least some fibromyalgia cases may be caused by irritation of nerve root fibers and sensory neurons due to moderately increased cerebrospinal pressure. Because of the rostro-caudal hydrostatic pressure gradient, neurogenic abnormalities are expected to be most pronounced in sacral nerve roots. The purpose was to review electrodiagnostic tests of patients with fibromyalgia.
METHODS
A retrospective review of electrodiagnostic test results, including the lumbar and sacral nerve root myotomes of patients diagnosed with fibromyalgia according to the 1990 criteria of the American College of Rheumatology was done.
RESULTS
All 17 patients were female. Sural nerve responses could not be elicited in 12% and S1-Hoffmann reflex latencies were increased in 41%. In 12% of the patients, fibular motor nerve distal latency and conduction velocity were outside normal limits. Needle-EMG revealed neurogenic motor unit potentials in 0% of L2, 6% of L3, 29% of L4, 71% of L5, 47% of S1, 94% of S2, and 76% of S3-S4 myotomes. S3-S4 nerve-supplied anal reflexes were delayed in 94%.
CONCLUSION
This is the first time that electrodiagnostic data of both lumbar and sacral nerve root myotomes in fibromyalgia patients are presented. All patients showed neurogenic abnormalities that were more pronounced in the sacral than in the lumbar myotomes with a rather patchy distribution pattern. We propose that, in addition to skin punch biopsies to assess small fiber neuropathy, assessment of the anal reflex may be a useful part of the diagnostic pathway in patients with fibromyalgia.
PubMed: 32308473
DOI: 10.2147/JPR.S234475 -
Frontiers in Neurology 2022During physiological stress responses such as vigorous exercise, emotional states of fear and rage, and asphyxia, the nervous system induces a massive release of... (Review)
Review
During physiological stress responses such as vigorous exercise, emotional states of fear and rage, and asphyxia, the nervous system induces a massive release of systemic catecholamines that prepares the body for survival by increasing cardiac output and redirecting blood flow from non-essential organs into the cardiopulmonary circulation. A curious byproduct of this vital response is a sudden, transient, and redistributive leukocytosis provoked mostly by the resultant shear forces exerted by rapid blood flow on marginated leukocytes. Generalized convulsive seizures, too, result in catecholamine surges accompanied by similar leukocytoses, the magnitude of which appears to be rooted in semiological factors such as convulsive duration and intensity. This manuscript reviews the history, kinetics, physiology, and clinical significance of post-convulsive leukocyte elevations and discusses their clinical utility, including a proposed role in the scientific investigation of sudden unexpected death in epilepsy (SUDEP).
PubMed: 36408527
DOI: 10.3389/fneur.2022.1021042 -
Cellular and Molecular Neurobiology Aug 2023Several spinal motor output and essential rhythmic behaviors are controlled by supraspinal structures, although their contribution to neuronal networks for respiration...
Several spinal motor output and essential rhythmic behaviors are controlled by supraspinal structures, although their contribution to neuronal networks for respiration and locomotion at birth still requires better characterization. As preparations of isolated brainstem and spinal networks only focus on local circuitry, we introduced the in vitro central nervous system (CNS) from neonatal rodents to simultaneously record a stable respiratory rhythm from both cervical and lumbar ventral roots (VRs).Electrical pulses supplied to multiple sites of brainstem evoked distinct VR responses with staggered onset in the rostro-caudal direction. Stimulation of ventrolateral medulla (VLM) resulted in higher events from homolateral VRs. Stimulating a lumbar dorsal root (DR) elicited responses even from cervical VRs, albeit small and delayed, confirming functional ascending pathways. Oximetric assessments detected optimal oxygen levels on brainstem and cortical surfaces, and histological analysis of internal brain structures indicated preserved neuron viability without astrogliosis. Serial ablations showed precollicular decerebration reducing respiratory burst duration and frequency and diminishing the area of lumbar DR and VR potentials elicited by DR stimulation, while pontobulbar transection increased the frequency and duration of respiratory bursts. Keeping legs attached allows for expressing a respiratory rhythm during hindlimb stimulation. Trains of pulses evoked episodes of fictive locomotion (FL) when delivered to VLM or to a DR, the latter with a slightly better FL than in isolated cords.In summary, suprapontine centers regulate spontaneous respiratory rhythms, as well as electrically evoked reflexes and spinal network activity. The current approach contributes to clarifying modulatory brain influences on the brainstem and spinal microcircuits during development. Novel preparation of the entire isolated CNS from newborn rats unveils suprapontine modulation on brainstem and spinal networks. Preparation views (A) with and without legs attached (B). Successful fictive respiration occurs with fast dissection from P0-P2 rats (C). Decerebration speeds up respiratory rhythm (D) and reduces spinal reflexes derived from both ventral and dorsal lumbar roots (E).
Topics: Rats; Animals; Spinal Cord; Animals, Newborn; Rats, Sprague-Dawley; Electric Stimulation; Brain Stem
PubMed: 36732488
DOI: 10.1007/s10571-023-01321-z -
Theoretical Medicine and Bioethics Oct 2023This work begins with a brief review - from the physical education movement that began in ancient Greece and is deeply rooted in 19th century Europe, to the somatics... (Review)
Review
This work begins with a brief review - from the physical education movement that began in ancient Greece and is deeply rooted in 19th century Europe, to the somatics movement alive today. The review captures primary historical and conceptual references, relevant to the therapeutic-embodied exploratory work. Then, G. Stanghellini's mental health care model [2] is reviewed. This model is considered within reflexive self-awareness and spoken dialogue: the main vehicles in relation with alterity and its consequences in the realm of psychotherapeutic encounter and intervention. This will highlight the individual's bodily movement and inter-corporeal 'proto-dialogue' as a prior realm of therapeutic intervention. Next, a brief consideration of E. Strauss work [31] is presented. This paper's hypothesis is that bodily qualitative dynamics highlighted by phenomenology are essential for an effective mental health therapeutic intervention. A 'seed' of a framework is proposed in this paper; this seed assesses some phenomenological assets of a positive conception of mental health, for which self-awareness education is key to develop skills such as kinaesthetic intelligence and attunement and to educate healthy persons who can promote edifying social relations and environments.
Topics: Humans; Mental Health; Europe; Psychopathology
PubMed: 37231205
DOI: 10.1007/s11017-023-09618-2