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Epileptic Disorders : International... Sep 2014The purpose of this review is to provide insight into the development of the nosological views of the epilepsies, from prehistoric times to the present, and highlight...
The purpose of this review is to provide insight into the development of the nosological views of the epilepsies, from prehistoric times to the present, and highlight how these views are reflected by terminology and classification. Even the earliest written documents reveal awareness that there are multiple forms of epilepsy, and it is surprising that they should be included under the same disease concept, perhaps because the generalised tonic-clonic seizure served as a common denominator. The Hippocratic doctrine that the seat of epilepsy is in the brain may be rooted in earlier knowledge of traumatic seizures. Galenus differentiated cases where the brain was the primary site of origin from others where epilepsy was concomitant with illness in other parts of the body. This laid the fundament for the distinction between idiopathic and symptomatic epilepsies, the definition of which changed considerably over time. The description of the multiple seizure types as they are known at present started in the late 18th century. Attempts to classify seizure types began in the late 19th century, when Jackson formulated a comprehensive pathophysiological definition of epilepsy. Electroencephalography supported a second dichotomy, between seizures with localised onset and others with immediate involvement of both hemispheres which became known as "generalised". In recent years, advanced methods of studying brain function in vivo, including the generation of both spontaneous and reflex epileptic seizures, have revolutionised our understanding of focal and "generalised" human ictogenesis. Both involve complex neuronal networks which are currently being investigated.
Topics: Epilepsy; History, 15th Century; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; History, Ancient; History, Medieval; Humans; Terminology as Topic
PubMed: 25256654
DOI: 10.1684/epd.2014.0676 -
Frontiers in Pediatrics 2023Pediatric spinal cord injury without radiographic abnormality (SCIWORA) caused by backbend practice is increasing. This study proposed an underlying 'combined injury...
OBJECTIVE
Pediatric spinal cord injury without radiographic abnormality (SCIWORA) caused by backbend practice is increasing. This study proposed an underlying 'combined injury mechanism' related to the spinal cord and femoral nerve overstretching.
METHODS
Pediatric patients diagnosed with backbend-associated SCIWORA at the China Rehabilitation Research Center during 2017-2021 were recruited. Clinical and imaging data were collected, and each patient's clinical course and prognosis were determined. Healthy dancers were recruited to simulate the backbend, obtain images, and estimate the spinal cord and femoral nerve stretch ratio. A model for the 'combined injury mechanism' was established using 4-week-old SD rats.
RESULTS
Forty-two SCIWORA female patients with an average age of 6 (SD 1) years and an average hospitalization time of 91 (SD 43) days were assessed. The primary initial symptom was pain in the back and/or lower extremities (33, 79%). The average time from injury onset to severe paralysis was 2.0 (SD 0.6) hours. Most patients had complete paraplegia (32, 76%), and neurological levels were distributed mainly in thoracic segments (38, 91%). Patients with elicited tendon reflexes on admission tended to have an incomplete spinal cord injury ( = 0.001) and improved motor recovery ( = 0.018). After one year, the most common complications were scoliosis (31, 74%) and abnormal hips (14, 33%). Injury of the caudal spinal cord torn by nerve roots was confirmed by surgical exploration in a case. The thoracic spinal cord and femoral nerves were overstretched by 148.8 ± 3.6% and111.7 ± 4.0%, respectively, in a full backbend posture. The 'combined injury mechanism' was partially replicated in the animal model.
CONCLUSION
Spinal overstretch and transient dislocation are considered the primary mechanisms by which SCIWORA occurs in children. Overstretching the femoral nerve aggravates spinal cord injuries caused by backbend practice.
PubMed: 37881636
DOI: 10.3389/fped.2023.1263280 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Oct 2022To analyze the early effectiveness of unilateral biportal endoscopic discectomy (UBED) combined with annulus fibrosus suture in the treatment of lumbar disc herniation...
OBJECTIVE
To analyze the early effectiveness of unilateral biportal endoscopic discectomy (UBED) combined with annulus fibrosus suture in the treatment of lumbar disc herniation (LDH).
METHODS
The clinical data of 19 patients with LDH treated with UBED and annulus fibrosus suture between October 2020 and October 2021 were retrospectively analyzed. There were 12 males and 7 females with an average age of 39.1 years (range, 26-59 years). The operative segment was L in 13 cases, and L , S in 6 cases. The mean disease duration was 6.7 months (range, 3-15 months). Preoperative neurological examination showed that muscle strength, sensation, and tendon reflex weakened or disappeared in varying degrees. Single annulus fibrosus suture (14 cases) or anchor assisted annulus fibrosus suture (5 cases) was selected according to the location of annulus fibrosus tears. Visual analogue scale (VAS) score was used to assess the low back and leg pain before operation and at 3 days, 3 months, and 6 months after operation. Oswestry disability index (ODI) was used to evaluate the function recovery of lumbar spine before operation and at 3 days, 3 months, and 6 months after operation. At 3 days and 3 months after operation, MRI was used to examine the removal of nucleus pulposus and decompression of nerve root. MacNab criteria was used to evaluate the effectiveness at 6 months after operation and the recovery of nerve root function was recorded.
RESULTS
All operations were successfully completed with a mean operation time of 52.7 minutes (range, 40-75 minutes). There was no complication such as nerve injury, spinal cord hypertension syndrome, or dural sac tear during operation, and no complication such as infection, aggravation of nerve damage, or cerebrospinal fluid leakage after operation. All the patients were followed up 6-10 months (mean, 8.2 months). Postoperative MRI showed that the herniated disc was completely removed and nerve roots were fully decompressed. During the follow-up, there was no recurrence of disc herniation. The VAS scores of low back pain and leg pain and ODI at each time point after operation significantly improved when compared with those before operation, and those at 6 months after operation further improved than those at 3 days and 3 months after operation, all showing significant differences ( <0.05). At 6 months after operation, MacNab standard was used to evaluate the effectiveness, and the results were excellent in 14 cases, good in 4 cases, and fair in 1 case, with an excellent and good rate of 94.7%. Neurological examination showed that the sensation and muscle strength of the affected nerve root innervated area recovered significantly when compared with those before operation ( <0.05); the recovery of tendon reflex was not obvious, showing no significant difference when compared with that before operation ( >0.05).
CONCLUSION
UBED combined with annulus fibrosus suture is a safe and effective technique for LDH and early effectiveness is satisfactory.
Topics: Male; Female; Humans; Adult; Intervertebral Disc Displacement; Annulus Fibrosus; Retrospective Studies; Treatment Outcome; Diskectomy; Endoscopy; Lumbar Vertebrae; Low Back Pain; Sutures; Diskectomy, Percutaneous
PubMed: 36310453
DOI: 10.7507/1002-1892.202205095 -
Oncotarget Mar 2018Electrical stimulation of peripheral nerves controlling the bladder is an alternative, nondestructive medical treatment for urinary incontinence and retention. In this...
Electrical stimulation of peripheral nerves controlling the bladder is an alternative, nondestructive medical treatment for urinary incontinence and retention. In this study, we aimed to identify the most efficient sensory and motor spinal nerve roots involved in the micturition reflex. Unilateral L5-S2 dorsal and ventral roots were electrically stimulated, and bladder reflex contractions were recorded under isovolumetric conditions. Repeated stimulation of the L6 and S1 dorsal roots not only abolished bladder reflex contractions but also induced a poststimulation inhibitory effect, whereas repeated stimulation of the L5 and S2 dorsal roots had no effect. Only the L6 ventral root directly caused bladder contraction when ventral roots L5-S2 were stimulated in sequence. Upon retrograde tracing using pseudorabies virus (PRV), the sacral parasympathetic nucleus of the L6 segment had more PRV-positive cells than the other segments, though the S1 segment of the dorsal root ganglia had the highest density of PRV-positive neurons. These results suggest the L6 ventral root is most efficient in producing detrusor muscle contraction, and the S1 dorsal root best inhibits the micturition reflex.
PubMed: 29568364
DOI: 10.18632/oncotarget.23950 -
Medical Acupuncture Dec 2021Auriculotherapy, the treatment of patients using ear-point stimulation, is a French technique, deeply rooted in a European medical tradition. Although the French...
Auriculotherapy, the treatment of patients using ear-point stimulation, is a French technique, deeply rooted in a European medical tradition. Although the French physician, Paul Nogier, MD (1908-1996 ad) invented and promoted auriculotherapy, it is nevertheless worth mentioning, in the course of European history, the occasional use of the ear to relieve head, face, or sciatic nerve pain. It took several centuries to find a physician who attempted to understand why some healers obtained interesting therapeutic results with ear-point stimulation. The exact history of auriculotherapy remained a mystery for a long time. Only recently have researchers begun to understand it better. Many articles, admittedly not based on robust data, wrongly ascribed the discovery of auricular somatotopy to ancient civilizations. It was the recent reading of a book on the treatment of sciatica written in 1869 by Lagrelette that enabled the current author of this article to characterize and confirm the Western roots of auriculotherapy through the history of cauterizations.
PubMed: 34976274
DOI: 10.1089/acu.2021.0075 -
Journal of Integrative Neuroscience May 2022Spasticity is characterised by an atypical increase of muscle tone, affecting normal movements and interfering with the patient quality of life. The medicines may limit...
BACKGROUND
Spasticity is characterised by an atypical increase of muscle tone, affecting normal movements and interfering with the patient quality of life. The medicines may limit the effects of the disease and selective dorsal rhizotomy (SDR) can be used for selected cases or cases refractory to medicine. We present the surgical technique and the short-term results of this newly established surgical treatment in Slovenia.
METHODS
A retrospective analysis was performed of all patients that underwent the SDR from 2017 to 2019. The median follow-up was of 10 months. The following data have been collected: aetiology of spasticity, age at SDR, number of sectioned lumbar rootlets L1-S2, intraoperative disappearance of the H-reflex and intraoperative preservation of the bulbocavernosus reflex. The motor functions of all children have been classified by the Gross Motor Function Classification System (GMFCS) and Gross Motor Function Measure (GMFM-88). Twelve children underwent SDR, the median age at surgery was 9.6 years (min 3.9-max 16 years).
RESULTS
A mean of 57.8% of dorsal rootlets L2-S1 have been cut, while at level L1 50% of the dorsal roots have been routinely sectioned. The median amount of S2 rootlets cut was 14.3%. Postoperatively, we observed a sudden decrease in muscle tone. In all patients, there was an improvement of the muscle tone and of the gait pattern. The GMFM improved from 187.8 to 208.3 after a follow-up of 6 months.
CONCLUSIONS
There was no complication in terms of wound healing, cerebrospinal fluid fistula of neurological dysfunctions. Despite the relatively short follow-up, our early results confirm the efficacy of the SDR.
Topics: Cerebral Palsy; Child; Humans; Muscle Spasticity; Quality of Life; Retrospective Studies; Rhizotomy; Slovenia
PubMed: 35633171
DOI: 10.31083/j.jin2103090 -
Journal of Neurophysiology Oct 2005Dorsal root-evoked stimulation of sensory afferents in the hemisected in vitro rat spinal cord produces reflex output, recorded on the ventral roots. Transient spinal... (Comparative Study)
Comparative Study
Dorsal root-evoked stimulation of sensory afferents in the hemisected in vitro rat spinal cord produces reflex output, recorded on the ventral roots. Transient spinal 5-HT(2C) receptor activation induces a long-lasting facilitation of these reflexes (LLFR) by largely unknown mechanisms. Two Sprague-Dawley substrains were used to characterize network properties involved in this serotonin (5-HT) receptor-mediated reflex plasticity. Serotonin more easily produced LLFR in one substrain and a long-lasting depression of reflexes (LLDR) in the other. Interestingly, LLFR and LLDR were bidirectionally interconvertible using 5-HT(2A/2C) and 5-HT(1A) receptor agonists, respectively, regardless of substrain. LLFR was predominantly Abeta afferent fiber mediated, consistent with prominent 5-HT(2C) receptor expression in the Abeta fiber projection territories (deeper spinal laminae). Reflex facilitation involved an unmasking of polysynaptic pathways and an increased receptive field size. LLFR emerged even when reflexes were evoked three to five times/h, indicating an activity independent induction. Both the NMDA and AMPA/kainate receptor-mediated components of the reflex could be facilitated, and facilitation was dependent on 5-HT receptor activation alone, not on coincident reflex activation in the presence of 5-HT. Selective blockade of GABA(A) and/or glycine receptors also did not prevent reflex amplification and so are not required for LLFR. Indeed, a more robust response was seen after blockade of spinal inhibition, indicating that inhibitory processes serve to limit reflex amplification. Overall we demonstrate that the serotonergic system has the capacity to induce long-lasting bidirectional changes in reflex strength in a manner that is nonassociative and independent of evoked activity or activation of ionotropic excitatory and inhibitory receptors.
Topics: 8-Hydroxy-2-(di-n-propylamino)tetralin; Amphetamines; Analysis of Variance; Animals; Animals, Newborn; Clozapine; Dose-Response Relationship, Radiation; Drug Interactions; Electric Stimulation; Female; Ganglia, Spinal; Immunohistochemistry; In Vitro Techniques; Male; Pyrazines; Rats; Rats, Sprague-Dawley; Reaction Time; Receptor, Serotonin, 5-HT2C; Receptors, Serotonin, 5-HT2; Reflex; Serotonin; Serotonin Antagonists; Serotonin Receptor Agonists; Spinal Cord; Time Factors
PubMed: 16033939
DOI: 10.1152/jn.00465.2005 -
The Journal of Investigative Dermatology Jul 1977The diffuse area of arteriolar vasodilation surrounding a region of recently injured human skin (axon reflex flare) is dependent upon the integrity of nerve fibers with... (Review)
Review
The diffuse area of arteriolar vasodilation surrounding a region of recently injured human skin (axon reflex flare) is dependent upon the integrity of nerve fibers with cell bodies located in dorsal root ganglia. Evidence is presented to indicate that a vasodilator peptide similar to a kinin, neurotensin, or substance P, is implicated in the chain of biochemical events responsible for the transient shift in vascular tonus observable as the flare reaction.
Topics: Afferent Pathways; Brachial Plexus; Bradykinin; Burns; Dermatitis; Electric Stimulation; Ganglia, Spinal; Humans; Kininogens; Kinins; Microcirculation; Molecular Weight; Nerve Endings; Neurons; Perfusion; Peroneal Nerve; Spinal Nerve Roots; Sympathectomy; Vasomotor System
PubMed: 326995
DOI: 10.1111/1523-1747.ep12497896 -
Neuron Apr 2013To what extent dorsal horn interneurons contribute to the modality specific processing of pain and itch messages is not known. Here, we report that loxp/cre-mediated CNS...
To what extent dorsal horn interneurons contribute to the modality specific processing of pain and itch messages is not known. Here, we report that loxp/cre-mediated CNS deletion of TR4, a testicular orphan nuclear receptor, results in loss of many excitatory interneurons in the superficial dorsal horn but preservation of primary afferents and spinal projection neurons. The interneuron loss is associated with a near complete absence of supraspinally integrated pain and itch behaviors, elevated mechanical withdrawal thresholds and loss of nerve injury-induced mechanical hypersensitivity, but reflex responsiveness to noxious heat, nerve injury-induced heat hypersensitivity, and tissue injury-induced heat and mechanical hypersensitivity are intact. We conclude that different subsets of dorsal horn excitatory interneurons contribute to tissue and nerve injury-induced heat and mechanical pain and that the full expression of supraspinally mediated pain and itch behaviors cannot be generated solely by nociceptor and pruritoceptor activation of projection neurons; concurrent activation of excitatory interneurons is essential.
Topics: Animals; Cell Death; Cognition Disorders; Disease Models, Animal; Glutamate Decarboxylase; Green Fluorescent Proteins; Hyperalgesia; Interneurons; Lectins; Mice; Mice, Inbred C57BL; Mice, Transgenic; Oncogene Proteins v-fos; Pain; Pain Threshold; Phosphopyruvate Hydratase; Pruritus; Reaction Time; Receptors, Steroid; Receptors, Thyroid Hormone; Spinal Nerve Roots; Substance P
PubMed: 23622066
DOI: 10.1016/j.neuron.2013.03.001 -
Thyroid : Official Journal of the... May 2020The optimal management for patients with small, low-risk thyroid cancer is often debated. We aimed to characterize the attitudes and beliefs of providers and patients...
The optimal management for patients with small, low-risk thyroid cancer is often debated. We aimed to characterize the attitudes and beliefs of providers and patients about management of small, low-risk thyroid cancer and how they relate to overtreatment. We conducted 34 semi-structured interviews with surgeons ( = 12), endocrinologists ( = 12), and patients with <1.5 cm papillary thyroid cancer ( = 10). Interviews probed about diagnosis and treatment decision-making, including nonoperative options. We used thematic analysis to identify themes related to overtreatment and created concept diagrams to map observed relationships between themes. When providers discussed management of small, low-risk thyroid cancer, most felt that overtreatment was a problem, and some brought it up without prompting. Providers often believed that overtreatment results from overdiagnosis and relayed how the process commonly starts with incidental discovery of a thyroid nodule on imaging. Providers viewed biopsy of the nodule as a reflexive or habitual action. They ascribed inappropriate biopsy to lack of adherence to or knowledge of guidelines, radiologist recommendations, and the desire of patients and physicians to minimize diagnostic uncertainty. Providers described subsequent cancer diagnosis as an event that "opens Pandora's box" and often provokes a strong instinctive, culturally rooted need to proceed with surgery-specifically total thyroidectomy. Consequently, most providers felt that it is easier to prevent overdiagnosis than overtreatment and recommended strategies such as improving guideline adherence, resetting patients' expectations, and engaging the media. In contrast, patients did not bring up or openly discuss overtreatment or overdiagnosis. Some patients described the seemingly automatic process from an incidental finding to surgery. Their statements confirmed that the "need to know" was a major motivation for biopsying their nodule. Patients felt that once they had a cancer diagnosis, surgery was a foregone conclusion. Patients admitted their knowledge about thyroid nodules and cancer was low, leaving room for education about the need for biopsy and less extensive treatment options. Surgeons' and endocrinologists' attitudes and beliefs about overtreatment focus on the automaticity of overdiagnosis. Both patients and providers are cognizant of the cascade of clinical events that propel patients from incidental discovery of a thyroid nodule to surgery.
Topics: Adult; Aged; Attitude of Health Personnel; Endocrinologists; Female; Guideline Adherence; Humans; Male; Medical Overuse; Middle Aged; Thyroid Cancer, Papillary; Thyroid Neoplasms
PubMed: 31910092
DOI: 10.1089/thy.2019.0587