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M Ara - One of the best experts on this subject based on the ideXlab platform.
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intravesical capsaicin versus resiniferatoxin for the treatment of detrusor Hyperreflexia in spinal cord injured patients a double blind randomized controlled study
The Journal of Urology, 2004Co-Authors: Marianne De Seze, L Wia, J P Dosque, J M Mazau, Luc Soyeu, Sylvie Lajezewski, Nicholas Moore, Uno Oche, M AraAbstract:ABSTRACTPurpose: Chemical defunctionalization of C-fiber bladder afferents with intravesical vanilloids such as capsaicin (CAP) or resiniferatoxin (RTX) improves detrusor Hyperreflexia in humans and animals. The little existing data comparing the efficacy and tolerance of these 2 vanilloid agents seem to favor RTX in 10% alcohol over CAP, which is usually diluted in 30% alcohol. We compared the efficacy and tolerability of the 2 vanilloid agonists in what to our knowledge is the first randomized, controlled study comparing nonalcohol CAP vs RTX in 10% alcohol in neurogenic patients with detrusor Hyperreflexia.Materials and Methods: This single center, randomized, double-blind, parallel groups study included 39 spinal cord injured adults with detrusor Hyperreflexia. On day 0 patients were randomized to receive 1, 100 ml intravesical instillation of 100 nMol/l RTX diluted in 10% ethanol or 1 mmol/l CAP diluted in glucidic solvent. Efficacy (voiding chart and cystomanometry) and tolerability were evaluated d...
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capsaicin and neurogenic detrusor Hyperreflexia a double blind placebo controlled study in 20 patients with spinal cord lesions
Neurourology and Urodynamics, 1998Co-Authors: Marianne De Seze, L Wia, P A Joseph, J P Dosque, J M Mazau, M AraAbstract:The aim of this study was to investigate the efficacy and tolerance of capsaicin, a neurotoxin for C-fiber afferents, applied intravesically in the treatment of detrusor Hyperreflexia. Eleven male and nine female patients who had spinal cord lesions caused by multiple sclerosis (12) or trauma (eight) resulting in detrusor Hyperreflexia with urge incontinence and pollakiuria were randomized to receive one intravesical instillation of either 30 mg capsaicin in 100 ml 30% ethanol or 100 ml 30% ethanol alone. The patients were evaluated clinically (voiding diary) and urodynamically (maximum cystometric capacity, maximum detrusor pressure, first and normal desire to void) before and 30 days after the instillation. On day 30, the 10 patients who received capsaicin had significant decreases in 24-h voiding frequency from 9.3 ± 6.1 to 6.7 ± 3.8 (P = 0.016) and leakages from 3.9 ± 1.6 to 0.6 ± 0.8 (P = 0.0008); their maximum cystometric capacity increased from 169 ± 68 to 299 ± 96 ml (P = 0.01) and maximum detrusor pressure decreased from 77 ± 24 to 53 ± 27 cm H2O. There were no significant changes in the control group. In seven subjects in each group, instillation triggered immediate side effects (suprapubic pain, sensory urgency, flushes, hematuria, autonomic Hyperreflexia) that resolved within 2 weeks. Intravesical capsaicin significantly improves clinical and urodynamic parameters of detrusor Hyperreflexia in spinal cord–injured patients. Side effects are frequent, tolerable, and identical to those induced by 30% ethanol alone. Neurourol. Urodynam. 17:513–524, 1998. © 1998 Wiley-Liss, Inc.
Marianne De Seze - One of the best experts on this subject based on the ideXlab platform.
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intravesical capsaicin versus resiniferatoxin for the treatment of detrusor Hyperreflexia in spinal cord injured patients a double blind randomized controlled study
The Journal of Urology, 2004Co-Authors: Marianne De Seze, L Wia, J P Dosque, J M Mazau, Luc Soyeu, Sylvie Lajezewski, Nicholas Moore, Uno Oche, M AraAbstract:ABSTRACTPurpose: Chemical defunctionalization of C-fiber bladder afferents with intravesical vanilloids such as capsaicin (CAP) or resiniferatoxin (RTX) improves detrusor Hyperreflexia in humans and animals. The little existing data comparing the efficacy and tolerance of these 2 vanilloid agents seem to favor RTX in 10% alcohol over CAP, which is usually diluted in 30% alcohol. We compared the efficacy and tolerability of the 2 vanilloid agonists in what to our knowledge is the first randomized, controlled study comparing nonalcohol CAP vs RTX in 10% alcohol in neurogenic patients with detrusor Hyperreflexia.Materials and Methods: This single center, randomized, double-blind, parallel groups study included 39 spinal cord injured adults with detrusor Hyperreflexia. On day 0 patients were randomized to receive 1, 100 ml intravesical instillation of 100 nMol/l RTX diluted in 10% ethanol or 1 mmol/l CAP diluted in glucidic solvent. Efficacy (voiding chart and cystomanometry) and tolerability were evaluated d...
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capsaicin and neurogenic detrusor Hyperreflexia a double blind placebo controlled study in 20 patients with spinal cord lesions
Neurourology and Urodynamics, 1998Co-Authors: Marianne De Seze, L Wia, P A Joseph, J P Dosque, J M Mazau, M AraAbstract:The aim of this study was to investigate the efficacy and tolerance of capsaicin, a neurotoxin for C-fiber afferents, applied intravesically in the treatment of detrusor Hyperreflexia. Eleven male and nine female patients who had spinal cord lesions caused by multiple sclerosis (12) or trauma (eight) resulting in detrusor Hyperreflexia with urge incontinence and pollakiuria were randomized to receive one intravesical instillation of either 30 mg capsaicin in 100 ml 30% ethanol or 100 ml 30% ethanol alone. The patients were evaluated clinically (voiding diary) and urodynamically (maximum cystometric capacity, maximum detrusor pressure, first and normal desire to void) before and 30 days after the instillation. On day 30, the 10 patients who received capsaicin had significant decreases in 24-h voiding frequency from 9.3 ± 6.1 to 6.7 ± 3.8 (P = 0.016) and leakages from 3.9 ± 1.6 to 0.6 ± 0.8 (P = 0.0008); their maximum cystometric capacity increased from 169 ± 68 to 299 ± 96 ml (P = 0.01) and maximum detrusor pressure decreased from 77 ± 24 to 53 ± 27 cm H2O. There were no significant changes in the control group. In seven subjects in each group, instillation triggered immediate side effects (suprapubic pain, sensory urgency, flushes, hematuria, autonomic Hyperreflexia) that resolved within 2 weeks. Intravesical capsaicin significantly improves clinical and urodynamic parameters of detrusor Hyperreflexia in spinal cord–injured patients. Side effects are frequent, tolerable, and identical to those induced by 30% ethanol alone. Neurourol. Urodynam. 17:513–524, 1998. © 1998 Wiley-Liss, Inc.
Mostafa M Elhilali - One of the best experts on this subject based on the ideXlab platform.
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urinary bladder Hyperreflexia a rat animal model
Neurourology and Urodynamics, 2003Co-Authors: Hassa Shake, Mohammed Sherif Mourad, Mohammed Hatem Elbialy, Mostafa M ElhilaliAbstract:In this work, we are presenting a rat animal model for bladder Hyperreflexia after suprasacral spinal cord transection. Our aim was to standardize an animal model that can be useful in studying this condition. After standardizing the animal model in a pilot study, 26 female Sprague–Dawley rats were subjected to spinal cord transection at the level of T10 vertebra. Four animals were subjected to cystometrogram (CMG) 24 hr after spinalization and six rats 3 weeks post-spinalization. These CMGs were compared to that of six normal controls. The detailed description of the model presented in this manuscript, is the final result after several modifications. All the animals consistently developed Hyperreflexia after an initial period of spinal shock phase. Expressed volume of urine continued to decrease until it reached a plateau after peaking at 1-week post-spinalization. The attrition rate reached 27.3% after several improvements in the animal model and was mostly from self-inflicted injuries. Post-operative complications included hypothermia, decubitus ulcers, hematuria, urinary tract infection in addition to the unexplained death of two animals. In conclusion, we believe that this animal model closely resembles the clinical condition of Hyperreflexia and follows similar course. The relative low cost of this animal model and the easy maintenance makes it a valuable tool to study such a condition. Neurourol. Urodynam. 22:693–698, 2003. © 2003 Wiley-Liss, Inc.
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evidence of a peripheral role of neurokinins in detrusor Hyperreflexia a further study of selective tachykinin antagonists in chronic spinal injured rats
The Journal of Urology, 2001Co-Authors: Mahmoud Abdelgawad, Stephane Dio, Mostafa M ElhilaliAbstract:Purpose: Spinal cord injury above the sacral micturition center usually leads to detrusor Hyperreflexia, increased intravesical pressure and post-void residual urine. Detrusor Hyperreflexia is believed to be mediated by afferent C fibers with tachykinins as neurotransmitters. We investigated the selective peptide tachykinin antagonists MEN 11420 and GR 82334 of NK-2 and NK-1 receptors, respectively, in a chronic rat model of detrusor Hyperreflexia after suprasacral spinal cord injury.Materials and Methods: Adult female Sprague-Dawley rats weighing 200 to 250 gm. were used. The spinal cord was transected at the T10 level. The bladder was evacuated by the Crede maneuver 3 times daily. After 6 weeks the rats were implanted with femoral vein and bladder dome catheters 2 days before filling cystometry. The 5 rats in group 1 received 100 nmol./kg. of the NK-2 antagonist MEN 11420 intravenously. The 5 rats in group 2 received 100 nmol./kg. of the NK-1 antagonist GR 82334 intravenously. The 5 rats in group 3 rece...
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Hyperreflexia of the urinary bladder possible role of the efferent function of the capsaicin sensitive primary afferents
The Journal of Urology, 1998Co-Authors: Hassa Shake, Mario Kalfopoulos, Magdy M Hassouna, Stephane Dio, Mostafa M ElhilaliAbstract:AbstractPurpose: Capsaicin sensitive primary afferents (CSPA) have been implicated in the pathogenesis Hyperreflexia after spinalization. In this study we investigated the role of the efferent function of these fibers in detrusor Hyperreflexia and its effect on detrusor physiology and pharmacology.Materials and Methods: Four groups of female Sprague Dawley rats were included in our study. These groups were normal controls, capsaicin treated normal rats, spinalized rats and capsaicin treated spinalized rats. Six weeks following spinalization, animals were subjected to cystometric study, and bladders were obtained for either in vitro detrusor contractility study or substance P (SP), neurokinin A (NKA) and calcitonin gene related peptide (CGRP) quantification by radioimmunoassay.Results: Spinalized animals consistently developed Hyperreflexia after spinalization in the form of uninhibited contractions more than 15 cm. water in amplitude. This was accompanied by increased urinary bladder total content of the ...
Nobuhiro Yuki - One of the best experts on this subject based on the ideXlab platform.
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acute ataxic neuropathy with Hyperreflexia
Journal of Neurology, 2013Co-Authors: Leonard L L Yeo, Nobuhiro YukiAbstract:Dear Editor, The ataxic form of Guillain-Barre syndrome (GBS), characterized by acute profound ataxia with negative Romberg sign and no (or minimal) ophthalmoplegia [1], is considered as an incomplete form of Fisher syndrome [2]. However, its nosological relationship to acute sensory ataxic neuropathy was not discussed [3]. A recent comprehensive study shows how ataxic GBS and acute sensory ataxic neuropathy share similar clinical and laboratory features, forming a continuous spectrum under the term: acute ataxic neuropathy without ophthalmoplegia (AAN) [4]. AAN typically presents with areflexia or hyporeflexia. Preserved or brisk reflexes are seen in GBS or Bickerstaff brainstem encephalitis [5, 6], but not in AAN. We report the first case of AAN with Hyperreflexia. A 45-year-old male developed unsteady gait, 5 days after experiencing fever and sore throat. He had no prior medical history and abstained from alcohol. On day 2, he developed diplopia at all extremes of gaze, with left hand and foot numbness, and a broad-based gait. He demonstrated bilateral dysmetria, and abnormal left heel-shin test. Eye pursuit, vertical and horizontal eye movements were full, except for convergence. He had no nystagmus. Pupils were 5 mm bilaterally with normal light and accommodation reflexes. Cranial nerves were otherwise intact with no facial or oropharyngeal weakness. Limb power and tone were normal. He had Hyperreflexia in all 4 limbs, but with normal jaw jerk and down-going plantar responses. Despite complaining of left-sided distal dysesthesias, objective sensory testing of all modalities was normal, other than an abnormal Romberg’s test. There was no autonomic involvement. His brain MRI showed no abnormalities or Wernicke’s encephalopathy. MRI spine had no myelopathy or ventral nerve root enhancement. His vitamin B1 levels were normal and lumbar puncture on day 3 was slightly traumatic with 181 red blood cells/lL, protein 1.2 g/dL (normal, \0.6 g/dL) and 45 cells/lL of predominantly lymphocytic white blood cells. We diagnosed AAN with unusually brisk reflexes. As he was ambulatory, we treated him conservatively. Median, ulnar, tibial and peroneal nerve conduction studies on day 4 showed normal amplitudes of the compound motor action potentials and normal distal motor latencies. Sensory nerve action potential amplitudes and latencies were normal. F-waves had normal latencies and were not dispersed. However, his somatosensory evoked potentials, recording from bilateral median and posterior tibial nerves, showed prolonged cerebral evoked N18 and P37 latencies (Table 1). Nerve conduction studies, including peripheral sensory nerve potentials on day 10 remained normal, whereas N18 and P37 latencies normalized by day 15. Anti-GQ1b antibodies were absent, but IgG anti-GM1b antibodies were positive in his serum. Upon discharge on day 12, eye convergence and gait had improved while Hyperreflexia and left-sided limb dysmetria remained. His dysesthesia had resolved but Romberg’s test remained positive. He remained alert throughout the illness and his reflexes normalized on day 45. L. L. L. Yeo K. Ng Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
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acute facial diplegia and Hyperreflexia a guillain barre syndrome variant
Neurology, 2004Co-Authors: Keiichiro Susuki, Michiaki Koga, M Atsumi, Koichi Hirata, Nobuhiro YukiAbstract:Two patients with acute facial diplegia and Hyperreflexia are described. Both patients had serologic evidence of preceding Campylobacter jejuni infection and antiganglioside IgG antibodies as well as other laboratory and electrophysiologic findings suggesting Guillain-Barre syndrome (GBS). IV immunoglobulin produced recovery. Hyperreflexia does not necessarily exclude the diagnosis of a GBS variant. Antiganglioside antibodies can help with diagnosis in difficult cases.
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Hyperreflexia in axonal guillain barre syndrome subsequent to campylobacter jejuni enteritis
Journal of the Neurological Sciences, 2002Co-Authors: Satoshi Kuwabara, Michiaki Koga, Masahiro Mori, Takamichi Hattori, Miho Nakata, Jia Ying Sung, Naoko Kato, Nobuhiro YukiAbstract:We describe a patient with the acute motor axonal neuropathy (AMAN) form of Guillain-Barre syndrome (GBS), who showed generalized Hyperreflexia. A 24-year-old man developed acute paralysis following Campylobacter jejuni enteritis. He showed exaggerated tendon reflexes with abnormal reflex spread to other segments, and was initially diagnosed as having post-infectious myelitis. Nerve conduction studies showed motor axonal degeneration (the AMAN pattern), and increased soleus H-reflex amplitudes. His serum was positive for IgG antibodies to gangliosides GM1b and GalNAc-GD1a. He was treated with plasmapheresis, resulting in rapid recovery. Hyperreflexia was still present 12 months after onset when muscle strength was completely normal. This case provides further evidence that patients with AMAN can develop increased motor neuron excitability, and possible mechanisms for the Hyperreflexia are discussed.
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Hyperreflexia in guillain barre syndrome relation with acute motor axonal neuropathy and anti gm1 antibody
Journal of Neurology Neurosurgery and Psychiatry, 1999Co-Authors: Satoshi Kuwabara, Kazue Ogawara, Michiaki Koga, Masahiro Mori, Takamichi Hattori, Nobuhiro YukiAbstract:OBJECTIVES—To investigate the incidence of Hyperreflexia in patients with Guillain-Barre syndrome (GBS), and its relation with electrodiagnosis of acute motor axonal neuropathy (AMAN), antiganglioside GM1 antibody, and Campylobacter jejuni infection. It was reported that patients with AMAN in northern China often had Hyperreflexia in the recovery phase. METHODS—In 54 consecutive Japanese patients with GBS, sequential findings of tendon reflexes were reviewed. By electrodiagnostic criteria, patients were classified as having AMAN or acute inflammatory demyelinating polyneuropathy (AIDP). Anti-GM1 and anti-C jejuni antibodies were measured by enzyme linked immunosorbent assays. RESULTS—Seven (13%) patients developed Hyperreflexia with the spread of the myotatic reflex to other segments in the early recovery phase, one of whom already had Hyperreflexia in the acute progressive phase. Of the seven patients, six had AMAN and all seven had anti-GM1 antibodies, whereas only two had anti-C jejuni antibodies. Hyperreflexia was more often found in patients with AMAN than AIDP (6/23 v 1/18, p=0.002), and in patients with anti-GM1 antibodies than without them (7/26 v 0/28, p=0.01). Hyperreflexic patients had milder peak disabilities than patients without Hyperreflexia (p=0.03). Increased motor neuron excitability in the hyperreflexic patients was supported by increased soleus H-reflex amplitudes and the appearance of H-reflexes in the small hand or foot muscles. CONCLUSIONS—Hyperreflexia often occurs in patients with GBS especially with AMAN, anti-GM1 antibodies, and milder disease. Increased motor neuron excitability further characterises the subgroup of patients with GBS with AMAN and anti-GM1 antibodies.
Edga Garciarill - One of the best experts on this subject based on the ideXlab platform.
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chapter 11 novel mechanism for Hyperreflexia and spasticity
Progress in Brain Research, 2011Co-Authors: Charlotte Yates, Amanda Charlesworth, K Garriso, N Reese, Edga GarciarillAbstract:We established that Hyperreflexia is delayed after spinal transection in the adult rat and that passive exercise could normalize low frequency-dependent depression of the H-reflex. We were also able to show that such passive exercise will normalize Hyperreflexia in patients with spinal cord injury (SCI). Recent results demonstrate that spinal transection results in changes in the neuronal gap junction protein connexin 36 below the level of the lesion. Moreover, a drug known to increase electrical coupling was found to normalize Hyperreflexia in the absence of passive exercise, suggesting that changes in electrical coupling may be involved in Hyperreflexia. We also present results showing that a measure of spasticity, the stretch reflex, is rendered abnormal by transection and normalized by the same drug. These data suggest that electrical coupling may be dysregulated in SCI, leading to some of the symptoms observed. A novel therapy for Hyperreflexia and spasticity may require modulation of electrical coupling.
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novel mechanism for Hyperreflexia and spasticity
2011Co-Authors: Amanda Charlesworth, Charlotte Yates, K Garriso, N Reese, Edga GarciarillAbstract:Abstract We established that Hyperreflexia is delayed after spinal transection in the adult rat and that passive exercise could normalize low frequency-dependent depression of the H-reflex. We were also able to show that such passive exercise will normalize Hyperreflexia in patients with spinal cord injury (SCI). Recent results demonstrate that spinal transection results in changes in the neuronal gap junction protein connexin 36 below the level of the lesion. Moreover, a drug known to increase electrical coupling was found to normalize Hyperreflexia in the absence of passive exercise, suggesting that changes in electrical coupling may be involved in Hyperreflexia. We also present results showing that a measure of spasticity, the stretch reflex, is rendered abnormal by transection and normalized by the same drug. These data suggest that electrical coupling may be dysregulated in SCI, leading to some of the symptoms observed. A novel therapy for Hyperreflexia and spasticity may require modulation of electrical coupling.
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modafinil normalized Hyperreflexia after spinal transection in adult rats
Spinal Cord, 2009Co-Authors: Charlotte Yates, Amanda Charlesworth, N Reese, R D Skinne, Kazuto Ishida, Edga GarciarillAbstract:Hyperreflexia occurs after spinal cord injury and can be assessed by measuring low frequency-dependent depression of the H-reflex in the anesthetized animal. To determine the effects of Modafinil (MOD), given orally, following a complete SCI compared with animals receiving MBET and transected untreated animals and examine if changes exist in Connexin 36 (Cx-36) protein levels in the lumbar enlargement of animals for the groups described. Center for Translational Neuroscience, Little Rock, AR, USA. Adult female rats underwent complete transection (Tx) at T10 level. H-reflex testing was performed 30 days following Tx in one group, and after initiation of treatment with MOD in another group, and after MBET training in the third group. The Lumbar enlargement tissue was harvested and western blots were performed after immunoprecipitation techniques to compare Cx-36 protein levels. Statistically significant decreases in low frequency-dependent depression of the H-reflex were observed in animals that received MOD and those that were treated with MBET compared with the Tx, untreated group. Statistically significant changes in Cx-36 protein levels were not observed in animals treated with MOD compared with Tx, untreated animals. Normalization of the loss of low frequency -dependent depression of the H-reflex was demonstrated in the group receiving MOD and the group receiving MBET compared with the Tx, untreated group. Further work is needed to examine if Cx-36 protein changes occur in specific subregions of the spinal cord. NIH-NCRR Grant P20 RR020146 to the CTN and NINDS P30 NS047546
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the onset of Hyperreflexia in the rat following complete spinal cord transection
Spinal Cord, 2008Co-Authors: Amanda Charlesworth, Charlotte Yates, N Reese, Sam Alle, R D Skinne, Edga GarciarillAbstract:Hyperreflexia occurs after spinal cord injury (SCI) and can be assessed by measuring low frequency-dependent depression of the H-reflex. Previous studies showed the time course for the onset of Hyperreflexia to occur between 6–28 days in the contusion model of SCI. To determine the time course of the onset of Hyperreflexia in the transection model of SCI and examine changes in Connexin-36 (Cx-36) protein levels in the lumbar enlargement of animals. Spinal Cord Injury Mobilization Program of the Center for Translational Neuroscience, the research arm of the Jackson T. Stephens Neuroscience Institute, Little Rock, AR, USA. Adult female rats underwent transection at T10 level. Low frequency-dependent depression of the H-reflex was tested at 7, 14 and 30 days post-transection. Lumbar enlargement tissue was harvested following reflex testing and western blots were performed after immunoprecipitation to compare Cx-36 protein levels. Significant decreases in low frequency-dependent depression of the H-reflex were observed in animals tested 14 and 30 days post-transection compared with control animals, but it was not different from control animals at 7 days. Significant decreases in Cx-36 protein levels were observed in animals 7 days post-transection compared with controls. Rats transition to a state of Hyperreflexia between 7 and 14 days post-transection. Cx-36 protein levels decreased at 7 days post-transection and gradually returned to control levels by 30 days post-transection. These data suggest there may be a relationship between changes in neuronal gap junction protein levels and the delayed onset of Hyperreflexia.