Role of somatic afferents in autonomic system control of the intestinal motility

(1) In anesthetized (chloralose-urethane) rats, strong mechanical stimuli which were applied to the abdominal skin always inhibited motility of the small intestine. This reflex is referred to as an 'inhibitory cutaneo-intestinal reflex'. Similar stimuli applied to the skin of the upper chest, neck, forepaws, or hindpaws, however, evoked the opposite effect, which is referred to as a 'facilitatory cutaneo-intestinal reflex'. (2) By recording the activity of efferent sympathetic nerves to the small intestine and by transecting intestinal sympathetic or parasympathetic nerves we found that the inhibitory cutaneo-intestinal reflex was largely due to an increase in intestinal sympathetic efferent activity, and that the facilitatory cutaneo-intestinal reflex was due to decrease in the intestinal sympathetic efferent nerve activity; both changes reflexly evoked. (3) The inhibitory cutaneo-intestinal reflex was shown to be a propriospinal reflex which was caused by excitation of group IV (unmyelinated) cutaneous afferent nerve fibers. On the other hand, the facilitatory cutaneo-intestinal reflex seemed to be mediated through supraspinal pathways, and was evoked by excitation of mainly group III (A-delta group) cutaneous afferent nerve fibers. (4) Interaction between the cutaneo-intestinal reflex and intestino-intestinal reflex was demonstrated. (5) The possibility of a dorsal root reflex contribution to cutaneo-intestinal reflex was eliminated. (6) Significance of the cutaneo-intestinal reflex in neural control of the gastro-intestinal tract was discussed.     

Electro-acupuncture stimulation to a hindpaw and a hind leg produces different reflex responses in sympathoadrenal medullary function in anesthetized rats

The effects of electro-acupuncture stimulation (EAS) of two different areas of a hindlimb with different stimulus intensities on sympathoadrenal medullary functions were examined in anesthetized artificially ventilated rats. Two needles of 160 microm diameter and about 5 mm apart were inserted about 5 mm deep into a hindpaw (Chungyang, S42) or a hind leg (Tsusanli, S36) and current of various intensities passed to excite various afferent nerve fiber groups at a repetition rate of 20 Hz and pulse duration of 0.5 ms for 30-60 s. Fiber groups of afferent nerves stimulated in a hindlimb were monitored by recording evoked action potentials from the afferents innervating the areas stimulated. The sympathoadrenal medullary functions were monitored by recording adrenal sympathetic efferent nerve activity and secretion rates of catecholamines from the adrenal medulla. EAS of a hindpaw at a stimulus strength sufficient to excite the group III and IV somatic afferent fibers produced reflex increases in both adrenal sympathetic efferent nerve activity and the secretion rate of catecholamines. EAS of a hind leg at a stimulus strength sufficient to excite the group III and IV afferent fibers produced reflex responses of either increases or decreases in sympathoadrenal medullary functions. All responses of adrenal sympathetic efferent nerve activity were lost after cutting the afferent nerves ipsilateral to the stimulated areas, indicating that the responses are the reflexes whose afferents nerve pathway is composed of hindlimb somatic nerves. It is concluded that electro-acupuncture stimulation of a hindpaw causes an excitatory reflex, while that of a hind leg causes either excitatory or inhibitory reflex of sympathoadrenal medullary functions, even if both group III and IV somatic afferent fibers are stimulated.     

Influence of innocuous cervical vertebral movement on the efferent innervation of the adrenal gland in the rat

In general, in central nervous system intact anesthetized animals, adrenal sympathetic efferent nerve activity and catecholamine secretion increase in response to noxious somatic stimulation, and decrease in response to innocuous somatic stimulation. In anesthetized rats, noxious chemical stimulation of the thoracic and lumbar interspinous tissues is associated with large increases in adrenal sympathetic efferent nerve activity and catecholamine secretion, with a clear segmental organization to the reflex apparent in spinalized animals. However, the adrenal sympathetic nerve responses to mechanical stimulation in the form of pressure applied laterally to the lower thoracic and lower lumbar vertebrae do not display segmental organization, and the depressor response is more characteristic of responses to innocuous somatic stimulation despite the use of large forces (up to 3.0 kg). Therefore, we sought to determine whether innocuous movements of the mechanoreceptor-rich deep tissues of the neck modulate the sympathetic outflow to the adrenal gland. We performed experiments in 14 anaesthetised (Urethane 1 g/kg and Chloralose 0.1 g/kg) adult rats. Rats were intubated and breathed spontaneously. A computer driven small animal manipulator was used to impose ramp and hold rotational displacements (12 degrees /s, hold duration 2 s) of the 2nd cervical vertebra (range 2-30 degrees ) while recording multi-unit activity from sympathetic nerves innervating the adrenal gland. While noxious forepaw pinch elicited an increase in sympathetic nerve activity to the adrenal gland, there was no significant change in sympathetic nerve activity with small (2 degrees or 6 degrees ) rotations. Significant changes (P<0.05) in sympathetic activity were observed in only 7% (n=21) of all trials at larger displacements (12 degrees , 20 degrees , 25 degrees , 30 degrees n=287 trials). Our data suggest that although noxious stimuli may modulate sympathetic outflow, it is rare for afferents signalling innocuous cervical vertebral movements to modulate sympathetic nerves innervating the adrenal gland.     

Neural organization of the viscero-cardiac reflexes

The reflex responses evoked in the postganglionic nerves to the heart were tested in chloralose-anaesthetized cats. Electrical stimulation of the A delta afferent fibres from the left inferior cardiac nerve evoked spinal and supraspinal reflex responses with the onset latencies of 36 ms and 77 ms respectively. The most effective stimulus was a train of 3-4 electrical pulses with the intratrain frequency of 200-300 Hz. Electrical stimulation of the high threshold afferent fibres (C-fibres) from the left inferior cardiac nerve evoked the reflex response with the onset latency of 200 ms. The C-reflex was present in intact animals and disappeared after spinalization. The most effective stimulus to evoke this reflex was a train of electrical pulses delivered at a frequency of 1-2 Hz with an intratrain frequency of 20-30 Hz. The most prominent property of the C-reflex was its marked increase after prolonged repeated electrical stimulation. We conclude that: (1) viscero-cardiac sympathetic reflexes may be organized at the spinal and supraspinal level; (2) viscero-cardiac sympathetic reflexes evoked by stimulation of the A delta and C afferent fibres from the left inferior cardiac nerve have different central organization.     

Changes of reflexes in vasoconstrictor neurons supplying the cat hindlimb following chronic nerve lesions: a model for studying mechanisms of reflex sympathetic dystrophy?

The generic term 'reflex sympathetic dystrophy' describes a clinical syndrome which sometimes develops after traumata at the extremities with lesions of nerves or --more rarely--after other events. The syndrome consists of the following components: pain (hyperpathia, allodynia), trophic changes of skin and deep tissues, dysregulation of sweating and cutaneous blood flow of the extremity concerned. It is assumed that all symptoms are produced by abnormal sympathetic activity. Interruption of the sympathetic activity to the affected extremity abolishes most of the pain and may lead to remission of the trophic changes. The hypothesis is that the trauma with lesion of the primary afferent axons leads subsequently to an abnormal state of the primary afferent neurons and to distorted processing of information in the spinal cord. As a consequence of this abnormal central state the activity in the sympathetic (vasomotor and sudomotor) supply to the affected extremity is distorted. The results are pain, trophic changes and dysregulations of autonomic effector organs. In some yet unknown way a vicious circle between periphery and spinal cord is established (afferent leads to spinal cord leads to sympathetic leads to afferent). This hypothesis was the starting point for analysis of the reflex pattern in postganglionic vasoconstrictor neurons supplying the cat hindlimb after chronic nerve lesions performed in the same limb (cutting and ligating a skin nerve; suturing the central stump of a skin nerve to the peripheral stump of a muscle nerve). The results obtained show that the reciprocity of the reflex pattern which is normally observed between cutaneous and muscle vasoconstrictor neurons is lost in many animals. Cutaneous vasoconstrictor neurons are very similar to muscle vasoconstrictor neurons in their reactions to stimulation of arterial baroreceptors and chemoreceptors. If the same sequence of events also occurs in patients with reflex sympathetic dystrophy, it could explain the dysregulation of blood flow through skin and also the occurrence of trophic changes in the limb.     

Sympatho-inhibitory baroreflex in conscious rabbits: simultaneous recordings of sympathetic and aortic nerve activity

The purpose of this study was to evaluate simultaneously the activity of afferent and efferent neuronal pathways of the sympatho-inhibitory baroreceptor reflex in conscious rabbits. Bipolar electrodes were implanted around the intact aortic nerve and cervical sympathetic trunk. Baroreceptor activity and sympathetic discharges were continuously recorded along with mean blood pressure. The baroreceptor reflex response was evoked by changes in mean arterial pressure induced by i.v. administration of phenylephrine 10 micrograms/kg and sodium nitroprusside 10 micrograms/kg. The baroreflex was analysed as parallel changes of afferent and efferent activities per mmHg of mean blood pressure rise or fall. This method of investigation of baroreflex responsiveness permits analysis of afferent and efferent neural activities under different behavioural conditions in conscious animals.     

Mechanism of the reflex inhibition of heart rate elicited by acupuncture-like stimulation in anesthetized rats

Acupuncture or acupuncture-like stimulation applied to different body areas can modify autonomic nerve activity to various organs, including gut, bladder, adrenal medulla, and the heart. We studied the reflex bradycardia in response to insertion into the skin and underlying muscles and twisting of an acupuncture needle in pentobarbital-anesthetized rats. We found that acupuncture-like stimulation of forelimb, hindlimb, chest, and abdomen all produced significant heart rate decreases. Rate minima were reached at the end of the 60-second stimulation episode and significant bradycardia persisted for about 40 s after stimulation ended. Heart rate decreases were paralleled by decreases in cardiac sympathetic nerve activity, and could be produced by electrical stimulation of group IV muscle afferent fibers (tibial nerve). Electrical stimulation of the tibial nerve at rates as low as 0.1-2 Hz was effective for eliciting heart rate decreases. Nerve fiber groups were defined by stimulation of and recording from tibial nerve. Activation of groups I, II, or III fiber was ineffective for eliciting the reflex bradycardia. Sympathectomy, high spinal transection, or infusion of the GABA(A) receptor antagonist, bicuculline, into the cisterna magna were all effective for disrupting the reflex bradycardia. Vagotomy and opioid receptor blockade were ineffective for disrupting the reflex pathway. We conclude that the reflex pathway to decrease heart rate by acupuncture-like stimulation consists of mainly group IV muscle afferent fibers whose activity (even very low rate of activity) leads to the activation of GABA-ergic neurons in the brainstem and an inhibition of sympathetic outflow to the heart.     

Noxious and innocuous mechanical cutaneous stimulation increase the sympathetic efferent nerve activity innervating the interscapular brown adipose tissue in anesthetized rats

Effects of pinching and brushing of the various segmental skin areas (face, ear, neck, forelimb, chest, abdomen, hindlimb) on the activities of the sympathetic efferent nerve innervating the interscapular brown adipose tissue (IBAT) and contributing to its thermogenesis were examined in anesthetized rats. Pinching the face, ear, neck, or forelimb produced significant reflex increases in the efferent nerve activities, whereas pinching the chest, abdomen, or hindlimb did not produce any significant responses. In the case of brushing stimulation, only the stimulation of the ear produced significant increases. These results demonstrated that cutaneous mechanical stimulations at cranial, cervical, and upper thoracic segments were effective in producing reflex increases in the activities of the IBAT sympathetic nerve and that noxious stimulation was more dominant for eliciting the reflex responses.     

Characteristics of sympathetic reflexes evoked by electrical stimulation of phrenic nerve afferents.

In chloralose-anaesthetized cats, sympathetic reflex responses were recorded in left cardiac and renal nerve during stimulation of afferent fibres in the ipsilateral phrenic nerve. In cardiac nerve, a late reflex potential with a mean onset latency of 75.6 +/- 13.8 ms was regularly recorded which, in 20% of the experiments, was preceded by an early, very small reflex component (latency between 35 and 52 ms). In contrast, in renal nerve only a single reflex component after a mean latency of 122.1 +/- 13.1 ms was observed. Bilateral microinjections of the GABA-agonist muscimol into the rostral ventrolateral medulla oblongata resulted in a nearly complete abolition of sympathetic background activity and in an 88% reduction of the late reflex amplitude with only small effects on the latency of the evoked potentials. Under this condition, an early reflex component was never observed to appear. After subsequent high cervical spinalization, the residual small potentials which persisted after bilateral muscimol injections were completely abolished and in cardiac nerve an early reflex potential with a mean latency of 45 +/- 10 ms was observed in all but one experiment. The early reflex was therefore referred to as a spinal reflex component which, however, is suppressed in most animals with an intact neuraxis. In the renal nerve a spinal response was only observed in one experiment after spinalization. The results suggest that sympathetic reflexes evoked by stimulation of phrenic nerve afferent fibres possess similar spinal and supraspinal pathways as previously described for somato-sympathetic and viscero-sympathetic reflexes.(ABSTRACT TRUNCATED AT 250 WORDS)     

Reflex activation of the lower oesophageal sphincter in the cat induced by stimulation of the splanchnic afferent fibres

Reflex responses of the lower oesophageal sphincter (l.o.s.) to electrical stimulation of the splanchnic afferent fibres were recorded by electromyographic and manometric techniques. Repetitive stimulation of the central end of a splanchnic nerve induced a long latency excitation of the l.o.s., i.e. bursts of spike potentials concomitant with repetitive phasic contractions. Experiments involving nerve sections showed that the efferent pathways of this reflex were served either by stellate sympathetic and/or splanchnic fibres, or by vagal fibres. These responses were abolished following the administration of atropine. These results show that the splanchnic afferent fibres are involved in l.o.s. reflex motor responses through the activation of the sympathetic and parasympathetic efferent supply to the sphincter.     

Reflex changes in thermogenesis in the interscapular brown adipose tissue in response to thermal stimulation of the skin via sympathetic efferent nerves in anesthetized rats

Reflex responses of both temperature in the interscapular brown adipose tissue (IBAT) and activity of the sympathetic efferent nerves innervating the IBAT to cutaneous thermal stimulation were examined in anesthetized rats. Thermal stimulation of the ear at 4 degrees C for 20 s produced a transient decrease in the temperature of the IBAT during this period, followed by a prolonged increase (lasting 7 min). This response was completely abolished in animals whose IBAT sympathetic nerves were bilaterally sectioned. Direct recording of IBAT sympathetic efferent activity revealed that thermal stimulation of the ear at 4 degrees C for 20 s increased activity for 80 s after the onset of stimulation. The threshold temperature of the cold stimulation for eliciting increased nerve activity was around 22 degrees C. However, warm stimulation up to 49 degrees C had no significant effect on activity. In addition to stimulation of the ear, cold stimulation of the face and neck at 4 degrees C also increased nerve activity, while warm stimulation at 49 degrees C of any skin area had no influence. The present results demonstrate that excitation of cutaneous cold receptors, but not warm or heat receptors, reflexly increases thermogenesis in the IBAT via excitation of sympathetic nerve activity, and that cold receptor afferents to cranial and cervical segments effectively increase nerve activity in the IBAT.     

Responses of hepatic glucose output to electro-acupuncture stimulation of the hindlimb in anaesthetized rats

Responses of hepatic glucose output (HGO) to electro-acupuncture (EA) stimulation of the hindlimb were investigated in anaesthetized rats, focusing on involvement of the somatic afferent and autonomic efferent nerves. HGO was measured with a microdialysis probe implanted into the left lateral lobe of the liver. Stainless steel needles with a diameter of 0.25 mm were inserted into the right tibialis anterior muscle and connected to an electrical stimulator. The EA stimulation was delivered for 10 min at 10 mA, 20 Hz. Atropine was injected in order to block the action of the parasympathetic nerves, whereas phentolamine and propranolol were injected in order to block the action of the sympathetic nerves. Furthermore, adrenal sympathetic nerves were crushed bilaterally to block the reflex secretion of adrenal medullary hormones. The EA stimulation significantly increased HGO for 20 min after the onset of stimulation. The increases of HGO were abolished by severing the femoral and sciatic nerves, demonstrating that the responses are elicited via activation of somatic afferent nerves. Furthermore, the increases were diminished after severance of the adrenal sympathetic nerves, which regulate catecholamine secretion from the adrenal medulla. The increases were totally abolished after pretreatment with phentolamine, an alpha-adrenergic blocker, and propranolol, a beta-adrenergic blocker. On the other hand, the increases of HGO in response to the EA stimulation were augmented after pretreatment with atropine, a muscarinic cholinergic blocker. The present results demonstrate that EA stimulation to a hindlimb can reflexly increase HGO via activation of somatic afferents and, thereby, sympathetic efferents, including sympathetic efferents to the adrenal medulla. The present results further show that the increases of HGO in responses to EA stimulation are simultaneously reflexly inhibited via the parasympathetic nerves.     

Reflex patterns in preganglionic sympathetic neurons projecting to the superior cervical ganglion in the rat

Reflex patterns in preganglionic neurons projecting in the cervical sympathetic trunk (CST) were analyzed in response to stimulation of various afferent systems. We focused on the question whether these preganglionic neurons can be classified into functionally distinct subpopulations. Reflex responses were elicited by stimulation of trigeminal and spinal nociceptive, thermoreceptive as well as baroreceptor and chemoreceptor afferents. Multi- and single fiber preparations were studied in baroreceptor intact and sino-aortically denervated animals. Spontaneous activity of 36 preganglionic single neurons ranged from 0.2 to 3.5 imp/s (median= 1.11 imp/s). The degree of cardiac rhythmicity (CR) in the activity of sympathetic neurons was 69.5+/-13% (mean+/-S.D.; N=52; range=39-95%). Noxious stimulation of acral skin activated the majority (67%) of sympathetic preparations by 37+/-25% (N=35) above pre-stimulus activity; 15% were inhibited. In these neurons the response to noxious stimulation of acral skin was significantly correlated with the degree of CR (P<0.001, N=52) in that neurons showing the strongest excitation to noxious stimulation displayed the strongest CR. Noxious mechanical stimulation of body trunk skin (N=60) inhibited the majority (80%) of fiber preparations tested (by 34+/-18% of pre-stimulus activity, N=48); an activation was not observed. Cold stimulation of acral (N=9) and body trunk skin (N=42) activated most fiber preparations. Trigeminal stimulation evoked a uniform reflex activation of preganglionic neurons (+79+/-73% of pre-stimulus activity, N=32). Chemoreceptor stimulation by systemic hypercapnia elicited inhibitory (-31+/-19%, N=8) as well as excitatory (+59+/-5%, N=4) responses. These results show that preganglionic sympathetic neurons projecting to target organs in the head exhibit distinct reflex patterns to stimulation of various afferent systems; however, a clear classification into different functional subgroups did not emerge. Furthermore, reflex patterns showed a segmental organization to noxious cutaneous stimulation of acral parts and body trunk reflecting a differential central integration of spinal afferent input. Compared with the cat the reflex organization of sympathetic neurons projecting to the head seems to be less differentiated in the anesthetized rat.     

Discharge characteristics of sympathetic efferents to the knee joint of the cat

Sympathetic postganglionic neurons to the knee joint of the cat were studied to characterize the nerve supply and response to somatic stimulation. In halothane anesthetized cats, the sympathetic postganglionic units from a branch of medial articular nerve (MAN) were dissected. The other branch of MAN was left intact. Most of the central filaments of MAN showed spontaneous discharge. The frequency of the spontaneous discharge of single units ranged from 0.2 to 2.9 impulses per second. Cardiovascular rhythmic modulation was observed in most of the filaments tested. Phenylephrine-induced baroreceptor stimulation caused inhibition of the discharges. Repetitive stimulation of the lumbar sympathetic trunk or the peripheral cut end of MAN led to a decrease in the local temperature inside the joint. The frequency threshold for decreasing the temperature of the joint was approximately 1 Hz. Maximum effects were obtained with 5 Hz stimulation. Histograms of MAN sympathetic efferent fibre activity following electrical stimulation of afferent nerve fibres in the MAN exhibited two response periods. The first, of about 280 ms latency, was elicited by myelinated fibre excitation (the A-reflex) and the second, with a latency of approximately 700 ms, was evoked by unmyelinated fibre excitation (the C-reflex). Electrical stimulation of radial afferent nerve produced similar A- and C-reflex discharges in sympathetic fibres of MAN. Passive movement of the knee joint within its normal working range (flexion, extension or outward rotation) had very little effect on sympathetic efferent nerve activity in MAN, whereas noxious outward rotation of the joint produced a reflex increase in activity to about 140% of the prestimulus control level.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cutaneous vascular responses evoked by noxious stimulation in rats with the spinal nerve ligation-induced model of neuropathy

Antidromic activation of nociceptive nerve fibres innervating the skin produces an axon reflex that involves extravasation and vasodilation of cutaneous blood vessels. We determined whether the axon reflex of the hindlimb skin is influenced by an experimental model of neuropathy induced by unilateral ligation of spinal nerves L(5) and L(6) in the rat. Ligation of spinal nerves induced symptoms mimicking tactile allodynia, as indicated by a marked decrease of the hindlimb withdrawal threshold to mechanical stimulation. The axon reflex induced by antidromic electrical stimulation of nociceptive fibres innervating the plantar skin ipsilateral to the ligation was attenuated according to determination of extravasation response and blood flow response. Lidocaine block or transection of the sciatic nerve of the neuropathic limb did not induce any change in basal blood flow of the plantar skin. The results indicate that ligation of spinal nerves induces an attenuation of the axon reflex. This attenuation reflects a decrease in the efferent function of primary afferent nociceptors innervating the hypersensitive skin of the hindpaw. The attenuation of antidromically-induced vascular responses was not caused by overriding sympathetic activity, as indicated by lack of blood flow effects by lidocaine blocks or a transection of the sciatic nerve.     

Somatosplanchnic reflex discharges in rats

Splanchnic efferent reflex discharges caused by electrical stimulation of limb afferent nerves or intercostal afferent nerves were studied in chloralose-urethane anesthetized rats. Stimulation of the limb afferent nerve produced late supraspinal reflex discharges via group II and III afferent excitation. Stimulation of the intercostal afferent nerve produced early spinal reflex discharges via group II and III afferent excitation and also late spinal reflex discharges via group IV afferent excitation. Intercostal afferent nerve stimulation seemed to strongly depress the splanchnic late supraspinal reflex discharges.     

Trigeminally induced cardiovascular reflex responses in spinalized rats

The effects on cardiovascular functions of noxious stimulation to the orofacial areas innervated by trigeminal afferent nerves were analyzed in urethane-anesthetized, spinal cord-intact rats and in rats acutely spinalized at the second cervical level. In the spinal cord-intact rats, pinching of the upper lip produced increases in both heart rate (HR) and mean arterial pressure (MAP). Both responses were considered to be due to activation of sympathetic efferent nerves to the cardiovascular organs. Both responses were attenuated but did not disappear after spinalization at the C2 level. In spinalized rats, sympathetic preganglionic neurons emerging from the thoracolumbar spinal cord could not receive any neural influences from the brain. The HR response in the spinal rats was abolished after either bilateral vagotomy or intravenous injection of a peripherally acting muscarinic cholinergic receptor antagonist, methylatropine. This suggests that the increase in HR was elicited via vagal cholinergic efferent fibers, probably by decreasing tonic activity of vagus nerves to the heart. In spinal rats, neither vagotomy nor cholinergic blockade affected the increase in MAP, but i.v. injection of the vasopressin V1 receptor antagonist, OPC-21268, abolished the response of MAP. This suggests that the response of MAP was due to peripheral vasoconstriction elicited by vasopressin secreted from the posterior pituitary lobe. The present study demonstrated that, in rats acutely spinalized at the C2 level, noxious stimulation of orofacial areas innervated by the trigeminal nerve could produce reflex increases both in HR, by decreasing cholinergic vagal nerve activity to the heart, and blood pressure, by secreting vasopressin from the pituitary gland, even though sympathetic efferent innervation to the cardiovascular organs could not be directly affected by trigeminal afferent nerve excitation.     

Comparative study of sympathetic and parasympathetic discharges in the autonomic nerves during stimulation of different structures of the cat hypothalamus

Simultaneous recordings of hypothalamo-parasympathetic and hypothalamo-sympathetic evoked discharges in anesthetized cats demonstrated that both parasympathetic discharges in the pelvic nerve and sympathetic discharges in the splanchnic nerve of the lowest threshold and shortest latency could be obtained from stimulation of the posterior hypothalamus. The focus of the maximal neuronal activated elicited by stimulation of afferent fibres of visceral nerves and the focus evoking maximal efferent reactions of parasympathetic and sympathetic nerves were located in the same region of the postero-lateral hypothalamus. It is supposed (as a working hypothesis) that convergent polysensory neurons of the hypothalamus are also polyeffector divergent elements of the hypothalamo-visceral reflex system.     

Clinical application of laser evoked potentials using the Nd:YAG laser.

The clinical interest of a new type of laser evoked potentials (LEPs) using Nd:YAG laser was assessed in the diagnosis of peripheral neuropathies affecting the small-diameter nerve fibres, and of spinal cord lesions, affecting the spinothalamic tract. Twelve patients aged from 26 to 79 years with sensory neuropathies (n = 6) or spinal cord lesions (n = 6) underwent neurophysiological examination of the lower limbs comprising quantitative sensory testing, i.e., the determination of vibratory and thermal thresholds (VT and TT), somatosensory evoked potentials (SEPs) to electrical stimulation and Nd:YAG LEPs. VT and SEPs were used to assess large-diameter afferent nerve fibres and the lemniscal pathways while TT and LEPs were used to assess small-diameter afferent nerve fibres and the spinothalamic tract. In addition, patients with peripheral neuropathy underwent also standard nerve conduction studies to explore large fibres and the recording of sympathetic skin responses (SSRs) to explore small fibres, whereas motor evoked potentials were performed in patients with spinal cord lesion. LEPs were absent bilaterally in all patients with polyneuropathy, even when TT remained within the normal limits and SSRs were present. LEPs were absent after stimulation of the affected limb in all patients with a spinal cord lesion, and allowed to detect subclinical contralateral lesion in two cases. LEPs following Nd:YAG laser stimulation are sensitive in the diagnosis of peripheral and/or central nervous system disorders and they give complementary information as compared to routine electrophysiological tests.     

Electroneurographic correlates of the monosynaptic reflex: experimental studies and normative data.

The neurographic concomitants of the monosynaptic reflex, evoked either by electrical stimulation of the tibial nerve at the popliteal fossa or by percussion of the Achilles tendon, have been recorded from the sciatic nerve in the lower and middle thigh. Neurographic recordings were characterised by two travelling waves (P1 and P2), respectively increasing and decreasing in latency in the proximal direction, that showed the same chronological trend of the propagated action potentials concurrently recorded in the dorsal and ventral spinal roots at the lumbar level. At variance with P2, the speed of propagation of the P1 volley was stimulus-related, being faster on mechanical than on electrical stimulation, probably because in the latter case the latency of the fastest afferents is overestimated. The P2 volley is subserved by alpha-efferent fibres in either case as suggested, inter alia, by the strict parallelism between the P2 volley and the monosynaptic reflex under appropriate experimental conditions. Simultaneous recordings of spinal root and sciatic nerve action potentials allowed the direct assessment of afferent and efferent conduction velocities, both in the proximal (that is from the middle thigh to the spinal recording site and vice-versa) and in the distal (that is from the lower to the middle thigh recording site and vice versa) segments of the reflex arc. As expected, the speed of propagation of impulses was significantly higher in the proximal than in the distal segments, as well as in the afferent than in efferent limb of the monosynaptic pathway. The P1-P2 time interval was longer on mechanical than on electrical stimulation, probably due to the increased spinal delay of the T versus the H reflex. The present study provides a reliable method for the direct assessment of alpha-efferent as well as of Ia afferent group fibres conduction velocity, provided that in the latter case mechanical stimuli be used.