Repetitive nerve stimulation and stimulation single fiber electromyography studies in rats intoxicated with single or mixed insecticides

The function of the neuromuscular transmission in rats dosed with phoxim (P), methomyl (M), fenvalerate (F), and mixtures of P+M and P+F was studied by using both the stimulation single fiber electromyography (SSFEMG) and repetitive nerve stimulations (RNS) to determine the single muscle fiber action potential and compound muscle action potential (CMAP) respectively. The results showed that the mean consecutive difference (MCD) in SSFEMG was significantly prolonged in P, P+M and P+F intoxicated rats during the presence of myasthenia, but not in rats dosed with F and M when stimuli were given at 10 Hz or 20 Hz, thus indicating a transmission blocking at the neuromuscular junction (NMJ) induced by P. The frequency of neuromuscular transmission abnormalities detected by SSFEMG was significantly higher than those detected by RNS. This study demonstrated that the neuromuscular junction (NMJ) blocking is more frequently seen in P, P+M and P+F poisoning than in M and F poisoning, and that SSFEMG is a more sensitive electrophysiological method than RNS for detecting neuromuscular transmission blockage in myasthenia rats with acute insecticides poisoning.     

Functional changes of nicotinic acetylcholine receptor in muscle and lymphocyte of myasthenic rats following acute dimethoate poisoning

The mechanism underlying intermediate myasthenia syndrome (IMS) following acute organophosphate poisoning remains largely unknown. Previous studies indicated that the mechanism of myasthenia in rats and IMS patients is most likely due to a postsynaptic neurotransmission blocking at neuromuscular junctions (NMJ). Nicotinic acetylcholine receptor (nAChR) is a key postsynaptic component at NMJ. Whether functional changes of nAChR are related to the development of myasthenia has not been demonstrated and addressed in vivo so far. In this study, we attempted to investigate temporal and spatial changes of nAChR in the blood lymphocyte, muscle and brain of rats during the course of myasthenia after acute dimethoate poisoning by using radioligand-binding assay. We found that specific nAChR binding activity in the gastrocnemius muscle and blood lymphocytes of myasthenia rats was significantly increased at 48h after dimethoate poisoning. However, no changes of nAChR binding activity were found in the lymphocytes and muscle of non-myasthenia rats which were sacrificed at 1h after intoxication. Interestingly, no changes of nAChR and muscarinic acetylcholine receptor (mAChR) binding activity were found in the cerebrum and cerebellum of all rats after dimethoate intoxication either at 1 or 48h. The change of nAChR specific binding activity in the lymphocytes is parallel with that in the skeletal muscle during the development of myasthenia. This implied that the changes of nAChR receptor binding activity in the skeletal muscle and lymphocytes are highly associated with the development of myasthenia. The functional changes of nAChR at NMJ might play an important role in the paralysis of skeletal muscle following acute organophosphates (OPs) poisoning.     

Temporal analysis of dithiobiuret neurotoxicity in rats and assessment of potential nonneural causes

To evaluate the hypothesis that depressed neuromuscular transmission causes dithiobiuret (DTB)-induced muscle weakness in rats, the temporal development of impaired treadmill performance and deficits in the nerve-elicited muscle contractions were compared during daily treatment with the toxicant (DTB, 1 mg/kg/day X 6 days). Diminished treadmill test performance after 4 days of treatment marked the initial detection of impaired motor function. At this time fading (loss of tension during tetanus) of gastrocnemius contractions elicited in response to 100-Hz sciatic nerve stimulation occurred in DTB-treated rats but not in controls. After 5 and 6 days of treatment, treadmill failure became complete, tetanic fade worsened dramatically, and peak contractile tension measured during trains of nerve stimulation (10-250 Hz) decreased progressively. Appearing by Day 6 were marked body weight loss, dehydration, hypothermia, and a depression in serum concentrations of thyroid hormones. Total oxygen content of the blood was not reduced at any time during treatment, and serum concentrations of glucose, sodium, potassium, calcium, chloride, and phosphorus in DTB-treated rats on Day 6 were similar to those of control animals. Therefore, hypoxia, hypoglycemia, or a serum electrolyte imbalance do not initiate or modulate the neuromuscular toxicity. Light microscopic evaluation of liver, kidney, lung, thyroid, and other organs in intoxicated rats was unremarkable and in skeletal muscles and selected sites of brain, spinal cord, and sciatic nerve no morphologically significant lesions were observed. Even when DTB-intoxicated rats were maintained in a state of flaccid muscle weakness for 5 continuous days, peripheral nerve lesions proximal to the intramuscular nerves were not detected. Thus, depressed neuromuscular transmission appears to be the primary cause of the flaccid muscle weakness and no evidence was obtained that nonneural effects of DTB initiate or modulate this effect.     

Inactivation of end-plate acetylcholinesterase during the course of organophosphate intoxications

Blood organophosphate (OP) levels, serum butyrylcholinesterase (BChE) activity and electrophysiological neuromuscular transmission following repetitive nerve stimulation at 10 Hz and 50 Hz were studied serially in five patients with severe acute organophosphate intoxication following suicide attempts. Eight to 45 hours after oral ingestion, blood OP levels were elevated, BChE activity was markedly reduced, while repetitive nerve stimulation studies showed no or only mild abnormalities. The latter attained the maximal abnormality 32–69 h after ingestion, when BChE was inactivated further but elevated OP levels had fallen. Recovery from these abnormalities at 10 Hz nerve stimulation occurred within 100–237 h after the intoxication and it was still incomplete at 50 Hz stimulation 48–80 h later. BChE activity varied within a wide range and showed even normal values at both times. Neuromuscular transmission studies proved to be the most useful indicator for determining the severity and time course of organophosphate intoxication.     

A comprehensive review on experimental and clinical findings in intermediate syndrome caused by organophosphate poisoning

Acute organophosphate (OP) intoxication is important because of its high morbidity and mortality and occurrence of muscular paralysis associated by inhibition of acetylcholinesterase (AChE) activity at the neuromuscular junction. Cholinergic crisis, intermediate syndrome (IMS), and OP-induced delayed neuropathy (OPIDN) are the evidences that can be observed in OP intoxication. The main cause of morbidity due to OP poisoning is IMS that occurs 24-96 h after poisoning. Mechanisms underlying the IMS are not fully known. Although the electrophysiological aspects of delayed neuropathy are best characterized, the IMS remain very little studied. The aim of this study was to revisit current knowledge related to OP and the IMS. For this purpose, a systematic review without date limitation was performed. A total of 599 relevant articles were found and reviewed. Data were categorized according to experimental and clinical studies. Occurrences of persistent AChE inhibition, electromyography changes, muscle cell injury, and oxidative stress are the most important pieces of evidence for involvement of IMS in OP toxicity.Delayed AChE inhibition, muscle necrosis, down regulation or desensitization of postsynaptic ACh receptors, failure of postsynaptic ACh release, and oxidative stress-related myopathy are involved in IMS. Toxicokinetic factors, such as a high lipid-solubility, duration of AChE inhibition and metabolite excretion, evolution of alterations on repetitive nerve stimulation (RNS), type and frequency of muscle lesions can estimate the probability of the IMS. Plasma AChE of less than 200 units is a predictor and the 30 Hz RNS decremental response could be a useful marker for the IMS.     

Biochemical changes in primary culture of skeletal muscle cells following dimethoate exposure

In order to investigate the cellular mechanism of muscular weakness in the Intermediate Myasthenia Syndrome (IMS) following acute organophosphate poisoning, we studied the cytotoxicity of dimethoate and its effects on the activity of acetylcholine esterase (AChE), Na+-K+-ATPase, succinate dehydrogenase (SDH), and Ca2+-ATPase in primary cultured skeletal muscle cells. The results showed that the activity of AChE was significantly inhibited in a dose and time-dependent manner when cells were exposed to dimethoate for 2 h, but the expression of heat-shock protein (HSP70) in muscle cells was significantly increased in a time-dependent manner following dimethoate exposure. Dimethoate can significantly increase the activity of Na+-K+-ATPase in the mitochondrial and cytoplasm fraction of muscle cells, and inhibit the activity of Ca2+-ATPase. This study suggests that the disruption of intracellular homeostasis and energy metabolism of the muscle cells may play a role in the etiology of IMS.     

Actions of triethylcholine on neuromuscular transmission

The effects of the triethyl analogue of choline (triethyl 2-hydroxyethyl ammonium) on muscular activity have been studied in conscious rabbits, chicks, dogs and a cat. The contractions of the tibialis anticus and soleus muscles of cats under chloralose anaesthesia, and of the tibialis anticus muscle of rabbits under urethane anaesthesia and the isolated diaphragm preparation of the rat were also used. In conscious animals, triethylcholine caused a slowly developing muscular weakness which was more severe after exercise and which resembled the symptoms of myasthenia gravis. In nerve-muscle preparations triethylcholine had a selective action in reducing the contractions of muscles elicited by a high rate of nerve stimulation while leaving unaffected the contractions caused by slower rates of stimulation. During the paralysis of the tibialis muscle of the cat produced by triethylcholine, action potentials recorded from the motor nerve were unaffected and the muscle responded normally to injected acetylcholine and to direct electrical stimulation. The failure of neuromuscular transmission produced by triethylcholine was reversed by injection of choline, but anticholinesterases were ineffective. Choline reduced the toxicity of triethylcholine in mice. It is concluded that triethylcholine produces transmission failure at the neuromuscular junction by interfering with the ability of the nerve endings to synthesize acetylcholine. The possibility that triethylcholine is itself acetylated by the nerve endings and released as an inactive neurohormone is discussed. It was shown that triethylcholine was devoid of depolarizing action and curare-like blocking action. It possesses a transient ganglion blocking action of the tetraethylammonium-type as shown in experiments in which it caused a fall in blood pressure and blocked the response of the nictitating membrane to pre- but not to post-ganglionic stimulation of the cervical sympathetic nerve.     

Intermediate syndrome following acute organophosphate poisoning: correlation with initial serum levels of muscle enzymes

Following acute organophosphate poisoning, intermediate syndrome essentially relates to the impairment of neuromuscular transmission due to prolonged inhibition of acetylcholinesterase activity at the muscle end-plate. However, the role of muscle injury in the development of intermedicate syndrome is not clear. The aim of this study was to determine whether the initial serum levels of the muscle enzymes can predict the subsequent development of intermediate syndrome. We reviewed the files of 47 adult patients with organophosphate poisoning between April 2003 and February 2006. The muscle enzymes were obtained within first 24 hr from each patient. Among the patients, 17% (n = 8) had severe poisoning and 83% (n = 39) mild poisoning. In 10 patients (21%), intermediate syndrome was observed. Of the patients with severe poisoning, 63% (n = 5) developed subsequent intermediate syndrome; among those with mild poisoning, 13% (n = 5) developed intermediate syndrome. There was no significant difference in initial serum levels of creatine kinase and aspartate aminotransferase between the patients with severe poisoning and mild poisoning, and there was no difference in initial serum levels of creatine kinase and aspartate aminotransferase between the patients with and without intermediate syndrome. The serum levels of the muscle enzymes measured within the first 24 hr may not predict the subsequent development of intermediate syndrome.     

Lambert-Eaton肌无力综合征10例临床分析

目的 探讨Lambert-Eaton肌无力综合征(Lambert-Eaton myasthenic syndrome, LEMS)的临床特点.方法对2001年3月-2011年3月诊治的10例LEMS的临床资料进行回顾性分析.结果 本组癌性LEMS 9例,临床表现为双下肢无力,体征为双下肢或双上肢力弱、双下肢腱反射减弱或消失.重复神经电刺激均示低频衰减16%~38%,高频递增152%~726%.结论 对以双下肢无力就诊的重症肌无力,应常规检查高频重复电刺激,确诊LEMS后应行常规检查和随访以早期发现肿瘤.     

肟硫磷中毒肌无力大鼠骨骼肌烟碱样乙酰胆碱受体通道特性

目的　探讨肟硫磷引起肌无力大鼠骨骼肌烟碱样乙酰胆碱受体 (nAChR)通道特性的改变 ,揭示其发生机制。方法　用ip 1 .1 5g·kg-1肟硫磷制作成年大鼠肌无力模型 ,同时ip 1 6mg·kg-1阿托品以对抗毒蕈碱样症状。染毒后 0 .5～ 2h,8只大鼠出现肌无力 ,7只大鼠肌力正常。将 3只肌无力大鼠于肌力恢复后 (染毒后 1 2～ 1 8h) ,其余大鼠于染毒2～ 3h后 ,断颈处死 ,取后肢趾短屈肌 ,酶解制备骨骼肌纤维 ,用膜片钳对肌纤维nAChR通道做单通道电流记录。结果　肌无力大鼠nAChR单通道开放频率、表观平均开放时间、平均开放时间和电导均显著低于对照组和肌力正常的染毒大鼠 ,且肌力恢复后 ,以上各参数均接近对照组。结论　肟硫磷中毒引起肌无力可能与肟硫磷导致或促进nAChR的脱敏 ,以及阻断nAChR通道的开放有关。     

Single fiber electromyographic jitter and detection of acute changes in neuromuscular function in young and adult rats

IntroductionExposure to irreversible cholinesterase (ChE)-inhibiting compounds, such as organophosphates may produce neuromuscular dysfunction. However, less is known about changes in neuromuscular transmission after treatment with reversible ChE-inhibitors. These studies adapted single fiber electromyography (SFEMG) techniques to quantify neuromuscular jitter in adult and juvenile rats after treatment with agents that alter cholinergic neurotransmission.MethodsAnesthetized adult and juvenile rats were tested using stimulation SFEMG, recorded in the gastrocnemius muscle, after stimulation in the sciatic notch region. The influence of electrode placement, treatment with decamethonium (to disrupt neuromuscular transmission) or physostigmine (reversible ChE inhibitor), and the impact of varied stimulation frequency were quantified.ResultsNo significant effects of needle placement or criterion amplitude were observed when calculating the mean consecutive difference (MCD). Treatment with decamethonium did not alter MCD values in adult or juvenile rats. However, decamethonium produced an increased blocking of muscle action potentials (MAP) in juveniles. Also, when stimulated at 9.09 Hz, both adult and juvenile animals had a greater decrease in MAP amplitude between the first and fourth responses (T₁–T₄ decrement) after treatment with decamethonium. Prior to treatment with decamethonium, the T₁–T₄ decrement averaged about 3 fold greater in juveniles than adults, and was larger at 3.03 and 9.09 Hz than with 0.91 Hz stimulation. Treatment with physostigmine resulted in at least 50% inhibition of muscle ChE activity, but produced minimal changes in the MCD values in adults or juveniles. Combined over treatments and stimulation frequencies, the median MCD for juveniles (11.6 µs) was less than that for of adults (18.8 µs). In juveniles, the median MCD increased from 9.3 µs to 13.9 µs as the stimulation rate was increased from 0.91 to 9.09 Hz. This stimulus-dependant change was more evident in juveniles than in adults.DiscussionA technique was developed to record stimulation SFEMG and neuromuscular jitter, in vivo, in adult and juvenile rats. The method was sufficiently sensitive to detect age-related differences, potentially allowing developmental processes to be examined. Based on the literature and the current data, the technique appears to be more sensitive to prolonged inhibition of ChE enzymes than the reversible inhibition produced by physostigmine.     

Restoration of soman-blocked neuromuscular transmission in human and rat muscle by the bispyridinium non-oxime MB327 in vitro

The standard treatment of poisoning by organophosphorus (OP) nerve agents with atropine and oximes is not sufficiently effective against all types of nerve agents. Alternative therapeutic strategies are required and bispyridinium non-oximes, acting as nicotinic antagonists, were identified as promising compounds. A previous study showed that the di(methanesulfonate) salt of the bispyridinium compound MB327 could restore soman-impaired neuromuscular function in vitro and improve survival of sarin, soman and tabun poisoned guinea pigs in vivo. Here, by using the indirect field stimulation technique, the ability of MB327 to counteract soman-impaired neuromuscular transmission was investigated in human intercostal muscle and rat diaphragm preparations. MB327 restored muscle force in a concentration-dependent manner in both species without reactivating soman-inhibited acetylcholinesterase. The therapeutic effect of MB327 could be washed out, indicating a direct effect at the nicotinic receptor level. Also the ability of MB327 to restore respiratory muscle function could be demonstrated for the first time in rat and human tissue. In combination with previous in vitro and in vivo findings MB327 may be considered a promising compound for the treatment of nerve agent poisoning and further studies are needed to identify optimized drug combinations, concentrations and dosing intervals to provide an effective therapy for OP poisoning.     

Effect of Cleistanthus collinus leaf extract on neuromuscular function of the isolated mouse phrenic nerve-diaphragm

Cleistanthus collinus is a toxic plant whose leaves have been used for homicidal or suicidal purposes. Since the toxic effects include muscle cramps and weakness, the effect of the leaf extract on the electrical and mechanical responses to nerve and muscle stimulation was studied in the isolated phrenic nerve-diaphragm preparation of the mouse. Following a 1 hr exposure to 0.015% leaf extract, the response of the compound nerve action potential to supramaximal nerve stimulation was reduced by 38%. The compound muscle action potential was reduced by 97%, and isometric tension by 99%. In response to direct muscle stimulation the compound muscle action potential and isometric tension were reduced by 38%. There was only an 11% reduction in resting membrane potential, but a 51% reduction in the amplitude of miniature endplate potentials. Endplate potentials could be evoked by nerve stimulation without prior treatment of the muscle with curare or a high concentration of magnesium. These studies indicate that the leaf extract markedly inhibits muscle contraction by reducing excitability of the nerve and muscle membranes, and by blocking neuromuscular transmission, without affecting excitation-contraction coupling or contractility of the muscle fibers.     

丙烯酰胺抑制大鼠肌注A型肉毒毒素后的神经芽生

目的观察丙烯酰胺是否能抑制肉毒毒素肌注后的神经芽生,以延长其治疗肌肉过强活动疾病的疗效。方法SD大鼠随机分为肉正常对照组、丙烯酰胺组、肉毒毒素组和毒毒素+丙烯酰胺组。每只大鼠右肢腓肠肌分别肌肉注射A型肉毒毒素5U或生理盐水1次(0.2mL),肌注后d3,6,9,12,15,18及21分别ip3%丙烯酰胺或生理盐水,每次0.1mL。肌肉注射肉毒毒素后1,2,3,4,6,8,10及12周的8个时间点评定大鼠右后肢肌力,观察单纤维肌电图和形态学计数神经纤维。结果肉毒毒素组右后肢肌力下降,单纤维肌电图纤维密度测定和病理形态神经纤维计数结果均显示A型肉毒毒素肌肉注射后神经芽生现象;单纤维肌电图动作电位平均连续差结果提示出现神经肌肉接头传导异常,12周可基本恢复正常。加用丙烯酰胺可延缓芽生高峰的时间和抑制芽生程度,并延缓神经肌肉接头功能的恢复。结论应用丙烯酰胺可抑制A型肉毒毒素局部注射后神经芽生,延迟肌力恢复。     

Prolonged toxicity with intermediate syndrome after combined parathion and methyl parathion poisoning.

A prolonged type of organophosphate toxicity, previously characterized as the Intermediate Syndrome, has been recognized in 6 out of 7 prospectively studied patients poisoned by insecticide containing parathion and methyl parathion in equal proportions. The clinical characteristics included respiratory paresis, weakness in the territories of several motor cranial nerves, neck flexors and proximal limb muscles, and depressed tendon reflexes, all lasting for several days or weeks. Electromyography in the early stages disclosed diverse types of impaired neuromuscular transmission. EMG normalization preceded clinical recovery. Severe plasma butyrylcholinesterase and erythrocyte acetylcholinesterase inhibition persisted along with the occurrence of Intermediate Syndrome-related symptoms. We conclude that combined parathion and methyl parathion poisoning is more likely to induce Intermediate Syndrome than parathion poisoning alone. The mechanisms underlying this difference remain obscure. The Intermediate Syndrome shows clinical and electromyographic hallmarks of combined postsynaptic impairment of neuromuscular transmission.     

The intermediate syndrome in organophosphate poisoning: presentation of a case and review of the literature.

A dimethoate-poisoned woman gradually developed a moderately severe cholinergic crisis that was readily treated by atropine. After being symptom-free for nearly two days, she suffered from sudden life-threatening respiratory paresis and weakness of the facial, extraocular, neck flexor and proximal limb muscles. Muscarinic symptoms were absent. Cholinesterase inhibition was severe, and EMG revealed marked decrements at low rates of repetitive nerve stimulation, and increments at a high rate. The clinical course was compatible with the Intermediate Syndrome. This syndrome seems due to persistent cholinesterase inhibition presumably leading to combined pre- and postsynaptic impairment of neuromuscular transmission. Inadequate pralidoxime therapy is proposed but not established as contributory. Prolonged monitoring of respiratory function in patients poisoned by particular organophosphate agents is mandatory.     

The efficacy of some bis-pyridinium oximes as antidotes to soman in isolated muscles of several species including man

Previous results had shown that bis-pyridinium oximes, particularly HI-6 are quite effective therapeutically in soman-poisoned rats and mice in vivo and in the rat diaphragm preparation in vitro. The aim of the present study was to investigate the efficacy of bis-pyridinium oximes on soman-inhibited neuromuscular transmission in muscle preparations from several species including man. The muscles tested were preparations of rat diaphragm and intercostal muscle, guinea-pig diaphragm, dog external intercostal muscle and human external interscotal muscle. These muscles were stimulated indirectly with field stimulation. With a few exceptions the preparations were exposed to soman for 2.5 or 15 min. In some cases different exposure times were employed or the organophosphate sarin was administered instead of its analogue soman. After the degree of inhibition of neuromuscular transmission had been established, oximes were added to the bath fluid. After washout 15 min later, recovery of neuromuscular transmission was tested. Subsequently, a second dose of soman was administered to investigate whether the recovery observed had been caused by cholinesterase reactivation. The results of these experiments indicate that the oximes tested, mostly HI-6, were quite effective as soman antidotes in muscle preparations of rats, guinea-pigs and dogs. In the human preparation while these oximes were quite effective after sarin intoxication they were essentially without effect against soman.     

吡喹酮对神经肌肉接头传递的作用

吡喹酮可使电刺激腓总神经所引起的胫前肌收缩反应明显加强。如给腓总神经施加超强刺激,静脉注射筒箭毒碱可减弱肌肉收缩反应,吡喹酮却能加强筒箭毒碱的抑制作用,使神经肌肉传递迅即完全阻断。采用微电极细胞内记录技术研究吡喹酮对离体大鼠膈神经隔肌的作用,发现吡喹酮不明显影响膈肌细胞的静息膜电位。低浓度吡喹酮(2×10^-4M)可使微终板电位(mepp)频率明显增加。高浓度吡喹酮8×10^-4M则使mepp振幅逐渐变小和消失。吡喹酮在使神经肌肉传递阻滞不断加深的同时,尚能使终板电位的振幅变小,终致完全消失。     

Effect of diabetes on relaxations to non-adrenergic, non-cholinergic nerve stimulation in longitudinal muscle of the rat gastric fundus.

1. The effect of 8-week streptozotocin-induced diabetes has been examined on relaxations to non-adrenergic, non-cholinergic (NANC) nerve stimulation in longitudinal strips of rat gastric fundus. 2. In the presence of noradrenergic and cholinergic blockade and raised tissue tone, electrical field stimulation (0.5-4 Hz, 30 s trains) induced frequency-dependent relaxations that were significantly smaller in gastric fundus strips from diabetic rats than in strips from control rats. 3. NG-nitro-L-arginine methyl ester (NAME, 100 microM) significantly reduced NANC relaxations in muscle strips from both control and diabetic rats, but the reduction was greater in muscle strips from diabetic rats than in those from control rats at frequencies of 2 and 4 Hz. alpha-Chymotrypsin (1 u ml-1) slightly reduced relaxations to nerve stimulation in muscle strips from both control and diabetic rats. 4. The duration of NANC nerve relaxations (1-4 Hz, 30 s trains) was smaller in muscle strips from diabetic rats than in those from control rats. The duration of NANC relaxations was reduced by alpha-chymotrypsin (1 u ml-1) in muscle strips from control rats but not in muscle strips from diabetic rats. 5. Relaxations to both nitric oxide (NO; 1-30 microM) and vasoactive intestinal polypeptide (VIP; 0.1-30 microM) were concentration-dependent and did not differ between muscle strips from control and diabetic rats. 6. The results suggest that streptozotocin-induced diabetes impairs relaxations to NANC nerve stimulation in the rat gastric fundus, which are largely mediated by NO and to a lesser extent by VIP.(ABSTRACT TRUNCATED AT 250 WORDS)