Botulinum toxin in the treatment of focal dystonias: own experience with botulinum toxin

During the last 5 years, 75 patients with focal dystonias were longitudinally treated with injections of botulinum toxin A. Each patient received 2-6 injections. The improvement was assessed after each injection and estimated as significant after 68.47% of injections, as mediocre after 23.42% of injections and none after 8.11% of the injections. The most significant improvement was obtained in patients with blepharospasm and hemifacial spasm, the worst effect was obtained in spasmodic torticollis. Varying responses were observed following repeated injections of botulinum toxin, the clinically assessed improvement did not decrease after successively applied doses. Side-effects occurred after 18% of the injections and were mostly mild and disappeared after short time. This study confirms the usefulness of botulinum toxin, which is an effective and safe treatment of focal dystonias.     

A five-minute, but not a fifteen-minute, conditioning trial duration induces conditioned place preference for cocaine administration into the olfactory tubercle

The establishment of conditioned place preference (CPP) with intracranial injections requires specific injection sites, drug doses, and conditioning trial durations. We examined the role of conditioning trial duration in CPP with cocaine injections into the medial olfactory tubercle. Only those rats that had spent 5 min in the compartments showed CPP for cocaine, while rats that had been removed immediately or spent 15 min following cocaine injections did not show CPP. Effective conditioning trial durations for CPP induced by intracranial cocaine injections are apparently much shorter than those typically used for intracranial injections of other drugs of abuse.     

The duration of maintenance therapy in chronic schizophrenia.

The incidence of relapse was compared between two groups of chronic schizophrenic patients (mean duration periods 19 months and 29.5 months) discontinuing depot neuroleptic injections, and matched controls remaining on depot injections. The results show a higher relapse rate in patients discontinuing injections, significant at the 1% level, in both groups. The proportion of patients improving upon resumption of depot injections confirms the importance of this form of medication in comparison to prescribed oral medication. The results strongly suggest that there is a significant therapeutic gain in continuing maintenance therapy with depot neuroleptic injections for a minimum period of 3 years after the last relapse in a substantial proportion of chronic schizophrenic patients.     

Loss of active avoidance of responding after lateral hypothalamic injections of 6-hydroxydopamine.

After injections of 6-hydroxydopamine (6-OHDA) along the medial forebrain bundle in the lateral hypothalamus, rats failed to acquire a one-way active avoidance response or failed to perform a previously acquired active avoidance response. Such rats, however, acquired a passive avoidance response and a conditioned taste aversion normally. Thus the effect of lateral hypothalamic injections of 6-OHDA was not a total loss of the capacity to acquire or perform conditioned responses, but was a failure to initiate forward movement in the presence of a conditional stimulus. Most of these rats could initiate a similar forward movement to escape from the unconditioned stimulus (foot shock). Failure to acquire or perform the active avoidance response was correlated with the loss of hypothalamic, striatal and forebrain catecholamines produced by lateral hypothalamic 6-OHDA injections. Identical injections of 6-ohda placed along the medial hypothalamus produced a similar loss of regional catecholamines, but medial 6-OHDA injections did not affect active avoidance responding. We interpret this dissociation between loss of catecholamines and the capacity for active avoidance responding to mean that medial 6-OHDA injections did not damage the same catecholaminergic terminal fields as lateral 6-OHDA injections and that the integrity of the terminal fields damaged by lateral 6-OHDA injections is necessary for active avoidance responding.     

The frequency of cocaine administration impacts cocaine-induced receptor alterations

The present study investigated the impact of dosing schedule on cocaine-induced receptor alterations. Rats were injected with 30 mg/kg per day of cocaine given either as a single injection or in two equally divided doses for 14 days. The effects of these two dosing regimens were compared with our previous findings following administration of cocaine three times daily at 1-h intervals. Using receptor autoradiography, twice daily injections of cocaine produced an upregulation of mu opioid receptors in the rostral nucleus accumbens, rostral caudate putamen, and layer I of the rostral cingulate cortex, whereas single daily injections resulted in a significant increase in the nucleus accumbens only. Only small insignificant increases in kappa opioid receptor densities were found following either once or twice daily cocaine injections, whereas three daily injections produced an increase in kappa receptor density in the cingulate cortex, nucleus accumbens, and caudate putamen. Increased dopamine D1 receptor binding was found in the nucleus accumbens and olfactory tubercle following twice daily cocaine injections, but not after single daily injections of the same total daily dose. These results demonstrate that the same total daily dose of cocaine administered in multiple small injections produces a greater effect on receptor regulation than a single larger injection. This suggests that the interval between cocaine injections is an important variable when studying the effects of cocaine on neurochemistry.     

Intrathecal baclofen for intractable spinal spasticity--a double-blind cross-over comparison with placebo in 6 patients.

A group of six subjects with intractable spinal spasticity completed a double-blind cross-over paradigm in which they received two intrathecal bolus injections of baclofen solution five hours apart on two different days and two intrathecal bolus injections of placebo saline five hours apart on two other days. Each subject was repeatedly tested with a battery of clinical and physiological tests. In contrast to the placebo injections, the group responded to the baclofen injections with subjective and objective, clinically significant improvement in parameters of spasticity in their lower limbs, including muscle tone, frequency of spasms, hyperreflexia and passive range of joint motion. Furthermore, this improvement was maintained following thirty consecutive days of intrathecal bolus injections of baclofen at a fixed dose.     

Angelica injection reduces cognitive impairment during chronic cerebral hypoperfusion through brain-derived neurotrophic factor and nerve growth factor

The current study investigated whether chronic cerebral hypoperfusion produced by permanent bilateral common carotid artery occlusion (2-vessel occlusion (2-VO)) induced cognitive impairment and whether angelica injections alleviated the impairment. Furthermore, the study examined whether 2-VO altered the expression patterns of brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) in the hippocampus of rats and whether angelica injections attenuated the alteration. Rats were divided into four groups to receive either 2-VO surgery or sham surgery followed by either angelica injections or saline injections for eight weeks. Spatial learning in Morris water maze and the expression patterns of BDNF and NGF in the hippocampus of all rats were examined. The results showed that 2-VO significantly impaired spatial learning and memory, and angelica injections significantly reversed the learning and memory impairment. Furthermore, 2-VO resulted in significantly decreased BDNF protein, NGF protein, and NGF mRNA expression in the hippocampus. Angelica injections significantly attenuated the decreased expression. Moreover, spatial learning in Morris water maze was positively correlated to the expression of BDNF and NGF in the hippocampus. Thus, angelica injections might alleviate cognitive impairment during chronic cerebral hypoperfusion through BDNF and NGF.     

A comparative crossover study on the treatment of hemifacial spasm and blepharospasm: preseptal and pretarsal botulinum toxin injection techniques

Hemifacial spasm (HFS) and benign essential blepharospasm (BEB) are chronic and disabling abnormal craniofacial movements that produce involuntary eyelid twitching and closure. The efficacy and safety of botulinum toxin type A (BoNT-A) injections have been accepted and widely used for the treatment of HFS and BEB. However, different injection sites may influence the effectiveness, doses, and side effects. The aim of this study is to compare the efficacy, patient satisfaction, and complications of low-dose BoNT-A injections between injection at the preseptal (PS) and the pretarsal (PT) portion of the orbicularis oculi muscle. A total of 40 patients, 31 patients with HFS and 9 patients with BEB, participated in this study. Each patient received both PS and PT BoNT-A injections in a crossover design study. Latency to response, duration of improvement, the Jankovic Rating Scale (JRS), self-response scale, patient satisfaction scale, and complications were compared. Low-dose injections of BoNT-A at the PT portion produced a significantly higher response rate in terms of latency to response, duration of improvement, JRS, self-response scale, and patient satisfaction scale than the PS injections. Major side effects including ptosis and droopy eyelid were observed only after the PS injections. These findings confirmed that low-dose injections of BoNT-A at the PT portion provide more efficacy, patient satisfaction, and fewer complications than the PS injections for the treatment of involuntary eyelid twitching and closure in patients with HFS and BEB.     

Responses of lateral preoptic neurons in the rat to hypertonic sucrose and NaCl.

Multiple-unit recordings were taken from the lateral preoptic region during a series of hypertonic and isotonic NaCl and sucrose intracarotid injections. Subjects were 11 hooded rats (8 males and 3 ovariectomized females) under urethane anesthesia. The data showed that under favorable cannulation conditions there were strong multiple-unit responses to hypertonic sucrose injections, and that under these conditions NaCl injections were not significantly more effective than sucrose injections. The possible bearing of these findings on hypotheses concerning central receptors for thirst is discussed.     

Disruption of food hoarding by injections of procaine into mediodorsal thalamus,GABA into subpallidal region and haloperidol into accumbens

The contributions of accumbens-subpallido-mediodorsal thalamus (MD) projections to food hoarding were investigated. The number of food pellets hoarded was reduced by bilateral injections of haloperidol into the accumbens, by bilateral injections of GABA into the subpallidal region and by bilateral injections of procaine into the mediodorsal thalamus. Food hoarding was not reduced by bilateral injections of procaine into the pedunculopontine nucleus. It appears that subpallido-mediodorsal thalamus projections are associated with hoarding behavior but not subpallido-pedunculopontine projections.     

Treatment of hemifacial spasm with botulinum toxin.

The effectiveness of botulinum toxin injections in 11 patients with hemifacial spasm was investigated in a prospective placebo-controlled blinded study. The patients were treated with four sets of injections to various facial muscles, selected by clinical evaluation. Three injections were with graded doses of toxin and one was with placebo. The order of injections was random and unknown to the patients. Results were scored both subjectively by patient assessment of symptoms and objectively by blinded review of videotapes made one month after each injection. Subjective improvement occurred after 79% of injections with botulinum toxin, regardless of dose of toxin. Only 1 patient improved after placebo. Objective improvement was seen after 84% of injections with botulinum toxin. No patient showed objective improvement after placebo injection. The most frequent side effect was facial weakness, seen after 97% of injections of botulinum toxin. Facial bruising (20%), diplopia (13%), ptosis (7%), and various other mild side effects were seen less frequently. Botulinum toxin appears to be an effective and safe method of therapy for hemifacial spasm.     

Botulinum toxin A injection in the treatment of hemifacial spasm

Introduction – There are conflicting reports concerning the variation in duration of symptoms relief for patients with hemifacial spasm who have undergone several injections of botulinum A toxin (BOTX-A). We present our experience of BOTX-A injections in Taiwanese patients to analyze this issues, and to inspect whether the efficacy of treatment depends on the pre-injection severity. Material and method — From July 1992 to December 1994, 137 patients received injections of BOTX-A. We used objective and subjective score system to evaluate the efficacy and side effects of BOTX-A injection. Results — The overall successful rate of substantial relief of spasm was 88%. The mean duration of response was 20 weeks. Patents with more severe spasm tended to have shorter duration of improvement. The effects of consecutive injections remained fairly constant over the first 4 injections. Conclusion — The BOTX-A injection is an effective and safe treatment for patients with hemifacial spasm and the effect could be sustained over the consecutive injections.     

Osmosensitive neurons in the rat's dorsal midbrain.

In experiment 1, multiple unit recordings were taken simultaneously from lateral preoptic and dorsal midbrain areas during a series of intracarotid hypertonic and isotonic NaCl injections. Subjects were 15 hooded rats (11 males and 4 ovariectomized females) under urethane anesthesia. Results showed that the neuronal reactions to a series of hypertonic NaCl injections (0.30 M, 0.45 M, 0.60 M and 0.75 M) were at least as strong in the dorsal midbrain as in the lateral preoptic area. Strength of neuronal reaction correlated with osmolarity of the NaCl solution injected. Control isotonic NaCl injections were ineffective, and the (monitored) force of injection was found not to affect the results. In experiment 2 with 15 hooded rats (9 males and 6 ovariectomized females), and two male Wistar rats under urethane anesthesia, recording from dorsal midbrain units were made during intracarotid injections of hypertonic and isotonic NaCl solutions. In addition, other sensory stimulations, including tail pinches, were presented. Of the 52 units studied, 39 cells (75%) reacted to injections of hypertonic NaCl, but not the isotonic (control) solution (Normosol-R). Again, strength of neuronal reaction correlated with osmolarity of the NaCl solution injected, and force of injections was found not to influence results. Eleven cells reacted to hypertonic NaCl injections but not to tail pinch. This and other evidence indicated that certain dorsal midbrain cells were specifically osmosensitive, and not merely showing general 'arousal' reactions to the injections. These results indicate that, for the rat, the osmosensitive zone extends into the midbrain. The functional significance of these findings is discussed.     

Brainstem carbachol injections in the urethane anesthetized rat produce hippocampal theta rhythm and cortical desynchronization: a comparison of pedunculopontine tegmental versus nucleus pontis oralis injections

Previous research has demonstrated that brainstem injections of acetylcholine agonists (e.g., carbachol) produced electrophysiological indicators of rapid-eye-movement (REM) sleep in the cat. Recent reports now indicate that this phenomenon may hold true for rats as well. Relatively few reports, however, have examined the effect of these injections on REM indicators in the anesthetized rat, a preparation useful for elucidating underlying neurobiological mechanisms controlling REM sleep processes. The present study compared the effect of injections of carbachol (5 μg in 250 nl) into the pedunculopontine tegmental nucleus (PPTg) or the nucleus pontis oralis (NPO) on two tonic indicators of REM sleep in the urethane-anesthetized rat. Namely, changes in the hippocampal EEG and in the cortical EEG. Carbachol injections into either site produced a change in both the hippocampal EEG and cortical EEG to a REM-like state at short latencies. The length of these changes (duration of effect), however, was site-dependent. Thus, PPTg carbachol injections induced significantly longer lasting effects in both the hippocampal and cortical EEG than did NPO injections. The results suggest that brainstem carbachol injections in rats, as in cats, may provide a useful model for investigating tonic REM sleep processes.     

Distribution and central projections of primary afferent neurons that innervate the masseter muscle and mandibular periodontium: a double-label study

A double-label strategy was used to determine the distribution and central projections of primary afferent neurons that innervate the periodontium and muscles of mastication in cats. Central injections of either Fast Blue (FB) or a mixture of wheat germ agglutinin-conjugated horseradish peroxidase (WGA-HRP) and HRP were made into one of three cytoarchitectonically distinct regions of the spinal trigeminal nucleus. These regions included the subnucleus oralis (Vo), the subnucleus interpolaris (Vi), and the medullary dorsal horn (MDH). In each case, injections were also made into the periodontium of the ipsilateral mandibular teeth or into the ipsilateral masseter muscle. FB injections preceded the peroxidase injections by at least 48 hours and total survival time ranged from 72 to 96 hours. Animals were perfused with phosphate-buffered paraformaldehyde (4%; pH 7.2). Serial frozen sections were made through the brainstem and trigeminal ganglion. Tetramethylbenzidine was used as a chromagen to demonstrate HRP and sections were viewed with brightfield and epifluorescent illumination. Cells containing peripherally injected tracer were observed in the lateral portion of the ganglion and in the mesencephalic nucleus (Vmes). Double-labeled ganglion cells were observed in most cats that received periodontal injections in combination with central injections in the dorsal part of spinal trigeminal nucleus regardless of the rostrocaudal level of the central injection. In the animals that received intramuscular injections, double-labeled ganglion cells were observed only in the animals that received central injections caudal to the Vo. Double-labeled Vmes perikarya were observed in cats that received either intramuscular or periodontal injections in combination with central injections into the MDH and Vo but not in animals that received injections into the Vi. These results demonstrate that ganglion cell periodontal afferents project to the three major rostrocaudal subdivisions of the spinal trigeminal nucleus while ganglion cell muscle afferents have more limited central projections to caudal regions of the nucleus. Masseter and periodontal Vmes afferents also project ot the spinal trigeminal nucleus--specifically, to the Vo and MDH. These findings are consistent with physiological observations regarding the role of periodontal and masseteric afferents in oral and facial reflexes and somesthetic mechanisms.     

Afferent connections of the corpus cerebelli in holocentrid teleosts

The holocentrid corpus cerebelli (CC) is composed of the dorsal (CCd) and ventral (CCv) lobes. In the present study, afferent connections of the CCd and CCv in holocentrid teleosts (Sargocentron rubrum and S. diadema) were examined by means of tract-tracing methods. Tracer injections into either lobe of the CC labeled neurons in the ipsilateral area pretectalis pars anterior et posterior, nucleus paracommissuralis (NPC), nucleus accessorius opticus and nucleus tegmentocerebellaris. Labeled neurons were also present in the bilateral nucleus lateralis valvulae (NLV), nucleus raphes, nucleus reticularis lateralis and inferior reticular formation, and in the contralateral inferior olive. Injections into the CCd labeled only a few neurons in the area pretectalis pars anterior et posterior, nucleus accessorius opticus and nucleus tegmentocerebellaris, whereas many labeled cells were seen in these nuclei after CCv injections. Injections into the CCv also revealed afferent connections that were not observed after CCd injections. The CCv injections labeled additional neurons in the ipsilateral torus longitudinalis and nucleus subeminentialis and in the bilateral nucleus subvalvularis and nucleus of the commissure of Wallenberg. These differences in afferent connections suggest functional differences between the CCd and CCv. After injections into the CCd, labeled neurons in the NPC were restricted to a medial portion of the nucleus. On the other hand, after injections into the CCv, labeled neurons were found throughout the NPC. Labeled neurons in the NLV were mainly located in its rostral portion following CCd injections, whereas labeled neurons were mainly distributed in the medial portion following CCv injections. These observations suggest topographical organizations of the NPC-CC and NLV-CC projections.     

Increasing the effectiveness of intracerebral injections in adult and neonatal mice: a neurosurgical point of view

Intracerebral injections of tracers or viral constructs in rodents are now commonly used in the neurosciences and must be executed perfectly. The purpose of this article is to update existing protocols for intracerebral injections in adult and neonatal mice. Our procedure for stereotaxic injections in adult mice allows the investigator to improve the effectiveness and safety,and save time. Furthermore,for the first time,we describe a two-handed procedure for intracerebral injections in neonatal mice that can be performed by a single operator in a very short time. Our technique using the stereotaxic arm allows a higher precision than freehand techniques previously described. Stereotaxic injections in adult mice can be performed in 20 min and have 90% efficacy in targeting the injection site. Injections in neonatal mice can be performed in 5 min. Effi cacy depends on the diffi culty of precisely localizing the injection sites,due to the small size of the animal. We describe an innovative,effortless,and reproducible surgical protocol for intracerebral injections in adult and neonatal mice.     

Identification of a Median Thalamic System Regulating Seizures and Arousal

This study better defines the way in which the thalamus controls expression of experimental generalized seizures. The effects of small intrathalamic injections of the direct GABA agonist muscimol on the thresholds of pentylenetetrazol (PTZ)-induced seizures and on spontaneous behavior were determined in the rat and compared with the effects of injections of gamma-vinyl-GABA (GVG), an irreversible inhibitor of GABA transaminase. Muscimol injections produced neuronal inhibition in a relatively small area of thalamus, whereas GVG injections produced inhibition in a much larger area. Muscimol injections in the midline thalamus in the vicinity of the paraventricular, paratenial, interanteromedial, intermediodorsal, and central medial nuclei facilitated PTZ myoclonic and clonic seizures and also produced sedation. These effects on seizure thresholds were attributable both to a lower PTZ threshold dose for initiation of electroencephalographic (EEG) seizure activity and to an increased probability of this EEG activity being expressed as behavioral seizures. Midline injections located more posteriorly in the thalamus also inhibited tonic seizures. Muscimol injections placed laterally, dorsally, or ventrally to this midline thalamic region had much less effect on behavior or seizures. In contrast, GVG injections in the anterior medial thalamus elevated the threshold for all PTZ seizure types and for associated EEG seizure activity but had little effect on spontaneous behavior. These findings demonstrate the existence of an important seizure regulatory system in the midline of the thalamus and a direct anatomic link between the mechanisms for regulating arousal and seizure production which may help explain the association between sleep and seizure facilitation in humans.(ABSTRACT TRUNCATED AT 250 WORDS)     

Involvement of amygdala pathways in the influence of post-training intra-amygdala norepinephrine and peripheral epinephrine on memory storage

These experiments examined the role of two major amygdala afferent-efferent pathways--the stria terminalis (ST) and the ventral amygdalofugal pathway (VAF)--in mediating the effects, on memory storage, of post-training intra-amygdala injections of norepinephrine (NE) and subcutaneous (s.c.) injections of epinephrine (E). Rats with either ST lesions or VAF transections and sham-operated rats were trained on a one-trial step-through inhibitory avoidance task and immediately after training received intra-amygdala injections of NE or a buffer solution. Other groups of VAF-transected animals received post-training s.c. injections of E or saline. ST lesions blocked the memory-enhancing effect of intra-amygdala injections of a low dose of NE (0.2 microgram) as well as the amnestic effect of a high dose of NE (5.0 microgram). In contrast, VAF transections did not block the memory-enhancing effect of NE (0.2 microgram). However, VAF transections attenuated the memory-enhancing effect of s.c. injections of E: the effective dose of E was shifted from 0.1 to 0.5 mg/kg. These findings, considered together with previous evidence that ST lesions block the memory-enhancing effect of peripheral E injections, suggest that the VAF is involved in mediating the central influence of peripheral E on amygdala functioning, while the ST is involved in mediating amygdala influences on memory storage elsewhere in the brain.