Current trends in neurology最新文献

Chronic visceral pain is a complex and often a serious burden on patients' life. It is strongly implicated in the etiology of many diseases, which often are complicated by co-morbid depression and other psychiatric disorders, all of which pose significant health risks. Understanding the mechanisms of nociception is an important step in treating pain-associated chronic diseases. The inflammatory process that is often associated with nociception produces a number of mediators, which activate nociceptors by interacting with ligand-gated ion channels, activation of different signal transduction pathways or by sensitizing primary afferent neurons located within the dorsal root ganglia (DRG). Primary afferents studied in vitro or in vivo are well-accepted models to examine various nociceptive and anti-nociceptive signals in peripheral nervous system. This review focuses on the recent work in the area of peripheral modulation of chronic pain at the level of visceral primary afferent neurons. Many studies intended to develop a coherent framework for a better understanding of heterogeneity of nociceptive neurons functioning as a gate for pain transmission and novel therapeutic tool for pain relief. Specifically, recent studies from the author's research group helped to define the role of ATP-sensitive purinergic and vanilloid-sensitive TRPV1 receptors in DRG-mediated nociceptive pathways. Tropic and physiological changes associated with chronic visceral pain indeed are mediated through different pathways; therefore, designing new and specific anti-nociceptive therapies will have a major impact on quality of life in patients by significantly reducing pharmacological and therapeutic interventions.

Functional pain syndromes, including such common disorders as irritable bowel syndrome (within the field of gastroenterology); chronic pelvic pain (in gynecology); interstitial cystitis/painful bladder syndrome (in urology); fibromyalgia (in rheumatology) and others cross multiple disciplines affecting more than 20% of the population worldwide and are more common in women. Inflammation is not a common pathophysiological pathway for a number of chronic (including functional) diseases. One of the possible explanations for this phenomenon is the neuronal reorganization associated with pain transmission (nociception), but the mechanisms of the crosstalk are unclear. Moreover, clinical presentations of functional syndromes often lack a specific pathology in the affected organ but may respond to a visceral cross-sensitization in which increased nociceptive input from an inflamed organ (i.e., uterus) sensitizes neurons that receive convergent input from an unaffected organ (i.e., colon or bladder). This mini-review focuses on the novel mechanisms for possible therapeutic interventions associated with the visceral pain primarily focusing on visceral nociceptors located within primary afferent neurons of dorsal root ganglia. Since there are observed gender differences in prevalence of functional diseases, it is proposed that estrogen may modulate nociceptor sensitization. Understanding these gender differences and neuronal reorganization associated with visceral pain will be the basis of translational efforts to modulate viscerally mediated mechanisms or functional disorders with ultimate goal to develop new therapies to treat functional disorders.

This mini-review summarizes the different pain-associated diseases and potential mechanisms that may help to achieve a deeper understanding of gender differences presented in clinical aspects of the functional syndromes. Chronic visceral pain is the most common complication of many functional disorders that do not have a defined pathophysiological cause. Functional pain syndromes include common disorders such as Irritable Bowel Syndrome (Gastroenterology), Interstitial Cystitis/Painful Bladder Syndrome (Urology), Fibromyalgia (Rheumatology), and Chronic Pelvic Pain (Gynecology) and cross multiple medical disciplines. Patients suffering from functional diseases may progress to cognitive decline and depression through neuroplastic changes not only at the level of central nervous system but also in the periphery. Pain pathways are activated in virtually all human diseases and only a thorough understanding of the mechanism implicated in the functional, painful disorders can truly contribute to more efficient therapeutic interventions.

Recent discoveries on the nature of the activity generated by the reticular activating system (RAS) suggest that arousal is much more involved in perception and movement than previously thought. The RAS is not simply an amorphous, unspecific region but rather a distinct group of nuclei with specific cell and transmitter types that control waking and modulate such processes as perception and movement. Thus, disturbances in the RAS will affect a number of neurological disorders. The discovery of gamma band activity in the RAS determined that high threshold calcium channels are responsible for generating gamma band activity in the RAS. Results showing that waking is mediated by CaMKII modulation of P/Q-type channels and REM sleep is modulated by cAMP/PK modulation of N-type channels points to different intracellular pathways influencing each state. Few studies address these important breakthroughs. Novel findings also show that the same primate RAS neurons exhibiting activity in relation to arousal are also involved in locomotion. Moreover, deep brain stimulation of this region, specifically the pedunculopontine nucleus (PPN DBS), in Parkinson's disease has salutary effects on movement, sleep, and cognition. Gamma oscillations appear to participate in sensory perception, problem solving, and memory, and coherence at these frequencies may occur at cortical or thalamocortical levels. However, rather than participating in the temporal binding of sensory events, gamma band activity generated in the RAS may help stabilize coherence related to arousal, providing a stable activation state during waking, and relay such activation to the cortex. Continuous sensory input will thus induce gamma band activity in the RAS to participate in the processes of preconscious awareness, and provide the essential stream of information for the formulation of many of our perceptions and actions. Such a role has received little attention but promises to help understand and treat a number of neurological disorders.

Increasing evidence suggests that vascular dysfunction, a universal feature of aging, mechanistically contributes to the onset and pathogenesis of neurological diseases of aging. It was recently discovered that attenuating activity of the mammalian/mechanistic target of rapamycin (mTOR) extends both life- and health-span in mice by delaying aging. Here we review current evidence for a critical role of mTOR in age-associated vascular dysfunction and discuss potential mechanisms by which this pathway may lead to cognitive decline in Alzheimer's disease.

In the late stage of human immunodeficiency virus-1 (HIV) infection, a subset of individuals develops HIV associated neurocognitive disorders (HAND), which in its severe form, is characterized by motor and cognitive dysfunction. Dendritic pruning, synaptic abnormalities and neuronal apoptosis are observed in these patients. There are numerous advances in our understanding of HIV interactions with cells of the central nervous system. However, the underlying causes of neurological symptoms and pathological alterations observed in HIV positive subjects are poorly understood. Moreover, little is still known about the molecular mechanisms by which HIV induces synaptic dysfunction and degeneration. HAND resembles other common neurological diseases such as Alzheimer's and Huntington's diseases. These neurodegenerative disorders are characterized by accumulation of toxic proteins such as tau and huntingtin, respectively, which promote axonal degeneration by impairing axonal transport. Axonal degeneration precedes neuronal death. Therefore, a better understanding of the mechanisms whereby HIV triggers axonal degeneration has potential implications for developing therapeutic compounds to prevent synaptic failure in HAND. This article highlights and reviews evidence showing that neuronal accumulation of viral proteins promotes axonal damage.

Neuroimaging studies have found a correlation between activation in the anterior insula and love, and a correlation between activation in the posterior insula and lust. The present control-case study describes a neurological male patient, with a rare, circumscribed lesion in the anterior insula, whom we tested using a decision task that required he judge whether each of a series of attractive individuals could be the object of his love or lust. The patient, in contrast with neurologically typical participants matched on age, gender, and ethnicity, performed normally when making decisions about lust but showed a selective deficit when making decisions about love. These results provide the first clinical evidence indicating that the anterior insula may play an instrumental role in love but not lust more generally. These data support the notion of a posterior-to-anterior insular gradient, from sensorimotor to abstract representations, in the evaluation of anticipatory rewards in interpersonal relationships.

The modern field of perceptual learning addresses improvements of sensory and perceptual functioning in adult observers and provides powerful tools to ameliorate the effects of neurological conditions that involve a sensory or attentional deficit. While the sensory systems were once thought to be plastic only during early development, modern research demonstrates a great deal of plasticity in the adult brain. Here we discuss the value of perceptual learning as a method to improve sensory and attentional function, with a brief overview of the current approaches in the field, including how perceptual learning can be highly specific to the training set, and also how new training approaches can overcome this specificity and transfer learning effects to untrained tasks. We discuss these in the context of extant applications of perceptual learning as a treatment for neurological conditions and how new knowledge mechanisms (including attention, exposure based learning, reinforcement learning and multisensory facilitation) that allow or restrict learning in the visual system can lead to enhanced treatment approaches. We suggest new approaches that integrate multiple mechanisms of perceptual learning that promise greater learning and more generalization to real world conditions.

Huntington's Disease is an adult-onset dominant heritable disorder characterized by progressive psychiatric disruption, cognitive deficits, and loss of motor coordination. It is caused by expansion of a polyglutamine tract within the N-terminal domain of the Huntingtin protein. The mutation confers a toxic gain-of-function phenotype, resulting in neurodegeneration that is most severe in the striatum. Increasing experimental evidence from genetic model systems such as mice, zebrafish, and Drosophila suggest that polyglutamine expansion within the Huntingtin protein also disrupts its normal biological function. Huntingtin is widely expressed during development and has a complex and dynamic distribution within cells. It is predicted to be a protein of pleiotropic function, interacting with a large number of effector proteins to mediate a host of physiological processes. In this review, we highlight the wildtype function of Huntingtin, focusing on its postdevelopmental roles in axonal trafficking, regulation of gene transcription, and cell survival. We then discuss how potential loss-of-function phenotypes resulting in polyglutamine expansion within Huntingtin may have direct relevance to the underlying pathophysiology of Huntington's Disease.

The anatomical connections of the parvocellular red nucleus (RNp) have led to the suggestion that it might participate along with the cerebellum in modifying old and developing new programs for the control of complex, compound, coordinated movements of multiple body parts. RNp projects to and excites the inferior olivary nuclear neurons, which send climbing fibers to excite neurons in contralateral cerebellar cortex and nuclei. RNp receives excitatory inputs from ipsilateral cerebral cortex (onto distal dendrites) and from contralateral cerebellar nuclei (onto proximal dendrites). We here further develop a hypothesis as to mechanism, and offer preliminary evidence from RNp inactivation studies in awake, trained macaques during modification of their gaze-reach calibration while wearing wedge prism spectacles.