Sample records for trigeminal para invadir

  1. O Herpesvírus bovino tipo 5 (BoHV-5 pode utilizar as rotas olfatória ou trigeminal para invadir o sistema nervoso central de coelhos, dependendo da via de inoculação Bovine herpesvirus 5 may use the olfactory and trigeminal pathways to invade the central nervous system of rabbits, depending upon the route of inoculation

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    Diego Gustavo Diel


    resultados demonstram que tanto a via olfatória como a trigeminal podem servir de acesso para o BoHV-5 invadir o cérebro de coelhos inoculados experimentalmente, dependendo da via de inoculação. Inoculação IN resulta em um transporte rápido e eficiente pela via olfatória; com a via trigeminal servindo de acesso mais lento e menos eficiente. Inoculação IC resulta em transporte e invasão eficientes, porém mais tardios, provavelmente pela via trigeminal.Bovine herpesvirus type 5 (BoHV-5 is a major etiological agent of meningoencephalitis in cattle. Following replication in the nasal mucosa, viral invasion of the brain is thought to occur mainly by the olfactory pathway. To address the role of this pathway in the pathogenesis of neurological infection in a laboratory model, 30 days old rabbits had the main olfactory bulbs (MOBs surgically removed and were subsequently inoculated intranasally (IN or conjunctivally (IC with a highly neurovirulent BoHV-5 strain (SV-507. Following IN inoculation, 10 out of 10 (100 % control rabbits developed neurological disease. The clinical onset ranged from day 5 to 10 post-inoculation (pi, average 7.5 days; nine being euthanized in extremis and one recovering after a mild clinical course. In contrast, only one rabbit (9.1 % of the group lacking the MOBs (n=11 developed neurological disease (onset at day 17 pi. Dexamethasone administration to the survivors (n=10 at day 50pi was followed by virus shedding in nasal and/or ocular secretions by 8 animals, demonstrating that the virus was able to reach the trigeminal ganglia (TG during acute infection. These results demonstrate that the olfactory route provides the main, yet not the sole access to the brain of rabbits following IN inoculation. To address the role of a second pathway, groups of control (n=12 or MOB-lacking rabbits (n=12 were inoculated into the conjunctival sac (IC, following which the virus would be expected to use the ophtalmic branch of the trigeminal nerve to reach the

  2. Trigeminal neuralgia

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    Maarbjerg, Stine; Di Stefano, Giulia; Bendtsen, Lars


    Introduction Trigeminal neuralgia (TN) is characterized by touch-evoked unilateral brief shock-like paroxysmal pain in one or more divisions of the trigeminal nerve. In addition to the paroxysmal pain, some patients also have continuous pain. TN is divided into classical TN (CTN) and secondary TN...

  3. Con o sin permiso: saber invadir el espacio del otro

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    Saiz de Mingo, Ariadna


    Full Text Available Partiendo de la idea de que la explicación de una aparente falta de cortesía en determinados comportamientos comunicativos hispanos no puede quedar limitada a la presencia / ausencia de una forma lingüística, trataremos de reflexionar sobre la importancia de la variación pragmática intercultural a la hora de abordar la enseñanza de la (descortesía en el aula de ELE. Para ilustrarlo, analizaremos el “fracaso”, desde el punto de vista de los presupuestos de la cortesía, del primer encuentro de los protagonistas de la película Fresa y chocolate (Juan Carlos Tabío; Cuba, 1995, en un intento por ampliar el concepto de lo (descortés.


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    Marinos KONTZIALIS


    Full Text Available Trigeminal neuralgia is a debilitating pain syndrome in the sensory distribution of the trigeminal nerve. Compression of the cisternal segment of the trigeminal nerve by a vessel, usually an artery, is considered the most common cause of trigeminal neuralgia. A number of additional lesions may affect the trigeminal nerve anywhere along its course from the trigeminal nuclei to the most peripheral branches to cause facial pain. Relevant differential considerations are reviewed starting proximally at the level of the brainstem.

  5. Painful Traumatic Trigeminal Neuropathy. (United States)

    Rafael, Benoliel; Sorin, Teich; Eli, Eliav


    This article discusses neuropathic pain of traumatic origin affecting the trigeminal nerve. This syndrome has been termed painful traumatic trigeminal neuropathy by the International Headache Society and replaces atypical odontalgia, deafferentation pain, traumatic neuropathy, and phantom toothache. The discussion emphasizes the diagnosis and the early and late management of injuries to the trigeminal nerve and subsequent painful conditions. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Perception of trigeminal mixtures. (United States)

    Filiou, Renée-Pier; Lepore, Franco; Bryant, Bruce; Lundström, Johan N; Frasnelli, Johannes


    The trigeminal system is a chemical sense allowing for the perception of chemosensory information in our environment. However, contrary to smell and taste, we lack a thorough understanding of the trigeminal processing of mixtures. We, therefore, investigated trigeminal perception using mixtures of 3 relatively receptor-specific agonists together with one control odor in different proportions to determine basic perceptual dimensions of trigeminal perception. We found that 4 main dimensions were linked to trigeminal perception: sensations of intensity, warmth, coldness, and pain. We subsequently investigated perception of binary mixtures of trigeminal stimuli by means of these 4 perceptual dimensions using different concentrations of a cooling stimulus (eucalyptol) mixed with a stimulus that evokes warmth perception (cinnamaldehyde). To determine if sensory interactions are mainly of central or peripheral origin, we presented stimuli in a physical "mixture" or as a "combination" presented separately to individual nostrils. Results showed that mixtures generally yielded higher ratings than combinations on the trigeminal dimensions "intensity," "warm," and "painful," whereas combinations yielded higher ratings than mixtures on the trigeminal dimension "cold." These results suggest dimension-specific interactions in the perception of trigeminal mixtures, which may be explained by particular interactions that may take place on peripheral or central levels. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:

  7. Imaging the trigeminal nerve

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    Borges, Alexandra [Radiology Department, Instituto Portugues de Oncologia Francisco Gentil, Centro de Lisboa, Rua Prof. Lima Basto, 1093, Lisboa (Portugal)], E-mail:; Casselman, Jan [Department of Radiology, A. Z. St Jan Brugge and A. Z. St Augustinus Antwerpen Hospitals (Belgium)


    Of all cranial nerves, the trigeminal nerve is the largest and the most widely distributed in the supra-hyoid neck. It provides sensory input from the face and motor innervation to the muscles of mastication. In order to adequately image the full course of the trigeminal nerve and its main branches a detailed knowledge of neuroanatomy and imaging technique is required. Although the main trunk of the trigeminal nerve is consistently seen on conventional brain studies, high-resolution tailored imaging is mandatory to depict smaller nerve branches and subtle pathologic processes. Increasing developments in imaging technique made possible isotropic sub-milimetric images and curved reconstructions of cranial nerves and their branches and led to an increasing recognition of symptomatic trigeminal neuropathies. Whereas MRI has a higher diagnostic yield in patients with trigeminal neuropathy, CT is still required to demonstrate the bony anatomy of the skull base and is the modality of choice in the context of traumatic injury to the nerve. Imaging of the trigeminal nerve is particularly cumbersome as its long course from the brainstem nuclei to the peripheral branches and its rich anastomotic network impede, in most cases, a topographic approach. Therefore, except in cases of classic trigeminal neuralgia, in which imaging studies can be tailored to the root entry zone, the full course of the trigeminal nerve has to be imaged. This article provides an update in the most recent advances on MR imaging technique and a segmental imaging approach to the most common pathologic processes affecting the trigeminal nerve.

  8. Modeling and commissioner of a set of cones brain lab for trigeminal neuralgia; Modelado y comisionado de un sistema de conos brainlab para la neuralgia de trigemino

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    Radiosurgery is an effective treatment for trigeminal neuralgia. The use of LINAC with cone system is an alternative front other procedures. As the fields to measure are very small we prefer not to use camera type pinpoint due to lack of lateral balance and the use of diodes implies fixes to correct the over-estimation of his reading. (Author)

  9. Triggering trigeminal neuralgia

    DEFF Research Database (Denmark)

    Di Stefano, Giulia; Maarbjerg, Stine; Nurmikko, Turo


    Introduction Although it is widely accepted that facial pain paroxysms triggered by innocuous stimuli constitute a hallmark sign of trigeminal neuralgia, very few studies to date have systematically investigated the role of the triggers involved. In the recently published diagnostic classification...

  10. Accommodation to Diagnosis of Trigeminal Neuralgia (United States)

    Bašić Kes, Vanja; Zadro Matovina, Lucija


    Trigeminal neuralgia is one of the most common causes of facial pain. It implies short lasting episodes of unilateral electric shock-like pain with abrupt onset and termination, in the distribution of one or more divisions of the trigeminal nerve that are triggered by innocuous stimuli. Most cases of trigeminal neuralgia are caused by compression of the trigeminal nerve root. Depending on the etiology, trigeminal neuralgia can be classified as classic trigeminal neuralgia or painful trigeminal neuropathy. It may be precipitated by some actions at trigger zones. The diagnosis of trigeminal neuralgia is based on diagnostic criteria for classic trigeminal neuralgia, neuroimaging and electrophysiologic trigeminal reflex testing. Treatment of classic trigeminal neuralgia for most patients is pharmacological therapy, while surgical approach is reserved for patients that are refractory to medical therapy and in cases of painful trigeminal neuropathy.

  11. Accommodation to Diagnosis of Trigeminal Neuralgia


    Bašić Kes, Vanja; Zadro Matovina, Lucija


    Trigeminal neuralgia is one of the most common causes of facial pain. It implies short lasting episodes of unilateral electric shock-like pain with abrupt onset and termination, in the distribution of one or more divisions of the trigeminal nerve that are triggered by innocuous stimuli. Most cases of trigeminal neuralgia are caused by compression of the trigeminal nerve root. Depending on the etiology, trigeminal neuralgia can be classified as classic trigeminal neuralgia or painful trigemina...

  12. MR imaging of trigeminal neuropathy

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    Kim, Si Yeon; Yoon, Pyeong Ho; Chung, Jin Il; Lee, Seung Ik; Kim, Dong Ik [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)


    The trigeminal nerve is the largest of the cranial nerves and has both sensory and motor functions. It can be divided into proximal (brainstem, preganglionic, gasserian ganglion, and cavernous sinus) and distal (extracranial opthalmic, maxillary, and mandibular) segments. Patients with trigeminal neuropathy present with a wide variety of symptoms, and lesions producing those symptoms may occur anywhere along the protracted course of the trigeminal nerve, from its distal facial branches to its nuclear columns in the brainstem. The purpose of this article is to illustrate the normal anatomy of the trigeminal nerve and associated various pathologic conditions. These are arranged anatomically according to their site of interaction with it.

  13. Trigeminal Trophic Syndrome – Case Report

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    Boštjan Matos


    Full Text Available 1024x768 Trigeminal trophic syndrome is a rare condition resulting from compulsive self-manipulation of the skin after a peripheral or central injury to the trigeminal system. The classic triad consists of trigeminal anesthesia, facial paresthesias, and crescentric lateral nasal alar erosion and ulceration. Although the symptoms are visibly clear, the diagnosis is not easy to establish. The appearance of the ulcers mimics many other disease entities such as neoplasm, infection, granulomatous disease, vasculitis and factitial dermatitis. Trigeminal trophic syndrome should be considered with a positive neurologic history and when laboratory and biopsy workup is inconclusive. Once diagnosis is confirmed, treatment is complicated and often multidisciplinary. We report a case of a woman who developed a strictly unilateral crescent ulcer of the ala nasi after resection of an statoacoustic neurinoma. A clinician who is faced with a patient with nasal ulceration should consider this diagnosis.     Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}


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    Sama Surya Sravani


    Full Text Available BACKGROUND Neuralgia is the set of symptoms associated with nerve dysfunction. The most common of these symptoms is pain, which can occur intermittently in one area of the body or can radiate along the length of a damaged nerve. The most common type of neuralgia is trigeminal neuralgia. This study focuses on the effectiveness of MRI in visualising the entire course of trigeminal nerve and to diagnose the exact location, aetiology responsible for trigeminal neuralgia and possible pretreatment evaluation. MATERIALS AND METHODS Clinical records and imaging studies of 30 patients between the ages of 18-60 years who presented to the Department of Radiodiagnosis, KIMS, for brain magnetic resonance imaging with (Philips 1.5T machine during June 2015 to December 2016 were analysed retrospectively. RESULTS  The entire course of trigeminal nerve is evaluated in these patients.  There are different causes of trigeminal neuralgia, but in our study, most frequent cause is mechanical irritation of nerve is due to neurovascular contact (24 cases. The other causes identified are cerebellopontine angle lesions, brainstem tumours, demyelinating disease involving brainstem.  The cisternal portion of the nerve is the most common site of involvement. CONCLUSION Trigeminal nerve is the largest cranial nerve. MRI is unique as it produces images of entire course of the nerve. Of the many causes of trigeminal neuralgia, neurovascular conflict is the most common cause. The exact location and degree of neurovascular compression is graded on MRI.

  15. Historical characterization of trigeminal neuralgia. (United States)

    Eboli, Paula; Stone, James L; Aydin, Sabri; Slavin, Konstantin V


    TRIGEMINAL NEURALGIA IS a well known clinical entity characterized by agonizing, paroxysmal, and lancinating facial pain, often triggered by movements of the mouth or eating. Historical reviews of facial pain have attempted to describe this severe pain over the past 2.5 millennia. The ancient Greek physicians Hippocrates, Aretaeus, and Galen, described kephalalgias, but their accounts were vague and did not clearly correspond with what we now term trigeminal neuralgia. The first adequate description of trigeminal neuralgia was given in 1671, followed by a fuller description by physician John Locke in 1677. André described the convulsive-like condition in 1756, and named it tic douloureux; in 1773, Fothergill described it as "a painful affection of the face;" and in 1779, John Hunter more clearly characterized the entity as a form of "nervous disorder" with reference to pain of the teeth, gums, or tongue where the disease "does not reside." One hundred fifty years later, the neurological surgeon Walter Dandy equated neurovascular compression of the trigeminal nerve with trigeminal neuralgia.

  16. Trigeminal Nerve Root Demyelination Not Seen in Six Horses Diagnosed with Trigeminal-Mediated Headshaking

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    Veronica L. Roberts


    Full Text Available Trigeminal-mediated headshaking is an idiopathic neuropathic facial pain syndrome in horses. There are clinical similarities to trigeminal neuralgia, a neuropathic facial pain syndrome in man, which is usually caused by demyelination of trigeminal sensory fibers within either the nerve root or, less commonly, the brainstem. Our hypothesis was that the neuropathological substrate of headshaking in horses is similar to that of trigeminal neuralgia in man. Trigeminal nerves, nerve roots, ganglia, infraorbital, and caudal nasal nerves from horse abattoir specimens and from horses euthanized due to trigeminal-mediated headshaking were removed, fixed, and processed for histological assessment by a veterinary pathologist and a neuropathologist with particular experience of trigeminal neuralgia histology. No histological differences were detected between samples from horses with headshaking and those from normal horses. These results suggest that trigeminal-mediated headshaking may have a different pathological substrate from trigeminal neuralgia in man.

  17. Anatomy of the trigeminal nerve

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    van Eijden, T.M.G.J.; Langenbach, G.E.J.; Baart, J.A.; Brand, H.S.


    The trigeminal nerve is the fifth cranial nerve (n. V), which plays an important role in the innervation of the head and neck area, together with other cranial and spinal nerves. Knowledge of the nerve’s anatomy is very important for the correct application of local anaesthetics.

  18. Straightening the trigeminal nerve axis by complete dissection of arachnoidal adhesion and its neuroendoscopic confirmation for trigeminal neuralgia without neurovascular compression

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    Mami Ishikawa, MD, PhD


    Conclusions: Straightening the trigeminal nerve axis by complete dissection of the arachnoidal adhesion around the trigeminal nerve was effective for typical trigeminal neuralgia without neurovascular compression.

  19. MR findings of trigeminal neurinoma

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    Park, Hong Suk; Han, Moon Hee; Chang, Kee Hyun; Yoo, In Kyu; Kim, Sam Soo; Lee, Kyoung Won; Jung, Hee Won; Yeon, Kyung Mo [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of)


    To describe the MRI findings of trigeminal neurinoma. We retrospectively analyzed the MRI findings of 19 patients with trigeminal neurinomas proven by surgery and pathologic examination. Axial T1- and T2-weighted MR images in all patients and gadolinium-enhanced T1-weighted images in 14 patients were obtained at 2.0T(8 cases), 1.5T(6 cases) or 0.5T(5 cases). These were analyzed in terms of tumor size, signal intensity, degree of contrast enhancement, the presence or absence of cystic change and denervation atrophy of the masticator muscles. Clinical manifestations included sensory abnormality or pain(n=12), headache(n=10), impaired visual acuity or diplopia(n=6), hearing loss or tinnitus(n=3), weakness of masticator muscles(n=2), and mass or nasal obstruction(n=2). On MR images, tumor size was seen to average 4.2(range 1.5-6)cm;tumors were located in the posterior cranial fossa(n=8), middle cranial fossa(n=4), ophthalmic nerve(n=2), maxillary nerve(n=1), and mandibular nerve(n=1), and in three cases were dumbbell-shaped and extended into both the middle and posterior cranial fossa. On T1-weighted images, signals were isointense with cortical grey matter, in ten cases(53%), and of low intensity in nine (47%);on T2-weighted images, signals were of high intensity in 15cases(79%) and were isointense in four (21%). Cystic change was seen in 12 cases(63%). After enhancement, all (14/14) the tumors enhanced. Denervation atrophy was seen in nine cases(47%) and all of these involved the trigeminal ganglion or mandibular nerve. A trigeminal neurinoma shows similar signal intensity and enhancement to other cranial neurinomas with a higher incidence of cystic degeneration. Its location and shape are characteristic, and where there is involvement of the trigeminal ganglion or mandibular nerve, denervation atrophy may be seen.

  20. MR findings of trigeminal neurinoma

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    Park, Hong Suk; Han, Moon Hee; Chang, Kee Hyun; Yoo, In Kyu; Kim, Sam Soo; Lee, Kyoung Won; Jung, Hee Won; Yeon, Kyung Mo


    To describe the MRI findings of trigeminal neurinoma. We retrospectively analyzed the MRI findings of 19 patients with trigeminal neurinomas proven by surgery and pathologic examination. Axial T1- and T2-weighted MR images in all patients and gadolinium-enhanced T1-weighted images in 14 patients were obtained at 2.0T(8 cases), 1.5T(6 cases) or 0.5T(5 cases). These were analyzed in terms of tumor size, signal intensity, degree of contrast enhancement, the presence or absence of cystic change and denervation atrophy of the masticator muscles. Clinical manifestations included sensory abnormality or pain(n=12), headache(n=10), impaired visual acuity or diplopia(n=6), hearing loss or tinnitus(n=3), weakness of masticator muscles(n=2), and mass or nasal obstruction(n=2). On MR images, tumor size was seen to average 4.2(range 1.5-6)cm;tumors were located in the posterior cranial fossa(n=8), middle cranial fossa(n=4), ophthalmic nerve(n=2), maxillary nerve(n=1), and mandibular nerve(n=1), and in three cases were dumbbell-shaped and extended into both the middle and posterior cranial fossa. On T1-weighted images, signals were isointense with cortical grey matter, in ten cases(53%), and of low intensity in nine (47%);on T2-weighted images, signals were of high intensity in 15cases(79%) and were isointense in four (21%). Cystic change was seen in 12 cases(63%). After enhancement, all (14/14) the tumors enhanced. Denervation atrophy was seen in nine cases(47%) and all of these involved the trigeminal ganglion or mandibular nerve. A trigeminal neurinoma shows similar signal intensity and enhancement to other cranial neurinomas with a higher incidence of cystic degeneration. Its location and shape are characteristic, and where there is involvement of the trigeminal ganglion or mandibular nerve, denervation atrophy may be seen

  1. Transcriptional repressor DREAM regulates trigeminal noxious perception. (United States)

    Benedet, Tomaso; Gonzalez, Paz; Oliveros, Juan C; Dopazo, Jose M; Ghimire, Kedar; Palczewska, Malgorzata; Mellstrom, Britt; Naranjo, Jose R


    Expression of the downstream regulatory element antagonist modulator (DREAM) protein in dorsal root ganglia and spinal cord is related to endogenous control mechanisms of acute and chronic pain. In primary sensory trigeminal neurons, high levels of endogenous DREAM protein are preferentially localized in the nucleus, suggesting a major transcriptional role. Here, we show that transgenic mice expressing a dominant active mutant of DREAM in trigeminal neurons show increased responses following orofacial sensory stimulation, which correlates with a decreased expression of prodynorphin and brain-derived neurotrophic factor in trigeminal ganglia. Genome-wide analysis of trigeminal neurons in daDREAM transgenic mice identified cathepsin L and the monoglyceride lipase as two new DREAM transcriptional targets related to pain. Our results suggest a role for DREAM in the regulation of trigeminal nociception. This article is part of the special article series "Pain". © 2016 International Society for Neurochemistry.

  2. Chemosensory properties of the trigeminal system. (United States)

    Viana, Félix


    The capacity of cutaneous, including trigeminal endings, to detect chemicals is known as chemesthesis or cutaneous chemosensation. This sensory function involves the activation of nociceptor and thermoreceptor endings and has a protective or defensive function, as many of these substances are irritants or poisonous. However, humans have also developed a liking for the distinct sharpness or pungency of many foods, beverages, and spices following activation of the same sensory afferents. Our understanding of the cellular and molecular mechanisms of chemosensation in the trigeminal system has experienced enormous progress in the past decade, following the cloning and functional characterization of several ion channels activated by physical and chemical stimuli. This brief review attempts to summarize our current knowledge in this field, including a functional description of various sensory channels, especially TRP channels, involved in trigeminal chemosensitivy. Finally, some of these new findings are discussed in the context of the pathophysiology of trigeminal chemosensation, including pain, pruritus, migraine, cough, airway inflammation, and ophthalmic diseases.

  3. Stereotactic Radiosurgery for Classical Trigeminal Neuralgia

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    Henry Kodrat


    Full Text Available Trigeminal neuralgia is a debilitating pain syndrome with a distinct symptom mainly excruciating facial pain that tends to come and go unpredictably in sudden shock-like attacks. Medical management remains the primary treatment for classical trigeminal neuralgia. When medical therapy failed, surgery with microvascular decompression can be performed. Radiosurgery can be offered for classical trigeminal neuralgia patients who are not surgical candidate or surgery refusal and they should not in acute pain condition. Radiosurgery is widely used because of good therapeutic result and low complication rate. Weakness of this technique is a latency period, which is time required for pain relief. It usually ranges from 1 to 2 months. This review enlightens the important role of radiosurgery in the treatment of classical trigeminal neuralgia.

  4. Atypical Trigeminal Neuralgia Secondary to Meningioma

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    Premeshwar Niwant


    Full Text Available Trigeminal neuralgia is a disorder of the fifth cranial nerve that causes episodes of intense, stabbing, electric shock-like pain that lasts from few seconds to few minutes in the areas of the face where the branches of the nerve are distributed. More than one nerve branch can be affected by the disorder. We report an unusual case of trigeminal neuralgia affecting right side of face presenting atypical features of neuralgia and not responding to the usual course of treatment. The magnetic resonance imaging study of brain revealed a large extra-axial mass involving right cerebellopontine angle region causing moderate pressure effect on trigeminal nerve and brain stem. The aim of this case report is to show a tumor of cerebellopontine angle, presenting clinically as atypical trigeminal neuralgia.

  5. Sleep in trigeminal autonomic cephalagias

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    Barløse, Mads; Lund, Nunu; Jensen, Rigmor Højland


    PURPOSE OF REVIEW: Sleep and cluster headache (CH) are believed to be interconnected but the precise relation to the other trigeminal autonomic cephalalgias (TACs) is uncertain and complex. A better understanding of these relations may eventually lead to a clarification of the underlying mechanisms...... and eventually to more effective therapeutic regimens. This review aims to evaluate the existing literature on the subject of TACs and sleep. An association between episodic CH and distinct macrostructural sleep phases, especially the relation to rapid eye movement (REM) sleep, has been described in some older...... studies but could not be confirmed in other, more recent studies. Investigations into the microstructure of sleep in these patients are lacking. Only a few case reports exist on the relation between sleep and other TACs. SUMMARY: Recent studies do not find an association between CH and REM sleep. One...

  6. Medical management of trigeminal neuropathic pains. (United States)

    Zakrzewska, Joanna M


    Although trigeminal neuralgia has traditionally been considered the prime neuralgic condition in the face region, other forms of neuropathic pain are now being more frequently recognized and require recognition and a different management approach. This review principally covers medical management of trigeminal neuralgia; but also included is glossopharyngeal neuralgia, trigeminal neuropathic pain (atypical odontalgia) and burning mouth syndrome. Systematic reviews and guidelines will be discussed. An update will be provided of drug therapy for these relatively rare facial pains. Trigeminal neuralgia continues to be best managed using anticonvulsant drugs, the primary ones being carbamazepine and oxcarbazepine; baclofen may be helpful and, of the newly emerging drugs, pregabalin has potential. Glossopharyngeal neuralgia remains managed in the same way as trigeminal neuralgia. Trigeminal neuropathic pain is probably best managed according to guidelines used for the management of neuropathic pain, which include the use of tricyclic antidepressants, gabapentin, pregabalin, duloxetine, venalafaxine and topical lidocaine. Burning mouth syndrome is a neuropathic pain managed initially with topical clonazepam and then with other neuropathic drugs. Patients need to be involved in their management.

  7. Microvascular decompression for trigeminal neuralgia

    International Nuclear Information System (INIS)

    Khan, S.A.; Khan, B.; Khan, A.A.; Afridi, E.A.A.; Mehmood, S.; Muhammad, G.; Hussain, I.; Zadran, K.K.; Bhatti, S.N.


    Background: Trigeminal Neuralgia (TGN) is the most frequently diagnosed type of facial pain. In idiopathic type of TGN it is caused by the neuro-vascular conflict involving trigeminal nerve. Microvascular decompression (MVD) aims at addressing this basic pathology in the idiopathic type of TGN. This study was conducted to determine the outcome and complications of patients with idiopathic TGN undergoing MVD. Method: In a descriptive case series patients with idiopathic TGN undergoing MVD were included in consecutive manner. Patients were diagnosed on the basis of detailed history and clinical examination. Retromastoid approach with craniectomy was used to access cerebellopontine angle (CP-angle) and microsurgical decompression was done. Patients were followed up for 6 months. Results: A total of 53 patients underwent MVD with mean age of 51.6±4.2 years and male predominance. In majority of cases (58.4 percentage) both Maxillary and Mandibular divisions were involved. Per-operatively superior cerebellar artery (SCA) was causing the neuro-vascular conflict in 33 (62.2 percentage) of the cases, anterior inferior cerebellar artery (AICA) in 6 (11.3 percentage) cases, both CSA and AICA in 3 (5.6 percentage) cases, venous compressions in only 1 (1.8percentage) patient and thick arachnoid adhesions were seen in 10 (18.9 percentage) patients. Postoperatively, 33 (68 percentage) patients were pain free, in 14 (26.45 percentage) patients pain was significantly improved whereas in 3 (5.6 percentage) patients there was mild improvement in symptoms. Three (5.6 percentage) patients did not improve after the primary surgery. Cerebrospinal fluid (CSF) leak was encountered in 7 (13.2 percentage) patients post-operatively, 4 (7.5 percentage) patients developed wound infection and 1 (1.8 percentage) patient developed aseptic meningitis. Three (5.6 percentage) patients had transient VII nerve palsy while one patient developed permanent VII nerve palsy. Conclusion: MVD is a safe and

  8. Gamma knife treatment of trigeminal neuralgia

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    Hirai, Tatsuo; Yoshida, Mamoru; Watanabe, Shinichi; Takihana, Toshiki; Shouzuhara, Hidetaka; Yamamoto, Yoshisuke


    Effectiveness and limitations of Gamma Knife treatment for various kinds of trigeminal neuralgia (typical, atypical and mixed types) were analyzed from the data of 54 cases treated over the past 4 years. The mean patient age was 74 years (range 50 to 101 years). Forty five patients with typical trigeminal neuralgia, four patients with atypical facial pain and five patients with mixed type trigeminal neuralgia were evaluated. Isodose distribution determined with a 4 mm collimator was centered on the root entry zone of the trigeminal nerve in 35 cases and centered on the retro-Gasserian trigeminal nerve in 19 cases. The maximum dose range used was 70 to 80 Gy. Median follow-up after radiosurgery was 21.4 months (range 3 to 54 months). Typical trigeminal neuralgia treated at the root entry zone became pain free without medication in 53.6% (15/28), 78.6% (22/28) and 78.6% (22/28) of the patients after 3, 6 and 12 months, respectively, while, that treated at the retro-Gasserian nerve became pain free in 29.4% (5/17), 53.8% (7/13) and 70.0% (7/10) of the patients after 3, 6 and 8 months. No matter whether the target was the root entry zone or the retro-Gasserian nerve, 70 to 78% of patients became pain free without medication when examined at 8 to 12 months after radiosurgery. Facial hypesthesia including localized slight hypesthesia occurred in 13 to 20% of the patients at 12 to 24 months after radiosurgery, but no patients developed any other new neurological deficits or systemic complications. Patients with atypical trigeminal neuralgia did not respond well to this treatment. Further study is required to determine the optimal target and dose. Because of its noninvasive nature, radiosurgery is an attractive option for treatment of typical and mixed typed trigeminal pain, particularly in elderly patients and patients not amenable to the various surgical methods available for treatment of trigeminal neuralgia. (author)

  9. Treatment of trigeminal neuralgia with radiosurgery

    International Nuclear Information System (INIS)

    Latorzeff, I.; Redon, A.; Debono, B.; Sol, J.C.; Menegalli, D.; Mertens, P.; Muracciole, X.


    Idiopathic trigeminal neuralgia is defined as brief paroxysms of pain limited to the facial distribution of the trigeminal nerve. Drug therapy is considered to be the first-line of treatment for trigeminal neuralgia. Unfortunately, medical treatment does not always provide satisfactory pain relief for 25% of the patients. Moreover, the relief provided by drug therapy generally decreases over time, and increased dosages of these medications are limited because of side effects. In this case, patients can be offered several surgical approaches, such as percutaneous techniques (thermo-coagulation, micro-compression, glycerol injection) or microvascular decompression in the cerebello-pontine angle (Gardner-Jannetta's technique). In this indication, stereotactic radiosurgery, driven by teams using Gamma Knife R , has shown promising efficacy and tolerance to allow this treatment being truly part of trigeminal neuralgia treatment. Technological progresses now allow performing radiosurgery with ballistic and dosimetric processes optimized with stereotactic radiosurgery dedicated linear accelerators. This procedure supports frame implantation to guarantee targeting accuracy in accordance of elevated dose distribution. This article on trigeminal neuralgia treatment will review the different medical and surgical therapeutic options and specify the contemporary place of stereotactic radiosurgery in the light of its clinical results and tolerance aspects. (authors)

  10. Trigeminal perineural spread of renal cell carcinoma

    International Nuclear Information System (INIS)

    Hornik, Alejandro; Rosenblum, Jordan; Biller, Jose


    A 55-year-old man had a five-day history of “pins and needles” sensation on the left chin. Examination showed decreased pinprick sensation on the territory of the left mandibular branch of the trigeminal nerve. Brain magnetic resonance imaging (MRI) with gadolinium showed enhancement involving the left mandibular branch. Computed tomography (CT) of the chest, abdomen, and pelvis showed a left kidney mass diagnosed as renal carcinoma following nephrectomy. The “numb-chin” syndrome heralds or accompanies systemic malignancies. Trigeminal perineural spread has been well-documented in head and neck neoplasms, however, to our knowledge, it has not been reported in renal neoplasms. (author)

  11. Management of Trigeminal Neuralgia using Amitriptyline and ...

    African Journals Online (AJOL)

    Trigeminal neuralgia (TN) is a clinical condition presenting with severe, paroxysmal facial pain, often described by patients also known as tic douloureux. Carbamazepine (CBZ) is the drug of choice, but some patients develop adverse effects and some others may become unresponsive to CBZ. We present three cases of TN ...

  12. Management of trigeminal neuralgia by radiofrequency ...

    African Journals Online (AJOL)

    The outcome depends on the type of TN with best results with classical idiopathic type. Also better results occurred with isolated V3 affection. The radiofrequency thermocoagulation of trigeminal nerve is a low risk, highly effective and minimally invasive procedure that should be started with in all cases of TN.

  13. Idiopathic trigeminal neuropathy in a poodle

    Directory of Open Access Journals (Sweden)

    Carlos Eduardo Aparicio


    Full Text Available A seven years old, male poodle is examined presenting acute mandible paralysis (dropped jaw, drooling and difficulty for the apprehension and chewing; not evidence of an other alteration of cranial nerves. The muscular biopsy rules out a myositisof masticatory muscles. The disorder is resolved completely in 3 weeks confirming diagnosis of idiopathic trigeminal neuropathy.

  14. Management of trigeminal neuralgia by radiofrequency ...

    African Journals Online (AJOL)

    Wael Fouad


    Jun 24, 2011 ... Abstract Introduction: The trigeminal neuralgia (TN) which is resistant to medical treatment has been benefited from many surgical techniques. Opinions differ regarding the best surgical treatment. Objective: This study was done to evaluate the functional results of percutaneous radiofre-.

  15. Trigeminal perineural spread of renal cell carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Hornik, Alejandro; Rosenblum, Jordan; Biller, Jose [Stritch School of Medicine, Loyola University Medical Center, Chicago (United States)


    A 55-year-old man had a five-day history of 'pins and needles' sensation on the left chin. Examination showed decreased pinprick sensation on the territory of the left mandibular branch of the trigeminal nerve. Brain magnetic resonance imaging (MRI) with gadolinium showed enhancement involving the left mandibular branch. Computed tomography (CT) of the chest, abdomen, and pelvis showed a left kidney mass diagnosed as renal carcinoma following nephrectomy. The 'numb-chin' syndrome heralds or accompanies systemic malignancies. Trigeminal perineural spread has been well-documented in head and neck neoplasms, however, to our knowledge, it has not been reported in renal neoplasms. (author)

  16. Dietary grape seed polyphenols repress neuron and glia activation in trigeminal ganglion and trigeminal nucleus caudalis

    Directory of Open Access Journals (Sweden)

    Durham Paul L


    Full Text Available Abstract Background Inflammation and pain associated with temporomandibular joint disorder, a chronic disease that affects 15% of the adult population, involves activation of trigeminal ganglion nerves and development of peripheral and central sensitization. Natural products represent an underutilized resource in the pursuit of safe and effective ways to treat chronic inflammatory diseases. The goal of this study was to investigate effects of grape seed extract on neurons and glia in trigeminal ganglia and trigeminal nucleus caudalis in response to persistent temporomandibular joint inflammation. Sprague Dawley rats were pretreated with 200 mg/kg/d MegaNatural-BP grape seed extract for 14 days prior to bilateral injections of complete Freund's adjuvant into the temporomandibular joint capsule. Results In response to grape seed extract, basal expression of mitogen-activated protein kinase phosphatase 1 was elevated in neurons and glia in trigeminal ganglia and trigeminal nucleus caudalis, and expression of the glutamate aspartate transporter was increased in spinal glia. Rats on a normal diet injected with adjuvant exhibited greater basal levels of phosphorylated-p38 in trigeminal ganglia neurons and spinal neurons and microglia. Similarly, immunoreactive levels of OX-42 in microglia and glial fibrillary acidic protein in astrocytes were greatly increased in response to adjuvant. However, adjuvant-stimulated levels of phosphorylated-p38, OX-42, and glial fibrillary acidic protein were significantly repressed in extract treated animals. Furthermore, grape seed extract suppressed basal expression of the neuropeptide calcitonin gene-related peptide in spinal neurons. Conclusions Results from our study provide evidence that grape seed extract may be beneficial as a natural therapeutic option for temporomandibular joint disorders by suppressing development of peripheral and central sensitization.

  17. Psychological assessment of a case of trigeminal neuralgia | Osawe ...

    African Journals Online (AJOL)

    Objective: Recent report links trigeminal neuralgia as a trigger for psychiatric crisis. This article reports the findings from psychological assessment of a case of trigeminal neuralgia, to highlight the associated psychological problems of this condition. Method: A 58 years old male trader, who presented with one year history of ...

  18. Trigeminal small-fibre dysfunction in patients with diabetes mellitus

    DEFF Research Database (Denmark)

    Agostino, R.; Cruccu, G.; Iannetti, G. D.


    Objective: To investigate trigeminal small-fibre function in patients with diabetes mellitus. Methods: In 52 diabetic patients we studied the trigeminal laser evoked potentials after stimulation of the skin bordering the lower lip. In the 21 patients with the severest peripheral nerve damage we a...

  19. Pharmaceutical Management of Trigeminal Neuralgia in the Elderly

    NARCIS (Netherlands)

    Oomens, M.A.E.; Forouzanfar, T.


    Classical trigeminal neuralgia (CTN) is a severe neuropathic pain in the distribution of one or more branches of the trigeminal nerve, which occurs in recurrent episodes, causing deterioration in quality of life, affecting everyday habits and inducing severe disability. The aim of this review is to

  20. Pharmaceutical management of trigeminal neuralgia in the elderly

    NARCIS (Netherlands)

    Oomens, M.A.E.M.; Forouzanfar, T.


    Classical trigeminal neuralgia (CTN) is a severe neuropathic pain in the distribution of one or more branches of the trigeminal nerve, which occurs in recurrent episodes, causing deterioration in quality of life, affecting everyday habits and inducing severe disability. The aim of this review is to

  1. Trigeminal neuralgia: how often are trigeminal nerve-vessel contacts found by MRI in normal volunteers

    International Nuclear Information System (INIS)

    Kress, B.; Schindler, M.; Haehnel, S.; Sartor, K.; Rasche, D.; Tronnier, V.


    Purpose: To assess prospectively how often contacts are found between the trigeminal nerve and arteries or veins in the perimesencephalic cistern via MRI in normal volunteers. Materials and methods: 48 volunteers without a history of trigeminal neuralgia were examined prospectively (MRI at 1.5T; T2-CISS sequence, coronal orientation, 0.9 mm slice thickness). Two radiologists decided by consensus whether there was a nerve-vessel contact in the perimesencephalic cistern. Results: In 27% of the volunteers, no contact was found between the trigeminal nerve and regional vessels, while in 73%, such a contact was present. In 61% of the cases, the offending vessel was an artery, in 39%, it was a vein. In 2 volunteers, a deformation of the nerve was noted. Conclusion: Contrary to what has been suggested by retrospective studies, the majority of normal volunteers, if studied prospectively, do show a contact between the trigeminal nerve and local vessels. A close proximity between the nerve and regional vessels is thus normal and is not necessarily proof of a pathological nerve-vessel conflict. (orig.)

  2. Linear accelerator radiosurgery for trigeminal neuralgia: case report

    International Nuclear Information System (INIS)

    Yun, Hyong Geun


    Trigeminal neuralgia is defined as an episodic electrical shock-like sensation in a dermatomal distribution of the trigeminal nerve. When medications fail to control pain, various procedures are used to attempt to control refractory pain. Of available procedures, stereotactic radiosurgery is the least invasive procedure and has been demonstrated to produce significant pain relief with minimal side effects. Recently, linear accelerators were introduced as a tool for radiosurgery of trigeminal neuralgia beneath the already accepted gamma unit. Author have experienced one case with trigeminal neuralgia treated with linear accelerator. The patient was treated with 85 Gy by means of 5 mm collimator directed to trigeminal nerve root entry zone. The patient obtained pain free without medication at 20 days after the procedure and remain pain free at 6 months after the procedure. He didn't experience facial numbness or other side effects

  3. Comparison of Trigeminal and Postherpetic Neuralgia

    Directory of Open Access Journals (Sweden)

    C Peter N Watson


    Full Text Available Although postherpetic neuralgia and trigeminal neuralgia (tic douloureux are common causes of facial pain, they have very little in common aside from lancinating pain (other qualities of pain in each disorder are different. Each disorder affects different areas of the face and the treatment of each is quite dissimilar. The pathogenesis of these two disorders quite likely involves different mechanisms. This report reviews aspects of these two difficult pain problems, particularly with reference to the work of the late Gerhard Fromm, to whom this is dedicated.

  4. Gastric Lymphoma with Secondary Trigeminal Nerve Lymphoma: A Case Report

    Directory of Open Access Journals (Sweden)

    Warissara Rongthong


    Full Text Available Data supporting the role of radiotherapy in secondary trigeminal nerve lymphoma is scarce. Here, I report the case of 64-year-old Thai male diagnosed as gastric diffuse large B cell lymphoma with secondary trigeminal nerve lymphoma. He had previously received one cycle of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP, followed by five cycles of rituximab plus CHOP (R-CHOP with intrathecal methotrexate (MTX and cytarabine (Ara-C. One month after the last cycle of R-CHOP, he developed a headache and numbness on the left side of his face. MRI revealed thickening of the left trigeminal nerve. He received one intrathecal injection of MTX and Ara-C, followed by systemic chemotherapy. After receiving intrathecal chemotherapy, his symptoms disappeared. Clinical response and MRI studies suggested secondary trigeminal nerve lymphoma. Two months later, our patient’s secondary trigeminal nerve lymphoma had progressed. Salvage whole brain irradiation (36 Gy with boost dose (50 Gy along the left trigeminal nerve was given. Unfortunately, our patient developed heart failure and expired during the radiotherapy session. In conclusion and specific to secondary central nervous system lymphoma (SCNSL, radiotherapy may benefit patients who fail to respond to systemic chemotherapy and palliative treatment. The results this report fail to support the role of radiotherapy in secondary trigeminal nerve lymphoma.

  5. Gamma knife radiosurgery for trigeminal neuralgia

    International Nuclear Information System (INIS)

    Tomida, Mihoko; Hayashi, Motohiro; Kawakami, Yoriko; Ishimaru, Jun-ichi


    Gamma knife surgery (GKS) has been employed for treating intractable pain such as trigeminal neuralgia (TN) and pain relief has been gained from the treatment, however, little is understood about the side effects of other sensitivities induced from GKS. We assessed ten patients (four men and six women; mean age 67 years) with TN who were investigated by questionnaire for symptoms and visual analog scale (VAS) of pain, and their threshold of touch sensation was examined using Semmes-Weinstein monofilaments, cold sensation and allodynia before and after GKS. MR and CT images were obtained after a Leksell head frame was applied to the head parallel to the trigeminal nerve. These images were uploaded to a computer system and retro-Gasserian area planned the target was correctly marked on the images of a computer in which gamma planning software was installed. All patients were irradiated with a maximum dose of 90 Gy at retro-Gasserian using a 4 mm collimator. The mean±standard deviation (SD) of VAS of pain was 8.5±1.3 and 8 patients had facial paresthesia before GKS. All patients experienced a significant reduction in pain without side effects such as effect on the peripheral nerves without 6 month after GKS. Allodynia, facial paresthesia or cold sensation numbness occurred in the patients before GKS disappeared according to complete pain relief. These results suggest that GKS is a safe and effective treatment for TN. (author)

  6. The usual treatment of trigeminal autonomic cephalalgias. (United States)

    Pareja, Juan A; Álvarez, Mónica


    Trigeminal autonomic cephalalgias include cluster headache, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection, tearing, and rhinorrhea (SUNCT). Conventional pharmacological therapy can be successful in the majority of trigeminal autonomic cephalalgias patients. Most cluster headache attacks respond to 100% oxygen inhalation, or 6 mg subcutaneous sumatriptan. Nasal spray of sumatriptan (20 mg) or zolmitriptan (5 mg) are recommended as second choice. The bouts can be brought under control by a short course of corticosteroids (oral prednisone: 60-100 mg/day, or intravenous methylprednisolone: 250-500 mg/day, for 5 days, followed by tapering off the dosage), or by long-term prophylaxis with verapamil (at least 240 mg/day). Alternative long-term preventive medications include lithium carbonate (800-1600 mg/day), methylergonovine (0.4-1.2 mg/day), and topiramate (100-200 mg/day). As a rule, paroxysmal hemicrania responds to preventive treatment with indomethacin (75-150 mg/day). A short course of intravenous lidocaine (1-4 mg/kg/hour) can reduce the flow of attacks during exacerbations of SUNCT. Lamotrigine (100-300 mg/day) is the preventive drug of choice for SUNCT. Gabapentin (800-2700 mg/day), topiramate (50-300 mg/day), and carbamazepine (200-1600 mg/day) may be of help. © 2013 American Headache Society.

  7. Trigeminal sensory neuropathy and facial contact dermatitis due to Anthurium sp Neuropatia trigeminal sensitiva e dermatite de contato facial por Anthurium sp

    Directory of Open Access Journals (Sweden)

    Carlos A. Twardowschy


    Full Text Available BACKGROUND: Trigeminal sensory neuropathy (TSN describes a heterogeneous group of disorders manifesting as facial numbness. OBJECTIVE: We report the case of a patient who had TSN associated with contact dermatitis due to Anthurium sp. METHOD/RESULTS: A 21-year-old female patient developed left hemifacial contact dermatitis after exposure to the anthurium plant. The patient had paresthesias and pain in the V2 and V3 divisions of the left trigeminal nerve. Eight days after its onset the dermatitis resolved, but numbness developed in the V2 and V3 divisions of the left trigeminal nerve. Cranial CT scan and MRI, as well as CSF and extensive work-up exams, were normal. After one month the symptoms disappeared completely. CONCLUSION: Anthurium sp, an indoor ornamental plant that contains calcium oxalate crystals, and can causes contact dermatitis. To our knowledge, this is the first report associating TSN with contact dermatitis due to Anthurium sp.INTRODUÇÃO: A neuropatia trigeminal sensitiva (NTS representa um grupo heterogêneo de doenças, cuja manifestação clínica é a presença de dormência na região facial. OBJETIVO: Relatamos o caso de paciente que apresenta NTS associada com dermatite de contato (DC devido à planta Anthurium sp. MÉTODO/RESULTADOS: Uma paciente com 21 anos desenvolveu DC na região hemi-facial esquerda, após exposição à planta Anthurium sp. Após a resolução do quadro de dermatite, a referida paciente apresentou dormência e parestesias no território do segundo e terceiro ramos do nervo trigêmeo esquerdo. Um mês após o início do quadro houve resolução completa dos sintomas. CONCLUSÃO: O Anthurium é uma planta ornamental que contém cristas de oxalato de cálcio, que podem causar DC. Para o nosso conhecimento este é o primeiro relato associando NTS e dermatite de contato devido à exposição ao Anthurium sp.

  8. Neurophysiological aspects of the trigeminal sensory system: an update. (United States)

    Van der Cruyssen, Frederic; Politis, Constantinus


    The trigeminal system is one of the most complex cranial nerve systems of the human body. Research on it has vastly grown in recent years and concentrated more and more on molecular mechanisms and pathophysiology, but thorough reviews on this topic are lacking, certainly on the normal physiology of the trigeminal sensory system. Here we review the current literature on neurophysiology of the trigeminal nerve from peripheral receptors up to its central projections toward the somatosensory cortex. We focus on the most recent scientific discoveries and describe historical relevant research to substantiate further. One chapter on new insights of the pathophysiology of pain at the level of the trigeminal system is added. A database search of Medline, Embase and Cochrane was conducted with the search terms 'animal study', 'neurophysiology', 'trigeminal', 'oral' and 'sensory'. Articles were manually selected after reading the abstract and where needed the article. Reference lists also served to include relevant research articles. Fifty-six articles were included after critical appraisal. Physiological aspects on mechanoreceptors, trigeminal afferents, trigeminal ganglion and central projections are reviewed in light of reference works. Embryologic and anatomic insights are cited where needed. A brief description of pathophysiology of pain pathways in the trigeminal area and recent advances in dental stem cell research are also discussed. Neurophysiology at the level of the central nervous system is not reviewed. The current body of knowledge is mainly based on animal and cadaveric studies, but recent advancements in functional imaging and molecular neuroscience are elucidating the pathways and functioning of this mixed nerve system. Extrapolation of animal studies or functioning of peripheral nerves should be warranted.

  9. Dosimetric analysis of trigeminal nerve, brain stem doses in CyberKnife radiosurgery of trigeminal neuralgia

    International Nuclear Information System (INIS)

    Sudahar, H.; Kurup, P.G.G.; Murali, V.; Velmurugan, J.


    CyberKnife radiosurgery treatment of Trigeminal neuralgia (TN) is performed as a non-invasive image guided procedure. The prescription dose for TN is very high. The brainstem is the adjacent critical organ at risk (OAR) which is prone to receive the very high target dose of TN. The present study is to analyze the dose distribution inside the tiny trigeminal nerve target and also to analyze the dose fall off in the brain stem. Seven TN cases treated between November 2010 and January 2012 were taken for this study retrospectively. The treatment plans were analyzed for target dose conformity, homogeneity and dose coverage. In the brainstem the volume doses D 1% and D 2% were taken for analyzing the higher doses in the brain stem. The dose fall off was analyzed in terms of D 5% and D 10% . The mean value of maximum dose within the trigeminal nerve target was 73.5±2.1 Gy (P=0.0007) and the minimum dose was 50.0±4.1Gy (P=0.1315). The mean conformity index was 2.19 and the probable reason could be the smallest CyberKnife collimator of 5mm used in the treatment plan. The mean D 1% , of the brainstem was 10.5±2.1Gy(P=0.5316) and the mean value of the maximum point dose within the brainstem was 35.6±3.8Gy. This shows the degree of dose fall off within the brainstem. Though the results of the present study are showing superior sparing of brain stem and reasonable of target coverage, it is necessary to execute the treatment plan with greater accuracy in CyberKnife as the immobilization is noninvasive and frameless. (author)

  10. Temporomandibular joint inflammation activates glial and immune cells in both the trigeminal ganglia and in the spinal trigeminal nucleus

    Directory of Open Access Journals (Sweden)

    Jasmin Luc


    Full Text Available Abstract Background Glial cells have been shown to directly participate to the genesis and maintenance of chronic pain in both the sensory ganglia and the central nervous system (CNS. Indeed, glial cell activation has been reported in both the dorsal root ganglia and the spinal cord following injury or inflammation of the sciatic nerve, but no data are currently available in animal models of trigeminal sensitization. Therefore, in the present study, we evaluated glial cell activation in the trigeminal-spinal system following injection of the Complete Freund's Adjuvant (CFA into the temporomandibular joint, which generates inflammatory pain and trigeminal hypersensitivity. Results CFA-injected animals showed ipsilateral mechanical allodynia and temporomandibular joint edema, accompanied in the trigeminal ganglion by a strong increase in the number of GFAP-positive satellite glial cells encircling neurons and by the activation of resident macrophages. Seventy-two hours after CFA injection, activated microglial cells were observed in the ipsilateral trigeminal subnucleus caudalis and in the cervical dorsal horn, with a significant up-regulation of Iba1 immunoreactivity, but no signs of reactive astrogliosis were detected in the same areas. Since the purinergic system has been implicated in the activation of microglial cells during neuropathic pain, we have also evaluated the expression of the microglial-specific P2Y12 receptor subtype. No upregulation of this receptor was detected following induction of TMJ inflammation, suggesting that any possible role of P2Y12 in this paradigm of inflammatory pain does not involve changes in receptor expression. Conclusions Our data indicate that specific glial cell populations become activated in both the trigeminal ganglia and the CNS following induction of temporomandibular joint inflammation, and suggest that they might represent innovative targets for controlling pain during trigeminal nerve sensitization.

  11. Pain in trigeminal neuralgia: neurophysiology and measurement: a comprehensive review. (United States)

    Kumar, S; Rastogi, S; Kumar, S; Mahendra, P; Bansal, M; Chandra, L


    Trigeminal neuralgia (TN) is defined as sudden, usually unilateral, severe, brief, stabbing recurrent episodes of pain within the distribution of one or more branches of the trigeminal nerve. It is the most frequent cranial neuralgia, the incidence being 1 per 1,000,00 persons per year. Pain attacks start abruptly and last several seconds but may persist 1 to 2 minutes. The attacks are initiated by non painful physical stimulation of specific areas (trigger points or zones) that are located ipsilateral to the pain. After each episode, there is usually a refractive period during which stimulation of the trigger zone will not induce the pain. According to the European Federation of Neurological Societies (EFNS) guidelines on neuropathic pain assessment and the American Academy of Neurology (AAN)-EFNS guidelines on TN management the neurophysiological recording of trigeminal reflexes represents the most useful and reliable test for the neurophysiological diagnosis of trigeminal pains. The present article discusses different techniques for investigation of the trigeminal system by which an accurate topographical diagnosis and profile of sensory fiber pathology can be determined. With the aid of neurophysiological recordings and quantitative sensory testing, it is possible to approach a mechanism-based classification of orofacial pain.

  12. Trigeminal neuralgia and facial nerve paralysis

    International Nuclear Information System (INIS)

    Borges, Alexandra


    The trigeminal nerve is the largest of the cranial nerves. It provides sensory input from the face and motor innervation to the muscles of mastication. The facial nerve is the cranial nerve with the longest extracranial course, and its main functions include motor innervation to the muscles of facial expression, sensory control of lacrimation and salivation, control of the stapedial reflex and to carry taste sensation from the anterior two-thirds of the tongue. In order to be able adequately to image and follow the course of these cranial nerves and their main branches, a detailed knowledge of neuroanatomy is required. As we are dealing with very small anatomic structures, high resolution dedicated imaging studies are required to pick up normal and pathologic nerves. Whereas CT is best suited to demonstrate bony neurovascular foramina and canals, MRI is preferred to directly visualize the nerve. It is also the single technique able to detect pathologic processes afflicting the nerve without causing considerable expansion such as is usually the case in certain inflammatory/infectious conditions, perineural spread of malignancies and in very small intrinsic tumours. Because a long course from the brainstem nuclei to the peripheral branches is seen, it is useful to subdivide the nerve in several segments and then tailor the imaging modality and the imaging study to that specific segment. This is particularly true in cases where topographic diagnosis can be used to locate a lesion in the course of these nerves. (orig.)

  13. Trigeminal neuralgia and facial nerve paralysis

    Energy Technology Data Exchange (ETDEWEB)

    Borges, Alexandra [IPOFG, Department of Radiology, Lisbon (Portugal)


    The trigeminal nerve is the largest of the cranial nerves. It provides sensory input from the face and motor innervation to the muscles of mastication. The facial nerve is the cranial nerve with the longest extracranial course, and its main functions include motor innervation to the muscles of facial expression, sensory control of lacrimation and salivation, control of the stapedial reflex and to carry taste sensation from the anterior two-thirds of the tongue. In order to be able adequately to image and follow the course of these cranial nerves and their main branches, a detailed knowledge of neuroanatomy is required. As we are dealing with very small anatomic structures, high resolution dedicated imaging studies are required to pick up normal and pathologic nerves. Whereas CT is best suited to demonstrate bony neurovascular foramina and canals, MRI is preferred to directly visualize the nerve. It is also the single technique able to detect pathologic processes afflicting the nerve without causing considerable expansion such as is usually the case in certain inflammatory/infectious conditions, perineural spread of malignancies and in very small intrinsic tumours. Because a long course from the brainstem nuclei to the peripheral branches is seen, it is useful to subdivide the nerve in several segments and then tailor the imaging modality and the imaging study to that specific segment. This is particularly true in cases where topographic diagnosis can be used to locate a lesion in the course of these nerves. (orig.)

  14. Some experience of trigeminal neuralgia treatment by glycerol rhizolysis

    Directory of Open Access Journals (Sweden)

    А. В. Семенов


    Full Text Available Aim. The study was to evaluate the advantages and disadvantages of trigeminal neuralgia treatment by Hakanson S. glycerol rhizolysis method. Methods. The results of glycerol rhizolysis treatment were retrospectively evaluated in 96 patients with trigeminal neuralgia, who had been operated at Neurosurgical Department of Irkutsk City Hospital over a period from 2009 to 2016. To study the prospective follow-up, 53 patients operated during 2009 – 2014 were surveyed over the phone. The comparison of our long-term results and the results of other authors from literature sources was then performed.Results. The median of follow-up period was 43 months. The pain recurrence (III-V rate of Barrow Neurological Institute score for trigeminal neuralgia was observed in 30.2 % of patients, with the mean rate of the visual analogue scale amounting to 1.96. Complications included aseptic meningitis in 3.1 % cases, intracerebral hematoma – 1.04 %, hyperesthesia in appropriate trigeminal region – 3.8%, labial herpes – 40.7 %, temporary anesthesia in appropriate trigeminal region – 30.2%, temporary decrease of corneal reflex sensitivity – 41.5 %. There was no postoperative mortality.Conclusion. Glycerol rhizolysis is an effective method of trigeminal neuralgia treatment and its results are comparable with those of other surgical methods. Strict adherence to all surgical steps and contrast cistenography is the key to success of intervention. The method is minimally invasive, applicable for anesthesia and particularly promising for patients over 70 years old.Received 25 May 2016. Accepted 14 September 2016.Funding: The study had no sponsorship. Conflict of interest: The authors declare no conflict of interest.

  15. Trigeminal Neuralgia and Multiple Sclerosis: A Historical Perspective. (United States)

    Burkholder, David B; Koehler, Peter J; Boes, Christopher J


    Trigeminal neuralgia (TN) associated with multiple sclerosis (MS) was first described in Lehrbuch der Nervenkrankheiten für Ärzte und Studirende in 1894 by Hermann Oppenheim, including a pathologic description of trigeminal root entry zone demyelination. Early English-language translations in 1900 and 1904 did not so explicitly state this association compared with the German editions. The 1911 English-language translation described a more direct association. Other later descriptions were clinical with few pathologic reports, often referencing Oppenheim but citing the 1905 German or 1911 English editions of Lehrbuch. This discrepancy in part may be due to the translation differences of the original text.

  16. Taste, olfactory and trigeminal neophobia in rats with forebrain lesions. (United States)

    Lin, Jian-You; Roman, Christopher; St Andre, Justin; Reilly, Steve


    The present study was designed to examine whether lesions of the insular cortex (IC; Experiment 1), the basolateral amygdala (BLA) or medial amygdala (MeA; Experiment 2) influence the neophobic reactions to orally consumed liquid stimuli. Three different types of stimuli were used: taste (0.5% saccharin), olfactory (0.1% amyl acetate), and trigeminal (0.01 mM capsaicin). Rats with IC, BLA and MeA lesions showed normal responses to the olfactory and trigeminal stimuli. Each type of lesion, however, disrupted the initial occurrence of neophobia to the taste stimulus. The significance of these findings to conditioned taste aversion is discussed.

  17. Unilateral pure trigeminal motor nerve neuropathy: A rare case report

    Directory of Open Access Journals (Sweden)

    Nishant K Srivastava


    Full Text Available Unilateral pure trigeminal motor nerve neuropathy is an extremely rare and unique condition, characterized by atrophy of the muscles, innervated by the motor branch of the trigeminal nerve. We report such a case in a 25-year-old male patient. The diagnosis was made on the basis of clinical and radiological examinations. Magnetic Resonance Imaging (MRI proved to be the key for establishing the diagnosis, which showed atrophy and fatty infiltration over the affected side of the muscles of mastication. We were unable to establish the cause of the condition even after performing a brain MRI.

  18. Arterial compression of nerve is the primary cause of trigeminal neuralgia. (United States)

    Chen, Guo-Qiang; Wang, Xiao-Song; Wang, Lin; Zheng, Jia-Ping


    Whether arterial or venous compression or arachnoid adhesions are primarily responsible for compression of the trigeminal nerve in patients with trigeminal neuralgia is unclear. The aim of this study was to determine the causes of trigeminal nerve compression in patients with trigeminal neuralgia. The surgical findings in patients with trigeminal neuralgia who were treated by micro vascular decompression were compared to those in patients with hemifacial spasm without any signs or symptoms of trigeminal neuralgia who were treated with microvascular decompression. The study included 99 patients with trigeminal neuralgia (median age, 57 years) and 101 patients with hemifacial spasm (median age, 47 years). There were significant differences between the groups in the relationship of artery to nerve (p relationship of vein to nerve. After adjustment for age, gender, and other factors, patients with vein compression of nerve or with artery compression of nerve were more likely to have trigeminal neuralgia (OR = 5.21 and 42.54, p = 0.026 and p compression of the trigeminal nerve is the primary cause of trigeminal neuralgia and therefore, decompression of veins need not be a priority when performing microvascular dissection in patients with trigeminal neuralgia.

  19. A Case Report About Cluster-Tic Syndrome Due to Venous Compression of the Trigeminal Nerve. (United States)

    de Coo, Ilse; van Dijk, J Marc C; Metzemaekers, Jan D M; Haan, Joost


    The term "cluster-tic syndrome" is used for the rare ipsilateral co-occurrence of attacks of cluster headache and trigeminal neuralgia. Medical treatment should combine treatment for cluster headache and trigeminal neuralgia, but is very often unsatisfactory. Here, we describe a 41-year-old woman diagnosed with cluster-tic syndrome who underwent microvascular decompression of the trigeminal nerve, primarily aimed at the "trigeminal neuralgia" part of her pain syndrome. After venous decompression of the trigeminal nerve both a decrease in trigeminal neuralgia and cluster headache attacks was seen. However, the headache did not disappear completely. Furthermore, she reported a decrease in pain intensity of the remaining cluster headache attacks. This case description suggests that venous vascular decompression in cluster-tic syndrome can be remarkably effective, both for trigeminal neuralgia and cluster headache. © 2016 American Headache Society.

  20. Frequent mild head injury promotes trigeminal sensitivity concomitant with microglial proliferation, astrocytosis, and increased neuropeptide levels in the trigeminal pain system. (United States)

    Tyburski, Ashley L; Cheng, Lan; Assari, Soroush; Darvish, Kurosh; Elliott, Melanie B


    Frequent mild head injuries or concussion along with the presence of headache may contribute to the persistence of concussion symptoms. In this study, the acute effects of recovery between mild head injuries and the frequency of injuries on a headache behavior, trigeminal allodynia, was assessed using von Frey testing up to one week after injury, while histopathological changes in the trigeminal pain pathway were evaluated using western blot, ELISA and immunohistochemistry.  RESULTS: A decreased recovery time combined with an increased mild closed head injury (CHI) frequency results in reduced trigeminal allodynia thresholds compared to controls. The repetitive CHI group with the highest injury frequency showed the greatest reduction in trigeminal thresholds along with greatest increased levels of calcitonin gene-related peptide (CGRP) in the trigeminal nucleus caudalis. Repetitive CHI resulted in astrogliosis in the central trigeminal system, increased GFAP protein levels in the sensory barrel cortex, and an increased number of microglia cells in the trigeminal nucleus caudalis. Headache behavior in rats is dependent on the injury frequency and recovery interval between mild head injuries. A worsening of headache behavior after repetitive mild head injuries was concomitant with increases in CGRP levels, the presence of astrocytosis, and microglia proliferation in the central trigeminal pathway. Signaling between neurons and proliferating microglia in the trigeminal pain system may contribute to the initiation of acute headache after concussion or other traumatic brain injuries.

  1. Update on the challenges of treating trigeminal neuralgia

    Directory of Open Access Journals (Sweden)

    Obermann M


    Full Text Available Mark Obermann Department of Neurology, University of Duisburg-Essen, Essen, Germany Abstract: Despite the multitude of treatment options currently available for trigeminal neuralgia, its management remains challenging in a considerable number of patients. The response to any particular treatment can be quite variable interindividually, and personalized treatment options are both resource-consuming and time-consuming. Anticonvulsant drugs, muscle relaxants, and neuroleptic agents are the preferred medical treatment for trigeminal neuralgia. Large placebo-controlled clinical trials are scarce, and no specific established substance has been developed for the treatment of trigeminal neuralgia. Promising new treatment options currently in clinical evaluation are botulinum neurotoxin type A injections and CNV1014802, a novel sodium channel blocker that selectively blocks the Nav1.7 sodium channel. Patients who do not respond to medical therapy may be eligible for more invasive treatment options, such as percutaneous Gasserian ganglion techniques, gamma knife surgery, and microvascular decompression. Keywords: trigeminal neuralgia, treatment, current, future, options, orphan drugs 

  2. Chronic dysphagia and trigeminal anesthesia after trichloroethylene exposure

    Energy Technology Data Exchange (ETDEWEB)

    Lawrence, W.H.; Partyka, E.K.


    A patient is described who inhaled trichloroethylene fumes while working in a closed underground pit. At the time of exposure he developed dysphagia, dysarthria and dyspnea. Assessment of his condition 11 years after the incident indicated major damage of cranial nerves, particularly the trigeminal, chronic involvement of the bulbar cranial nerves, and resultant esophageal and pharnygeal motility impairment. (JMT)

  3. Persistent trigeminal artery: angio-tomography and angio-magnetic resonance finding

    Energy Technology Data Exchange (ETDEWEB)

    Pereira, Licia Pacheco; Nepomuceno, Lara A.M.; Coimbra, Pablo Picasso; Oliveira Neto, Sabino Rodrigues de [Hospital Geral de Fortaleza (HGF), CE (Brazil). Radiology Dept.], e-mail:; Natal, Marcelo Ricardo C. [Hospital de Base do Distrito Federal, Brasilia, DF (Brazil)


    The trigeminal artery (TA) is the most common embryonic carotid-vertebrobasilar anastomosis to persist into adulthood. It typically extends from the internal carotid artery to the basilar artery. Persistent primitive arteries are usually found incidentally, but are often associated with vascular malformation, cerebral aneurysm and, in case of TA, with trigeminal neuralgia. We present one patient with TA as a cause of trigeminal neuralgia and in other three as an incidental finding, on TC and MR angiograms. (author)

  4. Trigeminal nerve electrophysiological assessment in sickle cell anemia: correlation with disease severity and radiological findings

    Directory of Open Access Journals (Sweden)

    Naglaa Gadallah


    Conclusion Subclinical trigeminal neuropathy may be associated with SCA. The trigeminal nerve could be affected along its peripheral or the central pathway. Central affection may occur as a result of lesions in its nuclei or at the somatosensory cortex. Electrophysiological assessment is recommended in SCA patients to diagnose trigeminal neuropathy and detect the level of its affection. This will provide new insights into its prevention and treatment.

  5. Early trigeminal nerve involvement in Listeria monocytogenes rhombencephalitis

    DEFF Research Database (Denmark)

    Karlsson, William K; Harboe, Zitta Barrella; Roed, Casper


    dysfunction on that side. In addition, we identified another 120 cases of Listeria rhombencephalitis following a systematic review. Cranial nerves VII, V, IX, and X, respectively, medulla oblongata, cerebellum and pons, were the most frequently involved brain structures. The present clinical and radiological...... findings corroborate earlier data from animal experiments, indicating that L. monocytogenes may be capable of retrograde intra-axonal migration along the cranial nerves. We suggest that in a subset of patients with rhombencephalitis L. monocytogenes enters the cerebellopontine angle through the trigeminal......Listeria monocytogenes is associated with rhombencephalitis. However, the exact mechanisms of brainstem invasion remains poorly understood. Here, we demonstrate clinical and radiological data suggesting that Listeria may invade the brainstem via the trigeminal nerve. Three females (41, 64 and 70...

  6. Beneficial effects of botulinum toxin type A in trigeminal neuralgia


    Zúñiga,Carlos; Díaz,Sergio; Piedimonte,Fabián; Micheli,Federico


    Botulinum toxin has been thoroughly studied as a potential tool in the treatment of several pain syndromes. Therefore, we assessed the clinical effects of botulinum toxin type A injections in 12 patients with otherwise unresponsive idiopathic trigeminal neuralgia. Patients were infiltrated with 20-50 units of botulinum toxin in trigger zones. Those who presented with mandibular involvement were also infiltrated in the masseter muscle. The patients were assessed on a weekly basis using the Vis...

  7. Immediate pain relief by microvascular decompression for idiopathic trigeminal neuralagia

    International Nuclear Information System (INIS)

    Haq, N.U.; Ali, M.; Khan, H.M.; Ishaq, M.; Khattak, M.I.


    Background: Trigeminal neuralgia is a common entity which is managed by neurosurgeons in day to day practice. Up-till now many treatment options have been adopted for it but micro-vascular decompression is much impressive in terms of pain control and recurrence rate in all of them. The objective of study was known the efficacy of micro vascular decompression for idiopathic trigeminal neuralgia by using muscle patch in terms of immediate pain relief. Methods: This descriptive study was carried out in Neurosurgery Department lady reading hospital, Peshawar from January 2010 to December 2012. All patients who underwent micro vascular decompression for idiopathic trigeminal neuralgia were included in the study. Patients were assessed 72 hours after the surgery by borrow neurological institute pain scale (BNIP scale) for pain relief and findings were documented on predesigned proforma. Data was analysed by SPSS-17. Results: Total 52 patients were included in this study. Among these 32 (61.53 percentage) were female and 20 (38.46 percentage) were males having age from 22-76 years (mean 49 years). Right side was involved in 36 (69.23 percentage) and left side in 16 (30.76 percentage) patients. Duration of symptoms ranged from 6 months to 16 years (mean 8 years). History of dental extraction and peripheral neurectomy was present in 20 (38 percentage) and 3(5.76 percentage) patients while V3 was most commonly involved branch with 28(57.69 percentage) frequency and combined V2,V3 involvement was 1 (11.53 percentage). Superior cerebellar artery was most common offending vessel in 46(88.46 percentage) while arachnoid adhesions were in 2(3.84 percentage) patients. We assessed patient immediate postoperatively using BNIP pain scale. Conclusion: Micro-vascular decompression is most effective mode of treatment for trigeminal neuralgia in terms of immediate pain relief. (author)

  8. Nasal trigeminal chemosensitivity across the adult life span

    Czech Academy of Sciences Publication Activity Database

    Wysocki, C. J.; Cowart, B. J.; Radil, Tomáš


    Roč. 65, č. 1 (2003), s. 115-122 ISSN 0031-5117 Grant - others:NI on Deafness (US) P50 DC00214; NI on Deafness (US) RO1 DC00298; Fogarty Center(US) F05 TW04839; Garfield Foundation(US) x Institutional research plan: CEZ:AV0Z5011922 Keywords : chemesthesis * trigeminal Subject RIV: FH - Neurology Impact factor: 1.856, year: 2003

  9. BDNF promotes target innervation of Xenopus mandibular trigeminal axons in vivo. (United States)

    Huang, Jeffrey K; Dorey, Karel; Ishibashi, Shoko; Amaya, Enrique


    Trigeminal nerves consist of ophthalmic, maxillary, and mandibular branches that project to distinct regions of the facial epidermis. In Xenopus embryos, the mandibular branch of the trigeminal nerve extends toward and innervates the cement gland in the anterior facial epithelium. The cement gland has previously been proposed to provide a short-range chemoattractive signal to promote target innervation by mandibular trigeminal axons. Brain derived neurotrophic factor, BDNF is known to stimulate axon outgrowth and branching. The goal of this study is to determine whether BDNF functions as the proposed target recognition signal in the Xenopus cement gland. We found that the cement gland is enriched in BDNF mRNA transcripts compared to the other neurotrophins NT3 and NT4 during mandibular trigeminal nerve innervation. BDNF knockdown in Xenopus embryos or specifically in cement glands resulted in the failure of mandibular trigeminal axons to arborise or grow into the cement gland. BDNF expressed ectodermal grafts, when positioned in place of the cement gland, promoted local trigeminal axon arborisation in vivo. BDNF is necessary locally to promote end stage target innervation of trigeminal axons in vivo, suggesting that BDNF functions as a short-range signal that stimulates mandibular trigeminal axon arborisation and growth into the cement gland.

  10. A rare cause of hyperprolactinemia: persistent trigeminal artery with stalk-section effect

    Energy Technology Data Exchange (ETDEWEB)

    Ekinci, G.; Baltacioglu, F.; Cimsit, C.; Akpinar, I.; Erzen, C. [Dept. of Radiology, Marmara University, Altunizade Istanbul (Turkey); Kilic, T.; Pamir, N. [Dept. of Neurosurgery, Faculty of Medicine, Marmara University, Altunizade Istanbul (Turkey)


    The primitive trigeminal, otic, hypoglossal, and proatlantal intersegmental arteries are fetal anastomoses between the carotid and vertebrobasilar systems. Persistent trigeminal artery (PTA) is the most frequent embryonic communication between the vertebrobasilar and carotid systems in adults. We report a case of PTA compressing the left side of the pituitary gland and stalk, in a patient with elevated blood prolactin level. (orig.)

  11. Nigro-subthalamic and nigro-trigeminal projections in the rat

    NARCIS (Netherlands)

    Marani, Enrico; Lazarov, N.E.; Heida, Tjitske; Usunoff, K.G.; Bamidis, Panagiotis D.; Pallikarakis, Nicolas


    The connections of the substantia nigra in rat have been extensively studied. Nevertheless the connections towards the subthalamic and sensory trigeminal nuclei were incidentally researched. This research showed that both the subthalamic and trigeminal nucleus received a bilateral projection of the

  12. Compression of the trigeminal ganglion produces prolonged nociceptive behavior in rats. (United States)

    Ahn, Dong K; Lim, Eun J; Kim, Byung C; Yang, Gwi Y; Lee, Min K; Ju, Jin S; Han, Seung R; Bae, Yong C


    The present study is the first demonstration of prolonged nociceptive behavior in the trigeminal region following compression of the trigeminal ganglion in rats. Experiments were carried out on male Sprague-Dawley rats mounted onto a stereotaxic frame under pentobarbital sodium anesthesia. For compression of the trigeminal ganglion, a 4% agar solution (8microl) was injected into the trigeminal ganglion through a stainless steel injector (24 gauge), which extended 2mm beyond the end of a guide cannula (21 gauge). Following agar injection, the injector and guide cannula were removed. In the control group, rats were sham operated without agar injection. Air-puff thresholds (mechanical allodynia), pin prick responses (mechanical hyperalgesia), and spontaneous scratching behavior were examined 3 days before surgery and at 3, 7, 10, 14, 17, 21, 24, 30, and 40 days after surgery. Data were analyzed using a repeated measures ANOVA followed by multiple group comparisons using the LSD post-hoc test. Air-puff thresholds significantly decreased after compression of the trigeminal ganglion. Mechanical allodynia was established within 3 days and lasted beyond postoperative day 24. Mechanical hyperalgesia was also evident 3 days after compression and persisted until the 40th postoperative day. Although mechanical allodynia and hyperalgesia appeared bilaterally, the ipsilateral side was significantly more sensitive. Intraperitoneal treatment with carbamazepine significantly blocked mechanical allodynia produced by compression of the trigeminal ganglion. These findings suggest that prolonged nociceptive behavior following compression of the trigeminal ganglion may mimic trigeminal neuralgia in this animal model.

  13. A Case Report About Cluster-Tic Syndrome Due to Venous Compression of the Trigeminal Nerve

    NARCIS (Netherlands)

    de Coo, Ilse; van Dijk, J. Marc C.; Metzemaekers, Jan D. M.; Haan, Joost

    Background.-The term "cluster-tic syndrome" is used for the rare ipsilateral co-occurrence of attacks of cluster headache and trigeminal neuralgia. Medical treatment should combine treatment for cluster headache and trigeminal neuralgia, but is very often unsatisfactory. Case.-Here, we describe a

  14. Distinct development of the trigeminal sensory nuclei in platypus and echidna. (United States)

    Ashwell, Ken W S; Hardman, Craig D


    Both lineages of the modern monotremes have been reported to be capable of electroreception using the trigeminal pathways and it has been argued that electroreception arose in an aquatic platypus-like ancestor of both modern monotreme groups. On the other hand, the trigeminal sensory nuclear complex of the platypus is highly modified for processing tactile and electrosensory information from the bill, whereas the trigeminal sensory nuclear complex of the short-beaked echidna (Tachyglossus aculeatus) is not particularly specialized. If the common ancestor for both platypus and echidna were an electroreceptively and trigeminally specialized aquatic feeder, one would expect the early stages of development of the trigeminal sensory nuclei in both species to show evidence of structural specialization from the outset. To determine whether this is the case, we examined the development of the trigeminal sensory nuclei in the platypus and short-beaked echidna using the Hill and Hubrecht embryological collections. We found that the highly specialized features of the platypus trigeminal sensory nuclei (i.e. the large size of the principal nucleus and oral part of the spinal trigeminal nuclear complex, and the presence of a dorsolateral parvicellular segment in the principal nucleus) appear around the time of hatching in the platypus, but are never seen at any stage in the echidna. Our findings support the proposition that the modern echidna and platypus are derived from a common ancestor with only minimal trigeminal specialization and that the peculiar anatomy of the trigeminal sensory nuclei in the modern platypus emerged in the ornithorhynchids after divergence from the tachyglossids. Copyright © 2012 S. Karger AG, Basel.

  15. Neuronal plasticity of trigeminal ganglia in mice following nerve injury

    Directory of Open Access Journals (Sweden)

    Lynds R


    Full Text Available Randi Lynds,1,2,* Chuang Lyu,3,* Gong-Wei Lyu,4 Xie-Qi Shi,1,2 Annika Rosén,5,6 Kamal Mustafa,6 Tie-Jun Sten Shi7 1Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden; 2Division of Oral and Maxillofacial Radiology, Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway; 3State Key Laboratory of Veterinary Biotechnology, Harbin Veterinary Research Institute of Chinese Academy of Agricultural Sciences, 4Department of Neurology, The First Hospital of Harbin Medical University, Harbin, People’s Republic of China; 5Division for Oral and Maxillofacial Surgery, 6Tissue Engineering Group, Department of Clinical Dentistry, Faculty of Medicine and Dentistry, 7Department of Biomedicine, University of Bergen, Bergen, Norway *These authors contributed equally to this work Background: Nerve injury may induce neuropathic pain. In studying the mechanisms of orofacial neuropathic pain, attention has been paid to the plastic changes that occur in the trigeminal ganglia (TGs and nucleus in response to an injury of the trigeminal nerve branches. Previous studies have explored the impact of sciatic nerve injury on dorsal root ganglia (DRGs and it has shown dramatic changes in the expression of multiple biomarkers. In large, the changes in biomarker expression in TGs after trigeminal nerve injury are similar to that in DRGs after sciatic nerve injury. However, important differences exist. Therefore, there is a need to study the plasticity of biomarkers in TGs after nerve injury in the context of the development of neuropathic pain-like behaviors. Aim: The aim of this study was to investigate the plasticity of biomarkers associated with chronic persistent pain in TGs after trigeminal nerve injury. Materials and methods: To mimic the chronic nature of the disorder, we used an intraoral procedure to access the infraorbital nerve (ION and induced a nerve injury in mice. Immunohistochemistry and

  16. Trigeminal cardiac reflex and cerebral blood flow regulation

    Directory of Open Access Journals (Sweden)

    Dominga Lapi


    Full Text Available The stimulation of some facial regions is known to trigger the trigemino-cardiac reflex: the main stimulus is represented by the contact of the face with water. This phenomenon called diving reflex induces a set of reactions in the cardiovascular and respiratory systems occurring in all mammals, especially marine (whales, seals. During the immersion of the face in the water, the main responses are aimed at reducing the oxygen consumption of the organism. Accordingly reduction in heart rate, peripheral vasoconstriction, blood pooling in certain organs, especially the heart and brain, and an increase in blood pressure have been reported. Moreover, the speed and intensity of the reflex is inversely proportional to the temperature of the water: more cold the water, more reactions as described are strong. In the case of deep diving an additional effect, such as blood deviation, has been reported: the blood is requested within the lungs, to compensate for the increase in the external pressure, preventing them from collapsing.The trigeminal-cardiac reflex is not just confined to the diving reflex; recently it has been shown that a brief proprioceptive stimulation (10 min by jaw extension in rats produces interesting effects both at systemic and cerebral level, reducing the arterial blood pressure and vasodilating the pial arterioles. The arteriolar dilation is associated with rhythmic diameter changes characterized by an increase in the endothelial activity. Fascinating the stimulation of trigeminal nerve is able to activated the nitric oxide release by vascular endothelial. Therefore the aim of this review was to highlight the effects due to trigeminal cardiac reflex induced by a simple mandibular extension, because produced opposite effects compared to those elicited by the diving reflex as it induces hypotension and modulation of cerebral arteriolar tone.

  17. Electrophysiological Features of Neurons in the Mesencephalic Trigeminal Nuclei

    Directory of Open Access Journals (Sweden)

    Jun-Ling Xing


    Full Text Available Mesencephalic trigeminal nucleus (Mes V neurons represent an uncommon class of primary sensory neurons. Besides receiving somatosensory information, Mes V neurons are also involved in regulating multisensory information. The present review first describes the passive features as well as three important currents, followed by a distinct excitability classification and a description of the excitability transition of Mes V neurons. Furthermore, their resonance property, the existence of membrane oscillation and electrical coupling which may promote strong synchronization, as well as their function in controlling stretch reflex activity, are discussed.

  18. Osteopetrosis presenting with paroxysmal trigeminal neuralgia. A case report. (United States)

    Chindia, M L; Ocholla, T J; Imalingat, B


    Osteopetrosis is a rare disease of unknown aetiology. The relentless bone growth may progressively obliterate the various craniofacial skeletal foramina leading to nerve compression and a diversity of neurological disorders. A case is reported of a 37-year-old woman who was seen because of frequent attacks of paroxysmal trigeminal neuralgia (PTN); other orofacial neurologic deficits and generalised craniofacial skeletal thickening. The prompt recognition and management of associated disorders such as PTN is emphasized. Despite the lack of definitive treatment modalities for both osteopetrosis and PTN, the patient's quality of life must be sustained.

  19. Primary Malignant Lymphoma of the Trigeminal Nerve: Case Report and Literature Review. (United States)

    Ogiwara, Toshihiro; Horiuchi, Tetsuyoshi; Sekiguchi, Nodoka; Kakizawa, Yukinari; Hongo, Kazuhiro


    Primary lymphomas of the cranial nerves are extremely rare except for optic nerve lymphoma, and it is difficult to make a correct diagnosis in the initial stage. Here, we report a case of primary malignant lymphoma of the left trigeminal nerve that presented as trigeminal nerve disorder. A 47-year-old man presented with aggravating left facial pain and hypesthesia within all three divisions of the trigeminal nerve. Magnetic resonance imaging (MRI) revealed a swollen left trigeminal nerve with gadolinium homogenous enhancement. An open biopsy had to be taken from two different locations of the tumor via the lateral suboccipital approach followed by subtemporal approach because adequate specimen volume was not obtained for definitive diagnosis at the first surgery. Histopathological examinations with flow cytometric analysis revealed diffuse large B cell lymphoma. Chemotherapy followed by whole-brain radiation therapy was effective. No recurrence was observed during a 15-month follow-up period. This is a rare clinical presentation of malignant lymphoma of the trigeminal nerve. It is difficult to establish a correct diagnosis of trigeminal nerve lesions during the initial stages without biopsy. Therefore it is important that a sufficient specimen should be taken for biopsy without hesitation in order to diagnose and treat rapidly. The most suitable operative approach must be selected in trigeminal nerve lesions considering functional preservation, operative difficulty, preference of each surgeon, and quantity of specimen to be removed. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. A Rare Case of Painful Trigeminal Neuropathy Secondary to Lateral Medullary Infarct: Neuroimaging and Electrophysiological Studies. (United States)

    Huang, Ching-Tang; Lo, Chung-Ping; Chen, Ying-Chu; Tu, Min-Chien


    To report a rare case of painful trigeminal neuropathy after lateral medullary infarct and probe its underlying pathogenesis on the basis of neuroimaging and electrophysiological study. A 45-year-old man presented acute onset of unsteady gait followed by paroxysmal and electric shock-like headache in the distribution of ophthalmic branch of left trigeminal nerve in 2 days. Neurological examinations showed hypoesthesia in the distribution of mandibular branch of left trigeminal nerve and left appendicular ataxia. Muscle powers and deep tendon reflexes were normal. Brain magnetic resonance imaging revealed infarct within the left cerebellum and middle portion of dorsolateral medulla. Vascular compression at the root entry zone of trigeminal nerve was excluded. Painful trigeminal neuropathy secondary to lateral medullary infarct was diagnosed. Ancillary blink reflex study 3 days after the stroke event showed abnormal late responses (R2), either ipsilateral or contralateral, after stimulation of left supraorbital nerve, suggesting left medullary lesion. Followup study 3 weeks later demonstrated normalization in absolute latencies of bilateral late responses, in line with remission of pain paroxysms on low-dose gabapentin treatment. Painful trigeminal neuropathy attributed to lateral medullary infarct is a unique disease entity. Ophthalmic branch involvement, coexisting sensory deficits, absence of triggers, and rapid evolvement and remission are its characteristics. Our neuroimaging study delineated ischemic stroke pathology within descending tract and spinal nucleus of trigeminal nerve. Serial electrophysiological studies provide evidences supporting ephaptic transmission as the main pathogenesis concordant with dynamics of neuropathic pain and therapeutic implications.

  1. Congenital absence of the internal carotid artery diagnosed during investigation of trigeminal neuralgia

    Energy Technology Data Exchange (ETDEWEB)

    Uchino, A.; Sawada, A.; Kudo, S. [Department of Radiology, Saga Medical School, 5-1-1, Nabeshima, Saga (Japan); Hirakawa, N.; Totoki, T. [Department of Anesthesiology, Saga Medical School, 5-1-1, Nabeshima, Saga (Japan)


    Congenital absence of the unilateral internal carotid artery (ICA) was found in a patient during MR imaging examination for right trigeminal neuralgia. Magnetic resonance angiography showed complete absence of the right ICA and a large tortuous basilar artery (BA). The source images revealed a deformed right trigeminal nerve resulting from compression by the BA. Computed tomography of the skull base showed absence of the right carotid canal, suggesting agenesis of the right ICA. Longstanding hemodynamic stress may have caused the BA to become extremely tortuous, resulting in the trigeminal neuralgia. (orig.)

  2. Immunogold localization of serotonin within synaptic terminals in the rat mesencephalic trigeminal nucleus

    NARCIS (Netherlands)

    Liem, RSB; Copray, JCVM


    With the use of postembedding electron-microscopic immunogold cytochemistry, the vesicular distribution of serotonin within serotonergic synaptic terminals in the mesencephalic trigeminal nucleus was determined in order to obtain further insight into the mechanisms and function, significance of

  3. Vagus nerve stimulation inhibits trigeminal nociception in a rodent model of episodic migraine

    Directory of Open Access Journals (Sweden)

    Jordan L. Hawkins


    Conclusion:. Our findings demonstrate that nVNS inhibits mechanical nociception and represses expression of proteins associated with peripheral and central sensitization of trigeminal neurons in a novel rodent model of episodic migraine.

  4. Neuroimaging and clinical neurophysiology in cluster headache and trigeminal autonomic cephalalgias

    DEFF Research Database (Denmark)

    Friberg, Lars; Sandrini, Giorgio; Perrotta, Armando


    Clinical neurophysiology and neuroimaging are two non-invasive approaches used to investigate the pathophysiological basis of primary headaches, including cluster headache (CH) and other trigeminal autonomic cephalalgias (TACs). Modern neuroimaging has revolutionized our understanding...

  5. Ophthalmic branch radiofrequency thermocoagulation for atypical trigeminal neuralgia:a case report. (United States)

    Du, Shibin; Ma, Xiaoliang; Li, Xiaoqin; Yuan, Hongjie


    Trigeminal neuralgia is an intense neuralgia involving facial areas supplied by trigeminal nerve. The pain is characterized by sudden onset, short persistence, sharp or lancinating. Trigeminal neuralgia commonly affects frontal areas, infraorbital or paranasal areas, mandibular areas and teeth. While Trigeminal neuralgia affecting merely the upper eyelid is rare. Here we report a case of atypical Trigeminal neuralgia confined to the upper eyelid. The patient was pain free during the follow-up period of 6 months after unusual ophthalmic branch radiofrequency thermocoagulation. A 55-year-old female patient was diagnosed as primary trigeminal neuralgia involving the right upper eyelid. As the pain could not be controlled by drug therapy, peripheral nerve branch radiofrequency thermocoagulation was recommended. A combination of infratrochlear, supratrochlear and lacrimal radiofrequency thermocoagulation was implemented in this case. The point where the bridge of the nose abuts the supraorbital ridge and the point slightly above the lateral canthus along outer border of the orbit were selected respectively as the puncture sites. After positive diagnostic test, radiofrequency thermocoagulation of the above-mentioned nerve branches was performed respectively. The patient was pain free immediately after the treatment and during the follow-up period of 6 months. Trigeminal neuralgia is a common severe and chronic facial neuralgia which requires accurate diagnosis and effective therapy. With typical clinical symptoms, normal neurological signs, normal CT and MRI findings, the patient was diagnosed as classic trigeminal neuralgia. As the patient was drug resistant, some invasive treatments were considered. Peripheral branch neurolysis was chosen for its minimal invasiveness, convenience, low risk and not affecting further invasive treatments. According to the anatomic data and the diagnostic test results, infratrochlear, supratrochlear and lacrimal nerve were responsible

  6. Gamma knife radiosurgery for medically refractory idiopathic trigeminal neuralgia

    International Nuclear Information System (INIS)

    Kang, J.H.; Yoon, Y.S.; Kang, D.W.; Chung, S.S.; Chang, J.W.


    Gamma knife radiosurgery (GKS) has been generally considered as a viable therapeutic option for the management of medically refractory idiopathic trigeminal neuralgia (TN). We reviewed our experience with GKS in patients with TN. Between Feb 1996 and May 2006. 77 patients with medical refractory idiopathic TN were treated using GKS. Thirty-six patients who had undergone other previous procedures, previous GKS, or had brain stem lesion, atypical symptoms, were excluded from this study. Pain improvement was achieved in 38 of the patients with TN (pain response rate 92.7 %). Twenty-three patients were pain free and 15 had reduced pain. There were no serious complications. We think that GKS is an effective treatment option for patients with medical refractory idiopathic TN. (author)

  7. Trigeminal neuralgia – a coherent cross-specialty management program

    DEFF Research Database (Denmark)

    Heinskou, Tone; Maarbjerg, Stine; Rochat, Per Bjørnstad


    BACKGROUND: Optimal management of patients with classical trigeminal neuralgia (TN) requires specific treatment programs and close collaboration between medical, radiological and surgical specialties. Organization of such treatment programs has never been described before. With this paper we aim...... had a standardized basis before decision-making on impending surgery. The program ensured that referral of the subgroup of patients in need for surgery was standardized, ensured continuous evaluation of the need for adjustments in pharmacological management and formed the basis for scientific research....... to describe the implementation and feasibility of an accelerated cross-speciality management program, to describe the collaboration between the involved specialties and to report the patient flow during the first 2 years after implementation. Finally, we aim to stimulate discussions about optimal management...

  8. Neurogenic inflammation: a study of rat trigeminal ganglion

    DEFF Research Database (Denmark)

    Kristiansen, Kim Anker; Edvinsson, Lars


    Calcitonin gene-related peptide (CGRP) is linked to neurogenic inflammation and to migraine. Activation of the trigeminovascular system plays a prominent role during migraine attacks with the release of CGRP. The trigeminal ganglion (TG) contains three main cell types: neurons, satellite glial...... cells (SGC) and Schwann cells; the first two have before been studied in vitro separately. Culture of rat TG provides a method to induce inflammation and the possibility to evaluate the different cell types in the TG simultaneously. We investigated expression levels of various inflammatory cytokines...... inhibitor SP600125. This method may be of value to examine local TG inflammation, putatively involved in the pathophysiology of some forms of primary headaches....

  9. [Horner's syndrome and paresthesia in the trigeminal nerve territory secondary to epidural analgesia for labor]. (United States)

    Ferreira, Céline; Macedo, Ana Luísa; Almeida, Valentina


    Currently, epidural analgesia is a common procedure for labor analgesia. Although it is considered a safe technique, it is not without complications. Horner's syndrome and paresthesia within the trigeminal nerve distribution are rare complications of epidural analgesia. We report a case of a pregnant woman who developed Horner's syndrome and paresthesia within the distribution of the trigeminal nerve following epidural analgesia for the relief of labor pain. Copyright © 2018 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  10. TRPV4 is necessary for trigeminal irritant pain and functions as a cellular formalin receptor. (United States)

    Chen, Yong; Kanju, Patrick; Fang, Quan; Lee, Suk Hee; Parekh, Puja K; Lee, Whasil; Moore, Carlene; Brenner, Daniel; Gereau, Robert W; Wang, Fan; Liedtke, Wolfgang


    Detection of external irritants by head nociceptor neurons has deep evolutionary roots. Irritant-induced aversive behavior is a popular pain model in laboratory animals. It is used widely in the formalin model, where formaldehyde is injected into the rodent paw, eliciting quantifiable nocifensive behavior that has a direct, tissue-injury-evoked phase, and a subsequent tonic phase caused by neural maladaptation. The formalin model has elucidated many antipain compounds and pain-modulating signaling pathways. We have adopted this model to trigeminally innervated territories in mice. In addition, we examined the involvement of TRPV4 channels in formalin-evoked trigeminal pain behavior because TRPV4 is abundantly expressed in trigeminal ganglion (TG) sensory neurons, and because we have recently defined TRPV4's role in response to airborne irritants and in a model for temporomandibular joint pain. We found TRPV4 to be important for trigeminal nocifensive behavior evoked by formalin whisker pad injections. This conclusion is supported by studies with Trpv4(-/-) mice and TRPV4-specific antagonists. Our results imply TRPV4 in MEK-ERK activation in TG sensory neurons. Furthermore, cellular studies in primary TG neurons and in heterologous TRPV4-expressing cells suggest that TRPV4 can be activated directly by formalin to gate Ca(2+). Using TRPA1-blocker and Trpa1(-/-) mice, we found that both TRP channels co-contribute to the formalin trigeminal pain response. These results imply TRPV4 as an important signaling molecule in irritation-evoked trigeminal pain. TRPV4-antagonistic therapies can therefore be envisioned as novel analgesics, possibly for specific targeting of trigeminal pain disorders, such as migraine, headaches, temporomandibular joint, facial, and dental pain, and irritation of trigeminally innervated surface epithelia. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

  11. Persistent primitive trigeminal artery associated with cerebrovascular diseases and other cerebrosis

    International Nuclear Information System (INIS)

    Chen Yuanchang; Li Minghua


    Persistent primitive trigeminal artery (PPTA) is the most common permanent abnormal vascular anastomosis between carotid artery and basilar artery. PPTA is a rare cerebrovascular variation and is often associated with cerebrovascular disease (CVD). Clinically, PPTA manifests itself in symptoms such as trigeminal neuralgia, oculomotor paralysis, abducens nerve paralysis, subarachnoid hemorrhage, etc. This paper aims to review 116 PPTA cases with CVD and other cerebrosis, which have ever been reported since 1983 in English or Chinese medical literature. (authors)

  12. Transient receptor potential channels encode volatile chemicals sensed by rat trigeminal ganglion neurons.

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    Matthias Lübbert

    Full Text Available Primary sensory afferents of the dorsal root and trigeminal ganglia constantly transmit sensory information depicting the individual's physical and chemical environment to higher brain regions. Beyond the typical trigeminal stimuli (e.g. irritants, environmental stimuli comprise a plethora of volatile chemicals with olfactory components (odorants. In spite of a complete loss of their sense of smell, anosmic patients may retain the ability to roughly discriminate between different volatile compounds. While the detailed mechanisms remain elusive, sensory structures belonging to the trigeminal system seem to be responsible for this phenomenon. In order to gain a better understanding of the mechanisms underlying the activation of the trigeminal system by volatile chemicals, we investigated odorant-induced membrane potential changes in cultured rat trigeminal neurons induced by the odorants vanillin, heliotropyl acetone, helional, and geraniol. We observed the dose-dependent depolarization of trigeminal neurons upon application of these substances occurring in a stimulus-specific manner and could show that distinct neuronal populations respond to different odorants. Using specific antagonists, we found evidence that TRPA1, TRPM8, and/or TRPV1 contribute to the activation. In order to further test this hypothesis, we used recombinantly expressed rat and human variants of these channels to investigate whether they are indeed activated by the odorants tested. We additionally found that the odorants dose-dependently inhibit two-pore potassium channels TASK1 and TASK3 heterologously expressed In Xenopus laevis oocytes. We suggest that the capability of various odorants to activate different TRP channels and to inhibit potassium channels causes neuronal depolarization and activation of distinct subpopulations of trigeminal sensory neurons, forming the basis for a specific representation of volatile chemicals in the trigeminal ganglia.

  13. Trigeminal neuralgia as the sole manifestation of an Arnold-Chiari type I malformation: case report. (United States)

    Caranci, Giovanni; Mercurio, Alessio; Altieri, Marta; Di Piero, Vittorio


    Arnold-Chiari type I malformations usually manifest clinically with short-lasting headaches typically involving the occipital-nuchal region and precipitated by the Valsalva maneuver, coughing, sudden postural change, or physical exertion. We describe the case of an adult patient who presented with symptomatic trigeminal neuralgia caused by an Arnold-Chiari type I malformation. Unlike previous cases, the malformation involved the trigeminal ophthalmic division alone.

  14. Cyto- and chemoarchitecture of the sensory trigeminal nuclei of the echidna, platypus and rat. (United States)

    Ashwell, Ken W S; Hardman, Craig D; Paxinos, George


    We have examined the cyto- and chemoarchitecture of the trigeminal nuclei of two monotremes using Nissl staining, enzyme reactivity for cytochrome oxidase, immunoreactivity for calcium binding proteins and non-phosphorylated neurofilament (SMI-32 antibody) and lectin histochemistry (Griffonia simplicifolia isolectin B4). The principal trigeminal nucleus and the oralis and interpolaris spinal trigeminal nuclei were substantially larger in the platypus than in either the echidna or rat, but the caudalis subnucleus was similar in size in both monotremes and the rat. The numerical density of Nissl stained neurons was higher in the principal, oralis and interpolaris nuclei of the platypus relative to the echidna, but similar to that in the rat. Neuropil immunoreactivity for parvalbumin was particularly intense in the principal trigeminal, oralis and interpolaris subnuclei of the platypus, but the numerical density of parvalbumin immunoreactive neurons was not particularly high in these nuclei of the platypus. Neuropil immunoreactivity for calbindin and calretinin was relatively weak in both monotremes, although calretinin immunoreactive somata made up a large proportion of neurons in the principal, oralis and interpolaris subnuclei of the echidna. Distribution of calretinin immunoreactivity and Griffonia simplicifolia B4 isolectin reactivity suggested that the caudalis subnucleus of the echidna does not have a clearly defined gelatinosus region. Our findings indicate that the trigeminal nuclei of the echidna do not appear to be highly specialized, but that the principal, oralis and interpolaris subnuclei of the platypus trigeminal complex are highly differentiated, presumably for processing of tactile and electrosensory information from the bill.

  15. Eyelid Opening with Trigeminal Proprioceptive Activation Regulates a Brainstem Arousal Mechanism.

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    Kiyoshi Matsuo

    Full Text Available Eyelid opening stretches mechanoreceptors in the supratarsal Müller muscle to activate the proprioceptive fiber supplied by the trigeminal mesencephalic nucleus. This proprioception induces reflex contractions of the slow-twitch fibers in the levator palpebrae superioris and frontalis muscles to sustain eyelid and eyebrow positions against gravity. The cell bodies of the trigeminal proprioceptive neurons in the mesencephalon potentially make gap-junctional connections with the locus coeruleus neurons. The locus coeruleus is implicated in arousal and autonomic function. Due to the relationship between arousal, ventromedial prefrontal cortex, and skin conductance, we assessed whether upgaze with trigeminal proprioceptive evocation activates sympathetically innervated sweat glands and the ventromedial prefrontal cortex. Specifically, we examined whether 60° upgaze induces palmar sweating and hemodynamic changes in the prefrontal cortex in 16 subjects. Sweating was monitored using a thumb-mounted perspiration meter, and prefrontal cortex activity was measured with 45-channel, functional near-infrared spectroscopy (fNIRS and 2-channel NIRS at Fp1 and Fp2. In 16 subjects, palmar sweating was induced by upgaze and decreased in response to downgaze. Upgaze activated the ventromedial prefrontal cortex with an accumulation of integrated concentration changes in deoxyhemoglobin, oxyhemoglobin, and total hemoglobin levels in 12 subjects. Upgaze phasically and degree-dependently increased deoxyhemoglobin level at Fp1 and Fp2, whereas downgaze phasically decreased it in 16 subjects. Unilateral anesthetization of mechanoreceptors in the supratarsal Müller muscle used to significantly reduce trigeminal proprioceptive evocation ipsilaterally impaired the increased deoxyhemoglobin level by 60° upgaze at Fp1 or Fp2 in 6 subjects. We concluded that upgaze with strong trigeminal proprioceptive evocation was sufficient to phasically activate sympathetically

  16. Secondary Traumatic Stress Increases Expression of Proteins Implicated in Peripheral and Central Sensitization of Trigeminal Neurons. (United States)

    Hawkins, J L; Moore, N J; Miley, D; Durham, P L


    The pathology of migraine, a common neurological disease, involves sensitization and activation of trigeminal nociceptive neurons to promote hyperalgesia and allodynia during an attack. Migraineurs often exhibit characteristics of a hyperexcitable or hypervigilant nervous system. One of the primary reported risk factors for development of a hyperexcitable trigeminal system is chronic, unmanaged stress and anxiety. While primary traumatic stress is a commonly cited risk factor for many pain conditions, exposure to secondary traumatic stress early in life is also thought to be a contributing risk factor. The goal of this study was to investigate cellular changes within the spinal trigeminal nucleus and trigeminal ganglion mediated by secondary traumatic stress. Male Sprague Dawley rats (sender) were subjected to forced swim testing (primary traumatic stress) and were then housed in close visual, olfactory, and auditory proximity to the breeding male and female rats, pregnant female rats, or female rats and their nursing offspring (all receivers). In response to secondary stress, levels of calcitonin gene-related peptide, active forms of the mitogen activated protein kinases ERK, JNK, and p38, and astrocyte expression of glial fibrillary acidic protein were significantly elevated in the spinal trigeminal nucleus in day 45 offspring when compared to naïve offspring. In addition, increased nuclear expression of ERK and p38 was observed in trigeminal ganglion neurons. Our results demonstrate that secondary traumatic stress promotes cellular events associated with prolonged trigeminal sensitization in the offspring, and provides a mechanism of how early life stress may function as a risk factor for migraine. Copyright © 2018. Published by Elsevier B.V.

  17. Advances in diagnosis and treatment of trigeminal neuralgia

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    Montano N


    Full Text Available Nicola Montano,1 Giulio Conforti,1 Rina Di Bonaventura,1 Mario Meglio,2 Eduardo Fernandez,1 Fabio Papacci1 1Institute of Neurosurgery, Catholic University, Rome, 2Institute of Neurosurgery, Azienda Ospedaliera Universitaria Integrata, Verona, Italy Abstract: Various drugs and surgical procedures have been utilized for the treatment of trigeminal neuralgia (TN. Despite numerous available approaches, the results are not completely satisfying. The need for more contemporaneous drugs to control the pain attacks is a common experience. Moreover, a number of patients become drug resistant, needing a surgical procedure to treat the neuralgia. Nonetheless, pain recurrence after one or more surgical operations is also frequently seen. These facts reflect the lack of the precise understanding of the TN pathogenesis. Classically, it has been related to a neurovascular compression at the trigeminal nerve root entry-zone in the prepontine cistern. However, it has been evidenced that in the pain onset and recurrence, various neurophysiological mechanisms other than the neurovascular conflict are involved. Recently, the introduction of new magnetic resonance techniques, such as voxel-based morphometry, diffusion tensor imaging, three-dimensional time-of-flight magnetic resonance angiography, and fluid attenuated inversion recovery sequences, has provided new insight about the TN pathogenesis. Some of these new sequences have also been used to better preoperatively evidence the neurovascular conflict in the surgical planning of microvascular decompression. Moreover, the endoscopy (during microvascular decompression and the intraoperative computed tomography with integrated neuronavigation (during percutaneous procedures have been recently introduced in the challenging cases. In the last few years, efforts have been made in order to better define the optimal target when performing the gamma knife radiosurgery. Moreover, some authors have also evidenced that

  18. Refractory trigeminal neuralgia treatment outcomes following CyberKnife radiosurgery

    International Nuclear Information System (INIS)

    Karam, Sana D; Tai, Alexander; Snider, James W; Bhatia, Shilpa; Bedrick, Edward J; Rashid, Abdul; Jay, Ann; Kalhorn, Christopher; Nair, Nathan; Harter, K William; Collins, Sean P; Jean, Walter


    A handful of studies have reported outcomes with CyberKnife radiosurgery (CKRS) for the treatment of trigeminal neuralgia. However, the follow-up has been short with no minimum follow-up required and have included patients with short duration of symptoms. Here we report our institutional experience on patients with a minimum follow-up of 1 year and a median follow-up of 28 months (mean 38.84 months). Twenty-five patients with medically and surgically intractable TN received CKRS with a mean marginal radiation dose of 64 Gy applied to an average isodose line of 86% of the affected trigeminal nerve. Follow-up data were obtained by clinical examination and telephone questionnaire. Outcome results were categorized based on the Barrow Neurological Institute (BNI) pain scale with BNI I-III considered to be good outcomes and BNI IV-V considered as treatment failure. BNI facial numbness score was used to assess treatment complications. A large proportion of patients (42.9%) reported pain relief within 1 month following CKRS treatment. The mean time to recurrence of severe pain was 27.8 months (range 1–129 months). At median follow-up of 28 months (mean 38.84 months), actuarial rate of freedom from severe pain (BNI ≥ III) was 72%. At last follow-up 2 (8%) patients had freedom from any pain and no medications (BNI I) and the majority (48%) had some pain that was adequately controlled with medications. Seven patients (28%) had no response to treatment and continued to suffer from severe pain (BNI IV or V). Patient’s diabetic status and overall post-treatment BNI facial numbness scores were statistically significant predictors of treatment outcomes. CKRS represents an acceptable salvage option for with medically and/or surgically refractory patients. Even patients with severely debilitating symptoms may experience significant and sustained pain relief after CKRS. Particularly, CKRS remains an attractive option in patients who are not good surgical candidates or possibly

  19. Trigeminal nerve agenesis with absence of foramina rotunda in Gómez-López-Hernández syndrome. (United States)

    Choudhri, Asim F; Patel, Rakesh M; Wilroy, Robert S; Pivnick, Eniko K; Whitehead, Matthew T


    Gómez-López-Hernández syndrome (GLHS) is a clinical condition traditionally characterized by rhombencephalosynapsis (RS), parieto-occipital alopecia, and trigeminal anesthesia. It is a neurocutaneous disorder with no known etiology. The underlying cause of the trigeminal anesthesia in GLHS has not been examined or reported; it has merely been identified on clinical grounds. In this report, a 10-month-old white female born at 37 weeks gestational age with GLHS underwent a contrast-enhanced CT for the evaluation of craniofacial dysmorphic features. Thin-section bone algorithm images showed absence of bilateral foramina rotunda and trigeminal nerve fibers. The maxillary branch of the trigeminal nerve passes through the foramen rotundum and carries sensory information from the face. This case is unique because trigeminal nerve absence has not been suggested as a possible etiology for trigeminal anesthesia associated with GLHS. It is not known how many cases of GLHS have agenesis of the trigeminal nerve; however, a review of the literature suggests that this patient is the first. The triad of RS, alopecia, and trigeminal anesthesia is specific to GLHS; therefore, early identification of trigeminal nerve agenesis in patients with RS could expedite diagnosis of GLHS, particularly given that the clinical diagnosis of trigeminal anesthesia in neonates is a challenging one. Diagnosing alopecia in newborns is likewise challenging. Early diagnosis could allow for early intervention, especially for ophthalmic complications, which are known to have significant long-term effects. This case illustrates the benefits of CT imaging in the detection of trigeminal nerve and foramina rotunda abnormalities in neonates with suspected GLHS. © 2014 Wiley Periodicals, Inc.

  20. Proinflammatory-activated trigeminal satellite cells promote neuronal sensitization: relevance for migraine pathology

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    Tringali Giuseppe


    Full Text Available Abstract Background Migraine is a complex, chronic, painful, neurovascular disorder characterized by episodic activation of the trigeminal system. Increased levels of calcitonin gene-related peptide (CGRP are found at different levels during migraine attacks. Interestingly, CGRP is also released within the trigeminal ganglia suggesting possible local effects on satellite cells, a specialized type of glia that ensheaths trigeminal neurons. CGRP was shown to enhance satellite-cell production of interleukin 1β (IL-1β, while trigeminal neurons express an activity-dependent production of nitric oxide (NO. Thus, in the present study we tested the hypothesis that IL-1β and NO induce trigeminal satellite cell activation, and that once activated these cells can influence neuronal responses. Results Primary cultures of rat trigeminal satellite cells isolated from neuronal cultures were characterized in vitro. Cyclooxygenase (COX expression and activity were taken as a marker of glial pro-inflammatory activation. Most of the experiments were carried out to characterize satellite cell responses to the two different pro-inflammatory stimuli. Subsequently, medium harvested from activated satellite cells was used to test possible modulatory effects of glial factors on trigeminal neuronal activity. IL-1β and the NO donor diethylenetriamine/nitric oxide (DETA/NO elevated PGE2 release by satellite cells. The stimulatory effect of IL-1β was mediated mainly by upregulation of the inducible form of COX enzyme (COX2, while NO increased the constitutive COX activity. Regardless of the activator used, it is relevant that short exposures of trigeminal satellite cells to both activators induced modifications within the cells which led to significant PGE2 production after removal of the pro-inflammatory stimuli. This effect allowed us to harvest medium from activated satellite cells (so-called 'conditioned medium' that did not contain any stimulus, and thus test the

  1. Phenytoin and carbamazepine in trigeminal neuralgia: marketing-based versus evidence-based treatment

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    Keppel Hesselink JM


    Full Text Available Jan M Keppel Hesselink,1 Michael E Schatman2,31Institute for Neuropathic Pain, Bosch en Duin, the Netherlands; 2Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA; 3Boston Pain Care, Waltham, MA, USAIntroductionMost review articles support carbamazepine as a first-line pharmacotherapy for idiopathic trigeminal neuralgia.1–3 However, the empirical support for this recommendation is somewhat suspect. Phenytoin, as the prototype for all anticonvulsants, was already positioned as an analgesic compound 70 years ago. Since these initial findings, the data that have been gathered have supported the use of anticonvulsants as painkillers – from phenytoin up to and including more recent anticonvulsants such as gabapentin and pregabalin. Since 1942, a number of papers supported phenytoin’s therapeutic effects in trigeminal neuralgia (Table 1. The introduction of carbamazepine in 1962 by Geigy shifted the interest of neurologists from phenytoin as a treatment for trigeminal neuralgia to carbamazepine, without sound scientific evidence. To date, no convincing randomized controlled trials (RCTs have been published supporting the role of carbamazepine in trigeminal neuralgia, and we could not identify a single study comparing the effects of phenytoin with those of carbamazepine. Accordingly, phenytoin should probably be considered more often as a viable therapy for (treatmentresistant trigeminal neuralgia.

  2. Orofacial neuropathic pain mouse model induced by Trigeminal Inflammatory Compression (TIC of the infraorbital nerve

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    Ma Fei


    Full Text Available Abstract Background Trigeminal neuropathic pain attacks can be excruciating for patients, even after being lightly touched. Although there are rodent trigeminal nerve research models to study orofacial pain, few models have been applied to studies in mice. A mouse trigeminal inflammatory compression (TIC model is introduced here which successfully and reliably promotes vibrissal whisker pad hypersensitivity. Results The chronic orofacial neuropathic pain model is induced after surgical placement of chromic gut suture in the infraorbital nerve fissure in the maxillary bone. Slight compression and chemical effects of the chromic gut suture on the portion of the infraorbital nerve contacted cause mild nerve trauma. Nerve edema is observed in the contacting infraorbital nerve bundle as well as macrophage infiltration in the trigeminal ganglia. Centrally in the spinal trigeminal nucleus, increased immunoreactivity for an activated microglial marker is evident (OX42, postoperative day 70. Mechanical thresholds of the affected whisker pad are significantly decreased on day 3 after chromic gut suture placement, persisting at least 10 weeks. The mechanical allodynia is reversed by suppression of microglial activation. Cold allodynia was detected at 4 weeks. Conclusions A simple, effective, and reproducible chronic mouse model mimicking clinical orofacial neuropathic pain (Type 2 is induced by placing chromic gut suture between the infraorbital nerve and the maxillary bone. The method produces mild inflammatory compression with significant continuous mechanical allodynia persisting at least 10 weeks and cold allodynia measureable at 4 weeks.

  3. [Clinical efficacy observation on primary trigeminal neuralgia treated with joint needling method at the trigger point]. (United States)

    Chen, Zhang-mei; Wu, Xin-tian


    To observe the clinical efficacy on primary trigeminal neuralgia treated with joint needling method at the trigger point. One hundred and three cases of primary trigeminal neuralgia were divided into a joint needling group (53 cases) and a conventional needling group (50 cases) according to the visit sequence. In the joint needling group, the joint needling method was used at the trigger point in the mandibular joint [the positive point near to Xiaguan (ST 7)]; the conventional needling was used at Hegu (LI 4), Waiguan (TE 5), Taichong (LR 3) and Neiting (ST 44). In the conventional needling group, Xiaguan (ST 7) and Fengchi (GB 20) were used and the supplementary acupoints were selected according to the involved branches of trigeminal nerve. The conventional needling method was used. The Visual Analogue Scale (VAS) and the score of trigeminal neuralgia were adopted to assess the pain severity and the comprehensive symptoms before treatment and after the 1st and 2nd sessions of treatment separately. The efficacy was assessed. After the 1st and 2nd sessions of treatment, VAS score and the comprehensive symptom score were reduced obviously as compared with those before treatment in either group (P trigger point achieves the significant efficacy on primary trigeminal neuralgia, which is superior to that with the conventional needling method.

  4. Mexico City air pollution adversely affects olfactory function and intranasal trigeminal sensitivity. (United States)

    Guarneros, Marco; Hummel, Thomas; Martínez-Gómez, Margaríta; Hudson, Robyn


    Surprisingly little is known about the effects of big-city air pollution on olfactory function and even less about its effects on the intranasal trigeminal system, which elicits sensations like burning, stinging, pungent, or fresh and contributes to the overall chemosensory experience. Using the Sniffin' Sticks olfactory test battery and an established test for intranasal trigeminal perception, we compared the olfactory performance and trigeminal sensitivity of residents of Mexico City, a region with high air pollution, with the performance of a control population from the Mexican state of Tlaxcala, a geographically comparable but less polluted region. We compared the ability of 30 young adults from each location to detect a rose-like odor (2-phenyl ethanol), to discriminate between different odorants, and to identify several other common odorants. The control subjects from Tlaxcala detected 2-phenyl ethanol at significantly lower concentrations than the Mexico City subjects, they could discriminate between odorants significantly better, and they performed significantly better in the test of trigeminal sensitivity. We conclude that Mexico City air pollution impairs olfactory function and intranasal trigeminal sensitivity, even in otherwise healthy young adults.

  5. Pharmacologic management of trigeminal nerve injury pain after dental implant surgery. (United States)

    Park, Ju Hyun; Lee, Seok Hyoung; Kim, Seong Taek


    Injuries to the trigeminal nerve are a common postoperative complication of dental implant surgery. Usually, the altered sensation and neuropathic pain caused by the nerve injury is temporary, but a permanent neurosensory disorder can sometimes occur. Surgery is commonly used to treat this condition, but the treatment is associated with some complications and a relatively low success rate. This study analyzed the characteristics of pharmacologic management of trigeminal nerve injury pain after dental implant surgery. Eighty-five patients who visited a temporomandibular joint and orofacial pain clinic with a history of trigeminal nerve injury pain after dental implant surgery were enrolled in this study. The pharmacologic management for trigeminal nerve injury pain was evaluated by prescribing a variety of medications for 12 weeks according to the prescription protocol of the study. The patients' pain characteristics, average percentage of pain reduction, and pain relieving factors were investigated prospectively. Patients who took anticonvulsants and antidepressants for at least 12 weeks reported a mean reduction in pain of 24.8%. Interestingly, patients who experienced an altered sensation and neuropathic pain for more than 1 year also reported a reduction in pain and discomfort, with an average decrease of 17.1%. In addition, it was found that early treatment using medications had a significant effect on reducing the level of pain and discomfort. These results suggest that pharmacologic management can be used for treating trigeminal nerve injury pain after dental implant surgery.

  6. Advanced MRI manifestations of trigeminal ganglioneuroma: a case report and literature review

    International Nuclear Information System (INIS)

    Deng, Xiaojuan; Fang, Jingqin; Luo, Qingya; Tong, Haipeng; Zhang, Weiguo


    Ganglioneuroma is a rare benign tumor originating from the sympathetic nerves, and its origination from the trigeminal nerves is even rarer. Only 4 cases of ganglioneuroma originating from the trigeminal nerve have previously been reported, and these studies only reported conventional MRI manifestations. To our knowledge, the advanced MRI features of trigeminal ganglioneuroma have not been reported thus far. This study reports a case of trigeminal ganglioneuroma in the left cerebellopontine angle. Advanced MRI showed the following tumor characteristics: significantly increased perfusion on perfusion imaging; isointense on diffusion-weighted imaging, whorled appearance within the tumor and no significant signs of damage to the white matter fiber tracts in the fractional anisotropy color map, and compare to the adjacent brain tissue, Choline didn’t show markedly elevation, and N-acetylaspartate peak showed slightly reduction on magnetic resonance spectroscopy. The tumor was completely resected, and the diagnosis of ganglioneuroma was confirmed by postoperative pathological examination. This case demonstrates the conventional as well as advanced MRI manifestations of this rare extra-axial tumor, which have never been previously reported. In addition, we reviewed the literature to demonstrate the advanced MRI features of trigeminal ganglioneuroma, in order to aid preoperative diagnosis and differentiation

  7. Cilostazol induces C-fos expression in the trigeminal nucleus caudalis and behavioural changes suggestive of headache with the migraine-like feature photophobia in female rats

    DEFF Research Database (Denmark)

    Christensen, S L; Petersen, Steffen; Sørensen, Dorte B


    in the trigeminal nucleus caudalis. Furthermore, trigeminal - but not hind paw hyperalgesia was observed. Conclusion The altered behaviours are suggestive of cilostazol induced headache with migraine-like features, but not specific. The presence of head specific hyperalgesia and the c-fos response in the trigeminal...

  8. Percutaneous high-frequency selective rhizotomy in the trigeminal neuralgia therapy in multiple sclerosis

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    V. M. Tyurnikov


    Full Text Available Trigeminal neuralgia is a rare symptom of multiple sclerosis affecting the disability. Multiple sclerosis related trigeminal neuralgia has been attributed to a demyelinating lesion in the pons. When the adequate pain drug-relieve therapy is not possible or when the patient becomes refractory to the treatment or can not continue pharmacological treatment because of the side effects, surgical intervention, including percutaneous radiofrequency rhizotomy is being discussed. Literature review and the data upon the efficiency and safety of this neurosurgical treatment in 16 patients with multiple sclerosis have been analyzed. Percutaneous radiofrequency rhizotomy has been proved to be a safe, reproducible and effective method of the symptomatic surgical treatment of trigeminal neuralgia in patients with multiple sclerosis in cases of the intolerance/inefficiency of the pharmacological therapy.

  9. Lipopolysaccharide-induced Pulpitis Up-regulates TRPV1 in Trigeminal Ganglia (United States)

    Chung, M.-K.; Lee, J.; Duraes, G.; Ro, J.Y.


    Tooth pain often accompanies pulpitis. Accumulation of lipopolysaccharides (LPS), a product of Gram-negative bacteria, is associated with painful clinical symptoms. However, the mechanisms underlying LPS-induced tooth pain are not clearly understood. TRPV1 is a capsaicin- and heat-gated nociceptive ion channel implicated in thermosensation and hyperalgesia under inflammation or injury. Although TRPV1 is expressed in pulpal afferents, it is not known whether the application of LPS to teeth modulates TRPV1 in trigeminal nociceptors. By assessing the levels of protein and transcript of TRPV1 in mouse trigeminal ganglia, we demonstrate that dentinal application of LPS increases the expression of TRPV1. Our results suggest that the up-regulation of TRPV1 in trigeminal nociceptors following bacterial infection could contribute to hyperalgesia under pulpitis conditions. PMID:21712529

  10. Ultrasound-Guided Intervention for Treatment of Trigeminal Neuralgia: An Updated Review of Anatomy and Techniques

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    Abdallah El-Sayed Allam


    Full Text Available Orofacial myofascial pain is prevalent and most often results from entrapment of branches of the trigeminal nerves. It is challenging to inject branches of the trigeminal nerve, a large portion of which are shielded by the facial bones. Bony landmarks of the cranium serve as important guides for palpation-guided injections and can be delineated using ultrasound. Ultrasound also provides real-time images of the adjacent muscles and accompanying arteries and can be used to guide the needle to the target region. Most importantly, ultrasound guidance significantly reduces the risk of collateral injury to vital neurovascular structures. In this review, we aimed to summarize the regional anatomy and ultrasound-guided injection techniques for the trigeminal nerve and its branches, including the supraorbital, infraorbital, mental, auriculotemporal, maxillary, and mandibular nerves.

  11. Treatment of trigeminal neuralgia with low doses of topiramate Tratamento da neuralgia do trigêmeo com baixas doses de topiramato

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    Renan Barros Domingues


    Full Text Available Topiramate was administered to eight patients with classical trigeminal neuralgia with or without previous symptomatic therapy with other antiepileptic drugs. The topiramate doses ranged from 50 to 100 mg a day, according to the clinical response and the reported side effects. Three patients had complete symptoms remission, three reported moderate improvement, and the treatment was not effective in two. The most frequently registered side effects were dizziness, somnolence and weight loss. Topiramate can be considered an alternative treatment for patients with trigeminal neuralgia.Oito pacientes com neuralgia do trigêmeo, com ou sem tratamentos prévios com anticonvulsivantes, foram submetidos a tratamento com topiramato. As doses de topiramato variaram de 50 a 100 mg ao dia, de acordo com a resposta clínica e com os efeitos colaterais relatados. Três pacientes obtiveram remissão completa, três relataram melhora parcial e o tratamento com topiramato foi ineficaz em dois pacientes. Os efeitos colaterais mais frequentemente citados foram tontura, sonolência e perda de peso. O topiramato pode ser considerado uma alternativa potencialmente eficaz para o tratamento de pacientes com neuralgia do trigêmeo.

  12. The human trigeminal ganglion: c-kit positive neurons and interstitial cells. (United States)

    Rusu, M C; Pop, F; Hostiuc, S; Dermengiu, D; Lală, A I; Ion, D A; Mănoiu, V S; Mirancea, N


    The presence of c-kit positive neurons in sensory ganglia has been verified in various species but not in humans. Our aim has been to identify whether human primary trigeminal neurons label with c-kit/CD117 and thus, whether data gathered in animal studies can be extrapolated to humans. We also intended to establish whether, and which non-neuronal cells also label with c-kit in the trigeminal ganglion. Human adult trigeminal ganglia from eight cadavers were processed for immunohistochemistry on paraffin embedded samples using monoclonal antibodies for CD117/c-kit, and three additional trigeminal ganglia were used for transmission electron microscopy (TEM). To evaluate which neuronal type (A or B) was labeled with c-kit, we evaluated the same neurons on adjacent sections labeled with antibodies for neurofilaments (NF). c-kit has labeled trigeminal neurons (TNs), mast cells and interstitial cells (ICs) within the trigeminal ganglion. c-kit+TNs were NF-and thus were strongly presumed to be nociceptive, as such neurons are known to be NF-poor. c-kit+ICs with long and moniliform processes intermingled with the satellite glial cells (SGCs) of the neuronal envelopes. TEM evaluations confirmed this mixed composition of the neuronal envelopes and demonstrated that the perineuronal ICs are in fact interstitial Cajal-like cells (ICLCs) and/or telocytes. c-kit+TNs were objectified in humans and strongly presumed to be nociceptive. TNs envelopes mostly consist of SGCs, but are also combined with ICLCs/telocytes. Copyright © 2011 Elsevier GmbH. All rights reserved.

  13. Safety of Superior Petrosal Vein Sacrifice During Microvascular Decompression of the Trigeminal Nerve. (United States)

    Pathmanaban, Omar N; O'Brien, Frazer; Al-Tamimi, Yahia Z; Hammerbeck-Ward, Charlotte L; Rutherford, Scott A; King, Andrew T


    Microvascular decompression (MVD) is a safe and effective treatment for trigeminal neuralgia. Cerebellar venous infarction is a complication associated with surgical sacrifice of the superior petrosal vein (SPV). The SPV intervenes between the trigeminal nerve and the surgeon. Optimal exposure of the cisternal trigeminal nerve, particularly at the brainstem, can be achieved by sacrificing the SPV. We analyzed a cohort of 224 patients to determine the frequency of cerebellar venous infarction. Retrospective analysis of records and neuroradiology for patients undergoing trigeminal MVD at the Manchester Skull Base Unit between August 1st 2008 and July 31st 2015. A total of 184 of 224 (82%) patients had coagulation and division of the main stem of the SPV. There were no cases of venous infarction. There was one case of mild, transient, cerebellar symptoms and signs, with no radiologic evidence of venous infarction. This patient had SPV sacrifice at surgery but also had postoperative thrombosis of the transverse sinus. Venous sinus thrombosis affected 5 of 184 (2.7%) patients. A total of 208 of 224 (93%) patients had a good outcome with improvement or resolution of their trigeminal neuralgia at 3 months. The overall rate of venous complications in this study was 2.7%; however, we had no cases of venous infarction in 184 patients who had sacrifice of the SPV. The incidence of venous infarction associated with SPV obliteration during MVD surgery is therefore sacrifice may be used where necessary to optimize visualization of the root entry zone and maximize the chance of effective decompression of the trigeminal nerve. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Isolated Bilateral Trigeminal Neuropathy in Sarcoidosis Presenting with Neurotrophic Corneal Ulcers

    Directory of Open Access Journals (Sweden)

    M. Gupta


    Full Text Available Sarcoidosis is a multisystem granulomatous disease that may affect various organs. Nevertheless, involvement of the trigeminal nerve is exceedingly uncommon. This report presents a rare case of isolated bilateral trigeminal neuropathy presenting with neurotrophic corneal ulcers. The patient was treated with topical chloramphenicol and lubricants, as well as botulinum toxin injection to the upper eyelid to induce ptosis. Our case illustrates the importance of recognizing that bilateral corneal ulceration might be a manifestation of sarcoidosis. Physicians should be aware of this rare association, when treating sarcoidosis patients with eye related symptoms.

  15. Trigeminal nerve involvement in T-cell acute lymphoblastic leukemia: value of MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Karadag, Demet; Karaguelle, Ayse Tuba; Erden, Ilhan; Erden, Ayse E-mail:


    A 30-year-old male with T-cell acute lymphoblastic leukemia presented with facial numbness. Neurological examination revealed paresthesia of the left trigeminal nerve. Cerebrospinal fluid (CSF) cytology showed no atypical cells. Gadolinium-enhanced magnetic resonance (MR) imaging demonstrated enlargement and enhancement of intracranial portions of the left trigeminal nerve. The abnormal MR imaging findings almost completely resolved after the chemotherapy. Gadolinium-enhanced MR imaging is not only a useful procedure for the early diagnosis of cranial nerve invasion by leukemia but it might be helpful to follow the changes after the treatment.

  16. Salvage Gamma Knife Stereotactic Radiosurgery for Surgically Refractory Trigeminal Neuralgia

    International Nuclear Information System (INIS)

    Little, Andrew S.; Shetter, Andrew G.; Shetter, Mary E.; Kakarla, Udaya K.; Rogers, C. Leland


    Purpose: To evaluate the clinical outcome of patients with surgically refractory trigeminal neuralgia (TN) treated with rescue gamma knife radiosurgery (GKRS). Methods and Materials: Seventy-nine patients with typical TN received salvage GKRS between 1997 and 2002 at the Barrow Neurological Institute (BNI). All patients had recurrent pain following at least one prior surgical intervention. Prior surgical interventions included percutaneous destructive procedures, microvascular decompression (MVD), or GKRS. Thirty-one (39%) had undergone at least two prior procedures. The most common salvage dose was 80 Gy, although 40-50 Gy was typical in patients who had received prior radiosurgery. Pain outcome was assessed using the BNI Pain Intensity Score, and quality of life was assessed using the Brief Pain Inventory. Results: Median follow-up after salvage GKRS was 5.3 years. Actuarial analysis demonstrated that at 5 years, 20% of patients were pain-free and 50% had pain relief. Pain recurred in patients who had an initial response to GKRS at a median of 1.1 years. Twenty-eight (41%) required a subsequent surgical procedure for recurrence. A multivariate Cox proportional hazards model suggested that the strongest predictor of GKRS failure was a history of prior MVD (p=0.029). There were no instances of serious morbidity or mortality. Ten percent of patients developed worsening facial numbness and 8% described their numbness as 'very bothersome.' Conclusions: GKRS salvage for refractory TN is well tolerated and results in long-term pain relief in approximately half the patients treated. Clinicians may reconsider using GKRS to salvage patients who have failed prior MVD.

  17. Presentation of pain and nerve involvement in trigeminal neuralgia patients

    International Nuclear Information System (INIS)

    Luqman, U.; Ahmed, A.; Janjua, O.S.; Umair, M.


    Objective: To determine pain distribution and nerve involvement of trigeminal neuralgia (TN) patients at Armed Forces Institute of Dentistry, Rawalpindi. Material and Methods: A one year cross sectional study from Feb 2009 to Feb 2010 of TN patients was conducted in oral and maxillofacial surgery department, Armed Forces Institute of Dentistry, Rawalpindi. A detailed history of patients suffering from TN was taken followed by thorough extra-oral and intra-oral examination. The parameters analyzed included age of onset, gender, site of involvement, nerve branch involvement and clinical presentations. History and clinical features of already diagnosed cases with TN was included as such. Results: A total of 52 patients were included in the study. The patients had a mean age of 52.25 +- 14.82 years. The male to female ratio was 1:1.3. The mean age of onset was 48.5 +- 13.3 years. Right side was involved in 59.6% of the patients. V2 was most commonly involved nerve (59.6%), followed by V3 (53.8%) and V1 (13.7%). Forty six percent of patients gave history of extractions of teeth as a treatment for this condition. Forty two percent recalled or had previous medical records prescribed with antibiotics and pain killers. Conclusion: TN in our population is more frequent in females and with more right side involvement. Maxillary division is most commonly affected followed by the mandibular nerve. It is a rare disorder and most of these patients are inadequately diagnosed and treated. Keeping the disease in differential diagnosis of atypical pain without local pathology is advised. (author)

  18. An unusual presentation of trigeminal neuralgia caused by fibrous dysplasia (managed with radiofrequency lesioning

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    Muralidhar Joshi


    Full Text Available Fibrous dysplasia (FD is a skeletal developmental disorder of the unknown etiology, uncertain pathogenesis, and diverse histopathology with one-fourth involving head and neck. The aim of this article is to report a rare case of craniofacial FD of the maxillary sinus as an etiology of trigeminal neuralgia treated with radiofrequency lesioning.

  19. Somesthetic, gustatory, olfactory function and salivary flow in patients with neuropathic trigeminal pain. (United States)

    Siviero, M; Teixeira, M J; de Siqueira, J T T; Siqueira, S R D T


    To determine somesthetic, olfactory, gustative and salivary abnormalities in patients with burning mouth syndrome (BMS), idiopathic trigeminal neuralgia (ITN) and trigeminal postherpetic neuralgia (PHN). Twenty patients from each group (BMS, ITN, PHN) and 60 healthy controls were evaluated with a systematized quantitative approach of thermal (cold and warm), mechanical, pain, gustation, olfaction and salivary flow; data were analyzed with ANOVA, Tukey, Kruskal-Wallis and Dunn tests with a level of significance of 5%. There were no salivary differences among the groups with matched ages; the cold perception was abnormal only at the mandibular branch of PHN (P = 0.001) and warm was abnormal in all trigeminal branches of PHN and BMS; mechanical sensitivity was altered at the mandibular branch of PHN and in all trigeminal branches of BMS. The salty, sweet and olfactory thresholds were higher in all studied groups; the sour threshold was lower and there were no differences of bitter. All groups showed abnormal thresholds of gustation and olfaction; somesthetic findings were discrete in ITN and more common in PHN and BMS; central mechanisms of balance of sensorial inputs might be underlying these observations.

  20. Whole transcriptome expression of trigeminal ganglia compared to dorsal root ganglia in Rattus Norvegicus

    DEFF Research Database (Denmark)

    Kogelman, Lisette Johanna Antonia; Christensen, Rikke Elgaard; Pedersen, Sara Hougaard


    The trigeminal ganglia (TG) subserving the head and the dorsal root ganglia (DRG) subserving the rest of the body are homologous handling sensory neurons. Differences exist, as a number of signaling substances cause headache but no pain in the rest of the body. To date, very few genes involved in...


    NARCIS (Netherlands)



    Projections of the parvocellular reticular nucleus (PCRt) to the contralateral mesencephalic trigeminal nucleus (Me5) were studied in the rat with neurophysiological and neuroanatomical techniques. Three types of responses (classified by latencies) were recorded extracellularly in the Me5 area after

  2. Modulation of inflammatory mediators in the trigeminal ganglion by botulinum neurotoxin type A

    DEFF Research Database (Denmark)

    Edvinsson, Jacob; Warfvinge, Karin; Edvinsson, Lars


    BACKGROUND: Onabotulinumtoxin type A (BoNT-A) has been found to reduce pain in chronic migraine. The aim of the present study was to ask if BoNT-A can interact directly on sensory mechanisms in the trigeminal ganglion (TG) using an organ culture method. METHODS: To induce inflammation, rat TGs we...

  3. Magnetic resonance neurography in the management of peripheral trigeminal neuropathy: experience in a tertiary care centre

    Energy Technology Data Exchange (ETDEWEB)

    Cox, Brian; Chhabra, Avneesh [UT Southwestern Medical Center, Department of Radiology, Dallas, TX (United States); Zuniga, John R. [UT Southwestern Medical Center, Department of Oral and Maxillofacial Surgery, Surgery, Neurology and Neurotherapeutics, Dallas, TX (United States); Panchal, Neeraj [University of Pennsylvania, Department of Oral Maxillofacial Surgery, Philadelphia, PA (United States); Cheng, Jonathan [UT Southwestern Medical Center, Department of Plastic Surgery, Dallas, TX (United States)


    This tertiary care experience examines the utility of magnetic resonance neurography (MRN) in the management of peripheral trigeminal neuropathies. Seventeen patients with clinically suspected peripheral trigeminal neuropathies (inferior alveolar nerve and lingual nerve) were imaged uniformly with 1.5-T examinations. MRN results were correlated with clinical and surgical findings in operated patients and the impact on clinical management was assessed. Clinical findings included pain (14/17), sensory changes (15/17), motor changes (2/17) and palpable masses (3/17). Inciting events included prior dental surgery (12/17), trauma (1/17) and idiopathic incidents (4/17). Non-affected side nerves and trigeminal nerves in the intracranial and skull base course were normal in all cases. Final diagnoses on affected sides were nerve inflammation (4/17), neuroma in continuity (2/17), LN transection (1/17), scar entrapment (3/17), infectious granuloma (1/17), low-grade injuries (3/17) and no abnormality (3/17). Associated submandibular gland and sublingual gland oedema-like changes were seen in 3/17 cases because of parasympathetic effects. Moderate-to-excellent MRN-surgical correlation was seen in operated (8/17) patients, and neuroma and nerve transection were prospectively identified in all cases. MRN is useful for the diagnostic work-up of suspected peripheral trigeminal neuropathy patients with significant impact on clinical management and moderate-to-excellent correlation with intra-operative findings. (orig.)

  4. Development of primary sensory neurons in the trigeminal nervous system; dependency on neurotrophins and other substances

    Directory of Open Access Journals (Sweden)

    Hiroyuki Ichikawa


    Full Text Available This review presents information about the development of primary sensory neurons in the trigeminal nervous system. The deficiency of high affinity receptors for nerve growth factor (trkA and neurotrophin-3 (trk-C causesa reduction of primary nociceptors in the trigeminal ganglion (TG. The disruption of trkB, a receptor for brain-derived neurotrophic factor and neurotrophin-4, causes a loss of Meissner endings in the palate and Ruffini endings in the periodontal ligament. The number of Merkel cells in palatal rugae is also severely reduced by the absence of trkA, trkB or trkC. In the mesencephalic trigeminal tract nucleus (Mes5, primary proprioceptors are decreased by 50% in trkC null mutant mice. On the other hand, the deficiency of Brn-3a, a member of the POU family of transcription factors, decreases primary nociceptors and low-threshold mechanoreceptors in the TG. In the Mes5 of Brn-3a knockout mice, primary proprioceptors are completely lost. In addition, the disruption of dystonin which is a member of the plakin family of high molecular weight cytoskeletal linker proteins causes a reduction of nociceptors in the TG but not proprioceptors in the Mes5. The dependency of primary nociceptors, low-threshold mechanoreceptors and proprioceptors on neurotrophins, Brn-3a and dystonin in the trigeminal nervous system is discussed.

  5. Cracked tooth syndrome mimicking trigeminal autonomic cephalalgia: A report of four cases. (United States)

    Noma, Noboru; Shimizu, Kohei; Watanabe, Kosuke; Young, Andrew; Imamura, Yoshiki; Khan, Junad


    This report describes four cases of cracked tooth syndrome secondary to traumatic occlusion that mimicked trigeminal autonomic cephalalgias. All patients were referred by general practitioners to the Orofacial Pain Clinic at Nihon University Dental School for assessment of atypical facial pain. Case 1: A 51-year-old woman presented with severe pain in the maxillary and mandibular left molars. Case 2: A 47-year-old woman presented with sharp, shooting pain in the maxillary left molars, which radiated to the temple and periorbital region. Case 3: A 49-year-old man presented with sharp, shooting, and stabbing pain in the maxillary left molars. Case 4: A 38-year-old man presented with intense facial pain in the left supraorbital and infraorbital areas, which radiated to the temporoparietal and maxillary regions. All cases mimicked trigeminal autonomic cephalalgias, a group of primary headache disorders characterized by unilateral facial pain and ipsilateral cranial autonomic symptoms. Trigeminal autonomic cephalalgias include cluster headache, paroxysmal hemicrania, hemicrania continua, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing/short-lasting neuralgiform headache attacks with cranial autonomic features. Pulpal necrosis, when caused by cracked tooth syndrome, can manifest with pain frequencies and durations that are unusual for pulpitis, as was seen in these cases. Although challenging, differentiation of cracked tooth syndrome from trigeminal autonomic cephalalgias is a necessary skill for dentists.

  6. New Insights in Trigeminal Anatomy: A Double Orofacial Tract for Nociceptive Input

    NARCIS (Netherlands)

    Henssen, D.J.H.A.; Kurt, E.; Kozicz, L.T.; Dongen, R.T.M. van; Bartels, R.H.M.A.; Cappellen van Walsum, A.M. van


    Orofacial pain in patients relies on the anatomical pathways that conduct nociceptive information, originating from the periphery towards the trigeminal sensory nucleus complex (TSNC) and finally, to the thalami and the somatosensorical cortical regions. The anatomy and function of the so-called

  7. Percutaneous radiofrequency rhizotomy and neurovascular decompression of the trigeminal nerve for the treatment of facial pain Rizotomia percutânea por radiofreqüência e a descompressão neurovascular do nervo trigêmeo no tratamento das algias faciais

    Directory of Open Access Journals (Sweden)

    Manoel J. Teixeira


    Full Text Available OBJECTIVE: To determine the outcomes of 354 radiofrequency rhizotomies and 21 neurovascular decompressions performed as treatment for 367 facial pain patients (290 idiopathic trigeminal neuralgia, 52 symptomatic trigeminal neuralgia, 16 atypical facial pain, 9 post-herpetic neuralgia. METHOD: Clinical findings and surgery success rate were considered for evaluation. A scale of success rate was determined to classify patients, which considered pain relief and functional/sensorial deficits. RESULTS: Radiofrequency rhizotomy was performed in 273 patients with idiopathic trigeminal neuralgia and in all other patients, except for trigeminal neuropathy; neurovascular decompression was performed in 18 idiopathic trigeminal neuralgia patients; 100% idiopathic trigeminal neuralgia, 96.2% symptomatic trigeminal neuralgia, 37.5% atypical facial pain and 88.9% post-herpetic neuralgia had pain relief. CONCLUSION: Both techniques for idiopathic trigeminal neuralgia are usefull. Radiofrequency rhizotomy was also efficient to treat symptomatic facial pain, and post-herpetic facial pain, but is not a good technique for atypical facial pain.OBJETIVO: Determinar eficácia e achados pós-operatórios após 354 rizotomias por radiofreqüência e 21 descompressões neurovasculares como tratamento de 367 pacientes com dor facial (290 neuralgia idiopática do trigêmeo, 52 neuralgia sintomática do trigêmeo, 16 dor facial atípica, 9 neuralgia pós-herpética. MÉTODO: Achados clínicos e taxa de sucesso das cirurgias foram considerados para a avaliação. Uma escala avaliando alívio da dor e complicações sensoriais e funcionais foi utilizada para classificar os pacientes. RESULTADOS: A rizotomia por radiofreqüência foi realizada em 273 pacientes com neuralgia idiopática do trigêmeo e em todos os outros pacientes, exceto neuropatia trigeminal; descompressão neurovascular foi realizada em 18 pacientes com neuralgia idiopática do trigêmeo; 100% dos pacientes

  8. Prostaglandin E2 receptor expression in the rat trigeminal-vascular system and other brain structures involved in pain

    DEFF Research Database (Denmark)

    Myren, Maja; Olesen, Jes; Gupta, Saurabh


    Prostaglandin E(2) (PGE(2)) is considered to be a key mediator in migraine pathophysiology. PGE(2) acts via four receptors (EP(1)-EP(4)) but their distribution in the brain districts implicated in migraine has yet to be delineated. We quantified amount of mRNA and protein expression for the EP...... receptors in both peripheral and central structures involved in pain transmission and perception in migraine: dura mater, cerebral arteries, trigeminal ganglion, trigeminal nucleus caudalis, periaqueductal grey, thalamus, hypothalamus, cortex, pituitary gland, hippocampus and cerebellum. In the trigeminal...

  9. Trigeminal neuralgia--a coherent cross-specialty management program. (United States)

    Heinskou, Tone; Maarbjerg, Stine; Rochat, Per; Wolfram, Frauke; Jensen, Rigmor Højland; Bendtsen, Lars


    Optimal management of patients with classical trigeminal neuralgia (TN) requires specific treatment programs and close collaboration between medical, radiological and surgical specialties. Organization of such treatment programs has never been described before. With this paper we aim to describe the implementation and feasibility of an accelerated cross-speciality management program, to describe the collaboration between the involved specialties and to report the patient flow during the first 2 years after implementation. Finally, we aim to stimulate discussions about optimal management of TN. Based on collaboration between neurologists, neuroradiologists and neurosurgeons a standardized program for TN was implemented in May 2012 at the Danish Headache Center (DHC). First out-patient visit and subsequent 3.0 Tesla MRI scan was booked in an accelerated manner. The MRI scan was performed according to a special TN protocol developed for this program. Patients initially referred to neurosurgery were re-directed to DHC for pre-surgical evaluation of diagnosis and optimization of medical treatment. Follow-up was 2 years with fixed visits where medical treatment and indication for neurosurgery was continuously evaluated. Scientific data was collected in a structured and prospective manner. From May 2012 to April 2014, 130 patients entered the accelerated program. Waiting time for the first out-patient visit was 42 days. Ninety-four percent of the patients had a MRI performed according to the special protocol after a mean of 37 days. Within 2 years follow-up 35% of the patients were referred to neurosurgery after a median time of 65 days. Five scientific papers describing demographics, clinical characteristics and neuroanatomical abnormalities were published. The described cross-speciality management program proved to be feasible and to have acceptable waiting times for referral and highly specialized work-up of TN patients in a public tertiary referral centre for headache

  10. Vagus nerve stimulation inhibits trigeminal nociception in a rodent model of episodic migraine (United States)

    Hawkins, Jordan L.; Cornelison, Lauren E.; Blankenship, Brian A.; Durham, Paul L.


    Abstract Introduction: Although neck muscle tension is considered a risk factor for migraine, pungent odors can act as a trigger to initiate an attack in sensitized individuals. Although noninvasive vagus nerve stimulation (nVNS) is now an approved treatment for chronic migraine, how it functions to inhibit trigeminal nociception in an episodic migraine model is not known. Objectives: The objectives of this study were to determine if nVNS could inhibit trigeminal nociception in a novel model of episodic migraine and investigate changes in the expression of proteins implicated in peripheral and central sensitization. Methods: Sprague-Dawley male rats were injected with an inflammatory agent in the trapezius muscle before exposure to pungent volatile compounds, which was used to initiate trigeminal nociceptor activation. The vagus nerve was stimulated transdermally by a 1-ms pulse of 5 kHz sine waves, repeated at 25 Hz for 2 minutes. Nocifensive head withdrawal response to von Frey filaments was determined and immunoreactive protein levels in the spinal cord and trigeminal ganglion (TG) were investigated. Results: Exposure to the pungent odor significantly increased the number of nocifensive withdrawals in response to mechanical stimulation of sensitized TG neurons mediated by neck muscle inflammation. Noninvasive vagus nerve stimulation inhibited nociception and repressed elevated levels of P-ERK in TG, Iba1 in microglia, and GFAP in astrocytes from sensitized animals exposed to the pungent odor. Conclusion: Our findings demonstrate that nVNS inhibits mechanical nociception and represses expression of proteins associated with peripheral and central sensitization of trigeminal neurons in a novel rodent model of episodic migraine. PMID:29392242

  11. Elevated Fractalkine (CX3CL1) Levels in the Trigeminal Ganglion Mechanically Sensitize Temporalis Muscle Nociceptors. (United States)

    Cairns, Brian E; O'Brien, Melissa; Dong, Xu-Dong; Gazerani, Parisa


    It has been proposed that after nerve injury or tissue inflammation, fractalkine (CX3CL1) released from dorsal root ganglion neurons acts on satellite glial cells (SGCs) through CX3C receptor 1 (CX3CR1) to induce neuroplastic changes. The existence and importance of fractalkine/CX3CR1 signaling in the trigeminal ganglia has not yet been clarified. This study investigated (1) whether trigeminal ganglion neurons that innervate temporalis muscle and their associated SGCs contain fractalkine and/or express CX3CR1, (2) if intraganglionic injection of fractalkine increases the mechanical sensitivity of temporalis muscle afferent fibers, (3) whether complete Freund's adjuvant (CFA)-induced inflammation of the temporalis muscle alters the expression of fractalkine or its receptor in the trigeminal ganglion, and (4) if intraganglionic administration of CX3CR1 antibodies alters afferent mechanical sensitivity. Immunohistochemistry and in vivo electrophysiological recordings in male and female rats were used to address these questions. It was found that ∼50 % of temporalis ganglion neurons and ∼25 % of their associated SGCs express CX3CR1, while only neurons expressed fractalkine. Temporalis muscle inflammation increased the expression of fractalkine, but only in male rats. Intraganglionic injection of fractalkine (25 g/ml; 3 μl) induced prolonged afferent mechanical sensitization. Intraganglionic injection of CX3CR1 antibody increased afferent mechanical threshold, but this effect was greater in controls than in rats with CFA-induced muscle inflammation. These findings raise the possibility that basal fractalkine signalling within the trigeminal ganglion plays an important role in mechanical sensitivity of masticatory muscle sensory afferent fibers and that inhibition of CX3CR1 signaling within the trigeminal ganglia may induce analgesia through a peripheral mechanism.

  12. Distribution of 5-HT1FReceptors in Monkey Vestibular and Trigeminal Ganglion Cells. (United States)

    Usman, Habiba O; Balaban, Carey D


    Evidence of serotonergic involvement in vestibular pathway contributions to migraine and balance disorders is compelling. Serotonergic 5-HT 1B and 5-HT 1D receptors are expressed extensively in inner ear ganglia of monkeys and rats. The serotonergic 5-HT 1F receptor is also a target of triptans. This study describes its distribution in vestibular and trigeminal ganglia of monkeys. Using primary polyclonal antibodies raised against oligopeptides specific for the human 5-HT 1F receptor, neuronal somatic area and intensity of immunoreactive vestibular and trigeminal ganglia were quantified. Virtually all vestibular and considerable trigeminal ganglia showed positive 5-HT 1F receptor immunoreactivity. Inferior and superior vestibular ganglia staining appeared confined to distinct cell regions, varying considerably among cells of different sizes: more intense in small, punctate in some medium and regionally polarized in some large cells. Analyses of average somatic vestibular neuronal immunoreactive intensity identified mainly medium sized cells with high standard deviation of intensity corresponding to punctately stained cells. Less variability occurred in somatic intensity staining and cellular distribution among 5-HT 1F receptor immunopositive trigeminal ganglia. Most exhibited similar punctate staining patterns, higher mean somatic immunoreactive intensity and larger neuronal somatic size proportions per size distribution subpopulation compared to vestibular ganglia size distribution populations. Centrally directed vestibular ganglion neuronal processes, cochlear inner hair cells, vestibular hair cells and blood vessels in vestibular maculae and cristae were immunoreactive. The 5-HT 1F receptor expression in vestibular ganglia shows complex variable staining intensity patterns associated with cell size of immunopositive neurons, not seen in immunopositive trigeminal ganglia and not previously evident with 5-HT 1B and 5-HT 1D receptor subtype immunoreactivity in

  13. Clinical value of a self-designed training model for pinpointing and puncturing trigeminal ganglion. (United States)

    He, Yu-Quan; He, Shu; Shen, Yun-Xia; Qian, Cheng


    OBJECTIVES. A training model was designed for learners and young physicians to polish their skills in clinical practices of pinpointing and puncturing trigeminal ganglion. METHODS. A head model, on both cheeks of which the deep soft tissue was replaced by stuffed organosilicone and sponge while the superficial soft tissue, skin and the trigeminal ganglion were made of organic silicon rubber for an appearance of real human being, was made from a dried skull specimen and epoxy resin. Two physicians who had experiences in puncturing foramen ovale and trigeminal ganglion were selected to test the model, mainly for its appearance, X-ray permeability, handling of the puncture, and closure of the puncture sites. Four inexperienced physicians were selected afterwards to be trained combining Hartel's anterior facial approach with the new method of real-time observation on foramen ovale studied by us. RESULTS. Both appearance and texture of the model were extremely close to those of a real human. The fact that the skin, superficial soft tissue, deep muscles of the cheeks, and the trigeminal ganglion made of organic silicon rubber all had great elasticity resulted in quick closure and sealing of the puncture sites. The head model made of epoxy resin had similar X-ray permeability to a human skull specimen under fluoroscopy. The soft tissue was made of radiolucent material so that the training can be conducted with X-ray guidance. After repeated training, all the four young physicians were able to smoothly and successfully accomplish the puncture. CONCLUSION. This self-made model can substitute for cadaver specimen in training learners and young physicians on foramen ovale and trigeminal ganglion puncture. It is very helpful for fast learning and mastering this interventional operation skill, and the puncture accuracy can be improved significantly with our new method of real-time observation on foramen ovale.

  14. Long-Term Results for Trigeminal Schwannomas Treated With Gamma Knife Surgery

    Energy Technology Data Exchange (ETDEWEB)

    Hasegawa, Toshinori, E-mail:; Kato, Takenori; Iizuka, Hiroshi; Kida, Yoshihisa


    Purpose: Surgical resection is considered the desirable curative treatment for trigeminal schwannomas. However, complete resection without any complications remains challenging. During the last several decades, stereotactic radiosurgery (SRS) has emerged as a minimally invasive treatment modality. Information regarding long-term outcomes of SRS for patients harboring trigeminal schwannomas is limited because of the rarity of this tumor. The aim of this study was to evaluate long-term tumor control and functional outcomes in patients harboring trigeminal schwannomas treated with SRS, specifically with gamma knife surgery (GKS). Methods and Materials: Fifty-three patients harboring trigeminal schwannomas treated with GKS were evaluated. Of these, 2 patients (4%) had partial irradiation of the tumor, and 34 patients (64%) underwent GKS as the initial treatment. The median tumor volume was 6.0 cm{sup 3}. The median maximum and marginal doses were 28 Gy and 14 Gy, respectively. Results: The median follow-up period was 98 months. On the last follow-up image, 7 patients (13%) had tumor enlargement, including the 2 patients who had partial treatment. Excluding the 2 patients who had partial treatment, the actuarial 5- and 10-year progression-free survival (PFS) rates were 90% and 82%, respectively. Patients with tumors compressing the brainstem with deviation of the fourth ventricle had significantly lower PFS rates. If those patients with tumors compressing the brainstem with deviation of the fourth ventricle are excluded, the actuarial 5- and 10-year PFS rates increased to 95% and 90%, respectively. Ten percent of patients had worsened facial numbness or pain in spite of no tumor progression, indicating adverse radiation effect. Conclusions: GKS can be an acceptable alternative to surgical resection in patients with trigeminal schwannomas. However, large tumors that compress the brainstem with deviation of the fourth ventricle should be surgically removed first and then

  15. Localization of CGRP, CGRP receptor, PACAP and glutamate in trigeminal ganglion. Relation to the blood-brain barrier

    DEFF Research Database (Denmark)

    Eftekhari, Sajedeh; Salvatore, Christopher A; Johansson, Sara


    Calcitonin gene-related peptide (CGRP) receptor antagonists have demonstrated anti-migraine efficacy. One remaining question is where do these blockers act? We hypothesized that the trigeminal ganglion could be one possible site. We examined the binding sites of a CGRP receptor antagonist (MK-3207......) and related this to the expression of CGRP and its receptor in rhesus trigeminal ganglion. Pituitary adenylate cyclase-activating polypeptide (PACAP) and glutamate were examined and related to the CGRP system. Furthermore, we examined if the trigeminal ganglion is protected by the blood-brain barrier (BBB......). Autoradiography was performed with [(3)H]MK-3207 to demonstrate receptor binding sites in rhesus trigeminal ganglion (TG). Immunofluorescence was used to correlate binding and the presence of CGRP and its receptor components, calcitonin receptor-like receptor (CLR) and receptor activity-modifying protein 1 (RAMP1...

  16. Quantitative sensory testing in classical trigeminal neuralgia-a blinded study in patients with and without concomitant persistent pain

    DEFF Research Database (Denmark)

    Younis, Samaira; Maarbjerg, Stine; Reimer, Maren


    The diagnostic criteria of the third International Classification of Headache Disorders state that there should be no neurological deficits in patients with classical trigeminal neuralgia (TN) at clinical examination. However, studies demonstrating sensory abnormalities at bedside examination in TN...

  17. Central sensitization of the trigeminal and somatic nociceptive systems in medication overuse headache mainly involves cerebral supraspinal structures. (United States)

    Ayzenberg, I; Obermann, M; Nyhuis, P; Gastpar, M; Limmroth, V; Diener, H C; Kaube, H; Katsarava, Z


    Trigeminal and somatic nociceptive systems were studied in controls (n=15), episodic migraine (n=16), analgesics (n=14) and triptan-induced medication overuse headache (MOH) (n=15) before and after withdrawal. Patients with MOH and comorbid depressive symptoms and depression without headache were studied to investigate the influence of depression. Trigeminal nociception was studied by simultaneous registration of pain-related cortical potentials (PREP) and nociceptive blink reflex (nBR) following nociceptive-specific electrical stimulation of the forehead. Somatic nociception was evaluated using PREP of upper limbs. We found facilitation of both trigeminal and somatic PREP but not of nBR in MOH, which normalized after withdrawal. No differences were found comparing analgesics vs. triptan MOH. No differences were observed between controls and patients with episodic migraine and depression without headache. A transient facilitation was found of trigeminal and somatic nociceptive systems in MOH, which was more pronounced on a supraspinal level.

  18. Evaluation of a novel mouse model of intracisternal strychnine-induced trigeminal allodynia. (United States)

    Lee, Il-Ok; Whitehead, Ryan A; Ries, Craig R; Schwarz, Stephan K W; Puil, Ernest; MacLeod, Bernard A


    Intractable neuropathic dynamic allodynia remains one of the major symptoms of human trigeminal neuropathy and is commonly accepted to be the most excruciatingly painful condition known to humankind. At present, a validated animal model of this disorder is necessary for efficient and effective development of novel drug treatments. Intracisternal strychnine in rats has been shown to result in localized trigeminal dynamic allodynia, thus representing a possible model of trigeminal neuralgia. The purpose of this study was to validate a mouse model of trigeminal glycinergic inhibitory dysfunction using established positive (carbamazepine epoxide) and negative (morphine) controls. The actions of conventional first-line treatment (carbamazepine epoxide [CBZe]) and clinically ineffective morphine were tested for trigeminal dynamic mechanical allodynia produced by intracisternal strychnine. In mice under halothane anesthesia, we injected either strychnine (0.3 μg), strychnine with CBZe (4 ng), or artificial cerebrospinal fluid (aCSF) intracisternally (i.c.). In a separate set of experiments, subcutaneous morphine (3 mg·kg(-1) sc) was injected with intracisternal strychnine. Dynamic mechanical allodynia was induced by stroking the fur with polyethylene (PE-10) tubing. The response of each mouse was rated to determine its allodynia score, and scores of each group were compared. In addition, in a separate dichotomous disequilibrium study, pairs of mice were injected with strychnine/saline, strychnine/strychnine-CBZe, or strychnine/strychnine-morphine. A blinded observer recorded which mouse of each pair had the greater global pain behaviour. Strychnine (i.c.) produced higher quantitative allodynia scores in the trigeminal distribution (mean 81.5%; 95% confidence interval [CI] 76.4 to 86.6) vs the aCSF group (mean 11.3%; 95% CI 8.1 to 14.4) (P strychnine (mean 83.2%; 95% CI 78.1 to 88.4) vs strychnine alone (mean 3.2%; 95% CI -0.9 to 7.2) (P strychnine did not result in

  19. Distinct development of peripheral trigeminal pathways in the platypus (Ornithorhynchus anatinus) and short-beaked echidna (Tachyglossus aculeatus). (United States)

    Ashwell, Ken W S; Hardman, Craig D; Giere, Peter


    The extant monotremes (platypus and echidnas) are believed to all be capable of electroreception in the trigeminal pathways, although they differ significantly in the number and distribution of electroreceptors. It has been argued by some authors that electroreception was first developed in an aquatic environment and that echidnas are descended from a platypus-like ancestor that invaded an available terrestrial habitat. If this were the case, one would expect the developmental trajectories of the trigeminal pathways to be similar in the early stages of platypus and short-beaked echidna development, with structural divergence occurring later. We examined the development of the peripheral trigeminal pathway from snout skin to trigeminal ganglion in sectioned material in the Hill and Hubrecht collections to test for similarities and differences between the two during the development from egg to adulthood. Each monotreme showed a characteristic and different pattern of distribution of developing epidermal sensory gland specializations (electroreceptor primordia) from the time of hatching. The cross-sectional areas of the trigeminal divisions and the volume of the trigeminal ganglion itself were also very different between the two species at embryonic ages, and remained consistently different throughout post-hatching development. Our findings indicate that the trigeminal pathways in the short-beaked echidna and the platypus follow very different developmental trajectories from the earliest ages. These findings are more consistent with the notion that the platypus and echidna have both diverged from an ancestor with rudimentary electroreception and/or trigeminal specialization, rather than the contention that the echidna is derived from a platypus-like ancestor. Copyright © 2011 S. Karger AG, Basel.

  20. Microvascular Decompression for Classical Trigeminal Neuralgia Caused by Venous Compression: Novel Anatomic Classifications and Surgical Strategy. (United States)

    Wu, Min; Fu, Xianming; Ji, Ying; Ding, Wanhai; Deng, Dali; Wang, Yehan; Jiang, Xiaofeng; Niu, Chaoshi


    Microvascular decompression of the trigeminal nerve is the most effective treatment for trigeminal neuralgia. However, when encountering classical trigeminal neuralgia caused by venous compression, the procedure becomes much more difficult, and failure or recurrence because of incomplete decompression may become frequent. This study aimed to investigate the anatomic variation of the culprit veins and discuss the surgical strategy for different types. We performed a retrospective analysis of 64 consecutive cases in whom veins were considered as responsible vessels alone or combined with other adjacent arteries. The study classified culprit veins according to operative anatomy and designed personalized approaches and decompression management according to different forms of compressive veins. Curative effects were assessed by the Barrow Neurological Institute (BNI) pain intensity score and BNI facial numbness score. The most commonly encountered veins were the superior petrosal venous complex (SPVC), which was artificially divided into 4 types according to both venous tributary distribution and empty point site. We synthetically considered these factors and selected an approach to expose the trigeminal root entry zone, including the suprafloccular transhorizontal fissure approach and infratentorial supracerebellar approach. The methods of decompression consist of interposing and transposing by using Teflon, and sometimes with the aid of medical adhesive. Nerve combing (NC) of the trigeminal root was conducted in situations of extremely difficult neurovascular compression, instead of sacrificing veins. Pain completely disappeared in 51 patients, and the excellent outcome rate was 79.7%. There were 13 patients with pain relief treated with reoperation. Postoperative complications included 10 cases of facial numbness, 1 case of intracranial infection, and 1 case of high-frequency hearing loss. The accuracy recognition of anatomic variation of the SPVC is crucial for the

  1. Keyhole craniotomy through retrosigmoid approach followed by microvascular decompression for primary trigeminal neuralgia:a report of 23 cases

    Directory of Open Access Journals (Sweden)

    Gang-ge CHENG


    Full Text Available Objective To explore the surgical technique,effects,and complications of keyhole craniotomy through retrosigmoid approach followed by microvascular decompression for primary trigeminal neuralgia.Methods The craniotomy with a keyhole incision above postauricular hairline followed by microvascular decompression was performed in 23 patients with primary trigeminal neuralgia.Dissection of intracranial part of trigeminal nerve under microscope was done to search for the offending vessels,which were thereby freed and between which and the root entry zone(REZ of trigeminal nerve the Teflon grafts were placed.Effects and complications were observed in follow-up,ranging from 1 month to 2 years.Results Out of 23 patients who were all found compression in REZ of trigeminal nerves by the offending vessels in operation,disappearance of symptoms post-surgery was found in 22 cases,face numbness on the surgical side in 3 cases and no effects in 1 case.Recurrence of pain was not observed in patients who had initially benefited from the surgery at the follow-up.Conclusion The keyhole craniotomy through retrosigmoid approach followed by microvascular decompression is safe and effective for primary trigeminal neuralgia,in which accurate technique during operation plays a vital role in the decrease of complications and the outcome post-surgery.

  2. RNA sequencing of trigeminal ganglia in Rattus Norvegicus after glyceryl trinitrate infusion with relevance to migraine

    DEFF Research Database (Denmark)

    Pedersen, Sara Hougaard; Sørensen, Lasse Maretty; Ramachandran, Roshni


    INTRODUCTION: Infusion of glyceryl trinitrate (GTN), a donor of nitric oxide, induces immediate headache in humans that in migraineurs is followed by a delayed migraine attack. In order to achieve increased knowledge of mechanisms activated during GTN-infusion this present study aims to investigate...... transcriptional responses to GTN-infusion in the rat trigeminal ganglia. METHODS: Rats were infused with GTN or vehicle and trigeminal ganglia were isolated either 30 or 90 minutes post infusion. RNA sequencing was used to investigate transcriptomic changes in response to the treatment. Furthermore, we developed...... a novel method for Gene Set Analysis Of Variance (GSANOVA) to identify gene sets associated with transcriptional changes across time. RESULTS: 15 genes displayed significant changes in transcription levels in response to GTN-infusion. Ten of these genes showed either sustained up- or down...

  3. Orbital exenteration under trigeminal block: An innovative method of regional anesthesia

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    Manjunath Timmappa Bhat


    Full Text Available Orbital exenteration is a disfiguring operation involving the removal of the entire contents of the orbit, with or without the eyelids. It is widely felt that such extensive surgery can only be performed under general anesthesia. We report our experience with a patient who underwent orbitalexenteration under trigeminal block with intravenous sedation. A 68-year-old male patient was diagnosed to have orbital cellulitis (mucormycosis, uncontrolled diabetes mellitus, ischemic heart disease, dilated cardiomyopathy with severe left ventricular systolic dysfunction with severe pulmonary artery hypertension, and nephropathy. We decided to avoid general anesthesia for such a high-risk patient with many co-morbid illnesses. We gave trigeminal block using a 22-G spinal needle with local anesthetic solution of bupivacaine 0.5% by classic approach. A standard exenteration was performed and the patient tolerated the procedure well with no complications.

  4. Glutamate release from satellite glial cells of the murine trigeminal ganglion. (United States)

    Wagner, Lysann; Warwick, Rebekah A; Pannicke, Thomas; Reichenbach, Andreas; Grosche, Antje; Hanani, Menachem


    It has been proposed that glutamate serves as a mediator between neurons and satellite glial cells (SGCs) in sensory ganglia and that SGCs release glutamate. Using a novel method, we studied glutamate release from SGCs from murine trigeminal ganglia. Sensory neurons with adhering SGCs were enzymatically isolated from wild type and transgenic mice in which vesicular exocytosis was suppressed in glial cells. Extracellular glutamate was detected by microfluorimetry. After loading the cells with a photolabile Ca(2+) chelator, the intracellular Ca(2+) concentration was raised in SGCs by a UV pulse, which resulted in glutamate release. The amount of released glutamate was decreased in cells with suppressed exocytosis and after pharmacological block of hemichannels. The data demonstrate that SGCs of the trigeminal ganglion release glutamate in a Ca(2+)-dependent manner. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  5. Focal atrophy of the masticatory muscles caused by pure trigeminal motor neuropathy: case report. (United States)

    Wilson, M H; Hodgson, E J; Felstead, A M


    Pure trigeminal motor neuropathy is rare and characterised by weakness of the mandibular motor branch with no signs of involvement of the trigeminal sensory or other cranial nerve. Its aetiology is unclear but it has been hypothesised that a viral infection may be a cause. Magnetic resonance imaging is useful in its diagnosis and typically shows loss of volume of the affected masticatory muscles and infiltration of fat. We describe the case of a 29-year-old woman who presented with a 12-year history of progressive facial asymmetry, which was later shown on imaging to be caused by unilateral atrophy of the masseter with compensatory contralateral hypertrophy. Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  6. Small Radiation Beam Dosimetry for Radiosurgery of Trigeminal Neuralgia: One Case Analysis

    International Nuclear Information System (INIS)

    Garcia-Garduno, O. A.; Larraga-Gutierrez, J. M.; Rodriguez-Villafuerte, M.; Martinez-Davalos, A.; Moreno-Jimenez, S.; Suarez-Campos, J. J.; Celis, M. A.


    The use of small radiation beams for trigeminal neuralgia (TN) treatment requires high precision and accuracy in dose distribution calculations and delivery. Special attention must be kept on the type of detector to be used. In this work, the use of GafChromic EBT registered radiochromic and X-OMAT V2 radiographic films for small radiation beam characterization is reported. The dosimetric information provided by the films (total output factors, tissue maximum ratios and off axis ratios) is compared against measurements with a shielded solid state (diode) reference detector. The film dosimetry was used for dose distribution calculations for the treatment of trigeminal neuralgia radiosurgery. Comparison of the isodose curves shows that the dosimetry produced with the X-OMAT radiographic film overestimates the dose distributions in the penumbra region

  7. Investigation of the abnormal nasal aerodynamics and trigeminal functions among empty nose syndrome patients. (United States)

    Li, Chengyu; Farag, Alexander A; Maza, Guillermo; McGhee, Sam; Ciccone, Michael A; Deshpande, Bhakthi; Pribitkin, Edmund A; Otto, Bradley A; Zhao, Kai


    Abnormal nasal aerodynamics or trigeminal functions have been frequently implicated in the symptomology of empty nose syndrome (ENS), yet with limited evidence. Individual computed tomography (CT)-based computational fluid dynamics (CFD) was applied to 27 ENS patients to simulate their nasal aerodynamics and compared with 42 healthy controls. Patients' symptoms were confirmed with Empty Nose Syndrome 6-item Questionnaire (ENS6Q), 22-item Sino-Nasal Outcome Test (SNOT-22), and Nasal Obstruction Symptom Evaluation (NOSE) scores. Nasal trigeminal sensitivity was measured with menthol lateralization detection thresholds (LDTs). ENS patients had significantly lower (∼25.7%) nasal resistance and higher (∼2.8 times) cross-sectional areas compared to healthy controls (both p aerodynamics in a large cohort of ENS patients. The results indicated that a combination of loss of neural sensitivity and poorer inferior air-mucosal stimulation may potentially lead to ENS symptomology. © 2017 ARS-AAOA, LLC.

  8. A Case of Acoustic Shock with Post-trauma Trigeminal-Autonomic Activation

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    Alain Londero


    Full Text Available This study reports the case of an acoustic shock injury (ASI, which did not result in a significant hearing loss, but was followed by manifold chronic symptoms both within (tinnitus, otalgia, tingling in the ear, tension in the ear, and red tympanum and outside the ears (blocked nose, pain in the neck/temporal region. We suggest that these symptoms may result from a loop involving injury to middle ear muscles, peripheral inflammatory processes, activation and sensitization of the trigeminal nerve, the autonomic nervous system, and central feedbacks. The pathophysiology of this ASI is reminiscent of that observed in post-traumatic trigeminal-autonomic cephalalgia. This framework opens new and promising perspectives on the understanding and medical management of ASI.

  9. Alcohol injection in the management of paroxysmal trigeminal neuralgia: a report of six cases. (United States)

    Chindia, M L; Ng'ang'a, P M


    The report revisits the role of alcohol in the treatment of paroxysmal trigeminal neuralgia (PTN). The study included 6 patients, 3 male and 3 female, average age 50 years. In 3 cases PTN involved both the infraorbital and mental nerves; in 2 cases the infraorbital alone while one case had buccal branch involvement. In each case 2mls standard Lignocaine was infiltrated at each site followed by 2mls 60% sterile alcohol. All patients reported swelling postoperatively. One case with mental and infraorbital nerve involvement complained of oral dysaesthesia. Another patient with similar involvement failed to respond and developed trismus. Responders remained pain-free for 9 months on average. While paroxysmal trigeminal neuralgia (PTN) has been recognised for centuries, the aetiology and definitive treatment remain obscure. Since this is a debilitating condition, management should aim at improving the quality of life. Alcohol is available, affordable and offers useful results where medical resources provide limited PTN treatment modalities.

  10. Comparison of Two Intravenous Sedation Techniques for Percutaneous Radiofrequency Trigeminal Rhizotomy: A Pilot Study


    Speedie, Lynn J.; Tung, Thomas J.; Shane, Sylvan M.; Chase, Gary A.; Brake, Nancy; Epstein, Melvin H.


    Conscious sedation, as used in dentistry and oral surgery, has been used satisfactorily to manage patients undergoing the intense pain encountered in radio frequency trigeminal rhizotomy for tic douloureux. The pain produced by this procedure cannot be blocked by local anesthesia. General anesthesia cannot be used because of the need for sensory testing in an awake, cooperative patient. Conscious sedation using alphaprodine, hydroxyzine, methohexital, and intensive behavioral modification was...

  11. Latent Herpes Simplex Virus 1 Infection Does Not Induce Apoptosis in Human Trigeminal Ganglia


    Himmelein, Susanne; Lindemann, Anja; Sinicina, Inga; Strupp, Michael; Brandt, Thomas; Hüfner, Katharina


    Herpes simplex virus 1 (HSV-1) can establish lifelong latency in human trigeminal ganglia. Latently infected ganglia contain CD8+ T cells, which secrete granzyme B and are thus capable of inducing neuronal apoptosis. Using immunohistochemistry and single-cell reverse transcription-quantitative PCR (RT-qPCR), higher frequency and transcript levels of caspase-3 were found in HSV-1-negative compared to HSV-1-positive ganglia and neurons, respectively. No terminal deoxynucleotidyltransferase-medi...

  12. Endoscope-assisted retrosigmoid intradural suprameatal approach for surgical treatment of trigeminal schwannomas. (United States)

    Samii, Madjid; Alimohamadi, Maysam; Gerganov, Venelin


    Trigeminal schwannomas are the most common intracranial nonvestibular schwannomas, and the dumbbell-shaped subtype is the most challenging. To evaluate the efficiency and safety of the endoscope-assisted retrosigmoid intradural suprameatal approach (EA-RISA) for dumbbell trigeminal schwannomas and to compare EA-RISA with classic RISA. A retrospective study of all patients with trigeminal schwannomas was performed with a focus on dumbbell tumors. Tumors were classified according to a modified Samii classification. Extent of tumor removal, outcome, and morbidity rates in the 2 subgroups were compared. Twenty patients were enrolled: 8 had dumbbell-shaped tumors (type C1), 8 had middle fossa tumors (A1-3), 3 had extracranial extension (D2), and 1 had posterior fossa tumor. Gross total resection was achieved in 15 and near-total resection in 5 patients. In 4 patients with dumbbell tumors, the classic RISA (Samii approach) was used; EA-RISA was used in the other 4 patients. The extent of petrous apex drilling was determined individually on the basis of the anatomic variability of suprameatal tubercle and degree of tumor-induced petrous apex erosion; in 2 patients, only minimal drilling was needed. The endoscope was applied after microsurgical tumor removal and in 3 of 4 patients revealed a significant unrecognized tumor remnant in the anterolateral and superolateral aspects of the Meckel cave. Thus, the EA-RISA technique allowed gross total resection of the tumor. The EA-RISA enlarges the exposure obtained with the classic RISA. Its judicious use can help achieve safe and radical removal of dumbbell-shaped trigeminal schwannomas (C1 type).

  13. Prolonged vertigo and ataxia after mandibular nerve block for treatment of trigeminal neuralgia


    Arvind Chaturvedi; H H Dash


    Common complications of neurolytic mandibular nerve block are hypoesthesia, dysesthesia, and chemical neuritis. We report a rare complication, prolonged severe vertigo and ataxia, after neurolytic mandibular blockade in a patient suffering from trigeminal neuralgia. Coronoid approach was used for right sided mandibular block. After successful test injection with local anesthetic, absolute alcohol was given for neurolytic block. Immediately after alcohol injection, patient developed nausea and...

  14. How Far Have We Come in the Field of Nerve Regeneration After Trigeminal Nerve Injury?


    Rosén, Annika; Tardast, Arezo; Shi, Tie-Jun


    Patients suffering from nerve injury with sensory disturbances or orofacial pain have greatly reduced quality of life, and it is a big cost for the society. Abnormal sensations caused by trigeminal nerve injury often become chronic, severely debilitating, and extremely difficult to treat. In general, non-invasive treatment such as drug treatment has been insufficient, and there are currently few available effective treatments. Surgical interventions such as end-to-end connection or nerve graf...

  15. Trigeminal nerve stimulation: A new way of treatment of refractory seizures

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    Mohammad Zare


    Full Text Available Background: Refractory epilepsy is a significant problem in clinical practice. Sometimes, multiple antiepileptic drugs are required to control the attacks. To avoid various complications ensuring from these drugs, new methods of treatment such as vagus nerve stimulation (VNS have been recommended. Trigeminal nerve stimulation (TNS is a new method under evaluation. The purpose of this paper is to determine whether this method is effective or not. Materials and Methods: Percutaneous simulation of supraorbital branches of the trigeminal nerve by an electrical device was planned in 18 patients over a six-month period. Participants who fulfilled the research criteria were selected randomly from epileptic patients referred to the clinic. (November 2011-December 2012. T-test was used for data analysis. Results: Only eight of 18 patients stayed in the study during all 6 months. A 47.9% reduction in daily seizure frequency was seen in this group (P = 0.022. Other subjects left the study earlier. In this group, seizure frequency increased by 10.6% (P = 0.82. Conclusions: The mechanism of the antiepileptic effects of TNS is not yet clear. In animal studies, it is suggested that the trigeminal nucleus and its projection to nucleus tractus solitarius (NTS and the locus ceruleus, are involved in seizure modulation.Although in comparison with seizure frequency prior to the study there was significant seizure reduction, according to the usual criteria for VNS i.e. 50% seizure frequency reduction, the effect of TNS per se may not yet be adequate for treatment of seizures. Trigeminal nerve stimulation may be an effective "adjuvant" method for treatment of intractable seizure.

  16. Thermal Perception as a Key Factor for Assessing Effects of Trigeminal Nerve Injury. (United States)

    Kim, Hye-Kyoung; Kim, Ki-Suk; Kim, Mee-Eun


    To conduct a functional examination using multimodal exploration of a sample of patients with iatrogenic trigeminal nerve injury to understand the underlying mechanisms of neuropathic pain following trigeminal nerve injury. Subjective and objective symptoms and responses to thermal and electrical quantitative sensory testing (QST) were evaluated in 85 patients with unilateral trigeminal nerve injury. Objective symptoms were measured by seven clinical sensory tests. Thermal QST included cold detection threshold (CDT), warm detection threshold (WDT), and heat pain threshold (HPT). Electrical current perception threshold was performed with electrical stimuli of 2,000, 250, and 5 Hz. The time since injury was included as a possible independent variable. The data were analyzed using chi-square test, independent t test, Mann Whitney U test, one-way analysis of variance (ANOVA), and Kruskal-Wallis test. Further analyses with Pearson correlation analysis, Spearman rank correlation analysis, and cluster analysis were applied. Unlike objective symptoms, thermal and electrical QST values and subjective symptoms did not improve in patients with an old injury. Thermal QST, particularly WDT, showed the highest positive correlation with subjective symptoms in all tests. Cluster analysis of the thermal QST values identified three subgroups: cluster 1, which was characterized by prominent cold and warm hypoesthesia; cluster 2, which presented elevated WDT; and cluster 3, which showed the smallest thermal differences for all thermal variables but had the highest proportion of neuropathic pain. These findings have demonstrated that thermal QST is a suitable tool for evaluating and characterizing the sensory effects of trigeminal nerve injury. Three subgroups with different thermosensory profiles showed that the less the damage, the more neuropathic pain occurs. The loss of warm perception in particular might play a pivotal role in the chronicity and severity of subjective sensory

  17. Trigeminal neuralgia--a prospective systematic study of clinical characteristics in 158 patients

    DEFF Research Database (Denmark)

    Maarbjerg, Stine; Gozalov, Aydin; Olesen, Jes


    OBJECTIVE: To prospectively describe the clinical characteristics of classical trigeminal neuralgia (TN) in a standardized manner. BACKGROUND: TN is a rare disease and most clinicians only see a few patients. There is a lack of prospective systematic studies of the clinical characteristics of TN....... We hypothesized that contrary to current thinking, some TN patients suffer from sensory abnormalities at neurological examination. METHODS: Clinical characteristics such as demographics, pain characteristics, and comorbidities were systematically and prospectively collected from consecutive TN...

  18. Description of a neural sheath tumor of the trigeminal nerve: immunohistochemical and electron microscopy study


    Khademi, Bijan; Owji, Seied Mohammad; Khosh, Khadije Jamshidi; Mohammadianpanah, Mohammad; Gandomi, Behrooz


    CONTEXT: Malignant neural sheath tumors of the trigeminal nerve affecting the nasal cavity and the paranasal sinuses are extremely rare. With conventional optical microscopy, their identification is difficult, and it is necessary to confirm them by means of electron microscopy and immunohistochemical techniques. CASE REPORT: The patient was a 41-year-old woman with a ten-month progressive history of pain followed by painful edema in the left facial region, and with symptoms of bleeding, secre...

  19. Modulatory effects of probenecid on the nitroglycerin-induced changes in the rat caudal trigeminal nucleus. (United States)

    Vamos, Eniko; Pardutz, Arpad; Fejes, Annamaria; Tajti, Janos; Toldi, Jozsef; Vecsei, Laszlo


    Four hours after systemic administration of the nitric oxide donor nitroglycerin (10 mg/kg bodyweight, s.c.), the neurons of the rat caudal trigeminal nucleus are activated, the area covered by calcitonin gene-related peptide (CGRP)-immunoreactive fibres is decreased and the neuronal nitric oxide synthase (nNOS)- and the calmodulin-dependent protein kinase II alpha (CamKIIalpha)-immunopositive neurons in the same area are increased. Probenecid is a non-selective inhibitor of multidrug-resistance associated proteins and organic anion transporters thus it can modulate the transport functions in the central nervous system influencing nociception. Accordingly, the aim of the present experiments was to examine the effects of probenecid administration on the nitroglycerin-induced expressions of nNOS, CamKIIalpha and CGRP in the rat caudal trigeminal nucleus. Probenecid (200 mg/kg bodyweight, i.p.) pretreatment proved to mitigate the nitroglycerin-induced changes in expression in the rat caudal trigeminal nucleus. The data suggest that the changes caused by nitroglycerin in the expressions of CGRP, nNOS and CamKIIalpha can be influenced by probenecid modulating the inflammatory functions in the nervous system. These data may be of relevance for the pathogenesis of migraine headache.

  20. Relationship between Sensory Stimulation and Side Effects in Percutaneous Radiofrequency Treatment of the Trigeminal Ganglion. (United States)

    Koning, Mark V; Koning, Nick J; Koning, Henk M; van Kleef, Maarten


    The objective of this study was to determine the efficacy of percutaneous radiofrequency (RF) treatment of the trigeminal ganglion for treating patients with trigeminal neuralgia, to determine which patients have a long-term benefit, and to evaluate the effect of RF parameters. A retrospective study in 28 consecutive patients in combination with a follow-up questionnaire (n = 26, 93% response). An initial treatment effect of 89% was observed, 60% sustained at 12-month follow-up. Major side effects were hypesthesia (56%), dry eye (20%), and masseter muscle weakness (12%). A lower sensory stimulation threshold during treatment was associated with better patient satisfaction (P = 0.016), improved pain relief (P = 0.039), and trended toward more hypesthesia (P = 0.077). This low-volume study reported treatment effects in an older population that were similar to previous studies. Only a higher incidence of hypesthesia was detected by long-term follow-up. This study supported the high efficiency of RF treatment, but there was a high level of side effects. Most notable, low sensory stimulation was associated with increased hypesthesia, whereas higher stimulation levels yielded less effectiveness. Further investigation of an optimal sensory stimulation range for percutaneous RF treatment of the trigeminal ganglion was found to be warranted. © 2013 World Institute of Pain.

  1. Trigeminal Neuralgia Caused by Cerebellopontine Angle Arteriovenous Malformation Treated With Gamma Knife Radiosurgery. (United States)

    Işik, Semra; Ekşi, Murat Şakir; Yilmaz, Baran; Toktaş, Zafer Orkun; Akakin, Akin; Kiliç, Türker


    Trigeminal neuralgia is a facial pain syndrome characterized as sudden onset and lightening-like sensation over somatosensorial branch(es) of fifth cranial nerve. Rarely, some underlying diseases or disorders could be diagnosed, such as multiple sclerosis, brain tumors, and vascular malformations. The authors present a 47-year-old man with trigeminal neuralgia over left V2 and V3 dermatomes. He had a previous transarterial embolization and long use of carbamazepine with partial response to treatment. Gamma knife radiosurgery (GKR) was planned. A marginal dose of 15 Gy was given to 50% isodose line. His pain was relieved by GKR in 1.5 years. Treatment of posterior fossa arteriovenous malformations causing trigeminal neuralgia, with GKR has a very limited use in the literature. It, however, is obvious that success rate as pain relief, in a very challenging field of functional neurosurgery, is satisfactory. Large series, however, are in need to make a more comprehensive statement about efficacy and safety of the procedure in these pathologies.

  2. Severe Headache with Eye Involvement from Herpes Zoster Ophthalmicus, Trigeminal Tract, and Brainstem Nuclei

    Directory of Open Access Journals (Sweden)

    Sasitorn Siritho


    Full Text Available A 43-year-old female presented with severe sharp stabbing right-sided periorbital and retroorbital area headache, dull-aching unilateral jaw pain, eyelid swelling, ptosis, and tearing of the right eye but no rash. The pain episodes lasted five minutes to one hour and occurred 10–15 times per day with unremitting milder pain between the attacks. She later developed an erythematous maculopapular rash over the right forehead and therefore was treated with antivirals. MRI performed one month after the onset revealed small hypersignal-T2 in the right dorsolateral mid-pons and from the right dorsolateral aspect of the pontomedullary region to the right dorsolateral aspect of the upper cervical cord, along the course of the principal sensory nucleus and spinal nucleus of the right trigeminal nerve. No definite contrast enhancement of the right brain stem/upper cervical cord was seen. Orbital imaging showed no abnormality of bilateral optic nerves/chiasm, extraocular muscles, and globes. Slight enhancement of the right V1, V2, and the cisterna right trigeminal nerve was detected. Our findings support the hypothesis of direct involvement by virus theory, reflecting rostral viral transmission along the gasserian ganglion to the trigeminal nuclei at brainstem and caudal spreading along the descending tract of CN V.

  3. Repression of calcitonin gene-related peptide expression in trigeminal neurons by a Theobroma cacao extract. (United States)

    Abbey, Marcie J; Patil, Vinit V; Vause, Carrie V; Durham, Paul L


    Cocoa bean preparations were first used by the ancient Maya and Aztec civilizations of South America to treat a variety of medical ailments involving the cardiovascular, gastrointestinal, and nervous systems. Diets rich in foods containing abundant polyphenols, as found in cocoa, underlie the protective effects reported in chronic inflammatory diseases. Release of calcitonin gene-related peptide (CGRP) from trigeminal nerves promotes inflammation in peripheral tissues and nociception. To determine whether a methanol extract of Theobroma cacao L. (Sterculiaceae) beans enriched for polyphenols could inhibit CGRP expression, both an in vitro and an in vivo approach was taken. Treatment of rat trigeminal ganglia cultures with depolarizing stimuli caused a significant increase in CGRP release that was repressed by pretreatment with Theobroma cacao extract. Pretreatment with Theobroma cacao was also shown to block the KCl- and capsaicin-stimulated increases in intracellular calcium. Next, the effects of Theobroma cacao on CGRP levels were determined using an in vivo model of temporomandibular joint (TMJ) inflammation. Capsaicin injection into the TMJ capsule caused an ipsilateral decrease in CGRP levels. Theobroma cacao extract injected into the TMJ capsule 24h prior to capsaicin treatment repressed the stimulatory effects of capsaicin. Our results demonstrate that Theobroma cacao extract can repress stimulated CGRP release by a mechanism that likely involves blockage of calcium channel activity. Furthermore, our findings suggest that the beneficial effects of diets rich in cocoa may include suppression of sensory trigeminal nerve activation.

  4. Repression of calcitonin gene-related peptide expression in trigeminal neurons by a Theobroma cacao extract☆ (United States)

    Abbey, Marcie J.; Patil, Vinit V.; Vause, Carrie V.; Durham, Paul L.


    Ethnopharmacological relevance Cocoa bean preparations were first used by the ancient Maya and Aztec civilizations of South America to treat a variety of medical ailments involving the cardiovascular, gastrointestinal, and nervous systems. Diets rich in foods containing abundant polyphenols, as found in cocoa, underlie the protective effects reported in chronic inflammatory diseases. Release of calcitonin gene-related peptide (CGRP) from trigeminal nerves promotes inflammation in peripheral tissues and nociception. Aim of the study To determine whether a methanol extract of Theobroma cacao L. (Sterculiaceae) beans enriched for polyphenols could inhibit CGRP expression, both an in vitro and an in vivo approach was taken. Results Treatment of rat trigeminal ganglia cultures with depolarizing stimuli caused a significant increase in CGRP release that was repressed by pretreatment with Theobroma cacao extract. Pretreatment with Theobroma cacao was also shown to block the KCl- and capsaicin-stimulated increases in intracellular calcium. Next, the effects of Theobroma cacao on CGRP levels were determined using an in vivo model of temporomandibular joint (TMJ) inflammation. Capsaicin injection into the TMJ capsule caused an ipsilateral decrease in CGRP levels. Theobroma cacao extract injected into the TMJ capsule 24 h prior to capsaicin treatment repressed the stimulatory effects of capsaicin. Conclusions Our results demonstrate that Theobroma cacao extract can repress stimulated CGRP release by a mechanism that likely involves blockage of calcium channel activity. Furthermore, our findings suggest that the beneficial effects of diets rich in cocoa may include suppression of sensory trigeminal nerve activation. PMID:17997062

  5. Symptomatic Trigeminal Autonomic Cephalalgia Associated with Allodynia in a Patient with Multiple Sclerosis

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    Fang-Chun Liu


    Full Text Available A patient with symptomatic trigeminal autonomic cephalalgia (TAC provides a chance to understand the pathophysiology and anatomic correlates of TAC. A 28-year-old woman experienced intermittent sharp and excruciating pain over her right temporal, ear and neck regions for 3 days. The headaches lasted 10–20 minutes each, occurred 1–2 times a day, and were accompanied by prominent ipsilateral lacrimation and conjunctival injection. The patient had hiccups, 4-limb numbness and impaired visual acuity in both eyes. She had also had 3 episodes of left-side optic neuritis in the past half year. Neurologic examination showed brushing allodynia over the right face and scalp during the headache attacks. The visual acuity of her right eye was 6/60 and that of the left eye was 1/60. Brain magnetic resonance imaging showed non-enhancing lesions on the right lateral tegmentum of the lower pons where the spinal trigeminal nucleus is located and the floor of the 4th ventricle. The patient was diagnosed as having multiple sclerosis with symptomatic TAC. Her headaches, autonomic signs and allodynia subsided 3 days after pulse therapy and gabapentin treatment were given. We suggest that the spinal trigeminal nucleus lesion was responsible for the symptomatology of TAC and cutaneous allodynia in our patient.

  6. An Open Study of Botulinum-A Toxin Treatment of Idiopathic Trigeminal Neuralgia

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    Karim Nikkhah


    Full Text Available Introduction: Trigeminal Neuralgia (TN is a unilateral, recurrent, sharp facial pain disorder that is limited to the distribution of divisions of the trigeminal nerve. The aim of this study was to evaluate the efficacy of Botulinum neurotoxin type A (BTX-A for alleviating the frequency and severity of TN pain. Materials and Methods: This trial was performed as a before and after study. We treated 31 patients (15 male and 16 female with mean age of 52 year old that their diagnosis was made at least 4.5 years before. We injected BTX-A in various parts of face and particularly in the origin of mandibular and maxillary branches of trigeminal nerve. Injection volume was determined by the necessity and pain intensity measured with visual analog scale up to 100U. Patients were evaluated before and after the injection and were followed after week, and each month, for a three months period. Other related variables were recorded such as: toxin complications, pain status variations by brushing, chewing, cold weather and patient’s satisfaction with their therapy. Results: showed that after injection, pain intensity and frequency decreased after tooth brushing, chewing and cold weather (P

  7. Hemorrhagic intracranial inflammatory pseudotumor originating from the trigeminal nerve: a case report. (United States)

    Jung, Tae-Young; Jung, Shin; Lee, Min-Cheol; Moon, Kyung-Sub; Kim, In-Young; Kang, Sam-Suk; Kim, Soo-Han


    We report here on a case of intracranial inflammatory pseudotumor arising from the trigeminal nerve. A 52-year-old man presented with sudden onset severe headache. He had had facial numbness several months earlier and no signs indicating infection. On the computerized tomography scan, intracranial hemorrhage was detected at the cerebellopontine angle. Magnetic resonance imaging demonstrated a 2.7-cm-sized, homogenously enhancing mass. A provisional diagnosis of trigeminal schwannoma was made, and suboccipital craniotomy was then performed. The mass was encapsulated and had multiple capsular veins. There was a evidence of intratumoral bleeding. It originated from the trigeminal root and was adhered to the 4th cranial nerve. Pathologic examination showed fibrovascular tissue with dense infiltrates of plasma cells and lymphocytes, some histiocytes, and occasional neutrophils and eosinophils. It showed immunopositivity for leukocyte common antigen (LCA) and immunonegativity for S-100 and lysozyme. It was also immunopositive for EBV antigen. Intracranial inflammatory pseudotumors mostly arise from dural/meningeal structures in the intracranial location. This case is the first to describe an intracranial inflammatory pseudotumor originating from a cranial nerve. The pathologic examination supported the postinfection hypothesis out of several possible pathologic mechanisms.

  8. Anatomy of Meckel's cave and the trigeminal ganglion: anatomical landmarks for a safer approach to them. (United States)

    Arslan, Mehmet; Deda, Haluk; Avci, Emel; Elhan, Alaittin; Tekdemir, Ibrahim; Tubbs, R Shane; Silav, Gokalp; Yilmaz, Erdal; Baskaya, Mustafa Kemal


    Surgical approaches to Meckel's cave (MC) are often technically difficult and sometimes associated with postoperative morbidity. The relationship of surgical landmarks to relevant anatomy is important. Therefore, we attempted to delineate quantitatively their anatomy and the relationships between MC and surrounding structures. With the aid of a surgical microscope, MC and its contents were studied in 15 formalin-fixed cadaver head specimens. Measurements were made and their relationships were observed. The distance from the zygomatic arch and the lateral end of the petrous ridge to MC was 26.5 and 34.4 mm, respectively. The distance from the arcuate eminence, the facial nerve hiatus, and the foramen spinosum to MC was 16.6, 12.8 and 7.46 mm respectively. The TG lay 5.81 mm posterior to the foramen ovale. The distance from the abducens, trochlear and oculomotor nerves to the trigeminal ganglion was 1.87, 5.53 and 6.57 mm respectively. The distance from the posterior and the anterior walls of the sigmoid sinus to the trigeminal porus was 43.6 and 33.1 mm respectively. The trigeminal porus was on average 7.19 mm from the anterior wall of the internal acoustic meatus. The anatomical landmarks as presented herein regarding MC may be used for a safer skull base approach to the region.

  9. Post-operative orofacial pain, temporomandibular dysfunction and trigeminal sensitivity after recent pterional craniotomy: preliminary study. (United States)

    Brazoloto, Thiago Medina; de Siqueira, Silvia Regina Dowgan Tesseroli; Rocha-Filho, Pedro Augusto Sampaio; Figueiredo, Eberval Gadelha; Teixeira, Manoel Jacobsen; de Siqueira, José Tadeu Tesseroli


    Surgical trauma at the temporalis muscle is a potential cause of post-craniotomy headache and temporomandibular disorders (TMD). The aim of this study was to evaluate the prevalence of pain, masticatory dysfunction and trigeminal somatosensory abnormalities in patients who acquired aneurysms following pterional craniotomy. Fifteen patients were evaluated before and after the surgical procedure by a trained dentist. The evaluation consisted of the (1) research diagnostic criteria for TMD, (2) a standardized orofacial pain questionnaire and (3) a systematic protocol for quantitative sensory testing (QST) for the trigeminal nerve. After pterional craniotomy, 80% of the subjects, 12 patients, developed orofacial pain triggered by mandibular function. The pain intensity was measured by using the visual analog scale (VAS), and the mean pain intensity was 3.7. The prevalence of masticatory dysfunction was 86.7%, and there was a significant reduction of the maximum mouth opening. The sensory evaluation showed tactile and thermal hypoesthesia in the area of pterional access in all patients. There was a high frequency of temporomandibular dysfunction, postoperative orofacial pain and trigeminal sensory abnormalities. These findings can help to understand several abnormalities that can contribute to postoperative headache or orofacial pain complaints after pterional surgeries.

  10. Trigeminal neuralgia post-styloidectomy in Eagle syndrome: a case report

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    Blackett John


    Full Text Available Abstract Introduction Eagle syndrome is a condition characterized by an elongated (>3cm styloid process with associated symptoms of recurrent facial or throat pain. In this report we present a case of Eagle syndrome exhibiting the typical findings of glossopharyngeal nerve involvement, as well as unusual involvement of the trigeminal nerve. Notably, this patient developed a classical trigeminal neuralgia post-styloidectomy. Case presentation A 68-year-old Caucasian woman presented with a 25-year history of dull pain along the right side of her throat, lateral neck, and jaw. Her symptoms were poorly controlled with medication until 15 years ago when she was diagnosed with Eagle syndrome, and underwent a manual fracture of her styloid process. This provided symptomatic relief until 5 years ago when the pain recurred and progressed. She underwent a styloidectomy via a lateral neck approach, which resolved the pain once again. However, 6 months ago a new onset of triggerable, electric shock-like facial pain began within the right V1 and V2 distributions. Conclusions Eagle syndrome is distressing to patients and often difficult to diagnose due to its wide variability in symptoms. It is easily confused with dental pain or temporomandibular joint disorder, leading to missed diagnoses and unnecessary procedures. Pain along the jaw and temple is an unusual but possible consequence of Eagle syndrome. An elongated styloid process should be considered a possible etiology of dull facial pain in the trigeminal distributions, in particular V3.

  11. [Influence of manual therapy of cervical spine on typical trigeminal neuralgia: a case report]. (United States)

    Grgić, Vjekoslav


    This article presents the case of a 43-year-old female patient with pain in the cervical spine area and a typical trigeminal neuralgia (TN; French name "tic douloureux") in the receptive field of the second and the third branches of the left trigeminal nerve. The patient came to our medical practice for a manual therapy of the cervical spine as the application of the standard therapy had not given her any pain reduction in the cervical spine area. As the result of the manual therapy of the cervical spine (nonspecific traction mobilization, specific or segmental mobilization, manipulation), not only a significant pain reduction in the cervical spine area occurred but also a complete cessation of TN. Before manual treatment, and in spite of antiepileptic drugs therapy and acupuncture, the patient had suffered from everyday typical TN attacks. The cessation of typical TN after manual therapy of cervical spine suggests a conclusion that the painful stimuli from the cervical spine structures can be manifested not only as atypical facial pain and/or a cervicogenic headache, but also as a typical TN (painful stimuli from the cervical spine structures-->trigeminocervical nuclei-->convergence of the painful stimuli-->referred pain in the receptive field of the trigeminal nerve-->typical or atypical TN and/or cervicogenic headache).

  12. Topiramate modulates trigeminal pain processing in thalamo-cortical networks in humans after single dose administration. (United States)

    Hebestreit, Julia M; May, Arne


    Migraine is the sixth most common cause of disability in the world. Preventive migraine treatment is used to reduce frequency, severity and duration of attacks and therefore lightens the burden on the patients' quality of life and reduces disability. Topiramate is one of the preventive migraine treatments of proven efficacy. The mechanism of action underlying the preventive effect of topiramate in migraine remains largely unknown. Using functional magnetic resonance imaging (fMRI) we examined the central effects of a single dose of topiramate (100mg) on trigeminal pain in humans, compared to placebo (mannitol). In this prospective, within subject, randomized, placebo-controlled and double-blind study, 23 healthy participants received a standardized nociceptive trigeminal stimulation and control stimuli whilst being in the scanner. No differences in the subjective intensity ratings of the painful stimuli were observed between topiramate and placebo sessions. In contrast, topiramate significantly decreased the activity in the thalamus and other pain processing areas. Additionally, topiramate increased functional coupling between the thalamus and several brain regions such as the bilateral precuneus, posterior cingulate cortex and secondary somatosensory cortex. These data suggest that topiramate exhibits modulating effects on nociceptive processing in thalamo-cortical networks during trigeminal pain and that the preventive effect of topiramate on frequent migraine is probably mediated by an effect on thalamo-cortical networks.

  13. Management of uncommon secondary trigeminal neuralgia related to a rare Arnold Chiari type I malformation

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    Zafar Ali Khan


    Full Text Available Background Trigeminal neuralgia (TN may sometimes present secondary to an intra-cranial cause. Arnold Chiari Malformation (ACM is downward herniation of the cerebellar tonsils through the foramen magnum that may be a cause of TN like pain in very rare cases. Aims The aim of this brief report is to suggest the proper management of uncommon secondary trigeminal neuralgia related to a rare Arnold Chiari type I malformation. Methods A male patient presented electric shock like stabbing pain on the right side of the face for more than ten years. The symptoms were typical of trigeminal neuralgia except that there was loss of corneal reflex on the right side and the patient also complained of gait & sleep disturbances. Complex and multilevel diagnosis was made. Results A multiplanar imaging through brain acquiring T1/T2W1 revealed ACM Type I Malformation with caudal displacement of cerebellar tonsils through foramen magnum. Conclusion Dental surgeons and oral and Maxillofacial Surgeons should exclude intra-cranial causes by Magnetic Resonance Imaging(MRI in patients of TN presenting with loss of corneal reflex, gait and sleep disturbances due to night time pain episodes.

  14. IL-1β stimulates COX-2 dependent PGE₂ synthesis and CGRP release in rat trigeminal ganglia cells. (United States)

    Neeb, Lars; Hellen, Peter; Boehnke, Carsten; Hoffmann, Jan; Schuh-Hofer, Sigrid; Dirnagl, Ulrich; Reuter, Uwe


    Pro-inflammatory cytokines like Interleukin-1 beta (IL-1β) have been implicated in the pathophysiology of migraine and inflammatory pain. The trigeminal ganglion and calcitonin gene-related peptide (CGRP) are crucial components in the pathophysiology of primary headaches. 5-HT1B/D receptor agonists, which reduce CGRP release, and cyclooxygenase (COX) inhibitors can abort trigeminally mediated pain. However, the cellular source of COX and the interplay between COX and CGRP within the trigeminal ganglion have not been clearly identified. 1. We used primary cultured rat trigeminal ganglia cells to assess whether IL-1β can induce the expression of COX-2 and which cells express COX-2. Stimulation with IL-1β caused a dose and time dependent induction of COX-2 but not COX-1 mRNA. Immunohistochemistry revealed expression of COX-2 protein in neuronal and glial cells. 2. Functional significance was demonstrated by prostaglandin E2 (PGE(2)) release 4 hours after stimulation with IL-1β, which could be aborted by a selective COX-2 (parecoxib) and a non-selective COX-inhibitor (indomethacin). 3. Induction of CGRP release, indicating functional neuronal activation, was seen 1 hour after PGE(2) and 24 hours after IL-1β stimulation. Immunohistochemistry showed trigeminal neurons as the source of CGRP. IL-1β induced CGRP release was blocked by parecoxib and indomethacin, but the 5-HT1B/D receptor agonist sumatriptan had no effect. We identified a COX-2 dependent pathway of cytokine induced CGRP release in trigeminal ganglia neurons that is not affected by 5-HT1B/D receptor activation. Activation of neuronal and glial cells in the trigeminal ganglion by IL-β leads to an elevated expression of COX-2 in these cells. Newly synthesized PGE(2) (by COX-2) in turn activates trigeminal neurons to release CGRP. These findings support a glia-neuron interaction in the trigeminal ganglion and demonstrate a sequential link between COX-2 and CGRP. The results could help to explain the

  15. Computed tomography-guided percutaneous ozone injection of the Gasserian ganglion for the treatment of trigeminal neuralgia. (United States)

    An, Jian-Xiong; Liu, Hui; Chen, Ruo-Wen; Wang, Yong; Zhao, Wen-Xing; Eastwood, Derek; Williams, John P


    The aim of this study was to evaluate the therapeutic effect of computed tomography (CT)-guided percutaneous ozone injection for refractory trigeminal neuralgia. A retrospective evaluation was performed in the study. The study was conducted at a university hospital pain center. A total of 29 patients with a clinical diagnosis of refractory trigeminal neuralgia were enrolled. All patients were treated with a percutaneous ozone injection and one patient was excluded. There were 21 patients with classical trigeminal neuralgia (group A) and seven patients with painful trigeminal neuropathy caused by post-herpetic neuralgia (group B). The percutaneous injection was an oxygen-ozone mixture at an ozone concentration of 30 μg/mL into the Gasserian ganglion performed under CT guidance. The number of procedures performed varied from one to as many as 16. Outcomes were evaluated using visual analog scale (VAS) pain scores. The combined VAS scores were 7.11 ± 1.23 pretreatment, 2.86 ± 1.69 posttreatment ( P ozone injection is a safe and effective treatment for patients with refractory trigeminal neuralgia.

  16. The differential effect of trigeminal vs. peripheral pain stimulation on visual processing and memory encoding is influenced by pain-related fear. (United States)

    Schmidt, K; Forkmann, K; Sinke, C; Gratz, M; Bitz, A; Bingel, U


    Compared to peripheral pain, trigeminal pain elicits higher levels of fear, which is assumed to enhance the interruptive effects of pain on concomitant cognitive processes. In this fMRI study we examined the behavioral and neural effects of trigeminal (forehead) and peripheral (hand) pain on visual processing and memory encoding. Cerebral activity was measured in 23 healthy subjects performing a visual categorization task that was immediately followed by a surprise recognition task. During the categorization task subjects received concomitant noxious electrical stimulation on the forehead or hand. Our data show that fear ratings were significantly higher for trigeminal pain. Categorization and recognition performance did not differ between pictures that were presented with trigeminal and peripheral pain. However, object categorization in the presence of trigeminal pain was associated with stronger activity in task-relevant visual areas (lateral occipital complex, LOC), memory encoding areas (hippocampus and parahippocampus) and areas implicated in emotional processing (amygdala) compared to peripheral pain. Further, individual differences in neural activation between the trigeminal and the peripheral condition were positively related to differences in fear ratings between both conditions. Functional connectivity between amygdala and LOC was increased during trigeminal compared to peripheral painful stimulation. Fear-driven compensatory resource activation seems to be enhanced for trigeminal stimuli, presumably due to their exceptional biological relevance. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Termination of trigeminal primary afferents on glossopharyngeal-vagal motoneurons: possible neural networks underlying the swallowing phase and visceromotor responses of prey-catching behavior. (United States)

    Kecskes, Szilvia; Matesz, Clara; Birinyi, András


    Prey-catching behavior (PCB) of the frog consists of a sequence of coordinated activity of muscles which is modified by various sensory signals. The aim of the present study was, for the first time, to examine the involvement of the trigeminal afferents in the swallowing phase of PCB. Experiments were performed on Rana esculenta, where the trigeminal and glossopharyngeal (IX)-vagus (X) nerves were labeled simultaneously with different fluorescent dyes. Using confocal laser scanning microscope, close appositions were detected between the trigeminal afferent fibers and somatodendritic components of the IX-X motoneurons of the ambiguus nucleus (NA). Neurolucida reconstruction revealed spatial distribution of the trigeminal afferents in the functionally different parts of the NA. Thus, the visceromotor neurons supplying the stomach, the heart and the lung received about two third of the trigeminal contacts followed by the pharyngomotor and then by the laryngomotor neurons. On the other hand, individual motoneurons responsible for innervation of the viscera received less trigeminal terminals than the neurons supplying the muscles of the pharynx. The results suggest that the direct contacts between the trigeminal afferents and IX-X motoneurons presented here may be one of the morphological substrate of a very quick response during the swallowing phase of PCB. Combination of direct and indirect trigeminal inputs may contribute to optimize the ongoing motor execution. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. Specific and somatotopic functional magnetic resonance imaging activation in the trigeminal ganglion by brush and noxious heat. (United States)

    Borsook, David; DaSilva, Alexandre F M; Ploghaus, Alex; Becerra, Lino


    We used functional magnetic resonance imaging (fMRI) to assess activation in the trigeminal ganglion during innocuous mechanical (brush) and noxious thermal (46 degrees C) stimulation of the face within the receptive fields of each of the three divisions of the trigeminal nerve in healthy volunteers. For both stimulus types, we observed signal changes only in the ipsilateral ganglion, and activation occurred somatotopically, as predicted by the known anatomical segregation of the neurons comprising the ophthalmic (V1), maxillary (V2), and mandibular (V3) divisions of the nerve. Signal decreased after brush stimuli and increased after the application of noxious heat. The abilities to detect somatotopic activation within the ganglion and to segregate non-noxious mechanical from noxious thermal stimuli suggest that fMRI will be valuable for measuring changes in the trigeminal ganglion in human models of neuropathic pain and in the clinical condition itself and may also be useful in the evaluation of pain therapies.

  19. c-fos expression in the trigeminal sensory complex and pontine parabrachial areas following experimental tooth movement. (United States)

    Yamashiro, T; Nakagawa, K; Satoh, K; Moriyama, H; Takada, K


    Ortodontic tooth movement causes continuous pain. However, it does not appear immediately, usually appearing after the application of orthodontic force to the teeth. Mechanically induced inflammatory responses in the periodontal membrane are assumed to be related to the mechanism of the later pain sensation. In the present study, we investigated Fos-like immunoreactivity in the trigeminal sensory complex and pontine parabrachial areas 24 h after the commencement of experimental tooth movement. An orthodontic elastic module was unilaterally inserted between upper molars. Following experimental tooth movement, Fos-like immunoreactive neurons appeared ipsilaterally in the trigeminal subnucleus caudalis and bilaterally in the lateral parabrachial nucleus. These results indicate that experimental tooth movement evokes delayed and continuous nociception after application of orthodontic force to the teeth and that the nociceptive information would be conveyed to the ipsilateral trigeminal subnucleus caudalis and further processed, at least in part, to the lateral parabrachial nucleus.

  20. Experimental inflammation following dural application of complete Freund's adjuvant or inflammatory soup does not alter brain and trigeminal microvascular passage

    DEFF Research Database (Denmark)

    Lundblad, Cornelia; Haanes, Kristian A; Grände, Gustaf


    migraine for many patients, their site of action remains unidentified. It has been suggested that during migraine attacks the leakiness of the blood-brain barrier (BBB) is altered, increasing the passage of anti-migraine drugs. This study aimed to investigate the effect of experimental inflammation......, following dural application of complete Freund's adjuvant (CFA) or inflammatory soup (IS) on brain and trigeminal microvascular passage. METHODS: In order to address this issue, we induced local inflammation in male Sprague-Dawley-rats dura mater by the addition of CFA or IS directly on the dural surface....... Following 2, 24 or 48 h of inflammation we calculated permeability-surface area product (PS) for [(51)Cr]-EDTA in the trigeminal ganglion (TG), spinal trigeminal nucleus, cortex, periaqueductal grey and cerebellum. RESULTS: We observed that [(51)Cr]-EDTA did not pass into the central nervous system (CNS...

  1. Corneal Sulfated Glycosaminoglycans and Their Effects on Trigeminal Nerve Growth Cone Behavior In Vitro: Roles for ECM in Cornea Innervation (United States)

    Schwend, Tyler; Deaton, Ryan J.; Zhang, Yuntao; Caterson, Bruce; Conrad, Gary W.


    Purpose. Sensory trigeminal nerve growth cones innervate the cornea in a highly coordinated fashion. The purpose of this study was to determine if extracellular matrix glycosaminoglycans (ECM–GAGs), including keratan sulfate (KS), dermatan sulfate (DS), and chondroitin sulfate A (CSA) and C (CSC), polymerized in developing eyefronts, may provide guidance cues to nerves during cornea innervation. Methods. Immunostaining using antineuron-specific-β-tubulin and monoclonal antibodies for KS, DS, and CSA/C was performed on eyefronts from embryonic day (E) 9 to E14 and staining visualized by confocal microscopy. Effects of purified GAGs on trigeminal nerve growth cone behavior were tested using in vitro neuronal explant cultures. Results. At E9 to E10, nerves exiting the pericorneal nerve ring grew as tight fascicles, advancing straight toward the corneal stroma. In contrast, upon entering the stroma, nerves bifurcated repeatedly as they extended anteriorly toward the epithelium. KS was localized in the path of trigeminal nerves, whereas DS and CSA/C–rich areas were avoided by growth cones. When E10 trigeminal neurons were cultured on different substrates comprised of purified GAG molecules, their neurite growth cone behavior varied depending on GAG type, concentration, and mode of presentation (immobilized versus soluble). High concentrations of immobilized KS, DS, and CSA/C inhibited neurite growth to varying degrees. Neurites traversing lower, permissive concentrations of immobilized DS and CSA/C displayed increased fasciculation and decreased branching, whereas KS caused decreased fasciculation and increased branching. Enzymatic digestion of sulfated GAGs canceled their effects on trigeminal neurons. Conclusions. Data herein suggest that GAGs may direct the movement of trigeminal nerve growth cones innervating the cornea. PMID:23132805

  2. Fetal alcohol exposure reduces responsiveness of taste nerves and trigeminal chemosensory neurons to ethanol and its flavor components. (United States)

    Glendinning, John I; Tang, Joyce; Morales Allende, Ana Paula; Bryant, Bruce P; Youngentob, Lisa; Youngentob, Steven L


    Fetal alcohol exposure (FAE) leads to increased intake of ethanol in adolescent rats and humans. We asked whether these behavioral changes may be mediated in part by changes in responsiveness of the peripheral taste and oral trigeminal systems. We exposed the experimental rats to ethanol in utero by administering ethanol to dams through a liquid diet; we exposed the control rats to an isocaloric and isonutritive liquid diet. To assess taste responsiveness, we recorded responses of the chorda tympani (CT) and glossopharyngeal (GL) nerves to lingual stimulation with ethanol, quinine, sucrose, and NaCl. To assess trigeminal responsiveness, we measured changes in calcium levels of isolated trigeminal ganglion (TG) neurons during stimulation with ethanol, capsaicin, mustard oil, and KCl. Compared with adolescent control rats, the adolescent experimental rats exhibited diminished CT nerve responses to ethanol, quinine, and sucrose and GL nerve responses to quinine and sucrose. The reductions in taste responsiveness persisted into adulthood for quinine but not for any of the other stimuli. Adolescent experimental rats also exhibited reduced TG neuron responses to ethanol, capsaicin, and mustard oil. The lack of change in responsiveness of the taste nerves to NaCl and the TG neurons to KCl indicates that FAE altered only a subset of the response pathways within each chemosensory system. We propose that FAE reprograms development of the peripheral taste and trigeminal systems in ways that reduce their responsiveness to ethanol and surrogates for its pleasant (i.e., sweet) and unpleasant (i.e., bitterness, oral burning) flavor attributes. NEW & NOTEWORTHY Pregnant mothers are advised to avoid alcohol. This is because even small amounts of alcohol can alter fetal brain development and increase the risk of adolescent alcohol abuse. We asked how fetal alcohol exposure (FAE) produces the latter effect in adolescent rats by measuring responsiveness of taste nerves and trigeminal

  3. Effects of the nasal decongestant oxymetazoline on human olfactory and intranasal trigeminal function in acute rhinitis. (United States)

    Hummel, T; Rothbauer, C; Pauli, E; Kobal, G


    The placebo-controlled, randomized, double-blind study was performed to investigate dose-related effects of oxymetazoline on olfactory function during the course of the spontaneously occurring cold. Drug effects were assessed using olfactory/ trigeminal event-related potentials (ERPs) and psychophysical measures (intensity ratings, odor discrimination, butanol threshold); nasal volume was monitored by means of acoustic rhinometry. The investigation was performed in 36 subjects (mean age 24.6 years). The subjects were assigned to treatment groups A, B or C (three groups with 12 subjects each; six women and six men per group). All the subjects received placebo on the left side; on the right side, group A subjects received placebo and group B and C subjects received 0.25 mg x ml(-1) and 0.5 mg x ml(-1) oxymetazoline, respectively. After onset of the rhinitis (day 0) measurements were performed on days 2, 4, 6 and 35. Oxymetazoline clearly produced an increase in nasal volume. However, during the 2-h observation period, effects produced by the two dosages were not significantly different. Despite the increase in nasal volume, oxymetazoline produced only an increase of the overall intensity of H2S stimuli; it had no systematic effect on other measures of olfactory or trigeminal function. In addition, after all the subjects had recovered from the cold, oxymetazoline had no significant main effect on olfactory/trigeminally mediated sensations. Oxymetazoline appeared to have neither negative nor major positive effects on intranasal chemosensory function. It is hypothesized that oxymetazoline needs to be applied locally to the area of the olfactory cleft in order to significantly improve olfaction during the course of the common cold.

  4. Effects of prostaglandin E2 on synaptic transmission in the rat spinal trigeminal subnucleus caudalis. (United States)

    Mizutani, Yuka; Ohi, Yoshiaki; Kimura, Satoko; Miyazawa, Ken; Goto, Shigemi; Haji, Akira


    The spinal trigeminal subnucleus caudalis (Vc) receives preferentially nociceptive afferent signals from the orofacial area. Nociceptive stimuli to the orofacial area induce cyclooxygenase both peripherally and centrally, which can synthesize a major prostanoid prostaglandin E2 (PGE2) that implicates in diverse physiological functions. To clarify the roles of centrally-synthesized PGE2 in nociception, effects of exogenous PGE2 on synaptic transmission in the Vc neurons were investigated in the rat brainstem slice. Spontaneously occurring excitatory and inhibitory postsynaptic currents (sEPSCs and sIPSCs) were recorded, respectively, under pharmacological blockade of inhibitory and excitatory transmission by whole-cell patch-clamp mode. Perfusion of PGE2 (1-5 μM) increased the frequency of sIPSCs in a concentration-dependent manner but had no significant effect on the amplitude. Similarly to the effects on sIPSCs, PGE2 increased the sEPSC frequency without any effect on the amplitude. These facilitatory effects of PGE2 on spontaneous synaptic transmissions were blocked by an EP1 antagonist SC19220 but not by an EP4 antagonist AH23848. Electrical stimulation of the trigeminal tract evoked short latency EPSCs (eEPSCs) in the Vc neurons. PGE2 (5 μM) was ineffective on the eEPSCs. The present study demonstrated that PGE2 facilitated spontaneous synaptic transmissions in the Vc neurons through activating the presynaptic EP1 receptors but had no effect on the trigeminal tract-mediated excitatory transmission. These results suggest that centrally-synthesized PGE2 modifies the synaptic transmission in the Vc region, thereby contributing to the processing of nociceptive signals originated from the orofacial area. Copyright © 2015 Elsevier B.V. All rights reserved.

  5. Safety and efficacy of a Nav1.7 selective sodium channel blocker in patients with trigeminal neuralgia

    DEFF Research Database (Denmark)

    Zakrzewska, Joanna M; Palmer, Joanne; Morisset, Valerie


    , can be administered at therapeutic doses without titration, and has shown good tolerability in healthy individuals in phase 1 studies. We therefore assessed the safety and efficacy of BIIB074 in patients with trigeminal neuralgia in a phase 2a study. METHODS: We did a double-blind, multicentre......BACKGROUND: Current standard of care for trigeminal neuralgia is treatment with the sodium channel blockers carbamazepine and oxcarbazepine, which although effective are associated with poor tolerability and the need for titration. BIIB074, a Nav1.7-selective, state-dependent sodium-channel blocker...

  6. Latent Herpes Simplex Virus 1 Infection Does Not Induce Apoptosis in Human Trigeminal Ganglia (United States)

    Lindemann, Anja; Sinicina, Inga; Strupp, Michael; Brandt, Thomas; Hüfner, Katharina


    Herpes simplex virus 1 (HSV-1) can establish lifelong latency in human trigeminal ganglia. Latently infected ganglia contain CD8+ T cells, which secrete granzyme B and are thus capable of inducing neuronal apoptosis. Using immunohistochemistry and single-cell reverse transcription-quantitative PCR (RT-qPCR), higher frequency and transcript levels of caspase-3 were found in HSV-1-negative compared to HSV-1-positive ganglia and neurons, respectively. No terminal deoxynucleotidyltransferase-mediated dUTP-biotin nick end labeling (TUNEL) assay-positive neurons were detected. The infiltrating T cells do not induce apoptosis in latently infected neurons. PMID:25762734

  7. Prolonged vertigo and ataxia after mandibular nerve block for treatment of trigeminal neuralgia

    Directory of Open Access Journals (Sweden)

    Arvind Chaturvedi


    Full Text Available Common complications of neurolytic mandibular nerve block are hypoesthesia, dysesthesia, and chemical neuritis. We report a rare complication, prolonged severe vertigo and ataxia, after neurolytic mandibular blockade in a patient suffering from trigeminal neuralgia. Coronoid approach was used for right sided mandibular block. After successful test injection with local anesthetic, absolute alcohol was given for neurolytic block. Immediately after alcohol injection, patient developed nausea and vomiting along with severe vertigo, ataxia and hypertension. Neurological evaluation was normal except for the presence of vertigo and ataxia. Computerised tomography scan brain was also normal. Patient was admitted for observation and symptomatic treatment was given. Vertigo and ataxia gradually improved over 24 hours.

  8. Prolonged vertigo and ataxia after mandibular nerve block for treatment of trigeminal neuralgia. (United States)

    Chaturvedi, Arvind; Dash, Hh


    Common complications of neurolytic mandibular nerve block are hypoesthesia, dysesthesia, and chemical neuritis. We report a rare complication, prolonged severe vertigo and ataxia, after neurolytic mandibular blockade in a patient suffering from trigeminal neuralgia. Coronoid approach was used for right sided mandibular block. After successful test injection with local anesthetic, absolute alcohol was given for neurolytic block. Immediately after alcohol injection, patient developed nausea and vomiting along with severe vertigo, ataxia and hypertension. Neurological evaluation was normal except for the presence of vertigo and ataxia. Computerised tomography scan brain was also normal. Patient was admitted for observation and symptomatic treatment was given. Vertigo and ataxia gradually improved over 24 hours.

  9. Expression of varicella-zoster virus and herpes simplex virus in normal human trigeminal ganglia

    International Nuclear Information System (INIS)

    Vafai, A.; Wellish, M.; Devlin, M.; Gilden, D.H.; Murray, R.S.


    Lysates of radiolabeled explants from four human trigeminal ganglia were immunoprecipitated with antibodies to varicella-zoster virus (VZV) and to herpes simplex virus. Both herpes simplex virus- and VZV-specific proteins were detected in lysates of all four ganglia. Absence of reactivity in ganglion explants with monoclonal antibodies suggested that herpes simplex virus and VZV were not reactivated during the culture period. In situ hybridization studies demonstrated the presence of RNA transcripts from the VZV immediate early gene 63. This approach to the detection of herpes simplex virus and VZV expression in human ganglia should facilitate analysis of viral RNA and proteins in human sensory ganglia

  10. Intractable trigeminal neuralgia: A single institution experience in 26 patients treated with stereotactic gamma knife radiosurgery

    International Nuclear Information System (INIS)

    Mark, Rufus J.; Duma, Christopher M.; Jacques, Dean B.; Kopyov, Oleg V.; Copcutt, Brian


    Purpose: In patients with trigeminal neuralgia, severe pain can persist, or recur despite aggressive medical management and open surgery. Recently, Gamma Knife radiosurgery has been used with promising results. We report on our series of 26 patients with intractable trigeminal neuralgia treated with stereotactic Gamma Knife radiosurgery. Materials and Methods: Between 1991 and 1995, 26 patients with intractable trigeminal neuralgia were treated at our institution using stereotactic Gamma Knife radiosurgery. Medical management had failed in all cases. In addition, 13 patients underwent a total of 20 open surgeries, with transient, or no pain relief. There were 19 females, and 7 males. Patient ages ranged from 37 to 87 years, with a median of 74 years. All patients were treated with a 201 source Cobalt-60 Gamma Knife unit. All patients underwent placement of the Leksell frame, followed by MRI scanning and computer treatment planning. The target in all patients was the fifth cranial nerve root entry zone into the brainstem. Twenty-five patients received between 64.3 to 70 Gy prescribed to Dmax in one shot. One patient received 120 Gy to Dmax in one shot. The 4 mm collimator was used in 22 cases, and the 8 mm in 4 cases. Follow-up ranged from 5 to 55 months, with a median of 19 months. Complete resolution (CR) of pain was scored when the patient reported being pain free off all medication. Partial resolution (PR) was scored when the patient reported > 50% pain reduction after Gamma Knife treatment. Results: At last follow-up, 84.6% ((22(26))) reported CR or PR of pain after Gamma Knife treatment. Forty-two percent ((11(26))) of patients reported CR, and 42%((11(26))) reported PR of pain. There was a dose response. In patients receiving < 70 Gy, 25% ((3(12))) reported CR, while 57% ((8(14))) of those receiving ≥ 70 Gy reported CR. Complications occurred in two (8%) patients. One patient developed transient numbness of the face after 70 Gy, and a second patient

  11. Auricular Neuromodulation: The Emerging Concept beyond the Stimulation of Vagus and Trigeminal Nerves

    Directory of Open Access Journals (Sweden)

    Beniamina Mercante


    Full Text Available Neuromodulation, thanks to intrinsic and extrinsic brain feedback loops, seems to be the best way to exploit brain plasticity for therapeutic purposes. In the past years, there has been tremendous advances in the field of non-pharmacological modulation of brain activity. This review of different neurostimulation techniques will focus on sites and mechanisms of both transcutaneous vagus and trigeminal nerve stimulation. These methods are scientifically validated non-invasive bottom-up brain modulation techniques, easily implemented from the outer ear. In the light of this, auricles could transpire to be the most affordable target for non-invasive manipulation of central nervous system functions.

  12. Pharmacological versus microvascular decompression approaches for the treatment of trigeminal neuralgia: clinical outcomes and direct costs

    Directory of Open Access Journals (Sweden)

    Almeida A


    Full Text Available Laurinda Lemos1,2, Carlos Alegria3, Joana Oliveira3, Ana Machado2, Pedro Oliveira4, Armando Almeida11Life and Health Sciences Research Institute (ICVS, School of Health Sciences, Campus de Gualtar, University of Minho, Braga, Portugal; 2Hospital Center of Alto Ave, Unit of Fafe, Fafe, Portugal; 3Department of Neurosurgery, Hospital São Marcos; 4Products and Systems Engineering, Campus de Azurém, University of Minho, Guimarães, PortugalAbstract: In idiopathic trigeminal neuralgia (TN the neuroimaging evaluation is usually normal, but in some cases a vascular compression of trigeminal nerve root is present. Although the latter condition may be referred to surgery, drug therapy is usually the first approach to control pain. This study compared the clinical outcome and direct costs of (1 a traditional treatment (carbamazepine [CBZ] in monotherapy [CBZ protocol], (2 the association of gabapentin (GBP and analgesic block of trigger-points with ropivacaine (ROP (GBP+ROP protocol, and (3 a common TN surgery, microvascular decompression of the trigeminal nerve (MVD protocol. Sixty-two TN patients were randomly treated during 4 weeks (CBZ [n = 23] and GBP+ROP [n = 17] protocols from cases of idiopathic TN, or selected for MVD surgery (n = 22 due to intractable pain. Direct medical cost estimates were determined by the price of drugs in 2008 and the hospital costs. Pain was evaluated using the Numerical Rating Scale (NRS and number of pain crises; the Hospital Anxiety and Depression Scale, Sickness Impact Profile, and satisfaction with treatment and hospital team were evaluated. Assessments were performed at day 0 and 6 months after the beginning of treatment. All protocols showed a clinical improvement of pain control at month 6. The GBP+ROP protocol was the least expensive treatment, whereas surgery was the most expensive. With time, however, GBP+ROP tended to be the most and MVD the least expensive. No sequelae resulted in any patient after drug

  13. Field-testing of the ICHD-3 beta diagnostic criteria for classical trigeminal neuralgia

    DEFF Research Database (Denmark)

    Maarbjerg, Stine; Sørensen, Morten Togo; Gozalov, Aydin


    INTRODUCTION: We aimed to field-test the beta version of the third edition of the International Classification of Headache Disorders (ICHD-3 beta) diagnostic criteria for classical trigeminal neuralgia (TN). The proposed beta draft of the 11th version of the International Classification of Diseases...... (ICD-11 beta) is almost exclusively based on the ICHD-3 beta classification structure although slightly abbreviated. We compared sensitivity and specificity to ICHD-2 criteria, and evaluated the needs for revision. METHODS: Clinical characteristics were systematically and prospectively collected from...

  14. Persistent trigeminal artery: angio-tomography and angio-magnetic resonance finding Artéria trigeminal persistente: achado na angio-tomografia e angio-ressonância magnética

    Directory of Open Access Journals (Sweden)

    Lícia Pachêco Pereira


    Full Text Available The trigeminal artery (TA is the most common embryonic carotid-vertebrobasilar anastomosis to persist into adulthood. It typically extends from the internal carotid artery to the basilar artery. Persistent primitive arteries are usually found incidentally, but are often associated with vascular malformation, cerebral aneurysm and, in case of TA, with trigeminal neuralgia. We present one patient with TA as a cause of trigeminal neuralgia and in other three as an incidental finding, on TC and MR angiograms.Artéria trigeminal (AT é a anastomose carótido-vertebrobasilar mais comum a persistir na vida adulta. Tipicamente estende-se da artéria carótida interna até a artéria basilar. Artérias primitivas persistentes são usualmente um achado incidental, mas freqüentemente estão associadas a malformações vasculares, aneurismas e, no caso da AT, a neuralgia do trigêmio. Apresentamos um paciente com AT como causa de neuralgia do trigêmio e em outros três como um achado incidental, em angiogramas por tomomografia computadorizada e ressonância magnética.

  15. Comparative Anatomy of Gastrin-releasing Peptide Pathways in the Trigeminal Sensory System of Mouse and the Asian House Musk ShrewSuncus murinus. (United States)

    Takanami, Keiko; Inoue, Kaihei; Mukai, Hiroki; Tamura, Kei; Jogahara, Takamichi; Oda, Sen-Ichi; Kawata, Mitsuhiro; Sakamoto, Tatsuya; Sakamoto, Hirotaka


    Gastrin-releasing peptide (GRP) has recently been identified as an itch-signaling molecule in the primary afferents and spinal cord of rodents. However, little information exists on the expression and localization of GRP in the trigeminal somatosensory system other than in rats. We examined the generality of the trigeminal GRP system in mammals using two distinct species, suncus as a model of specialized placental mammals known to have a well-developed trigeminal sensory system and mice as a representative small laboratory animal. We first analyzed the gross morphology of the trigeminal somatosensory system in suncus to provide a brainstem atlas on which to map GRP distribution. Immunohistochemical analyses showed that 8% of trigeminal ganglion neurons in suncus and 6% in mice expressed GRP. Expression was restricted to cells with smaller somata. The GRP-containing fibers were densely distributed in the superficial layers of the caudal part of the trigeminal spinal nucleus (Vc) but rare in the rostral parts, both in suncus and mice. Expression of GRP receptor mRNA and protein was also detected in the Vc of suncus. Taken together, these results suggest that the trigeminal GRP system mediating itch sensation is conserved in mammals.

  16. Botulinum neurotoxin type A for the treatment of pain: not just in migraine and trigeminal neuralgia. (United States)

    Sandrini, Giorgio; De Icco, Roberto; Tassorelli, Cristina; Smania, Nicola; Tamburin, Stefano


    Despite their huge epidemiological impact, primary headaches, trigeminal neuralgia and other chronic pain conditions still receive suboptimal medical approach, even in developed countries. The limited efficacy of current pain-killers and prophylactic treatments stands among the main reasons for this phenomenon. Botulinum neurotoxin (BoNT) represents a well-established and licensed treatment for chronic migraine, but also an emerging treatment for other types of primary headache, trigeminal neuralgia, neuropathic pain, and an increasing number of pain conditions. We searched and critically reviewed evidence for the efficacy of BoNT for the treatment of chronic pain. Meta-analyses and randomized controlled trials (RCTs) suggest that BoNT potentially represents a multi-purpose drug for the treatment of pain in several disorders due to a favorable safety profile and a long-lasting relief after a single injection. BoNT is an emerging treatment in different pain conditions. Future RCTs should explore the use of BoNT injection therapy combined with systemic drugs and/or physical therapies as new pain treatment strategies.

  17. Gamma Knife Stereotactic Radiosurgery for Trigeminal Neuralgia Caused by a Developmental Venous Anomaly. (United States)

    Harrison, Gillian; Lunsford, L Dade; Monaco Iii, Edward A


    Background: Trigeminal neuralgia (TN) is mostly caused by vascular compression of the nerve's root entry zone due to an ectatic artery. Rarer causes include compression from tumors, vascular malformations or multiple sclerosis plaques. Developmental venous anomalies (DVAs) are benign, aberrantly appearing venous structures that drain normal cerebral tissue. DVAs are a rare etiology of TN. The management of TN caused by a DVA is controversial as disruption of the DVA can be catastrophic. Methods: We report a case of a young man with severe medically refractory TN related to a brachium pontis DVA who was successfully treated by gamma knife stereotactic radiosurgery (GKSR) to the trigeminal nerve. Results: Within 2 weeks of GKSR, the patient reported experiencing 60% pain relief; 5 years postoperatively, he remains completely pain free with some mild sensory loss in the V2 and V3 areas. Conclusions: GKSR has an established role in the management of TN. This is the first reported case of using GKSR to treat TN caused by a DVA. In the setting of a DVA, GKSR should be an initial consideration for TN therapy after medical failure because of the high surgical risk related to disrupting the DVA. © 2015 S. Karger AG, Basel.

  18. RNA-Seq Analysis of Human Trigeminal and Dorsal Root Ganglia with a Focus on Chemoreceptors.

    Directory of Open Access Journals (Sweden)

    Caroline Flegel

    Full Text Available The chemosensory capacity of the somatosensory system relies on the appropriate expression of chemoreceptors, which detect chemical stimuli and transduce sensory information into cellular signals. Knowledge of the complete repertoire of the chemoreceptors expressed in human sensory ganglia is lacking. This study employed the next-generation sequencing technique (RNA-Seq to conduct the first expression analysis of human trigeminal ganglia (TG and dorsal root ganglia (DRG. We analyzed the data with a focus on G-protein coupled receptors (GPCRs and ion channels, which are (potentially involved in chemosensation by somatosensory neurons in the human TG and DRG. For years, transient receptor potential (TRP channels have been considered the main group of receptors for chemosensation in the trigeminal system. Interestingly, we could show that sensory ganglia also express a panel of different olfactory receptors (ORs with putative chemosensory function. To characterize OR expression in more detail, we performed microarray, semi-quantitative RT-PCR experiments, and immunohistochemical staining. Additionally, we analyzed the expression data to identify further known or putative classes of chemoreceptors in the human TG and DRG. Our results give an overview of the major classes of chemoreceptors expressed in the human TG and DRG and provide the basis for a broader understanding of the reception of chemical cues.

  19. Association between neurovascular contact on MRI and response to gamma knife radiosurgery in trigeminal neuralgia

    International Nuclear Information System (INIS)

    Erbay, Sami H.; Bhadelia, Rafeeque A.; Gupta, Punita; O'Callaghan, Mark; Yun, Eric; Oljeski, Steven; Riesenburger, Ron


    Treatment with gamma knife radiosurgery (GKRS) provides adequate short-term pain control in about 70% of the patients with intractable trigeminal neuralgia (TN). The purpose of our study was to evaluate whether the presence of neurovascular contact (NVC) at the root entry zone of the trigeminal nerve on pre-gamma knife MR imaging predicts an increased likelihood of an adequate response to GKRS.We studied 40 consecutive patients who underwent GKRS for treatment of intractable TN. Two neuroradiologists blinded to the side of symptoms analyzed pre-treatment constructive interference in steady state (CISS) images to determine the presence of NVC by consensus. An adequate response was defined as freedom from pain with or without reduced need for medical therapy. Adequate short-term response to GKRS was seen in 29 (72.5%) of 40 patients. NVC was seen in 30 of the 40 patients. Twenty-five (83.3%) of 30 patients with NVC had adequate short-term response to GKRS. Only four (40%) of the 10 patients without NVC had adequate response to GKRS (X 2 =7.06; P<0.01). Patients with NVC were seven times more likely to have an adequate response to GKRS than those without NVC (odds ratio =7.5).The presence of NVC on pre-treatment MR imaging predicts an increased likelihood of an adequate response to GKRS. (orig.)

  20. SU-E-T-420: Failure Effects Mode Analysis for Trigeminal Neuralgia Frameless Radiosurgery

    International Nuclear Information System (INIS)

    Howe, J


    Purpose: Functional radiosurgery has been used successfully in the treatment of trigeminal neuralgia but presents significant challenges to ensuring the high prescription dose is delivered accurately. A review of existing practice should help direct the focus of quality improvement for this treatment regime. Method: Failure modes and effects analysis was used to identify the processes in preparing radiosurgery treatment for TN. The map was developed by a multidisciplinary team including: neurosurgeon, radiation oncology, physicist and therapist. Potential failure modes were identified for each step in the process map as well as potential causes and end effect. A risk priority number was assigned to each cause. Results: The process map identified 66 individual steps (see attached supporting document). Corrective actions were developed for areas of high risk priority number. Wrong site treatment is at higher risk for trigeminal neuralgia treatment due to the lack of site specific pathologic imaging on MR and CT – additional site specific checks were implemented to minimize the risk of wrong site treatment. Failed collision checks resulted from an insufficient collision model in the treatment planning system and a plan template was developed to address this problem. Conclusion: Failure modes and effects analysis is an effective tool for developing quality improvement in high risk radiotherapy procedures such as functional radiosurgery

  1. The role of trigeminal function in the sensation of nasal obstruction in chronic rhinosinusitis. (United States)

    Saliba, Joe; Fnais, Naif; Tomaszewski, Marcel; Carriere, Junie S; Frenkiel, Saul; Frasnelli, Johannes; Tewfik, Marc A


    Trigeminal sensation (TS) within the nasal cavity is important for the perception of nasal airflow. The objective of this study is to examine whether impaired TS contributes to the sensation of nasal obstruction in patients with chronic rhinosinusitis (CRS). Prospective case-control study conducted in a tertiary referral rhinology clinic. Cases consisted of CRS patients with subjective nasal obstruction, not previously treated with oral corticoids. Controls consisted of patients without CRS. Neither group demonstrated obvious anatomical obstructions. Both groups underwent peak nasal inspiratory flows (PNIF), olfactory testing (quick eight-item odor identification test), and trigeminal testing (lateralization task using eucalyptol and odorless solvent). A total of 28 subjects (14 CRS patients and 14 controls) were recruited. Analyses revealed no statistical differences in age (P = .93), gender (P = .47), or PNIF (P = .82) between the two groups, but they differed in Lund-Mackay scores (P sensation of nasal obstruction in CRS. 3b. Laryngoscope, 126:E174-E178, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  2. Diagnostic and therapeutic errors in trigeminal autonomic cephalalgias and hemicrania continua: a systematic review (United States)


    Trigeminal autonomic cephalalgias (TACs) and hemicrania continua (HC) are relatively rare but clinically rather well-defined primary headaches. Despite the existence of clear-cut diagnostic criteria (The International Classification of Headache Disorders, 2nd edition - ICHD-II) and several therapeutic guidelines, errors in workup and treatment of these conditions are frequent in clinical practice. We set out to review all available published data on mismanagement of TACs and HC patients in order to understand and avoid its causes. The search strategy identified 22 published studies. The most frequent errors described in the management of patients with TACs and HC are: referral to wrong type of specialist, diagnostic delay, misdiagnosis, and the use of treatments without overt indication. Migraine with and without aura, trigeminal neuralgia, sinus infection, dental pain and temporomandibular dysfunction are the disorders most frequently overdiagnosed. Even when the clinical picture is clear-cut, TACs and HC are frequently not recognized and/or mistaken for other disorders, not only by general physicians, dentists and ENT surgeons, but also by neurologists and headache specialists. This seems to be due to limited knowledge of the specific characteristics and variants of these disorders, and it results in the unnecessary prescription of ineffective and sometimes invasive treatments which may have negative consequences for patients. Greater knowledge of and education about these disorders, among both primary care physicians and headache specialists, might contribute to improving the quality of life of TACs and HC patients. PMID:23565739

  3. Trigeminal nucleus caudalis anatomy: guidance for radiofrequency dorsal root entry zone lesioning. (United States)

    Sandwell, Stephen E; El-Naggar, Amr O; Nettleton, G Stephen; Acland, Robert D


    This study seeks to improve the accuracy of trigeminal nucleus caudalis dorsal root entry zone (DREZ) radiofrequency lesioning by quantifying the size and orientation of the nucleus caudalis. Using serial axial photographs of 6 formalin-fixed cadaver brainstems, digital nucleus caudalis measurements were taken at 1-mm intervals from the level of the obex to the C(2) dorsal nerve roots. From the obex to the C(2) dorsal nerve roots, the nucleus caudalis decreases in width (from 2.6 ± 0.2 to 1.0 ± 0.3 mm) and, excluding superficial tract thickness, decreases in axial nucleus depth (from 2.4 ± 0.3 to 1.7 ± 0.2 mm). At levels between the obex and 10 mm caudal to the obex, the accessory nerve rootlets exit the brainstem at the junction of the spinal trigeminal tract and the dorsal spinocerebellar tract. This study details the anatomic dimensions and orientation of the nucleus caudalis for surgeons who perform DREZ lesioning. 2010 S. Karger AG, Basel.

  4. Differential diagnostics of pain in the course of trigeminal neuralgia and temporomandibular joint dysfunction. (United States)

    Pihut, M; Szuta, M; Ferendiuk, E; Zeńczak-Więckiewicz, D


    Chronic oral and facial pain syndromes are an indication for intervention of physicians of numerous medical specialties, while the complex nature of these complaints warrants interdisciplinary diagnostic and therapeutic approach. Oftentimes, lack of proper differentiation of pain associated with pathological changes of the surrounding tissues, neurogenic pain, vascular pain, or radiating pain from idiopathic facial pain leads to improper treatment. The objective of the paper is to provide detailed characterization of pain developing in the natural history of trigeminal neuralgia and temporomandibular joint dysfunction, with particular focus on similarities accounting for the difficulties in diagnosis and treatment as well as on differences between both types of pain. It might seem that trigeminal neuralgia can be easily differentiated from temporomandibular joint dysfunction due to the acute, piercing, and stabbing nature of neuralgic pain occurring at a single facial location to spread along the course of the nerve on one side, sometimes a dozen or so times a day, without forewarning periods. Both forms differ significantly in the character and intensity of pain. The exact analysis of the nature, intensity, and duration of pain may be crucial for the differential diagnostics of the disorders of our interest.

  5. Trigeminal nerve stimulation in major depressive disorder: first proof of concept in an open pilot trial. (United States)

    Schrader, Lara M; Cook, Ian A; Miller, Patrick R; Maremont, Eve R; DeGiorgio, Christopher M


    Modulation of brain activity via trigeminal nerve stimulation is an emerging therapy in drug-resistant epilepsy. This cranial nerve also projects to structures implicated in depression (such as the nucleus tractus solitarius and locus coeruleus). We examined the effects of external trigeminal nerve stimulation in major depressive disorder as an adjunct to pharmacotherapy. Five adults (mean age 49.6, SD 10.9, three females and two males) participated in an 8-week open-label outpatient trial; all had persistent symptoms despite adequate pharmacotherapy, with a mean score on the 28-item Hamilton Depression Rating Scale of 25.4 (SD=3.9) at entry. Nightly stimulation over the V(1) branch was well tolerated. Both the clinician-rated 28-item Hamilton Depression Rating Scale (P=0.006) and the self-rated Beck Depression Inventory (P=0.0004) detected significant symptomatic improvement. This novel neuromodulation approach may have use as an adjunct to pharmacotherapy in major depressive disorder. Additional larger trials are needed to delineate efficacy and tolerability with greater reliability. Copyright © 2011 Elsevier Inc. All rights reserved.

  6. Pain outside the body: defensive peripersonal space deformation in trigeminal neuralgia. (United States)

    Bufacchi, R J; Sambo, C F; Di Stefano, G; Cruccu, G; Iannetti, G D


    Perception of space has been guiding effective therapeutic interventions in a number of unilateral chronic pain conditions. However little is known about how trigeminal neuralgia (TN), a condition in which trigeminal stimulation triggers paroxysmal facial pain, affects defensive peripersonal space (DPPS), the portion of space surrounding the body within which defensive responses are enhanced. Given that TN is unilateral, in TN patients the DPPS of the face might not be horizontally symmetric as in pain-free individuals, but instead larger around the affected side. We tested this a priori hypothesis by measuring the proximity-dependent modulation of the hand-blink reflex. Stimuli delivered to the hand ipsilateral to TN elicited a stronger blink, particularly when it was measured from the eye ipsilateral to TN and the hand was closer to the face. Geometric modelling revealed (1) that DPPS was larger on the side of space ipsilateral to TN, and (2) this asymmetry was consequent to an increased estimated potential of sensory events to cause harm when they occur ipsilaterally to TN. These observations demonstrate that neural mechanisms underlying body protection in TN are adjusted to reduce the likelihood that external events evoke the painful paroxysm typical of this condition.

  7. Diagnostic and therapeutic errors in trigeminal autonomic cephalalgias and hemicrania continua: a systematic review. (United States)

    Viana, Michele; Tassorelli, Cristina; Allena, Marta; Nappi, Giuseppe; Sjaastad, Ottar; Antonaci, Fabio


    Trigeminal autonomic cephalalgias (TACs) and hemicrania continua (HC) are relatively rare but clinically rather well-defined primary headaches. Despite the existence of clear-cut diagnostic criteria (The International Classification of Headache Disorders, 2nd edition - ICHD-II) and several therapeutic guidelines, errors in workup and treatment of these conditions are frequent in clinical practice. We set out to review all available published data on mismanagement of TACs and HC patients in order to understand and avoid its causes. The search strategy identified 22 published studies. The most frequent errors described in the management of patients with TACs and HC are: referral to wrong type of specialist, diagnostic delay, misdiagnosis, and the use of treatments without overt indication. Migraine with and without aura, trigeminal neuralgia, sinus infection, dental pain and temporomandibular dysfunction are the disorders most frequently overdiagnosed. Even when the clinical picture is clear-cut, TACs and HC are frequently not recognized and/or mistaken for other disorders, not only by general physicians, dentists and ENT surgeons, but also by neurologists and headache specialists. This seems to be due to limited knowledge of the specific characteristics and variants of these disorders, and it results in the unnecessary prescription of ineffective and sometimes invasive treatments which may have negative consequences for patients. Greater knowledge of and education about these disorders, among both primary care physicians and headache specialists, might contribute to improving the quality of life of TACs and HC patients.

  8. Effects of olfactory function, age, and gender on trigeminally mediated sensations: a study based on the lateralization of chemosensory stimuli. (United States)

    Hummel, Thomas; Futschik, Thomas; Frasnelli, Johannes; Hüttenbrink, Karl-Bernd


    The present investigation aimed to compare trigeminal nasal function of anosmic and hyposmic patients to healthy controls. Further, we aimed to study effects of age and gender on trigeminally mediated sensations following intranasal chemosensory stimulation. Participants were 35 patients with olfactory dysfunction (n=13: functional anosmia; n=22: hyposmia; age 28-69 years, mean age 56 years). Their results were compared with 17 normosmic subjects (28-82 years, mean 52 years). To analyze effects of age and gender in healthy subjects, an additional 24 healthy subjects were included (19-27 years; mean 24 years). Olfactory function was assessed using the 'Sniffin' Sticks' test kit (butanol odor threshold, odor discrimination, odor identification). The subjects' ability to lateralize odors was investigated for benzaldehyde and eucalyptol. Patients with olfactory dysfunction had lower scores in the lateralization task than controls (Pcauses of olfactory dysfunction (P>0.29). There was a weak, but significant, correlation between localization of eucalyptol and duration of olfactory dysfunction (P=0.017). When investigating normosmic subjects only, no gender-related difference was apparent for lateralization scores. However, older subjects had lower scores than younger ones (Pcause of olfactory loss. The deficit appears to improve with duration of the olfactory dysfunction, possibly indicating adaptive mechanisms. Further, the data suggest an age-related decrease of intranasal trigeminal sensitivity in healthy subjects. Analyses additionally indicate a correlation between olfactory and trigeminal sensitivity.

  9. Facial injections of pruritogens and algogens excite partly overlapping populations of primary and second-order trigeminal neurons in mice. (United States)

    Akiyama, T; Carstens, M Iodi; Carstens, E


    Intradermal cheek injection of pruitogens or algogens differentially elicits hindlimb scratching or forelimb wiping, suggesting that these behaviors distinguish between itch and pain. We studied whether pruritogens and algogens excite separate or overlapping populations of primary afferent and second-order trigeminal neurons in mice. Calcium imaging of primary sensory trigeminal ganglion (TG) cells showed that 15.4% responded to histamine, 5.8% to the protease-activated receptor (PAR)-2 agonist, 13.4% to allyl isothiocyanate (AITC), and 36.7% to capsaicin. AITC and/or capsaicin activated the vast majority of histamine- and PAR-2 agonist-sensitive TG cells. A chemical search strategy identified second-order neurons in trigeminal subnucleus caudalis (Vc) responsive to histamine, the PAR-2 agonist, or AITC. A minority of histamine or PAR-2 agonist-responsive Vc neurons responded to the other pruritogen, whereas a large majority of puritogen-responsive Vc neurons responded to capsaicin and/or AITC. A minority of AITC-responsive Vc neurons responded to pruritogens, whereas most responded to capsaicin. These data indicate that most primary and higher-order trigeminal sensory neurons are activated by both pruritic and algesic stimuli, although a minority exhibit selectivity. The results are discussed in terms of population codes for itch and pain that result in distinct behavioral responses of hindlimb scratching and forelimb wiping that are mediated at lumbar and cervical segmental levels, respectively.

  10. KYNA analogue SZR72 modifies CFA-induced dural inflammation- regarding expression of pERK1/2 and IL-1β in the rat trigeminal ganglion

    DEFF Research Database (Denmark)

    Lukács, M; Warfvinge, K; Kruse, L S


    BACKGROUND: Neurogenic inflammation has for decades been considered an important part of migraine pathophysiology. In the present study, we asked the question if administration of a novel kynurenic acid analogue (SZR72), precursor of an excitotoxin antagonist and anti-inflammatory substance, can...... modify the neurogenic inflammatory response in the trigeminal ganglion. METHODS: Inflammation in the trigeminal ganglion was induced by local dural application of Complete Freunds Adjuvant (CFA). Levels of phosphorylated MAP kinase pERK1/2 and IL-1β expression in V1 region of the trigeminal ganglion were...

  11. Neuralgia do trigêmeo bilateral: relato de caso Neuralgia del trigémino bilateral: relato de caso Bilateral trigeminal neuralgia: case report

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    Caio Marcio Barros de Oliveira


    Full Text Available JUSTIFICATIVA E OBJETIVOS: A neuralgia do nervo trigêmeo é uma condição intensamente dolorosa, caracterizada por surtos de dor lancinante e súbita, tipo choque, com duração de poucos segundos a dois minutos e geralmente unilateral. Sua incidência anual é de cerca de 4,3 em 100.000 na população geral, tendo manifestação bilateral em apenas 3% desses casos. O objetivo deste artigo foi descrever um caso raro de neuralgia do trigêmeo primário bilateral. RELATO DO CASO: Paciente de 61 anos, maranhense, casada, do lar, com antecedente de hipertensão arterial e há seis anos com queixa de dor intensa em V2-V3 à esquerda, com duração de 5 a 10 segundos, em região lateral do nariz e mandibular, com piora ao falar, mastigar e com diminuição da temperatura. Já havia utilizado clorpromazina (3 mg a cada oito horas e carbamazepina (200 mg a cada oito horas durante seis meses sem alívio da dor. Ao exame físico apresentava alodinia térmica e mecânica em regiões de V2-V3. Estava em uso de gabapentina (1.200 mg ao dia com alívio parcial da dor. Foi então aumentada a gabapentina para 1500 mg ao dia e introduzida amitriptilina 12,5 mg à noite. Evoluiu com dor leve e esporádica com diminuição da intensidade da dor ao longo de 10 meses de tratamento, sendo reduzida progressivamente a gabapentina para 600 mg ao dia e mantida a amitriptilina 12,5 mg ao dia. Após um ano, começou a apresentar dor de característica semelhante em região mandibular à direita, tendo melhorado com aumento de gabapentina para 900 mg ao dia. Não apresentava exames alterados de tomografia ou ressonância magnética de encéfalo. CONCLUSÕES: A carbamazepina é o fármaco de primeira escolha para tratamento de neuralgia trigeminal, porém a gabapentina tem sido cada vez mais utilizada como primeira medida farmacológica ou em casos refratários à terapia convencional.JUSTIFICATIVA Y OBJETIVOS: La neuralgia del nervio trigémino es una condici

  12. Botulinum neurotoxin type-A when utilized in animals with trigeminal sensitization induced a antinociceptive effect

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    Elcio J Piovesan


    Full Text Available ABSTRACT Purpose of the study was evaluate the possible antinociceptive effect of botulinum neurotoxin type-A (BoNT/A in an experimental model of trigeminal neuralgia. Method Neuropathic pain was induced by surgical constriction of the infraorbital nerve in rats. A control group underwent a sham procedure consisting of surgical exposure of the nerve. Subgroups of each group received either BoNT/A or isotonic saline solution. The clinical response was assessed with the -20°C test. Animals that underwent nerve constriction developed sensitization; the sham group did not. Results The sensitization was reversed by BoNT/A treatment evident 24 hours following application. Pronociceptive effect was observed in the sham group following BoNT/A. Conclusion BoNT/A has an antinociceptive effect in sensitized animals and a pronociceptive effect in non-sensitized animals.

  13. Latent acyclovir-resistant herpes simplex virus type 1 in trigeminal ganglia of immunocompetent individuals. (United States)

    van Velzen, Monique; van Loenen, Freek B; Meesters, Roland J W; de Graaf, Miranda; Remeijer, Lies; Luider, Theo M; Osterhaus, Albert D M E; Verjans, Georges M G M


    Specific mutations within the hypervariable herpes simplex virus (HSV) gene thymidine kinase (TK) gene lead to acyclovir (ACV) resistance. To uncover the existence of latent ACV-resistant (ACV(R)) HSV-1, we determined the genetic and functional variability of the HSV-1 TK gene pool in paired trigeminal ganglia (TG) of 5 immunocompetent individuals. The latent virus pool consisted of a donor-specific HSV-1 quasispecies, including one major ACV-sensitive (ACV(S)) and multiple phylogenetic-related minor ACV(S) and ACV(R) TK variants. Contrary to minor variants, major TK variants were shared between paired TG. The data demonstrate the coexistence of phylogenetic-related ACV(S) and ACV(R) latent HSV-1 in human TG.

  14. [Activity of glial cells in trigeminal nervous system in rats with experimental pulpitis]. (United States)

    Gu, Bin; Liu, Na; Liu, Hongchen


    To observe the activity change of astrocyte in related nucleus caused by acute pulpitis in rats. Rat acute pulpitis model was induced by lipopolysaccharides (LPS). And, according to processing time, a total of 30 rats were divided into 5 groups of control, 6, 12, 24 and 48 h. Immunohistochemistry and Western blot were employed to detect the dynamic expression of glial fibrillary acidic protein (GFAP) in spinal nucleus of trigeminal nerve (Vc). The relative gray value of ipsilateral Vc GFAP expression in experimental groups was 153 ± 11 at 12 h. And it significantly increased versus the control group (100 ± 4)(P pulpitis model, activated glial cells are probably involved in the processes of pulpitis and hyperalgesia.

  15. Sudden blindness as a complication of percutaneous trigeminal procedures: mechanism analysis and prevention. (United States)

    Agazzi, Siviero; Chang, Stanley; Drucker, Mitchell D; Youssef, A Samy; Van Loveren, Harry R


    The authors describe the case of a 76-year-old man in whom reversible sudden blindness developed after a percutaneous balloon compression rhizotomy for trigeminal neuralgia. His eye became tense and swollen with intraocular pressures of 66 mm Hg. Acetazolamide was administered, and visual acuity (20/50) returned within several months. Despite correct needle placement, the intraocular pressure rose acutely because of transient occlusion of the orbital venous drainage through the cavernous sinus; this was reversed with aggressive medical treatment. In cadaveric studies (dried skull and formalin-fixed head), the authors studied the mechanism of optic nerve penetration. Their findings showed that excessive cranial angulation of the needle with penetration of the inferior orbital fissure can directly traumatize the optic nerve in the orbital apex. Direct trauma to the optic nerve can therefore be prevented by early and repeated confirmation of the needle trajectory with lateral fluoroscopy before penetration of the foramen ovale.

  16. Effect of a calcitonin gene-related peptide-binding L-RNA aptamer on neuronal activity in the rat spinal trigeminal nucleus


    Fischer, Michael J. M.; Schmidt, Jakob; Koulchitsky, Stanislav; Klussmann, Sven; Vater, Axel; Messlinger, Karl


    Background Calcitonin gene-related peptide (CGRP) plays a major role in the pathogenesis of migraine and other primary headaches. Spinal trigeminal neurons integrate nociceptive afferent input from trigeminal tissues including intracranial afferents, and their activity is thought to reflect facial pain and headache in man. CGRP receptor inhibitors and anti-CGRP antibodies have been demonstrated to be therapeutically effective in migraine. In parallel, CGRP receptor inhibition has been shown t...

  17. Treatments' outcomes of patients suffered from trigeminal neuralgia in kerman, iran. (United States)

    Faryabi, Javad; Joolhar, Maryam


    Trigeminal neuralgia (TN) presents with a shooting pain in maxillofacial region which compels the involved patients to visit many medical and dental physicians to relieve the pain. Hence, assessing the outcomes of different treatment modalities may help the patients and their clinicians choose a suitable practical method of treatment. The study was aimed to evaluate the outcomes of different treatments of TN and to determine which surgical or non-surgical treatment is better for controlling the pain. This study included 42 patients with trigeminal neuralgia. A questionnaire was completed for each patient in order to evaluate the pain control status of patients' treatment with non-surgical (pharmaceutical) and surgical modalities. The questionnaire consisted of questions on an datasheet , concerning the duration of involvement with the condition, type and dose of the medication(s) used, the surgical technique administrated, patient satisfaction with the treatment modality and the intensity and frequency of the pain if present. The purpose of the study and the necessary information regarding the questions of the data sheet was given in detail to the patients for a careful completion of the questionnaires. Data was analyzed by adopting t-test using SPSS software. The results showed that the patients treated with pharmaceutical modalities had relatively lower improvement rate than those treated with surgery combined with medication (p< 0.035). Carbamazepine was the most consumed medication for pain control and the microvascular decompression was the most performed surgical method in patients. Although medication therapy alone was less effective than surgery combined with medication, both treatment modalities were significantly effective in controlling the pain of patients.

  18. A case of trigeminal hypersensitivity after administration of intrathecal sufentanil and bupivacaine for labor analgesia

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    Adriano Bechara de Souza Hobaika


    Full Text Available Rostral spread of intrathecal drugs and sensitization of supraspinal sites may provoke several adverse effects. This case describes a patient with right hemifacial paresthesia, trismus and dysphasia on the trigeminal nerve distribution after intrathecal sufentanil administration. Primigravida, 34 years, 39 weeks of pregnancy, with hypothyroidism and pregnancy induced hypertension. Allergic to latex. In the use of puran T4, 50 μg /day. When the patient presented cervical dilatation of 4 cm, she requested analgesia. She was placed in the sitting position and a spinal puncture was performed with a 27G needle pencil point in L4/L5 (1.5 mg of bupivacaine plus 7.5 μg of sufentanil. Next, was performed an epidural puncture in the same space. It was injected bupivacaine 0.065%, 10 ml, to facilitate the passage of the catheter. After 5 min lying down in the lateral upright position, she complained of perioral and right hemifacial paresthesia, mainly maxillary and periorbital, as well as trismus and difficulty to speak. The symptoms lasted for 30 min and resolved spontaneously. After 1 h, patient requested supplementary analgesia (12 ml of bupivacaine 0.125% and a healthy baby girl was born. Temporary mental alterations have been described with the use of fentanyl and sufentanil in combined epidural-spinal analgesia, such as aphasia, difficulty of swallowing, mental confusion and even unconsciousness. In this patient, facial areas with paresthesia indicated by patient appear in clear association with the ophthalmic and maxillary branches of the trigeminal nerve and the occurrence of trismus and dysphagia are in association with the mandibular motor branch. The exact mechanism of rostral spread is not known, but it is speculated that after spinal drug administration, a subsequent epidural dose may reduce the intratecal space and propel the drug into the supraspinal sites.

  19. The role of a trigeminal sensory nucleus in the initiation of locomotion (United States)

    Buhl, Edgar; Roberts, Alan; Soffe, Stephen R


    While we understand how stimuli evoke sudden, ballistic escape responses, like fish fast-starts, a precise pathway from sensory stimulation to the initiation of rhythmic locomotion has not been defined for any vertebrate. We have now asked how head skin stimuli evoke swimming in hatchling frog tadpoles. Whole-cell recordings and dye filling revealed a nucleus of ∼20 trigeminal interneurons (tINs) in the hindbrain, at the level of the auditory nerve, with long, ipsilateral, descending axons. Stimulation of touch-sensitive trigeminal afferents with receptive fields anywhere on the head evoked large, monosynaptic EPSPs (∼5–20 mV) in tINs, at mixed AMPAR/NMDAR synapses. Following stimuli sufficient to elicit swimming, tINs fired up to six spikes, starting 4–8 ms after the stimulus. Paired whole-cell recordings showed that tINs produce small (∼2–6 mV), monosynaptic, glutamatergic EPSPs in the hindbrain reticulospinal neurons (descending interneurons, dINs) that drive swimming. Modelling suggested that summation of EPSPs from 18–24 tINs can make 20–50% of dINs fire. We conclude that: brief activity in a few sensory afferents is amplified by recruitment of many tINs; these relay summating excitation to hindbrain reticulospinal dINs; dIN firing then initiates activity for swimming on the stimulated side. During fictive swimming, tINs are depolarised and receive rhythmic inhibition but do not fire. Our recordings demonstrate a neuron-by-neuron pathway from head skin afferents to the reticulospinal neurons and motoneurons that drive locomotion in a vertebrate. This direct pathway, which has an important amplifier function, implies a simple origin for the complex routes to initiate locomotion in higher vertebrates. PMID:22393253

  20. Sensitization of trigeminal brainstem pathways in a model for tear deficient dry eye. (United States)

    Rahman, Mostafeezur; Okamoto, Keiichiro; Thompson, Randall; Katagiri, Ayano; Bereiter, David A


    Chronic dry eye disease (DE) is associated with an unstable tear film and symptoms of ocular discomfort. The characteristics of symptoms suggest a key role for central neural processing; however, little is known about central neuroplasticity and DE. We used a model for tear deficient DE and assessed effects on eye blink behavior, orbicularis oculi muscle activity (OOemg), and trigeminal brainstem neural activity in male rats. Ocular-responsive neurons were recorded at the interpolaris/caudalis transition (Vi/Vc) and Vc/upper cervical cord (Vc/C1) regions under isoflurane, whereas OOemg activity was recorded under urethane. Spontaneous tear volume was reduced by ∼50% at 14 days after exorbital gland removal. Hypertonic saline-evoked eye blink behavior in awake rats was enhanced throughout the 14 days after surgery. Saline-evoked neural activity at the Vi/Vc transition and in superficial and deep laminae at the Vc/C1 region was greatly enhanced in DE rats. Neurons from DE rats classified as wide dynamic range displayed enlarged convergent periorbital receptive fields consistent with central sensitization. Saline-evoked OOemg activity was markedly enhanced in DE rats compared with controls. Synaptic blockade at the Vi/Vc transition or the Vc/C1 region greatly reduced hypertonic saline-evoked OOemg activity in DE and sham rats. These results indicated that persistent tear deficiency caused sensitization of ocular-responsive neurons at multiple regions of the caudal trigeminal brainstem and enhanced OOemg activity. Central sensitization of ocular-related brainstem circuits is a significant factor in DE and likely contributes to the apparent weak correlation between peripheral signs of tear dysfunction and symptoms of irritation.

  1. Colocalized structural and functional changes in the cortex of patients with trigeminal neuropathic pain.

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    Alexandre F DaSilva

    Full Text Available Recent data suggests that in chronic pain there are changes in gray matter consistent with decreased brain volume, indicating that the disease process may produce morphological changes in the brains of those affected. However, no study has evaluated cortical thickness in relation to specific functional changes in evoked pain. In this study we sought to investigate structural (gray matter thickness and functional (blood oxygenation dependent level - BOLD changes in cortical regions of precisely matched patients with chronic trigeminal neuropathic pain (TNP affecting the right maxillary (V2 division of the trigeminal nerve. The model has a number of advantages including the evaluation of specific changes that can be mapped to known somatotopic anatomy.Cortical regions were chosen based on sensory (Somatosensory cortex (SI and SII, motor (MI and posterior insula, or emotional (DLPFC, Frontal, Anterior Insula, Cingulate processing of pain. Both structural and functional (to brush-induced allodynia scans were obtained and averaged from two different imaging sessions separated by 2-6 months in all patients. Age and gender-matched healthy controls were also scanned twice for cortical thickness measurement. Changes in cortical thickness of TNP patients were frequently colocalized and correlated with functional allodynic activations, and included both cortical thickening and thinning in sensorimotor regions, and predominantly thinning in emotional regions.Overall, such patterns of cortical thickness suggest a dynamic functionally-driven plasticity of the brain. These structural changes, which correlated with the pain duration, age-at-onset, pain intensity and cortical activity, may be specific targets for evaluating therapeutic interventions.

  2. Trigeminal high-frequency stimulation produces short- and long-term modification of reflex blink gain. (United States)

    Ryan, Michael; Kaminer, Jaime; Enmore, Patricia; Evinger, Craig


    Reflex blinks provide a model system for investigating motor learning in normal and pathological states. We investigated whether high-frequency stimulation (HFS) of the supraorbital branch of the trigeminal nerve before the R2 blink component (HFS-B) decreases reflex blink gain in alert rats. As with humans (Mao JB, Evinger C. J Neurosci 21: RC151, 2001), HFS-B significantly reduced blink size in the first hour after treatment for rats. Repeated days of HFS-B treatment produced long-term depression of blink circuits. Blink gain decreased exponentially across days, indicating a long-term depression of blink circuits. Additionally, the HFS-B protocol became more effective at depressing blink amplitude across days of treatment. This depression was not habituation, because neither long- nor short-term blink changes occurred when HFS was presented after the R2. To investigate whether gain modifications produced by HFS-B involved cerebellar networks, we trained rats in a delay eyelid conditioning paradigm using HFS-B as the unconditioned stimulus and a tone as the conditioned stimulus. As HFS-B depresses blink circuits and delay conditioning enhances blink circuit activity, occlusion should occur if they share neural networks. Rats acquiring robust eyelid conditioning did not exhibit decreases in blink gain, whereas rats developing low levels of eyelid conditioning exhibited weak, short-term reductions in blink gain. These results suggested that delay eyelid conditioning and long-term HFS-B utilize some of the same cerebellar circuits. The ability of repeated HFS-B treatment to depress trigeminal blink circuit activity long term implied that it may be a useful protocol to reduce hyperexcitable blink circuits that underlie diseases like benign essential blepharospasm.

  3. Computational fluid dynamics and trigeminal sensory examinations of empty nose syndrome patients. (United States)

    Li, Chengyu; Farag, Alexander A; Leach, James; Deshpande, Bhakthi; Jacobowitz, Adam; Kim, Kanghyun; Otto, Bradley A; Zhao, Kai


    The precise pathogenesis of empty nose syndrome (ENS) remains unclear. Various factors such as nasal aerodynamics and sensorineural dysfunction have been suspected, although evidence is limited. This study reported the first examination of both nasal aerodynamics and trigeminal sensory factors in actual ENS patients. Prospective case control. We enrolled six patients diagnosed with ENS. Three patients had pre- and post-inferior turbinate (IT) reduction computed tomography scans, which allowed comparison of their nasal aerodynamics changes through computational fluid dynamic (CFD) simulation. Their symptoms were confirmed through Sino-nasal Outcome Test-22, ENS 6-item Questionnaire, acoustic rhinometry, and rhinomanometry findings. Nasal trigeminal sensitivity that potentially mediates their perception of airflow was assessed via menthol lateralization detection thresholds (LDT) and compared with 14 healthy controls. Post-surgical reductions in nasal resistance were observed and significantly lower than normal (P fluid dynamic analysis showed that, paradoxically for all ENS patients, IT reduction did not draw more airflow to the airway surrounding the ITs, but rather resulted in nasal airflow forming into a narrow jet toward the middle meatus region, leaving the airway surrounding the IT with significantly reduced airflow intensity and air-mucosal interactions (inferior region flow percentage reduced from 35.7% ± 15.9% to post-surgery 17.7% ± 15.7%, P < 0.05; inferior wall-shear-stress reduced from 7.5 ± 4.2 × 10 -2 Pa to 3.4 ± 3.1 × 10 -2 Pa, P < 0.01). Empty nose syndrome patients also had significantly impaired menthol LDT compared to healthy controls (P < 0.005). The results indicated that a combinatory of factors, including paradoxically distorted nasal aerodynamic, impaired sensorineural sensitivity, and potential predisposing conditions, may contribute to the development of ENS. 3b. Laryngoscope, 127:E176-E184, 2017. © 2017 The American Laryngological

  4. Trigeminal Nerve Stimulation for Comorbid Posttraumatic Stress Disorder and Major Depressive Disorder. (United States)

    Cook, Ian A; Abrams, Michelle; Leuchter, Andrew F


    External stimulation of the trigeminal nerve (eTNS) is an emerging neuromodulation therapy for epilepsy and depression. Preliminary studies suggest it has an excellent safety profile and is associated with significant improvements in seizures and mood. Neuroanatomical projections of the trigeminal system suggest eTNS may alter activity in structures regulating mood, anxiety, and sleep. In this proof-of-concept trial, the effects of eTNS were evaluated in adults with posttraumatic stress disorder (PTSD) and comorbid unipolar major depressive disorder (MDD) as an adjunct to pharmacotherapy for these commonly co-occurring conditions. Twelve adults with PTSD and MDD were studied in an eight-week open outpatient trial (age 52.8 [13.7 sd], 8F:4M). Stimulation was applied to the supraorbital and supratrochlear nerves for eight hours each night as an adjunct to pharmacotherapy. Changes in symptoms were monitored using the PTSD Patient Checklist (PCL), Hamilton Depression Rating Scale (HDRS-17), Quick Inventory of Depressive Symptomatology (QIDS-C), and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). Over the eight weeks, eTNS treatment was associated with significant decreases in PCL (p = 0.003; median decrease of 15 points; effect size d 1.5), HDRS-17 (p depression severity were achieved in the eight weeks of acute eTNS treatment. This novel approach to wearable brain stimulation may have use as an adjunct to pharmacotherapy in these disorders if efficacy and tolerability are confirmed with additional studies. © 2016 International Neuromodulation Society.

  5. Multimodal Image-Based Virtual Reality Presurgical Simulation and Evaluation for Trigeminal Neuralgia and Hemifacial Spasm. (United States)

    Yao, Shujing; Zhang, Jiashu; Zhao, Yining; Hou, Yuanzheng; Xu, Xinghua; Zhang, Zhizhong; Kikinis, Ron; Chen, Xiaolei


    To address the feasibility and predictive value of multimodal image-based virtual reality in detecting and assessing features of neurovascular confliction (NVC), particularly regarding the detection of offending vessels, degree of compression exerted on the nerve root, in patients who underwent microvascular decompression for nonlesional trigeminal neuralgia and hemifacial spasm (HFS). This prospective study includes 42 consecutive patients who underwent microvascular decompression for classic primary trigeminal neuralgia or HFS. All patients underwent preoperative 1.5-T magnetic resonance imaging (MRI) with T2-weighted three-dimensional (3D) sampling perfection with application-optimized contrasts by using different flip angle evolutions, 3D time-of-flight magnetic resonance angiography, and 3D T1-weighted gadolinium-enhanced sequences in combination, whereas 2 patients underwent extra experimental preoperative 7.0-T MRI scans with the same imaging protocol. Multimodal MRIs were then coregistered with open-source software 3D Slicer, followed by 3D image reconstruction to generate virtual reality (VR) images for detection of possible NVC in the cerebellopontine angle. Evaluations were performed by 2 reviewers and compared with the intraoperative findings. For detection of NVC, multimodal image-based VR sensitivity was 97.6% (40/41) and specificity was 100% (1/1). Compared with the intraoperative findings, the κ coefficients for predicting the offending vessel and the degree of compression were >0.75 (P impact on detection of small-caliber offending vessels with relatively slow flow speed in cases of HFS. Multimodal image-based VR using 3D sampling perfection with application-optimized contrasts by using different flip angle evolutions in combination with 3D time-of-flight magnetic resonance angiography sequences proved to be reliable in detecting NVC and in predicting the degree of root compression. The VR image-based simulation correlated well with the real

  6. Usefulness of a Virtual Reality Percutaneous Trigeminal Rhizotomy Simulator in Neurosurgical Training. (United States)

    Shakur, Sophia F; Luciano, Cristian J; Kania, Patrick; Roitberg, Ben Z; Banerjee, P Pat; Slavin, Konstantin V; Sorenson, Jeffrey; Charbel, Fady T; Alaraj, Ali


    Simulation-based training may be incorporated into neurosurgery in the future. To assess the usefulness of a novel haptics-based virtual reality percutaneous trigeminal rhizotomy simulator. A real-time augmented reality simulator for percutaneous trigeminal rhizotomy was developed using the ImmersiveTouch platform. Ninety-two neurosurgery residents tested the simulator at American Association of Neurological Surgeons Top Gun 2014. Postgraduate year (PGY), number of fluoroscopy shots, the distance from the ideal entry point, and the distance from the ideal target were recorded by the system during each simulation session. Final performance score was calculated considering the number of fluoroscopy shots and distances from entry and target points (a lower score is better). The impact of PGY level on residents' performance was analyzed. Seventy-one residents provided their PGY-level and simulator performance data; 38% were senior residents and 62% were junior residents. The mean distance from the entry point (9.4 mm vs 12.6 mm, P = .01), the distance from the target (12.0 mm vs 15.2 mm, P = .16), and final score (31.1 vs 37.7, P = .02) were lower in senior than in junior residents. The mean number of fluoroscopy shots (9.8 vs 10.0, P = .88) was similar in these 2 groups. Linear regression analysis showed that increasing PGY level is significantly associated with a decreased distance from the ideal entry point (P = .001), a shorter distance from target (P = .05), a better final score (P = .007), but not number of fluoroscopy shots (P = .52). Because technical performance of percutaneous rhizotomy increases with training, we proposed that the skills in performing the procedure in our virtual reality model would also increase with PGY level, if our simulator models the actual procedure. Our results confirm this hypothesis and demonstrate construct validity.

  7. Central syntropic effects elicited by trigeminal proprioceptive equilibrium in Alzheimer’s disease: a case report

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    De Cicco Vincenzo


    Full Text Available Abstract Introduction The presented patient, affected by Alzheimer’s disease, underwent neuropsychological evaluation and functional magnetic resonance imaging investigation under occlusal proprioceptive un-balance and re-balance conditions. Saccadic and pupillometric video-oculographic examinations were performed in order to detect connected trigeminal proprioceptive motor patterns able to interfere with reticular formation cerebellum functions linked to visual and procedural processes prematurely altered in Alzheimer’s disease. Case presentation A 66-year-old Caucasian man, affected by Alzheimer’s disease and with a neuropsychological evaluation issued by the Alzheimer’s Evaluation Unit, underwent an electromyographic investigation of the masseter muscles in order to assess their functional balance. The patient showed a bilateral lack of all inferior molars. The extreme myoelectric asymmetry in dental occlusion suggested the rebalancing of masseter muscular functions through concurrent transcutaneous stimulation of the trigeminal nerve supramandibular and submandibular motor branches. The above-mentioned method allows detection of symmetric craniomandibular muscular relation that can be kept constant through the use of a cusp bite modeled on the inferior dental arch, called orthotic-syntropic bite. A few days later, the patient underwent a new neuropsychological investigation, together with a functional magnetic resonance imaging study, and saccadic, pupillometric video-oculographic examinations in occlusal un-balance and re-balance conditions. Conclusions Comparative data analysis has shown that a re-balanced occlusal condition can improve a patient’s cognitive-attentive functions. Moreover, the saccadic and pupillometric video-oculographic investigations have proven useful both in analyzing reticulo-cerebellar subcortical systems, prematurely altered in Alzheimer’s disease, and in implementing neurological evaluations.

  8. Microvascularization in trigeminal ganglion of the common tree shrew (Tupaia glis). (United States)

    Kongstaponkit, S; Pradidarcheep, W; Toutip, S; Chunhabundit, P; Somana, R


    Since there is only a limited number of studies of the blood supply to the trigeminal ganglion (TG) in mammalian species, the TG from 16 common tree shrews (Tupaia glis) were investigated by light microscope, transmission electron microscope (TEM) and the corrosion cast technique in conjunction with scanning electron microscope (SEM). It was found that the TG contained clusters of neurons in the peripheral region whereas the bundles of nerve fibers were located more centrally. Each ganglionic neuron had a concentric nucleus and was ensheathed by satellite cells. It was noted that blood vessels of a continuous type were predominantly found in the area where the neurons were densely located and were much less frequently observed in the area occupied by nerve fibers. With TEM, the TG was shown to be mainly associated with large neurons containing big nuclei and prominent nucleoli. The blood supply of the TG is derived from the most rostral branch of the pontine artery, from the stapedial artery or sometimes from the supraorbital artery, and from the accessory meningeal artery which is a branch of the maxillary artery passing through the foramen ovale. These arteries give off branches and become capillary networks in the ganglion before draining blood to the peripheral region. The veins at the medial border drained into the cavernous sinus directly or through the inferior hypophyseal vein, while those at the lateral side of the ganglion carried the blood into the pterygoid plexus via an accessory meningeal vein. The veins along the trigeminal nerve root joined the posterior part of the cavernous sinus. These studies establish a unique anatomical distribution of the TG blood supply in the tree shrew and the utility of the cast/SEM technique in discerning detailed features of the blood supply in the nervous system.

  9. Magnetic resonance imaging of vascular compression in trigeminal neuralgia and hemifacial spasms

    International Nuclear Information System (INIS)

    Nagaseki, Yoshishige; Horikoshi, Tohru; Omata, Tomohiro; Sugita, Masao; Nukui, Hideaki; Sakamoto, Hajime; Kumagai, Hiroshi; Sasaki, Hideo; Tsuji, Reizou.


    We show how neurosurgical planning can benefit from the better visualization of the precise vascular compression of the nerve provided by the oblique-sagittal and gradient-echo method (OS-GR image) using magnetic resonance images (MRI). The scans of 3 patients with trigeminal neuralgia (TN) and of 15 with hemifacial spasm (HFS) were analyzed for the presence and appearance of the vascular compression of the nerves. Imaging sequences consisted of an OS-GR image (TR/TE: 200/20, 3-mm-thick slice) cut along each nerve shown by the axial view, which was scanned at the angle of 105 degrees taken between the dorsal line of the brain stem and the line corresponding to the pontomedullary junction. In the OS-GR images of the TN's, the vascular compressions of the root entry zone (REZ) of the trigeminal nerve were well visualized as high-intensity lines in the 2 cases whose vessels were confirmed intraoperatively. In the other case, with atypical facial pain, vascular compression was confirmed at the rostral distal site on the fifth nerve, apart from the REZ. In the 15 cases of HFS, twelve OS-GR images (80%) demonstrated vascular compressions at the REZ of the facial nerves from the direction of the caudoventral side. During the surgery for these 12 cases, in 11 cases (excepting the 1 case whose facial nerve was not compressed by any vessels), vascular compressions were confirmed corresponding to the findings of the OS-GR images. Among the 10 OS-GR images on the non-affected side, two false-positive findings were visualized. It is concluded that OS-GR images obtained by means of MRI may serve as a useful planning aid prior to microvascular decompression for cases of TN and HFS. (author)

  10. Trigeminal Neuralgia (United States)

    ... such as touching the face, chewing, speaking or brushing teeth Bouts of pain lasting from a few seconds ... neuralgia, including: Shaving Touching your face Eating Drinking Brushing your teeth Talking Putting on makeup Encountering a breeze Smiling ...

  11. ERK-GluR1 phosphorylation in trigeminal spinal subnucleus caudalis neurons is involved in pain associated with dry tongue. (United States)

    Nakaya, Yuka; Tsuboi, Yoshiyuki; Okada-Ogawa, Akiko; Shinoda, Masamichi; Kubo, Asako; Chen, Jui Yen; Noma, Noboru; Batbold, Dulguun; Imamura, Yoshiki; Sessle, Barry J; Iwata, Koichi


    Dry mouth is known to cause severe pain in the intraoral structures, and many dry mouth patients have been suffering from intraoral pain. In development of an appropriate treatment, it is crucial to study the mechanisms underlying intraoral pain associated with dry mouth, yet the detailed mechanisms are not fully understood. To evaluate the mechanisms underlying pain related to dry mouth, the dry-tongue rat model was developed. Hence, the mechanical or heat nocifensive reflex, the phosphorylated extracellular signal-regulated kinase and phosphorylated GluR1-IR immunohistochemistries, and the single neuronal activity were examined in the trigeminal spinal subnucleus caudalis of dry-tongue rats. The head-withdrawal reflex threshold to mechanical, but not heat, stimulation of the tongue was significantly decreased on day 7 after tongue drying. The mechanical, but not heat, responses of trigeminal spinal subnucleus caudalis nociceptive neurons were significantly enhanced in dry-tongue rats compared to sham rats on day 7. The number of phosphorylated extracellular signal-regulated kinase-immunoreactive cells was also significantly increased in the trigeminal spinal subnucleus caudalis following noxious stimulation of the tongue in dry-tongue rats compared to sham rats on day 7. The decrement of the mechanical head-withdrawal reflex threshold (HWT) was reversed during intracisternal administration of the mitogen-activated protein kinase kinase 1 inhibitor, PD98059. The trigeminal spinal subnucleus caudalis neuronal activities and the number of phosphorylated extracellular signal-regulated kinase-immunoreactive cells following noxious mechanical stimulation of dried tongue were also significantly decreased following intracisternal administration of PD98059 compared to vehicle-administrated rats. Increased number of the phosphorylated GluR1-IR cells was observed in the trigeminal spinal subnucleus caudalis of dry-tongue rats, and the number of phosphorylated GluR1-IR cells

  12. Computed tomography-guided percutaneous ozone injection of the Gasserian ganglion for the treatment of trigeminal neuralgia

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    An JX


    Full Text Available Jian-Xiong An,1,2 Hui Liu,1 Ruo-Wen Chen,1,2 Yong Wang,1 Wen-Xing Zhao,1 Derek Eastwood,3 John P Williams4 1Department of Anesthesiology, Pain Medicine & Critical Care Medicine, Aviation General Hospital of China Medical University & Beijing Institute of Translational Medicine, Chinese Academy of Sciences, 2Department of Anesthesiology, Weifang Medical University, Beijing, People’s Republic of China; 3Department of Pain Services, Wirral University Teaching Hospital, Wirral, Merseyside, UK; 4Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Objective: The aim of this study was to evaluate the therapeutic effect of computed tomography (CT-guided percutaneous ozone injection for refractory trigeminal neuralgia. Design: A retrospective evaluation was performed in the study. Setting: The study was conducted at a university hospital pain center. Patients and methods: A total of 29 patients with a clinical diagnosis of refractory trigeminal neuralgia were enrolled. All patients were treated with a percutaneous ozone injection and one patient was excluded. There were 21 patients with classical trigeminal neuralgia (group A and seven patients with painful trigeminal neuropathy caused by post-herpetic neuralgia (group B. The percutaneous injection was an oxygen–ozone mixture at an ozone concentration of 30 mg/­mL into the Gasserian ganglion performed under CT guidance. The number of ­procedures performed varied from one to as many as 16. Outcomes were evaluated using visual analog scale (VAS pain scores. Results: The combined VAS scores were 7.11 ± 1.23 pretreatment, 2.86 ± 1.69 posttreatment (P < 0.05 and 3.25 ± 2.01 after 6-month follow-up (P < 0.05. In group A, the VAS scores were 7.10 ± 1.04 pretreatment and 2.90 ± 1.84 posttreatment (P < 0.05. In group B, the VAS scores were 7.14 ± 1.77 pretreatment and 2.71 ± 1.25 posttreatment (P < 0.05. After 6-months follow-up, the VAS score was 3.38

  13. Assessment of neurovascular compression in patients with trigeminal neuralgia with a boundary fusion three-dimensional magnetic resonance cisternogram/angiogram

    International Nuclear Information System (INIS)

    Satoh, Toru; Omi, Megumi; Ohsako, Chika; Onoda, Keisuke; Date, Isao


    Precise assessment of the complex nerve-vessel relationship at the root entry zone (REZ) of the trigeminal nerve is useful for the planning of the microvascular decompression (MVD) in patients with trigeminal neuralgia. We have applied a boundary imaging of fusion three-dimensional (3D) magnetic resonance (MR) cisternogram/angiogram. The boundary imaging allows virtual assessment of the spatial relationship of the neurovascular compression at the REZ of the trigeminal nerve. The boundary images depicted complex anatomical relationship of the offending vessels to the trigeminal nerve REZ. The presence of offending vessels, compressive site, and degree of neurovascular compression were assessed from various viewpoints in the cistern and virtually through the brainstem and trigeminal nerve per se. The 3D visualization of the nerve-vessel relationship with fusion images was consistent with the intraoperative findings. The boundary fusion 3D MR cisternogram/angiogram may prove a useful adjunct for the diagnosis and decision-marking process to execute the MVD in patients with trigeminal neuralgia. (author)

  14. Proposal for evaluating the quality of reports of surgical interventions in the treatment of trigeminal neuralgia: the Surgical Trigeminal Neuralgia Score. (United States)

    Akram, Harith; Mirza, Bilal; Kitchen, Neil; Zakrzewska, Joanna M


    The aim of this study was to design a checklist with a scoring system for reporting on studies of surgical interventions for trigeminal neuralgia (TN) and to validate it by a review of the recent literature. A checklist with a scoring system, the Surgical Trigeminal Neuralgia Score (STNS), was devised partially based on the validated STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) criteria and customized for TN after a literature review and then applied to a series of articles. These articles were identified using a prespecified MEDLINE and Embase search covering the period from 2008 to 2010. Of the 584 articles found, 59 were studies of interventional procedures for TN that fulfilled the inclusion criteria and 56 could be obtained in full. The STNS was then applied independently by 3 of the authors. The maximum STNS came to 30, and was reliable and reproducible when used by the 3 authors who performed the scoring. The range of scores was 6-23.5, with a mean of 14 for all the journals. The impact factor scores of the journals in which the papers were published ranged from 0 to 4.8. Twenty-four of the studies were published in the Journal of Neurosurgery or in Neurosurgery. Studies published in neurosurgical journals ranked higher on the STNS scale than those published in nonneurosurgical journals. There was no statistically significant correlation between STNS and impact factors. Stereotactic radiosurgery (n = 25) and microvascular decompression (n = 15) were the most commonly reported procedures. The diagnostic criteria were stated in 35% of the studies, and 4 studies reported subtypes of TN. An increasing number of studies (46%) used the recommended Kaplan-Meier methodology for pain survival outcomes. The follow-up period was unclear in 8 studies, and 26 reported follow-ups of more than 5 years. Complications were reported fairly consistently but the temporal course was not always indicated. Direct interview, telephone conversation

  15. Persistência da artéria trigeminal primitiva associada com aneurisma da artéria cerebral média: relato de caso e revisão da literatura Persistent trigeminal artery associated with aneurysm of the middle cerebral artery: case report and literature review

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    Mauro Augusto de Oliveira


    Full Text Available Os autores apresentam um caso, demonstrado angiograficamente, de achado incidental de artéria trigeminal primitiva persistente associada com aneurisma do polígono de Willis no território da artéria cerebral média. A propósito, a literatura é revisada e a embriologia envolvida relatada.The authors report a case of persistent primitive trigeminal artery angiographically demonstrated as an incidental finding. The persistent primitive trigeminal artery was associated with an aneurysm arising from the circle of Willis in the middle cerebral artery territory. The literature is reviewed and the embryology involved is related.

  16. Dynamic Regulation of Delta-Opioid Receptor in Rat Trigeminal Ganglion Neurons by Lipopolysaccharide-induced Acute Pulpitis. (United States)

    Huang, Jin; Lv, Yiheng; Fu, Yunjie; Ren, Lili; Wang, Pan; Liu, Baozhu; Huang, Keqiang; Bi, Jing


    Delta-opioid receptor (DOR) and its endogenous ligands distribute in trigeminal system and play a very important role in modulating peripheral inflammatory pain. DOR activation can trigger p44/42 mitogen-activated protein kinase (ERK1/2) and Akt signaling pathways, which participate in anti-inflammatory and neuroprotective effects. In this study, our purpose was to determine the dynamic changes of DOR in trigeminal ganglion (TG) neurons during the process of acute dental pulp inflammation and elucidate its possible mechanism. Forty rats were used to generate lipopolysaccharide-induced acute pulpitis animal models at 6, 12, and 24 hours and sham-operated groups. Acute pulpitis was confirmed by hematoxylin-eosin staining, and TG neuron activation was determined by anti-c-Fos immunohistochemistry. DOR protein and gene expression in TG was investigated by immunohistochemistry, Western blotting, and real-time polymerase chain reaction, and DOR expression in trigeminal nerves and dental pulp was also determined by immunohistochemistry. To further investigate the mechanism of DOR modulating acute inflammation, the change of pErk1/2 and pAkt in TG was examined by immunohistochemistry. Lipopolysaccharide could successfully induce acute pulpitis and activated TG neurons. Acute pulpitis could dynamically increase DOR protein and gene expression at 6, 12, and 24 hours in TG, and DOR dimerization was significantly increased at 12 and 24 hours. Acute pulpitis also induced the dynamic change of DOR protein in trigeminal nerve and dental pulp. Furthermore, ERK1/2 and Akt signaling pathways were inhibited in TG after acute pulpitis. Increased DOR expression and dimerization may play important roles in peripheral acute inflammatory pain. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  17. Inhibition of excitatory synaptic transmission in the trigeminal motor nucleus by the nitric oxide-cyclic GMP signaling pathway. (United States)

    Pose, Inés; Silveira, Valentina; Morales, Francisco R


    Nitric oxide (NO) and cyclic GMP (cGMP) suppressed glutamatergic synaptic transmission to trigeminal motoneurons in brain stem slices of neonatal rats. Histological studies showed guanylate cyclase (GC) containing fibers in the trigeminal motor pool. Glutamatergic excitatory postsynaptic currents (EPSCs) were recorded from neonatal trigeminal motoneurons in response to stimulation of the supratrigeminal nucleus (SuV). The NO donors DETA/NONOate (DETA/NO), at a concentration which released 275.1 nM of NO, and Spermine/NONOate (Sper/NO) reduced the amplitude of the EPSC to 52.7±0.6% and 60.1±10.8% of control values, respectively. These actions were not blocked by the GC inhibitors, ODQ or NS-2028. However, in the presence of YC-1 or BAY41-2272, modulators of GC that act as NO sensitizers, lower and otherwise ineffective concentrations of DETA/NO induced a reduction of the EPSC to 60.6±5.2%. Moreover, NO effects were mimicked by 8BrcGMP and by Zaprinast, an inhibitor of Phosphodiesterase 5. Glutamatergic currents evoked by exogenous glutamate were not reduced by DETA/NO nor 8BrcGMP. Paired-pulse facilitation was increased by NO donors. Under "minimal stimulation" conditions NO donors and cGMP increased the failure rate of evoked EPSCs. Protein kinase inhibitors antagonized cGMP effects. The results suggest that NO, through the synthesis of cGMP, presynaptically inhibits glutamatergic synaptic transmission on trigeminal motoneurons. We propose that NO has complex actions on motor pools; specific studies are needed to elucidate their physiological significance in the behaving animal. Copyright © 2011 Elsevier B.V. All rights reserved.

  18. Convergence of meningeal and facial afferents onto trigeminal brainstem neurons: an electrophysiological study in rat and man. (United States)

    Ellrich, J; Andersen, O K; Messlinger, K; Arendt-Nielsen, L


    Headache is often accompanied by referred pain in the face. This phenomenon is probably due to a convergence of afferent inputs from the meninges and the face onto central trigeminal neurons within the medullary dorsal horn (MDH). The possible existence and extent of this convergence was examined in rat and man. MDH neurons activated by stimulation of the parietal meninges were tested for convergent tactile and noxious mechanical input from all three facial branches of the trigeminal nerve. All 21 units with meningeal input could also be activated by facial stimuli. Brush stimuli applied to the supraorbital nerve area activated 86%, to the infraorbital nerve area 29%, and to the mental nerve area none of the units. Pinch stimuli applied to the supraorbital nerve area activated 95%, to the infraorbital nerve area 86%, and to the mental nerve area 52% of the units. The results suggest convergence of meningeal and facial inputs concentrated on the supraorbital nerve in rat. In man convergence was examined by probing neuronal excitability of MDH applying the blink reflex (BR) during Valsalva maneuver which probably increases intracranial pressure. The BR evoked by supraorbital nerve stimulation remained unchanged, while the BR evoked by mental nerve stimulation was significantly facilitated. This facilitation may be due to convergence of meningeal and facial inputs onto trigeminal neurons in man.

  19. Structure-function correlations of rat trigeminal primary neurons: Emphasis on club-like endings, a vibrissal mechanoreceptor. (United States)

    Tonomura, Sotatsu; Ebara, Satomi; Bagdasarian, Knarik; Uta, Daisuke; Ahissar, Ehud; Meir, Inbal; Lampl, Ilan; Kuroda, Daichi; Furuta, Takahiro; Furue, Hidemasa; Kumamoto, Kenzo


    This study focuses on the structure and function of the primary sensory neurons that innervate vibrissal follicles in the rat. Both the peripheral and central terminations, as well as their firing properties were identified using intracellular labelling and recording in trigeminal ganglia in vivo. Fifty-one labelled neurons terminating peripherally, as club-like, Merkel, lanceolate, reticular or spiny endings were identified by their morphology. All neurons responded robustly to air puff stimulation applied to the vibrissal skin. Neurons with club-like endings responded with the highest firing rates; their peripheral processes rarely branched between the cell body and their terminal tips. The central branches of these neurons displayed abundant collaterals terminating within all trigeminal nuclei. Analyses of three-dimensional reconstructions reveal a palisade arrangement of club-like endings bound to the ringwulst by collagen fibers. Our morphological findings suggest that neurons with club-like endings sense mechanical aspects related to the movement of the ringwulst and convey this information to all trigeminal nuclei in the brainstem.

  20. Trigeminal somatosensorial evoked potentials suggest increased excitability during interictal period in patients with long disease duration in migraine. (United States)

    Abanoz, Yesim; Abanoz, Yasin; Gündüz, Aysegül; Savrun, Feray Karaali


    Migraine pathogenesis is suggested to involve many structures in cerebral cortex, brainstem and trigeminovascular system. Electrophysiological studies revealed loss of habituation, decreased cortical preactivation, segmental hypersensitivity and reduction in control of inhibitory descending pathways. Given these information, we aimed to evaluate the excitability changes of the trigeminal pathway in the cortex and brainstem in migraine using trigeminal nerve somatosensory evoked potentials (TSEP). Fifty-one women with migraine without aura and 32 age-matched healthy women were included. TSEPs were recorded in migraine patients during interictal period and in healthy subjects. Sensory thresholds, stimulation intensities, latencies of N1, P1, N2 and P2 waves as well as N1/P1 and N2/P1 amplitudes were measured. Comparisons of ipsilateral latencies with N1-P1 and N2-P1 amplitudes between migraine and control groups showed no difference. Sensory thresholds were also similar. Stimulation thresholds decreased as the attack frequency increased and ipsilateral N1/P1 amplitude increased with prolonged disease duration (p=0.043). Our study did not show significant difference between migraine patients and healthy subjects during interictal period. However, migraine with long duration affects the excitability of the cortical and brainstem trigeminal pathways even during interictal periods. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  1. Effects of NSAIDs on the Release of Calcitonin Gene-Related Peptide and Prostaglandin E2 from Rat Trigeminal Ganglia

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    Vittorio Vellani


    Full Text Available Nonsteroidal anti-inflammatory drugs (NSAIDs are frequently used to treat migraine, but the mechanisms of their effects in this pathology are not fully elucidated. The trigeminal ganglia and calcitonin gene-related peptide (CGRP have been implicated in the pathophysiology of migraine. The release of CGRP and prostaglandin E2 (PGE2 from freshly isolated rat trigeminal ganglia was evaluated after oral administration of nimesulide, etoricoxib, and ketoprofen, NSAIDs with different pharmacological features. Thirty minutes after oral administration, nimesulide, 10 mg/Kg, decreased the GCRP release induced by an inflammatory soup, while the other NSAIDs were ineffective at this point in time. Two hours after oral nimesulide (5 and 10 mg/Kg and ketoprofen (10 mg/Kg, but not of etoricoxib, a significant decrease in the CGRP release was observed. All drugs reduced PGE2, although with some differences in timing and doses, and the action on CGRP does not seem to be related to PGE2 inhibition. The reduction of CGRP release from rat trigeminal ganglia after nimesulide and ketoprofen may help to explain the mechanism of action of NSAIDs in migraine. Since at 30 minutes only nimesulide was effective in reducing CGRP release, these results suggest that this NSAID may exert a particularly rapid effect in patients with migraine.

  2. Subtemporal transtentorial approach for recurrent trigeminal neuralgia after microvascular decompression via the lateral suboccipital approach: case report. (United States)

    Ogiwara, Toshihiro; Goto, Tetsuya; Kusano, Yoshikazu; Kuroiwa, Masafumi; Kiuchi, Takafumi; Kodama, Kunihiko; Takemae, Toshiki; Hongo, Kazuhiro


    Microvascular decompression (MVD) via lateral suboccipital craniotomy is the standard surgical intervention for trigeminal neuralgia (TN). For recurrent TN, difficulties are sometimes encountered when performing reoperation via the same approach because of adhesions and prosthetic materials used in the previous surgery. In the present case report the authors describe the efficacy of the subtemporal transtentorial approach for use in recurrent TN after MVD via the lateral suboccipital approach. An 86-year-old woman, in whom an MVD via a lateral suboccipital craniotomy had previously been performed for TN, underwent surgery for recurrent TN via the subtemporal transtentorial approach, which provided excellent visualization of the neurovascular relationships and the trigeminal nerve without adhesions due to the previous surgery. Her TN disappeared after the MVD. The present approach is ideal for visualizing the trigeminal root entry zone, and the neurovascular complex can be easily dissected using a new surgical trajectory. This approach could be another surgical option for reoperation when the previous MVD had been performed via the suboccipital approach.

  3. Effects of WIN55,212-2 on voltage-gated sodium channels in trigeminal ganglion neurons of rats. (United States)

    Fu, Hui; Xiao, Jian Min; Cao, Xue Hong; Ming, Zhang Yin; Liu, Lie Ju


    This study was carried out to investigate the effects of WIN55,212-2, a potential cannabinoid receptor agonist, on voltage-gated sodium currents I(Na) in cultured trigeminal ganglion neurons of rats, and to investigate whether the anti-nociceptive effects of cannabinoid receptor subtype 1 (CB1) were produced through its modulation on I(Na). Whole cell patch clamp techniques were used to record I(Na) before and after WIN55,212-2 was perfused in cultured trigeminal ganglion neurons of rats. WIN55,212-2 (0.01 micromol/l) could enhance I(Na) slightly by 11.5 +/- 4.7% (n=7, p0.05). WIN55,212-2 (10 micromol/l) did not affect the active and stable inactive curves of I(Na) (n=7, p>0.05). WIN55,212-2 had bidirectional (two phases) effects on I(Na) in trigeminal ganglion neurons. It might act on different receptors, and the CB1 receptor participated in its modulation on I(Na).

  4. Does increased nerve length within the treatment volume improve trigeminal neuralgia radiosurgery? a prospective double-blind, randomized study

    International Nuclear Information System (INIS)

    Flickinger, John C.; Pollock, Bruce E.; Kondziolka, Douglas; Phuong, Loi K.; Foote, Robert L.; Stafford, Scott L.; Lunsford, L. Dade


    Purpose: To test the hypothesis that increasing the nerve length within the treatment volume for trigeminal neuralgia radiosurgery would improve pain relief. Methods and Materials: Eighty-seven patients with typical trigeminal neuralgia were randomized to undergo retrogasserian gamma knife radiosurgery (75 Gy maximal dose with 4-mm diameter collimators) using either one (n=44) or two (n=43) isocenters. The median follow-up was 26 months (range 1-36). Results: Pain relief was complete in 57 patients (45 without medication and 12 with low-dose medication), partial in 15, and minimal in another 15 patients. The actuarial rate of obtaining complete pain relief (with or without medication) was 67.7%±5.1%. The pain relief was identical for one- and two-isocenter radiosurgery. Pain relapsed in 30 of 72 responding patients. Facial numbness and mild and severe paresthesias developed in 8, 5, and 1 two-isocenter patients vs. 3, 4, and 0 one-isocenter patients, respectively (p=0.23). Improved pain relief correlated with younger age (p=0.025) and fewer prior procedures (p=0.039) and complications (numbness or paresthesias) correlated with the nerve length irradiated (p=0.018). Conclusions: Increasing the treatment volume to include a longer nerve length for trigeminal neuralgia radiosurgery does not significantly improve pain relief but may increase complications

  5. Short-Term Effects of Chewing on Task Performance and Task-Induced Mydriasis: Trigeminal Influence on the Arousal Systems

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    Maria Paola Tramonti Fantozzi


    Full Text Available Trigeminal input to the ascending activating system is important for the maintenance of arousal and may affect the discharge of the noradrenergic neurons of the locus coeruleus (LC, whose activity influences both vigilance state and pupil size, inducing mydriasis. For this reason, pupil size evaluation is now considered an indicator of LC activity. Since mastication activates trigeminal afferent neurons, the aims of the present study, conducted on healthy adult participants, were to investigate whether chewing a bolus of different hardness may: (1 differentially affect the performance on a cognitive task (consisting in the retrieval of specific target numbers within numerical matrices and (2 increase the dilatation of the pupil (mydriasis induced by a haptic task, suggesting a change in LC activation. Results show that chewing significantly increased both the velocity of number retrieval (without affecting the number of errors and the mydriasis associated with the haptic task, whereas simple task repetition did not modify either retrieval or mydriasis. Handgrip exercise, instead, significantly decreased both parameters. Effects were significantly stronger and longer lasting when subjects chewed hard pellets. Finally, chewing-induced improvements in performance and changes in mydriasis were positively correlated, which suggests that trigeminal signals enhanced by chewing may boost the cognitive performance by increasing LC activity.

  6. Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of the Barrow Neurological Institute

    International Nuclear Information System (INIS)

    Rogers, C. Leland; Shetter, Andrew G.; Fiedler, Jeffrey A.; Smith, Kris A.; Han, Patrick P.; Speiser, Burton L.


    Purpose: To assess the efficacy and complications of Gamma Knife radiosurgery for trigeminal neuralgia. Methods and Materials: The Barrow Neurological Institute (BNI) Gamma Knife facility has been operational since March 17, 1997. A total of 557 patients have been treated, 89 for trigeminal neuralgia (TN). This report includes the first 54 TN patients with follow-up exceeding 3 months. Patients were treated with Gamma Knife stereotactic radiosurgery (RS) in uniform fashion according to two sequential protocols. The first 41 patients received 35 Gy prescribed to the 50% isodose via a single 4-mm isocenter targeting the ipsilateral trigeminal nerve adjacent to the pons. The dose was increased to 40 Gy for the remaining 13 patients; however, the other parameters were unvaried. Outcome was evaluated by each patient using a standardized questionnaire. Pain before and after RS was scored as level I-IV per our newly-developed BNI pain intensity scoring criteria (I: no pain; II: occasional pain, not requiring medication; III: some pain, controlled with medication; IV: some pain, not controlled with medication; V: severe pain/no pain relief). Complications, limited to mild facial numbness, were similarly graded by a BNI scoring system. Results: Among our 54 TN patients, 52 experienced pain relief, BNI score I in 19 (35%), II in 3 (6%), III in 26 (48%), and IV in 4 (7%). Two patients (4%) reported no relief (BNI score V). Median follow-up was 12 months (range 3-28). Median time to onset of pain relief was 15 days (range 0-192), and to maximal relief 63 days (range 0-253). Seventeen (31%) noted immediate improvement (≤ 24 h). Prior to RS, all patients were on pharmacologic therapy felt to be optimal or maximal. Twenty-two (41%) were able to stop medications entirely (BNI score I or II). Another 16 (30%), with BNI Score III relief, decreased medication intake by at least 50%. Patients with classical TN pain symptoms were more likely to stop medications than those with

  7. After microvascular decompression to treat trigeminal neuralgia, both immediate pain relief and recurrence rates are higher in patients with arterial compression than with venous compression. (United States)

    Shi, Lei; Gu, Xiaoyan; Sun, Guan; Guo, Jun; Lin, Xin; Zhang, Shuguang; Qian, Chunfa


    We explored differences in postoperative pain relief achieved through decompression of the trigeminal nerve compressed by arteries and veins. Clinical characteristics, intraoperative findings, and postoperative curative effects were analyzed in 72 patients with trigeminal neuralgia who were treated by microvascular decompression. The patients were divided into arterial and venous compression groups based on intraoperative findings. Surgical curative effects included immediate relief, delayed relief, obvious reduction, and invalid result. Among the 40 patients in the arterial compression group, 32 had immediate pain relief of pain (80.0%), 5 cases had delayed relief (12.5%), and 3 cases had an obvious reduction (7.5%). In the venous compression group, 12 patients had immediate relief of pain (37.5%), 13 cases had delayed relief (40.6%), and 7 cases had an obvious reduction (21.9%). During 2-year follow-up period, 6 patients in the arterial compression group experienced recurrence of trigeminal neuralgia, but there were no recurrences in the venous compression group. Simple artery compression was followed by early relief of trigeminal neuralgia more often than simple venous compression. However, the trigeminal neuralgia recurrence rate was higher in the artery compression group than in the venous compression group.

  8. KYNA analogue SZR72 modifies CFA-induced dural inflammation- regarding expression of pERK1/2 and IL-1β in the rat trigeminal ganglion. (United States)

    Lukács, M; Warfvinge, K; Kruse, L S; Tajti, J; Fülöp, F; Toldi, J; Vécsei, L; Edvinsson, L


    Neurogenic inflammation has for decades been considered an important part of migraine pathophysiology. In the present study, we asked the question if administration of a novel kynurenic acid analogue (SZR72), precursor of an excitotoxin antagonist and anti-inflammatory substance, can modify the neurogenic inflammatory response in the trigeminal ganglion. Inflammation in the trigeminal ganglion was induced by local dural application of Complete Freunds Adjuvant (CFA). Levels of phosphorylated MAP kinase pERK1/2 and IL-1β expression in V1 region of the trigeminal ganglion were investigated using immunohistochemistry and Western blot. Pretreatment with one dose of SZR72 abolished the CFA-induced pERK1/2 and IL-1β activation in the trigeminal ganglion. No significant change was noted in case of repeated treatment with SZR72 as compared to a single dose. This is the first study that demonstrates that one dose of KYNA analog before application of CFA can give anti-inflammatory response in a model of trigeminal activation, opening a new line for further investigations regarding possible effects of KYNA derivates.

  9. Peripheral Neuropathic Facial/Trigeminal Pain and RANTES/CCL5 in Jawbone Cavitation

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    Johann Lechner


    Full Text Available Introduction. In this study, we elucidate the possible causative role of chronic subclinical inflammation in jawbone of patients with atypical facial pain (AFP and trigeminal neuralgia (TRN in the local overexpression of the chemokine regulated on activation and normal T-cell expressed and secreted (RANTES/C-C motif ligand 5 CCL5. Neurons contain opioid receptors that transmit antipain reactions in the peripheral and central nervous system. Proinflammatory chemokines like RANTES/CCL5 desensitize μ-opioid receptors in the periphery sensory neurons and it has been suggested that RANTES modifies the nociceptive reaction. Materials and Methods. In 15 patients with AFP/TRN, we examined fatty degenerated jawbone (FDOJ samples for the expression of seven cytokines by multiplex analysis and compared these results with healthy jawbones. Results. Each of these medullary jawbone samples exhibited RANTES as the only highly overexpressed cytokine. The FDOJ cohort with AFP/TRN showed a mean 30-fold overexpression of RANTES compared to healthy jawbones. Conclusions. To the best of our knowledge, no other research has identified RANTES overexpression in silent inflamed jawbones as a possible cause for AFP/TRN. Thus, we hypothesize that the surgical clearing of FDOJ might diminish RANTES signaling pathways in neurons and contribute to resolving chronic neurological pain in AFP/TRN patients.

  10. A neurofibromatosis type 2 case with vestibular, trigeminal and facial schwannomas together: magnetic resonance imaging findings

    International Nuclear Information System (INIS)

    Akay, S.; Hamcan, S.; Kara, K.; Battal, B.; Tasar, M.


    Full text: Introduction: Neurofibromatosis type 2 (NF2) is characterized by the development of multiple nervous system tumors. This disorder is also called multiple inherited schwannomas (MIS), meningiomas (M), and ependymomas (E) (MISME) syndrome. Objectives and tasks: To discuss the magnetic resonance (MR) imaging findings of a NF2 case who has bilateral vestibular and trigeminal schwannomas, unilateral facial schwannoma, multiple meningiomas and cervical intramedullary spinal cord tumors. Materials and methods: A 23-year-old male patient complaining of tinnitus and imbalance for 3 years, came to Neck-Nose-Throat department of our hospital. After the physical examination, the patient was referred to our department for the further work up with MR imaging. Results: Brain MR imaging showed bilateral acoustic schwannoma which reach through the internal acoustic canals. Bilateral symmetric homogeneously enhanced masses were also detected in Meckel's caves. Similarly, one milimetric enhancing lesion was seen at the right facial nerve. Eight meningiomas in various locations were observed, as well. Additionally, two enhancing intramedullary well-defined small foci were detected in the proximal cervical spinal cord. Ependymomas or intraparanchimal schwannomas were primarily suspected. Conclusion: This case includes all the probable intracranial and spinal mass lesions which may be associated with NF2. Enhanced MR is very reliable imaging modality for the detailed evaluation of NF2 patients

  11. Alleviation of Trigeminal Nociception Using p75 Neurotrophin Receptor Targeted Lentiviral Interference Therapy. (United States)

    O'Leary, Valerie B; O'Connell, Marie; Antyborzec, Inga; Ntziachristos, Vasilis; Oliver Dolly, J; Ovsepian, Saak V


    Acute and chronic trigeminal (TG) neuropathies are the cause of considerable distress, with limited treatments available at present. Nociceptive neurons enriched with the vanilloid type 1 receptor (VR1) partake in pain sensation and sensitization in the TG system. While VR1 blockers with anti-nociceptive potential are of substantial medical interest, their use remains limited due to poor selectivity and lack of cell-targeting capabilities. This study describes a methodology for the alleviation of nociception via targeted depletion of VR1 in TG sensory neurons in rats. In cultured TG ganglion neurons, VR1 expression was virtually abolished by lentiviral short hairpin RNA (LV-VR1). By decorating GFP encoding LV (LV-GFP) and LV-VR1 with IgG192 for targeting TG sensory neurons enriched with the p75 neurotrophin receptor (p75NTR), transduction of a reporter GFP and VR1 depletion was achieved after injection of targeted vectors into the whisker pad. In IgG192/LV-VR1-injected rats, the behavioral response to capsaicin exposure as well as Erk 1/2 phosphorylation and VR1 current activation by capsaicin were significantly reduced. This pioneering investigation, thus, provides a proof of principle for a means of attenuating TG nociception, revealing therapeutic potential.

  12. Oxaliplatin enhances gap junction-mediated coupling in cell cultures of mouse trigeminal ganglia. (United States)

    Poulsen, Jeppe Nørgaard; Warwick, Rebekah; Duroux, Meg; Hanani, Menachem; Gazerani, Parisa


    Communications between satellite glial cells and neighboring neurons within sensory ganglia may contribute to neuropathic and inflammatory pain. To elucidate the role of satellite glial cells in chemotherapy-induced pain, we examined the effects of oxaliplatin on the gap junction-mediated coupling between these cells. We also examined whether the gap junction blocker, carbenoxolone, can reverse the coupling. Primary cultures of mice trigeminal ganglia, 24-48h after cell isolation, were used. Satellite glial cells were injected with Lucifer yellow in the presence or absence of oxaliplatin (60 μM). In addition, the effect of carbenoxolone (100 μM) on coupling, and the expression of connexin 43 proteins were evaluated. Dye coupling between adjacent satellite glial cells was significantly increased (2.3-fold, Peffect. Hence, it is proposed that increased gap junction-mediated coupling was seen between satellite glial cells in TG. This observation together with our previous data obtained from a behavioral study suggests that this phenomenon might contribute to chemotherapy-induced nociception following oxaliplatin treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Trigeminal neurons detect cellphone radiation: Thermal or nonthermal is not the question. (United States)

    Marino, Andrew A; Kim, Paul Y; Frilot Ii, Clifton


    Cellphone electromagnetic radiation produces temperature alterations in facial skin. We hypothesized that the radiation-induced heat was transduced by warmth-sensing trigeminal neurons, as evidenced by changes in cognitive processing of the afferent signals. Ten human volunteers were exposed on the right side of the face to 1 GHz radiation in the absence of acoustic, tactile, and low-frequency electromagnetic stimuli produced by cellphones. Cognitive processing manifested in the electroencephalogram (EEG) was quantitated by analysis of brain recurrence (a nonlinear technique). The theoretical temperature sensitivity of warmth-sensing neurons was estimated by comparing changes in membrane voltage expected as a result of heat transduction with membrane-voltage variance caused by thermal noise. Each participant underwent sixty 12-s trials. The recurrence variable r ("percent recurrence") was computed second by second for the ∆ band of EEGs from two bilaterally symmetric derivations (decussated and nondecussated). Percent recurrence during radiation exposure (first 4 s of each trial) was reduced in the decussated afferent signal compared with the control (last four seconds of each trial); mean difference, r = 1.1 ± 0.5%, p cellphone radiation. Simulated cellphone radiation affected brain electrical activity associated with nonlinear cognitive processing of radiation-induced thermal afferent signals. Radiation standards for cellphones based on a thermal/nonthermal binary distinction do not prevent neurophysiological consequences of cellphone radiation.

  14. Reduced basal ganglia μ-opioid receptor availability in trigeminal neuropathic pain: A pilot study

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    DosSantos Marcos


    Full Text Available Abstract Background Although neuroimaging techniques have provided insights into the function of brain regions involved in Trigeminal Neuropathic Pain (TNP in humans, there is little understanding of the molecular mechanisms affected during the course of this disorder. Understanding these processes is crucial to determine the systems involved in the development and persistence of TNP. Findings In this study, we examined the regional μ-opioid receptor (μOR availability in vivo (non-displaceable binding potential BPND of TNP patients with positron emission tomography (PET using the μOR selective radioligand [11C]carfentanil. Four TNP patients and eight gender and age-matched healthy controls were examined with PET. Patients with TNP showed reduced μOR BPND in the left nucleus accumbens (NAc, an area known to be involved in pain modulation and reward/aversive behaviors. In addition, the μOR BPND in the NAc was negatively correlated with the McGill sensory and total pain ratings in the TNP patients. Conclusions Our findings give preliminary evidence that the clinical pain in TNP patients can be related to alterations in the endogenous μ-opioid system, rather than only to the peripheral pathology. The decreased availability of μORs found in TNP patients, and its inverse relationship to clinical pain levels, provide insights into the central mechanisms related to this condition. The results also expand our understanding about the impact of chronic pain on the limbic system.

  15. Trigeminal cardiac reflex: new thinking model about the definition based on a literature review. (United States)

    Meuwly, C; Golanov, E; Chowdhury, T; Erne, P; Schaller, B


    Trigeminocardiac reflex (TCR) is a brainstem reflex that manifests as sudden onset of hemodynamic perturbation in blood pressure (MABP) and heart rate (HR), as apnea and as gastric hypermotility during stimulation of any branches of the trigeminal nerve. The molecular and clinical knowledge about the TCR is in a constant growth since 1999, what implies a current need of a review about its definition in this changing context. Relevant literature was identified through searching in PubMed (MEDLINE) and Google scholar database for the terms TCR, oculocardiac reflex, diving reflex, vasovagale response. The definition of the TCR varies in clinical as well as in research studies. The main difference applies the required change of MABP and sometimes also HR, which most varies between 10% and 20%. Due to this definition problem, we defined, related to actual literature, 2 major (plausibility, reversibility) and 2 minor criteria (repetition, prevention) for a more proper identification of the TCR in a clinical or research setting. Latest research implies that there is a need for a more extended classification with 2 additional subgroups, considering also the diving reflex and the brainstem reflex. In this review, we highlighted criteria for proper definition and classification of the TCR in the light of increased knowledge and present a thinking model to overcome this complexity. Further we separately discussed the role of HR and MABP and their variation in this context. As another subtopic we gave attention to is the chronic TCR; a variant that is rarely seen in clinical medicine.

  16. Astrocytes are involved in trigeminal dynamic mechanical allodynia: potential role of D-serine. (United States)

    Dieb, W; Hafidi, A


    Trigeminal neuropathic pain affects millions of people worldwide. Despite decades of study on the neuronal processing of pain, mechanisms underlying enhanced pain states after injury remain unclear. N-methyl-D-aspartate (NMDA) receptor-dependent changes play a critical role in triggering central sensitization in neuropathic pain. These receptors are regulated at the glycine site through a mandatory endogenous co-agonist D-serine, which is synthesized by astrocytes. Therefore, the present study was carried out to determine whether astrocytes are involved, through D-serine secretion, in dynamic mechanical allodynia (DMA) obtained after chronic constriction of the infraorbital nerve (CCI-IoN) in rats. Two weeks after CCI-IoN, an important reaction of astrocytes was present in the medullary dorsal horn (MDH), as revealed by an up-regulation of glial fibrillary acidic protein (GFAP) in allodynic rats. In parallel, an increase in D-serine synthesis, which co-localized with its synthesis enzyme serine racemase, was strictly observed in astrocytes. Blocking astrocyte metabolism by intracisternal delivery of fluorocitrate alleviated DMA. Furthermore, the administration of D-amino-acid oxidase (DAAO), a D-serine-degrading enzyme, or that of L-serine O-sulfate (LSOS), a serine racemase inhibitor, significantly decreased pain behavior in allodynic rats. These results demonstrate that astrocytes are involved in the modulation of orofacial post-traumatic neuropathic pain via the release of the gliotransmitter D-serine.

  17. Trigeminal Electrophysiology: a 2 × 2 matrix model for differential diagnosis between temporomandibular disorders and orofacial pain

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    Chessa Giacomo


    Full Text Available Abstract Background Pain due to temporomandibular disorders (TMDs often has the same clinical symptoms and signs as other types of orofacial pain (OP. The possible presence of serious neurological and/or systemic organic pathologies makes differential diagnosis difficult, especially in early disease stages. In the present study, we performed a qualitative and quantitative electrophysiological evaluation of the neuromuscular responses of the trigeminal nervous system. Using the jaw jerk reflex (JJ and the motor evoked potentials of the trigeminal roots (bR-MEPs tests, we investigated the functional and organic responses of healthy subjects (control group and patients with TMD symptoms (TMD group. Method Thirty-three patients with temporomandibular disorder (TMD symptoms and 36 control subjects underwent two electromyographic (EMG tests: the jaw jerk reflex test and the motor evoked potentials of the trigeminal roots test using bilateral electrical transcranial stimulation. The mean, standard deviation, median, minimum, and maximum values were computed for the EMG absolute values. The ratio between the EMG values obtained on each side was always computed with the reference side as the numerator. For the TMD group, this side was identified as the painful side (pain side, while for the control group this was taken as the non-preferred masticatory side (non-preferred side. The 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles were also calculated. Results Analysis of the ratios (expressed as percentages between the values obtained on both sides revealed a high degree of symmetry in the bR-MEPs % in the control (0.93 ± 0.12% and TMD (0.91 ± 0.22% groups. This symmetry indicated organic integrity of the trigeminal root motor fibers and correct electrode arrangement. A degree of asymmetry of the jaw jerk's amplitude between sides (ipJJ%, when the mandible was kept in the intercuspal position, was found in the TMD group (0.24% ± 0.14% with a

  18. Efficacy and Quality of Life Outcomes in Patients With Atypical Trigeminal Neuralgia Treated With Gamma-Knife Radiosurgery

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    Dhople, Anil; Kwok, Young; Chin, Lawrence; Shepard, David Ph.D.; Slawson, Robert; Amin, Pradip; Regine, William


    Purpose: To assess efficacy and quality of life (QOL) outcomes associated with gamma-knife radiosurgery (GK-RS) in treating atypical trigeminal neuralgia (ATN) compared with classic trigeminal neuralgia (CTN). Methods and Materials: Between September 1996 and September 2004, 35 cases of ATN were treated with GK-RS. Patients were categorized into two groups: Group I comprised patients presenting with ATN (57%); Group II consisted of patients presenting with CTN then progressing to ATN (43%). Median prescription dose 75 Gy (range, 70-80 Gy) was delivered to trigeminal nerve root entry zone. Treatment efficacy and QOL improvements were assessed with a standardized questionnaire. Results: With median follow-up of 29 months (range, 3-74 months), 72% reported excellent/good outcomes, with mean time to relief of 5.8 weeks (range, 0-24 weeks) and mean duration of relief of 62 weeks (range, 1-163 weeks). This rate of pain relief is similar to rate achieved in our previously reported experience treating CTN with GK-RS (p = 0.36). There was a trend toward longer time to relief (p = 0.059), and shorter duration of relief (p = 0.067) in patients with ATN. There was no difference in rate of, time to, or duration of pain relief between Groups I and II. Of the patients with ATN, 88% discontinued or decreased the use of pain medications. Among the patients with sustained pain relief, QOL improved an average of 85%. Conclusion: This is the largest reported GK-RS experience for the treatment of ATN. Patients with ATN can achieve rates of pain relief similar to those in patients with CTN. Further follow-up is necessary to assess adequately the durability of response

  19. Epidemiologic assessment of trigeminal neuralgia in patients referred to the Imam clinic of Hamedan city during 2013-2015

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    Masoud Ghiasian


    Full Text Available Background: Trigeminal neuralgia is the most common disease of the fifth cranial nerve. This study aimed at evaluating the epidemiology of patients with the trigeminal neuralgia referred to Imam Clinic in Hamedan City, Iran. Materials and Methods: In this descriptive cross-sectional study, 40 patients with trigeminal neuralgia symptoms were studied. Diagnosis of patients was made based on the history, physical examination and paraclinical tests. Results: This study was conducted on 27 (67.5% females and 13 (32.5% males with the mean ages of 43.3±16.9 and 51.7±21.5 years, respectively (P=0.526.The incidence of this disease was higher among young women than others. The right side involvement was detected in 47.5%, left side involvement in 40% and bilateral involvement in 12.5% of the cases. Regarding the engaged nerve branch, simultaneous engagement of maxillary and mandibular nerves was seen in 47.5%, mandibular in 27.5%, maxillary in 20%, and ophthalmic in 5% of the individuals. The primary causes were seen in 42.5% and secondary causes in 57.5% of the cases. Among the secondary causes, face surgery and multiple sclerosis had the highest rate (39.1%, followed by tumors (21.7%. Also, 65% of the patients had normal MRI and 35% had abnormal one. Conclusion: Due to the similar symptoms of the disease such as dental pain, and also maxillofacial surgery in the elderly as one of the most common secondary causes of this disease, facial surgeons and dentists should know more about this disease to avoid unnecessary surgeries.

  20. Bilateral nerve alterations in a unilateral experimental neurotrophic keratopathy model: a lateral conjunctival approach for trigeminal axotomy.

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    Takefumi Yamaguchi

    Full Text Available To study bilateral nerve changes in a newly developed novel mouse model for neurotrophic keratopathy by approaching the trigeminal nerve from the lateral fornix. Surgical axotomy of the ciliary nerve of the trigeminal nerve was performed in adult BALB/c mice at the posterior sclera. Axotomized, contralateral, and sham-treated corneas were excised on post-operative days 1, 3, 5, 7 and 14 and immunofluorescence histochemistry was performed with anti-β-tubulin antibody to evaluate corneal nerve density. Blink reflex was evaluated using a nylon thread. The survival rate was 100% with minimal bleeding during axotomy and a surgical time of 8±0.5 minutes. The blink reflex was diminished at day 1 after axotomy, but remained intact in the contralateral eyes in all mice. The central and peripheral subbasal nerves were not detectable in the axotomized cornea at day 1 (p<0.001, compared to normal eyes (101.3±14.8 and 69.7±12.0 mm/mm² centrally and peripherally. Interestingly, the subbasal nerve density in the contralateral non-surgical eyes also decreased significantly to 62.4±2.8 mm/mm² in the center from day 1 (p<0.001, but did not change in the periphery (77.3±11.7 mm/mm², P = 0.819. Our novel trigeminal axotomy mouse model is highly effective, less invasive, rapid, and has a high survival rate, demonstrating immediate loss of subbasal nerves in axotomized eyes and decreased subbasal nerves in contralateral eyes after unilateral axotomy. This model will allow investigating the effects of corneal nerve damage and serves as a new model for neurotrophic keratopathy.

  1. Congenital absence of the internal carotid artery and the basilar artery with persistent trigeminal artery associated with coarctation of the aorta

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    Jaeger, H.J.; Mehring, U.M.; Gissler, H.M.; Mathias, K.D. [Dept. of Diagnostic Radiology, Staedtische Kliniken Dortmund (Germany); Dept. of Radiology and MicroTherapy, Univ. of Witten/Herdecke (Germany)


    We report a case of congenital absence of the cervical and petrous part of the left internal carotid artery, the middle and proximal part of the basilar artery, and the V4 segment of the left vertebral artery associated with a left persistent trigeminal artery and a coarctation of the aorta. The left cerebral vessels are supplied via the anterior communicating artery and the left persistent trigeminal artery. The coexisting coarctation of the aorta led to a subclavian steal phenomenon. The alteration of the cerebral hemodynamics has to be taken in consideration when performing cerebral angiography and surgical correction in such a case. (orig.)

  2. Investigating the expression of metabotropic glutamate receptors in trigeminal ganglion neurons and satellite glial cells: implications for craniofacial pain. (United States)

    Boye Larsen, Dennis; Ingemann Kristensen, Gunda; Panchalingam, Vinodenee; Laursen, Jens Christian; Nørgaard Poulsen, Jeppe; Skallerup Andersen, Maria; Kandiah, Aginsha; Gazerani, Parisa


    Previous studies have demonstrated that various subtypes of the metabotropic glutamate receptors (mGluRs) are expressed in the dorsal root ganglion (DRG) of the peripheral nervous system (PNS), implicating that glutamate potentially contributes to sensory transmission through these receptors. While mGluR expression has been investigated largely in the DRG, the present study focused on mGluR expression on neurons and satellite glial cells (SGCs) of the trigeminal ganglion (TG). To address the presence of mGluRs in rat TG neurons and their corresponding SGCs, the trigeminal ganglia from six adult male Wistar rats were isolated and immunohistochemistry and immunocytochemistry were performed. The expression of mGluR1α-, mGluR2/3- and mGluR8 on TG neurons and SGCs was investigated in tissue slices and isolated cells. 35.1 ± 6.0% of the TG neurons were positive for mGluR1α, whereas 39.9 ± 7.7% and 55.5 ± 6.3% were positive for mGluR2/3 and mGluR8, respectively. Immunoreactive neurons expressing mGluRs were mainly medium- to large sized, with a smaller population of small-sized neurons showing immunoreactivity. The SGCs showed immunoreactivity toward mGluR1α and mGluR8, but not mGluR2/3, both in the tissue and in isolated cells. Findings from the present study showed that trigeminal neurons express mGluR1α, mGluR2/3 and mGluR8, while SGCs only express mGluR1α and mGluR8. This novel evidence may advance investigations on a possible role of mGluRs in relation to trigeminal pain transmission within the craniofacial region.

  3. Trigeminal Inflammatory Compression (TIC) injury induces chronic facial pain and susceptibility to anxiety-related behaviors. (United States)

    Lyons, D N; Kniffin, T C; Zhang, L P; Danaher, R J; Miller, C S; Bocanegra, J L; Carlson, C R; Westlund, K N


    Our laboratory previously developed a novel neuropathic and inflammatory facial pain model for mice referred to as the Trigeminal Inflammatory Compression (TIC) model. Rather than inducing whole nerve ischemia and neuronal loss, this injury induces only slight peripheral nerve demyelination triggering long-term mechanical allodynia and cold hypersensitivity on the ipsilateral whisker pad. The aim of the present study is to further characterize the phenotype of the TIC injury model using specific behavioral assays (i.e. light-dark box, open field exploratory activity, and elevated plus maze) to explore pain- and anxiety-like behaviors associated with this model. Our findings determined that the TIC injury produces hypersensitivity 100% of the time after surgery that persists at least 21 weeks post injury (until the animals are euthanized). Three receptive field sensitivity pattern variations in mice with TIC injury are specified. Animals with TIC injury begin displaying anxiety-like behavior in the light-dark box preference and open field exploratory tests at week eight post injury as compared to sham and naïve animals. Panic anxiety-like behavior was shown in the elevated plus maze in mice with TIC injury if the test was preceded with acoustic startle. Thus, in addition to mechanical and cold hypersensitivity, the present study identified significant anxiety-like behaviors in mice with TIC injury resembling the clinical symptomatology and psychosocial impairments of patients with chronic facial pain. Overall, the TIC injury model's chronicity, reproducibility, and reliability in producing pain- and anxiety-like behaviors demonstrate its usefulness as a chronic neuropathic facial pain model. Copyright © 2015 IBRO. Published by Elsevier Ltd. All rights reserved.

  4. Comparison of evoked vs. spontaneous tics in a patient with trigeminal neuralgia (tic doloureux

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    Aiello-Lammens Matthew


    Full Text Available Abstract A 53-year old woman with tic doloureaux, affecting her right maxillary division of the trigeminal nerve (V2, could elicit shooting pains by slightly tapping her teeth when off medication. The pains, which she normally rated as > 6/10 on a visual analog scale (VAS, were electric shock-like in nature. She had no other spontaneous or ongoing background pain affecting the region. Based on her ability to elicit these tics, functional magnetic resonance imaging (fMRI was performed while she produced brief shocks every 2 minutes on cue (evoked pain over a 20 min period. In addition, she had 1–2 spontaneous shocks manifested between these evoked pains over the course of functional image acquisition. Increased fMRI activation for both evoked and spontaneous tics was observed throughout cortical and subcortical structures commonly observed in experimental pain studies with healthy subjects; including the primary somatosensory cortex, insula, anterior cingulate, and thalamus. Spontaneous tics produced more decrease in signals in a number of regions including the posterior cingulate cortex and amygdala, suggesting that regions known to be involved in expectation/anticipation may have been activated for the evoked, but not spontaneous, tics. In this patient there were large increases in activation observed in the frontal regions, including the anterior cingulate cortex and the basal ganglia. Spontaneous tics showed increased activation in classic aversion circuitry that may contribute to increased levels of anxiety. We believe that this is the first report of functional imaging of brain changes in tic-doloureaux.

  5. Pulsed Radiofrequency: A Management Option for Recurrent Trigeminal Neuralgia Following Radiofrequency Thermocoagulation. (United States)

    Liao, Chenlong; Visocchi, Massimiliano; Yang, Min; Liu, Pengfei; Li, Shiting; Zhang, Wenchuan


    Pain relief comparable with radiofrequency thermocoagulation (RFT) alone and fewer side effects than RFT have been achieved by combination treatment with pulsed radiofrequency (PRF) and short-duration RFT in trigeminal neuralgia (TN). We report the successful management of recurrent TN after RFT with single PRF in 2 patients. The RFT treatment was performed in 2-3 cycles for each division, with the lesion setting at 75°C-80°C for 90 seconds. The PRF treatment was applied for 120 seconds, with a generator output of 45 V, not exceeding a temperature of 42°C at the tip of the electrode. In case 1, pain relief was immediately achieved by RFT (75°C for 90 seconds), with moderate hypesthesia. Relapse of the triggered pain occurred 6 months later, and PRF was then applied. Long-term (18 months) pain relief without any additional pharmacologic or other treatment was reported. In case 2, a second RFT treatment at a higher temperature (80°C) was performed after recurrence after the first RFT within a week. Accompanied by worse hypesthesia, complete pain relief lasted for 6 months until the recurrence of pain was triggered by toothbrushing. PRF was then applied, and complete analgesia with long-term follow-up (28 months) was achieved. The PRF treatment for recurrent TN after RFT in this study could be viewed as a combination of PRF and RFT treatments in succession. Therefore, PRF and RFT should be considered to be complementary rather than alternative in the management of TN. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Tactile roughness perception in the presence of olfactory and trigeminal stimulants

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    Lara A. Koijck


    Full Text Available Previous research has shown that odorants consistently evoke associations with textures and their tactile properties like smoothness and roughness. Also, it has been observed that olfaction can modulate tactile perception. We therefore hypothesized that tactile roughness perception may be biased towards the somatosensory connotation of an ambient odorant. We performed two experiments to test this hypothesis. In the first experiment, we investigated the influence of ambient chemosensory stimuli with different roughness connotations on tactile roughness perception. In addition to a pleasant odor with a connotation of softness (PEA, we also included a trigeminal stimulant with a rough, sharp or prickly connotation (Ethanol. We expected that—compared to a No-odorant control condition—tactile texture perception would be biased towards smoothness in the presence of PEA and towards roughness in the presence of Ethanol. However, our results show no significant interaction between chemosensory stimulation and perceived tactile surface roughness. It could be argued that ambient odors may be less effective in stimulating crossmodal associations, since they are by definition extraneous to the tactile stimuli. In an attempt to optimize the conditions for sensory integration, we therefore performed a second experiment in which the olfactory and tactile stimuli were presented in synchrony and in close spatial proximity. In addition, we included pleasant (Lemon and unpleasant (Indole odorants that are known to have the ability to affect tactile perception. We expected that tactile stimuli would be perceived as less rough when simultaneously presented with Lemon or PEA (both associated with softness than when presented with Ethanol or Indole (odors that can be associated with roughness. Again, we found no significant main effect of chemosensory condition on perceived tactile roughness. We discuss the limitations of this study and we present suggestions for

  7. Thalamic metabolic alterations with cognitive dysfunction in idiopathic trigeminal neuralgia: a multivoxel spectroscopy study

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    Wang, Yuan; Bao, Faxiu; Ma, Shaohui; Guo, Chenguang; Jin, Chenwang; Zhang, Ming [First Affiliated Hospital of Xi' an Jiaotong University, Department of Medical Imaging, Xi' an, Shaanxi (China); Li, Dan [First Affiliated Hospital of Xi' an Jiaotong University, Department of Respiratory and Critical Care Medicine, Xi' an, Shaanxi (China)


    Although abnormalities in metabolite compositions in the thalamus are well described in patients with idiopathic trigeminal neuralgia (ITN), differences in distinct thalamic subregions have not been measured with proton magnetic resonance spectroscopy ({sup 1}H-MRS), and whether there are correlations between thalamic metabolites and cognitive function still remain unknown. Multivoxel MRS was recorded to investigate the metabolic alterations in the thalamic subregions of patients with ITN. The regions of interest were localized in the anterior thalamus (A-Th), intralaminar portion of the thalamus (IL-Th), posterior lateral thalamus (PL-Th), posterior medial thalamus (PM-Th), and medial and lateral pulvinar of the thalamus (PuM-Th and PuL-Th). The N-acetylaspartate to creatine (NAA/Cr) and choline to creatine (Cho/Cr) ratios were measured in the ITN and control groups. Scores of the visual analogue scale (VAS) and the Montreal Cognitive Assessment (MoCA) were analyzed to correlate with the neuroradiological findings. The NAA/Cr ratio in the affected side of PM-Th and PL-Th in ITN patients was statistically lower than that in the corresponding regions of the thalamus in controls. The NAA/Cr ratio in the affected PM-Th was negatively associated with VAS and disease duration. Furthermore, decreases of NAA/Cr and Cho/Cr were detected in the affected side of IL-Th, and lower Cho/Cr was positively correlated with MoCA values in the ITN group. Our result of low level of NAA/Cr in the affected PM-Th probably serves as a marker of the pain-rating index, and decreased Cho/Cr in IL-Th may be an indicator of cognitive disorder in patients with ITN. (orig.)

  8. Trigeminal pain and quantitative sensory testing in painful peripheral diabetic neuropathy. (United States)

    Arap, Astrid; Siqueira, Silvia R D T; Silva, Claudomiro B; Teixeira, Manoel J; Siqueira, José T T


    To evaluate patients with Diabetes Mellitus type 2 and painful peripheral neuropathy in order to investigate oral complaints and facial somatosensory findings. Case-control study; 29 patients (12 women, mean age 57.86 yo) with Diabetes Mellitus type 2 and 31 age-gender-matched controls were evaluated with a standardized protocol for general characteristics, orofacial pain, research diagnostic criteria for temporomandibular disorders, visual analogue scale and McGill Pain questionnaire, and a systematic protocol of quantitative sensory testing for bilateral facial sensitivity at the areas innervated by the trigeminal branches, which included the thermal detection by ThermoSensi 2, tactile evaluation with vonFrey filaments, and superficial pain thresholds with a superficial algometer (Micromar). Statistical analysis was performed with Wilcoxon, chi-square, confidence intervals and Spearman (ppain was reported by 55.2% of patients, and the most common descriptor was fatigue (50%); 17.2% had burning mouth. Myofascial temporomandibular disorders were diagnosed in 9 (31%) patients. The study group showed higher sensory thresholds of pain at the right maxillary branch (p=0.017) but sensorial differences were not associated with pain (p=0.608). Glycemia and HbA(1c) were positively correlated with the quantitative sensory testing results of pain (ppain thresholds were correlated with higher glycemia and glycated hemoglobin (p=0.027 and p=0.026). There was a high prevalence of orofacial pain and burning mouth was the most common complaint. The association of loss of pain sensation and higher glycemia and glycated hemoglobin can be of clinical use for the follow-up of DM complications. 2010 Elsevier Ltd. All rights reserved.

  9. Comparative analyses of linac and Gamma Knife radiosurgery for trigeminal neuralgia treatments

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    Ma, L; Kwok, Y; Chin, L S; Yu, C; Regine, W F


    Dedicated linac-based radiosurgery has been reported for trigeminal neuralgia treatments. In this study, we investigated the dose fall-off characteristics and setup error tolerance of linac-based radiosurgery as compared with standard Gamma Knife radiosurgery. In order to minimize the errors from different treatment planning calculations, consistent imaging registration, dose calculation and dose volume analysis methods were developed and implemented for both Gamma Knife and linac-based treatments. Intra-arc setup errors were incorporated into the treatment planning process of linac-based deliveries. The effects of intra-arc setup errors with increasing number of arcs were studied and benchmarked against Gamma Knife deliveries with and without plugging patterns. Our studies found equivalent dose fall-off properties between Gamma Knife and linac-based radiosurgery given a sufficient number of arcs (>7) and small intra-arc errors (<0.5 mm) were satisfied for linac-based deliveries. Increasing the number of arcs significantly decreased the variations in the dose fall-off curve at the low isodose region (e.g. from 40% to 10%) and also improved dose uniformity at the high isodose region (e.g. from 70% to 90%). As the number of arcs increased, the effects of intra-arc setup errors on the dose fall-off curves decreased. Increasing the number of arcs also reduced the integral dose to the distal normal brain tissues. In conclusion, linac-based radiosurgery produces equivalent dose fall-off characteristics to Gamma Knife radiosurgery with a high number of arcs. However, one must note the increased treatment time for a large number of arcs and isocentre accuracies

  10. Downregulation of selective microRNAs in trigeminal ganglion neurons following inflammatory muscle pain

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    Wei Dong


    Full Text Available Abstract Active regulation of gene expression in the nervous system plays an important role in the development and/or maintenance of inflammatory pain. MicroRNA (miRNA negatively regulates gene expression via posttranscriptional or transcriptional inhibition of specific genes. To explore the possible involvement of miRNA in gene regulation during inflammatory pain, we injected complete Freund's adjuvant (CFA unilaterally into the rat masseter muscle and quantified changes in neuron-specific mature miRNAs in the trigeminal ganglion (TG. Real-time reverse-transcription polymerase chain reaction revealed significant, but differential, downregulation of mature miR-10a, -29a, -98, -99a, -124a, -134, and -183 in the ipsilateral mandibular division (V3 of the TG within 4 hr after CFA. In contrast, levels of tested miRNAs did not change significantly in the contralateral V3 or the ipsilateral ophthalmic and maxillary divisions of the TG from inflamed rats, nor in the ipsilateral V3 of saline-injected animals. The downregulated miRNAs recovered differentially to a level equal to or higher than that in naive animals. Full recovery time varied with miRNA species but was at least 4 days. Expression and downregulation of some miRNAs were further confirmed by in situ hybridization of TG neurons that innervate the inflamed muscle. Although neurons of all sizes expressed these miRNAs, their signals varied between neurons. Our results indicate that miRNA species specific to neurons are quickly regulated following inflammatory muscle pain.

  11. Trigeminal-Rostral Ventromedial Medulla circuitry is involved in orofacial hyperalgesia contralateral to tissue injury

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    Chai Bryan


    Full Text Available Abstract Background Our previous studies have shown that complete Freund’s adjuvant (CFA-induced masseter inflammation and microinjection of the pro-inflammatory cytokine interleukin-1β (IL-1β into the subnucleus interpolaris/subnucleus caudalis transition zone of the spinal trigeminal nucleus (Vi/Vc can induce contralateral orofacial hyperalgesia in rat models. We have also shown that contralateral hyperalgesia is attenuated with a lesion of the rostral ventromedial medulla (RVM, a critical site of descending pain modulation. Here we investigated the involvement of the RVM-Vi/Vc circuitry in mediating contralateral orofacial hyperalgesia after an injection of CFA into the masseter muscle. Results Microinjection of the IL-1 receptor antagonist (5 nmol, n=6 into the ipsilateral Vi/Vc attenuated the CFA-induced contralateral hyperalgesia but not the ipsilateral hyperalgesia. Intra-RVM post-treatment injection of the NK1 receptor antagonists, RP67580 (0.5-11.4 nmol and L-733,060 (0.5-11.4 nmol, attenuated CFA-induced bilateral hyperalgesia and IL-1β induced bilateral hyperalgesia. Serotonin depletion in RVM neurons prior to intra-masseter CFA injection prevented the development of contralateral hyperalgesia 1–3 days after CFA injection. Inhibition of 5-HT3 receptors in the contralateral Vi/Vc with direct microinjection of the select 5-HT3 receptor antagonist, Y-25130 (2.6-12.9 nmol, attenuated CFA-induced contralateral hyperalgesia. Lesions to the ipsilateral Vc prevented the development of ipsilateral hyperalgesia but did not prevent the development of contralateral hyperalgesia. Conclusions These results suggest that the development of CFA-induced contralateral orofacial hyperalgesia is mediated through descending facilitatory mechanisms of the RVM-Vi/Vc circuitry.

  12. Trigeminal Neuralgia: Evaluation of the Relationship Between the Region of Neuralgic Manifestation and the Site of Neurovascular Compression Under Endoscopy. (United States)

    Zhang, Wenhao; Chen, Minjie; Zhang, Weijie; Chai, Ying


    This study aimed to evaluate the relationship among the pain region, branches of trigeminal nerve, and the neurovascular compression (NVC) location. A total of 123 consecutive patients with trigeminal neuralgia (TN) underwent endoscope-assisted microvascular decompression according to positive preoperative tomographic angiography. V2 alone was in 51 cases and V3 alone was in 64 cases. The location of NVC was classified into cranial, caudal, medial, or lateral sites. Some patients with multiple regions were recorded as medial + cranial, lateral + cranial, medial + caudal, and lateral + caudal. Twenty-eight (71.8%) of 39 patients with TN (V2) had their NVC at the medial site of the nerve. Twenty-seven (64.3%) of 42 patients with TN (V3) had their NVC at the lateral site of the nerve. There was a statistically significant difference (P = 0.0011  0.01). Evaluation of the relationship between the pain region and the NVC location by endoscopic images during microvascular decompression is more accurate. The second branch is mostly distributed in the medial area, and third branch is mainly distributed in the lateral area.

  13. Migratory Reed Warblers Need Intact Trigeminal Nerves to Correct for a 1,000 km Eastward Displacement. (United States)

    Kishkinev, Dmitry; Chernetsov, Nikita; Heyers, Dominik; Mouritsen, Henrik


    Several studies have shown that experienced night-migratory songbirds can determine their position, but it has remained a mystery which cues and sensory mechanisms they use, in particular, those used to determine longitude (east-west position). One potential solution would be to use a magnetic map or signpost mechanism like the one documented in sea turtles. Night-migratory songbirds have a magnetic compass in their eyes and a second magnetic sense with unknown biological function involving the ophthalmic branch of the trigeminal nerve (V1). Could V1 be involved in determining east-west position? We displaced 57 Eurasian reed warblers (Acrocephalus scirpaceus) with or without sectioned V1. Sham operated birds corrected their orientation towards the breeding area after displacement like the untreated controls did. In contrast, V1-sectioned birds did not correct for the displacement. They oriented in the same direction after the displacement as they had done at the capture site. Thus, an intact ophthalmic branch of the trigeminal nerve is necessary for detecting the 1,000 km eastward displacement in this night-migratory songbird. Our results suggest that V1 carries map-related information used in a large-scale map or signpost sense that the reed warblers needed to determine their approximate geographical position and/or an east-west coordinate.

  14. Malignant Trigeminal Nerve Sheath Tumor and Anaplastic Astrocytoma Collision Tumor with High Proliferative Activity and Tumor Suppressor P53 Expression

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    Maher Kurdi


    Full Text Available Background. The synchronous development of two primary brain tumors of distinct cell of origin in close proximity or in contact with each other is extremely rare. We present the first case of collision tumor with two histological distinct tumors. Case Presentation. A 54-year-old woman presented with progressive atypical left facial pain and numbness for 8 months. MRI of the brain showed left middle cranial fossa heterogeneous mass extending into the infratemporal fossa. At surgery, a distinct but intermingled intra- and extradural tumor was demonstrated which was completely removed through left orbitozygomatic-temporal craniotomy. Histopathological examination showed that the tumor had two distinct components: malignant nerve sheath tumor of the trigeminal nerve and temporal lobe anaplastic astrocytoma. Proliferative activity and expressed tumor protein 53 (TP53 gene mutations were demonstrated in both tumors. Conclusions. We describe the first case of malignant trigeminal nerve sheath tumor (MTNST and anaplastic astrocytoma in collision and discuss the possible hypothesis of this rare occurrence. We propose that MTNST, with TP53 mutation, have participated in the formation of anaplastic astrocytoma, or vice versa.

  15. Harvey Cushing's case series of trigeminal neuralgia at the Johns Hopkins Hospital: a surgeon's quest to advance the treatment of the 'suicide disease'.

    NARCIS (Netherlands)

    Adams, H.; Pendleton, C.; Latimer, K.; Cohen-Gadol, A.A.; Carson, B.S.; Quinones-Hinojosa, A.


    BACKGROUND: A review of Dr. Harvey Cushing's surgical cases at the Johns Hopkins Hospital provided insight into his early work on trigeminal neuralgia (TN). There was perhaps no other affliction that captured his attention in the way that TN did, and he built a remarkable legacy of successful

  16. Electrophysiological and Morphological Properties of α and γ Motoneurons in the Rat Trigeminal Motor Nucleus

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    Kayo Nishimura


    Full Text Available The muscle contraction during voluntary movement is regulated by activities of α- and γ-motoneurons (αMNs and γMNs, respectively. The tension of jaw-closing muscles can be finely tuned over a wide range. This excellent function is likely to be achieved by the specific populations of αMNs innervating jaw-closing muscles. Indeed, we have recently demonstrated that in the rat dorsolateral trigeminal motor nucleus (dl-TMN, the size distribution of αMNs was bimodal and the population of smaller αMNs showed a size distribution similar to that of γMNs, by immunohistochemically identifying αMNs and γMNs based on the expressions of estrogen-related receptor gamma (Err3 and neuronal DNA binding protein NeuN together with ChAT. This finding suggests the presence of αMNs as small as γMNs. However, differences in the electrophysiological membrane properties between αMNs and γMNs remain unknown also in the dl-TMN. Therefore, in the present study, we studied the electrophysiological membrane properties of MNs in the dl-TMN of infant rats at postnatal days 7–12 together with their morphological properties using whole-cell current-clamp recordings followed by immunohistochemical staining with an anti-NeuN and anti-ChAT antibodies. We found that the ChAT-positive and NeuN-positive αMNs were divided into two subclasses: the first one had a larger cell body and displayed a 4-aminopyridine (4-AP-sensitive current while the second one had a smaller cell body and displayed a less prominent 4-AP-sensitive current and a low-threshold spike, suitable for their orderly recruitment. We finally found that γMNs showing ChAT-positive and NeuN-negative immunoreactivities had smaller cell bodies and displayed an afterdepolarization mediated by flufenamate-sensitive cation current. It is suggested that these electrophysiological and morphological features of MNs in the dl-TMN are well correlated with the precise control of occlusion.

  17. Brainstem circuitry regulating phasic activation of trigeminal motoneurons during REM sleep.

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    Christelle Anaclet


    Full Text Available Rapid eye movement sleep (REMS is characterized by activation of the cortical and hippocampal electroencephalogram (EEG and atonia of non-respiratory muscles with superimposed phasic activity or twitching, particularly of cranial muscles such as those of the eye, tongue, face and jaw. While phasic activity is a characteristic feature of REMS, the neural substrates driving this activity remain unresolved. Here we investigated the neural circuits underlying masseter (jaw phasic activity during REMS. The trigeminal motor nucleus (Mo5, which controls masseter motor function, receives glutamatergic inputs mainly from the parvocellular reticular formation (PCRt, but also from the adjacent paramedian reticular area (PMnR. On the other hand, the Mo5 and PCRt do not receive direct input from the sublaterodorsal (SLD nucleus, a brainstem region critical for REMS atonia of postural muscles. We hypothesized that the PCRt-PMnR, but not the SLD, regulates masseter phasic activity during REMS.To test our hypothesis, we measured masseter electromyogram (EMG, neck muscle EMG, electrooculogram (EOG and EEG in rats with cell-body specific lesions of the SLD, PMnR, and PCRt. Bilateral lesions of the PMnR and rostral PCRt (rPCRt, but not the caudal PCRt or SLD, reduced and eliminated REMS phasic activity of the masseter, respectively. Lesions of the PMnR and rPCRt did not, however, alter the neck EMG or EOG. To determine if rPCRt neurons use glutamate to control masseter phasic movements, we selectively blocked glutamate release by rPCRt neurons using a Cre-lox mouse system. Genetic disruption of glutamate neurotransmission by rPCRt neurons blocked masseter phasic activity during REMS.These results indicate that (1 premotor glutamatergic neurons in the medullary rPCRt and PMnR are involved in generating phasic activity in the masseter muscles, but not phasic eye movements, during REMS; and (2 separate brainstem neural circuits control postural and cranial muscle

  18. Characterizing Treatment Utilization Patterns for Trigeminal Neuralgia in the United States. (United States)

    Zakrzewska, Joanna M; Wu, Ning; Lee, John Y K; Werneburg, Brian; Hoffman, Deborah; Liu, Ying


    Trigeminal neuralgia (TN) is a rare orofacial disorder characterized by severe unilateral paroxysmal pain in the region of the fifth cranial nerve. Clinical guidelines recommend carbamazepine (only US Food and Drug Administration-approved drug for TN) and oxcarbazepine as first-line therapies. We utilized the US Truven Health MarketScan database to examine treatment patterns among patients with TN. Included patients were aged ≥18 years, newly diagnosed with TN (≥2 TN diagnoses ≥14 days apart; no diagnosis in the prior year), continuously enrolled 1 year pre-index, with ≥3 years' follow-up post-index. We assessed utilization of selected pharmacotherapies (carbamazepine, oxcarbazepine, pregabalin, gabapentin, baclofen, duloxetine, topiramate), surgery (posterior fossa, radiosurgery), and injections (peripheral anesthetic injections, Gasserian ganglion procedures) for TN. 3685 patients were included (2425 commercial, 1260 Medicare; 71.8% female; mean[SD] age, 59 [15] years). Overall, 72.5% of patients received at least 1 studied medication, most commonly carbamazepine (51.7%) or gabapentin (48.6%). Sixty-five percent of pharmacologically treated patients had ≥2 treatment episodes; 41.6% had ≥3 (defined by a change in pharmacotherapy [monotherapy/combination] regimen). Overall, 12.3% had surgery and 7.3% injections; 42.9% received opioids for TN. In the 3 years after diagnosis, patients with TN in the United States receive a variety of pharmacological treatments, including opioids, despite carbamazepine being the only approved medication. A notable proportion utilize surgeries/injections. A high proportion of pharmacologically treated patients receive multiple treatment episodes, suggesting frequent therapy switching, perhaps due to suboptimal efficacy/tolerability. Our data suggest a high burden of illness associated with TN.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License

  19. Topical dura mater application of CFA induces enhanced expression of c-fos and glutamate in rat trigeminal nucleus caudalis

    DEFF Research Database (Denmark)

    Lukács, M; Warfvinge, K; Tajti, J


    BACKGROUND: Migraine is a debilitating neurological disorder where trigeminovascular activation plays a key role. We have previously reported that local application of Complete Freund's Adjuvant (CFA) onto the dura mater caused activation in rat trigeminal ganglion (TG) which was abolished......) was achieved by application of CFA onto the dural parietal surface. SZR72 was given intraperitoneally (i.p.), one dose prior CFA deposition and repeatedly daily for 7 days. Immunohistochemical studies were performed for mapping glutamate, c-fos, PACAP, substance P, IL-6, IL-1β and TNFα in the TNC/Sp5 and other...... regions of the brainstem and at the C1-C2 regions of the spinal cord. RESULTS: We found that CFA increased c-fos and glutamate immunoreactivity in TNC and C1-C2 neurons. This effect was mitigated by SZR72. PACAP positive fibers were detected in the fasciculus cuneatus and gracilis. Substance P, TNFα, IL-6...

  20. Age-dependent trigeminal and female-specific lumbosacral increase in herpes zoster distribution in the elderly. (United States)

    Shiraki, Kimiyasu; Toyama, Nozomu; Shiraki, Atsuko; Yajima, Misako


    Varicella-zoster virus causes herpes zoster (HZ) along specific dermatomes, but the effects of age and sex on HZ distribution are unclear. We investigated the age- and sex-dependent distribution characteristics of HZ. Patients with HZ were monitored by members of the Miyazaki Dermatologist Society. Questionnaires containing information on age, sex, and dermatome distribution and lesion specimens from 2730 patients were collected, and 2508 PCR-diagnosed cases were analyzed. The ratio of lesions in the thoracic area to lesions in the whole body decreased with age, whereas those of other areas increased. HZ incidence increased with age to about four times that of the basic incidence in the dermatome areas at age 0-29 years; the incidence in the trigeminal area in both sexes increased 11-fold, and the incidence in the thoracic and lumbosacral areas increased in females more than in males. Furthermore, the fact that the highest incidence was found along the first branch of the trigeminal nerve suggests an association with long-term ultraviolet ray exposure. Segmental dermatomes comprising thoracic 10-lumbar 1/sacral 2-4 and thoracic 5-6 were significantly more frequently affected in female patients at age 50-59 years and are consistent with areas of obstetric anesthesia for childbirth and of breastfeeding, respectively. HZ incidence increased with age; moreover, exposure to ultraviolet rays, childbirth, and breastfeeding might increase the incidence at specific dermatomes in older individuals. This study provides important information on the etiology of HZ. Copyright © 2018 Japanese Society for Investigative Dermatology. Published by Elsevier B.V. All rights reserved.

  1. Electron Microscopic and Proteomic Comparison of Terminal Branches of the Trigeminal Nerve in Patients with and without Migraine Headaches (United States)

    Guyuron, Bahman; Yohannes, Elizabeth; Miller, Robert; Chim, Harvey; Reed, Deborah; Chance, Mark R.


    Background The purpose of this study was to compare the ultrastructural appearance and protein expression of the zygomaticotemporal branch of the trigeminal nerve in patients with and without migraine headaches. Methods After confirmation of migraine headache diagnosis on 15 patients, a 5-mm segment of the zygomaticotemporal branch of the trigeminal nerve that is routinely removed during migraine surgery was compared to similarly sized nerve segments obtained from 15 control patients without a history of migraine headaches, who underwent an endoscopic forehead lift where this nerve is routinely transected. The segments were snap-frozen at −80°C for the downstream proteomics analysis. In addition, the cytoarchitectural differences of the nerve segments obtained from the 15 migraine and 15 control subjects were examined in detail under the electron microscope. Results Analysis of liquid chromatography/tandem mass spectrometry data sets identified differentially expressed proteins and networks composed of highly connected molecular modules (p = 10−44 and p = 10−34) in patients with migraine headaches. The nerves from patients with migraine headaches had a linear organization, disrupted myelin sheaths and target axons, and discontinuous neurofilaments that were poorly registered with the discontinuous myelin sheaths, suggesting axonal abnormality. Conclusions This study offers electron microscopic and proteomic evidence of axonal abnormality and deregulation of the myelination process in patients with migraine headaches compared with controls, offering the first objective evidence to support the role of peripheral mechanisms in the migraine headache cascade and an explanation as to why the surgical treatment of migraine headaches is efficacious. PMID:25347655

  2. Involvement of ERK phosphorylation of trigeminal spinal subnucleus caudalis neurons in thermal hypersensitivity in rats with infraorbital nerve injury. (United States)

    Suzuki, Ikuko; Tsuboi, Yoshiyuki; Shinoda, Masamichi; Shibuta, Kazuo; Honda, Kuniya; Katagiri, Ayano; Kiyomoto, Masaaki; Sessle, Barry J; Matsuura, Shingo; Ohara, Kinuyo; Urata, Kentaro; Iwata, Koichi


    To evaluate the involvement of the mitogen-activated protein kinase (MAPK) cascade in orofacial neuropathic pain mechanisms, this study assessed nocifensive behavior evoked by mechanical or thermal stimulation of the whisker pad skin, phosphorylation of extracellular signal-regulated kinase (ERK) in trigeminal spinal subnucleus caudalis (Vc) neurons, and Vc neuronal responses to mechanical or thermal stimulation of the whisker pad skin in rats with the chronic constriction nerve injury of the infraorbital nerve (ION-CCI). The mechanical and thermal nocifensive behavior was significantly enhanced on the side ipsilateral to the ION-CCI compared to the contralateral whisker pad or sham rats. ION-CCI rats had an increased number of phosphorylated ERK immunoreactive (pERK-IR) cells which also manifested NeuN-IR but not GFAP-IR and Iba1-IR, and were significantly more in ION-CCI rats compared with sham rats following noxious but not non-noxious mechanical stimulation. After intrathecal administration of the MEK1 inhibitor PD98059 in ION-CCI rats, the number of pERK-IR cells after noxious stimulation and the enhanced thermal nocifensive behavior but not the mechanical nocifensive behavior were significantly reduced in ION-CCI rats. The enhanced background activities, afterdischarges and responses of wide dynamic range neurons to noxious mechanical and thermal stimulation in ION-CCI rats were significantly depressed following i.t. administration of PD98059, whereas responses to non-noxious mechanical and thermal stimulation were not altered. The present findings suggest that pERK-IR neurons in the Vc play a pivotal role in the development of thermal hypersensitivity in the face following trigeminal nerve injury.

  3. Communication between corneal epithelial cells and trigeminal neurons is facilitated by purinergic (P2 and glutamatergic receptors.

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    Duane J Oswald

    Full Text Available Previously, we demonstrated that nucleotides released upon mechanical injury to corneal epithelium activate purinergic (P2 receptors resulting in mobilization of a Ca(2+ wave. However, the tissue is extensively innervated and communication between epithelium and neurons is critical and not well understood. Therefore, we developed a co-culture of primary trigeminal neurons and human corneal limbal epithelial cells. We demonstrated that trigeminal neurons expressed a repertoire of P2Yand P2X receptor transcripts and responded to P2 agonists in a concentration-dependent manner. Mechanical injuries to epithelia in the co-cultures elicited a Ca(2+ wave that mobilized to neurons and was attenuated by Apyrase, an ectonucleotidase. To elucidate the role of factors released from each cell type, epithelial and neuronal cells were cultured, injured, and the wound media from one cell type was collected and added to the other cell type. Epithelial wound media generated a rapid Ca(2+ mobilization in neuronal cells that was abrogated in the presence of Apyrase, while neuronal wound media elicited a complex response in epithelial cells. The rapid Ca(2+ mobilization was detected, which was abrogated with Apyrase, but it was followed by Ca(2+ waves that occurred in cell clusters. When neuronal wound media was preincubated with a cocktail of N-methyl-D-aspartate (NMDA receptor inhibitors, the secondary response in epithelia was diminished. Glutamate was detected in the neuronal wound media and epithelial expression of NMDA receptor subunit transcripts was demonstrated. Our results indicate that corneal epithelia and neurons communicate via purinergic and NMDA receptors that mediate the wound response in a highly orchestrated manner.

  4. Prostaglandin E2 Upregulated Trigeminal Ganglionic Sodium Channel 1.7 Involving Temporomandibular Joint Inflammatory Pain in Rats. (United States)

    Zhang, Peng; Gan, Ye-Hua


    Prostaglandin E 2 (PGE 2 ) is a key proinflammatory mediator that contributes to inflammatory hyperalgesia. Voltage-gated sodium channel 1.7 (Na v 1.7) plays an important role in inflammatory pain. However, the modulation of Na v 1.7 in inflammatory pain remains poorly understood. We hypothesized that PGE 2 might regulate Na v 1.7 expression in inflammatory pain. We here showed that treatment of rat trigeminal ganglion (TG) explants with PGE 2 significantly upregulated the mRNA and protein expressions of Na v 1.7 through PGE 2 receptor EP2. This finding was confirmed by studies on EP2-selective antagonist PF-04418948. We also demonstrated that Na v 1.7 and COX-2 expressions, as well as PGE 2 levels, were upregulated in the TG after induction of rats' temporomandibular joint (TMJ) inflammation. Correspondingly, hyperalgesia, as indicated by head withdrawal threshold, was observed. Moreover, TMJ inflammation-induced upregulation of Na v 1.7 expression and PGE 2 levels in the TG could be reversed by COX-2-selective inhibitor meloxicam given by oral gavage, and meanwhile, the hyperalgesia of inflamed TMJ was also mitigated. So we concluded that PGE 2 upregulated trigeminal ganglionic Na v 1.7 expression to contribute to TMJ inflammatory pain in rats. Our finding suggests that PGE 2 was an important regulator of Na v 1.7 in TMJ inflammatory pain, which may help increase understanding on the hyperalgesia of peripheral inflammation and develop a new strategy to address inflammatory pain.

  5. Cerebro-afferent vessel and pupillary basal diameter variation induced by stomatognathic trigeminal proprioception: a case report. (United States)

    De Cicco, Vincenzo


    A patient affected by asymmetric hemodynamics of cerebro-afferent vessels underwent duplex color scanner investigations in occlusal proprioceptive un- and rebalance conditions. Pupillometric video-oculographic examinations were performed in order to spot connected trigeminal proprioceptive motor patterns able to interfere on sympathetic autonomic activity. The aim of this case report is to verify if involuntary jaw closing during swallowing, executed in unbalance and rebalance myoelectric activity, would be able to modify cerebral hemodynamics. A 56-year-old Caucasian Italian woman affected by asymmetric blood flow of cerebro-afferent vessels underwent an electromyographic investigation of her occlusal muscles in order to assess their occlusal functional balance. The extreme asymmetry of myoelectric activity in dental occlusion evidenced by electromyographic values suggested the rebalancing of the functions of occlusal muscles through concurrent transcutaneous stimulation of the trigeminal nerve supra- and submandibular motor branches. The above-mentioned method allowed the detection of a symmetric craniomandibular muscular relation that can be kept constant through the use of a cusp bite modeled on the inferior dental arch: called orthotic-syntropic bite for its peculiar use of electrostimulation. A few days later, the patient underwent a duplex color scanner investigation and pupillometric video-oculographic examinations in occlusal unbalance and rebalance conditions. A comparative data analysis showed that an unbalanced dental occlusal function may represent an interferential pattern on cerebral hemodynamics velocity and pupillometric evaluations have proved useful both in the analysis of locus coeruleus functional modalities and as a diagnostic tool in the assessment of pathologies involving locus coeruleus and autonomic systems. The inclusion of myoelectric masseter examinations can be useful in patients with asymmetric hemodynamics of cerebro


    DEFF Research Database (Denmark)

    Christensen, S. L. T.; Petersen, S.; Sorensen, D. B.


    in rats. Also, we tested the response to sumatriptan in order to evaluate the predictive properties of the model. Methods: The effect of cilostazol (125 mg/kg p.o.) was evaluated on a range of spontaneous behavioural parameters, light sensitivity and mechanical sensitivity thresholds. To assess headache...... specificity we evaluated the c-fos expression in the trigeminal nucleus caudalis. All experiments were done in female Sprague Dawley rats and the oestrous cycle was included in the analyses. Results: We found that cilostazol increased the light sensitivity and grooming behaviour of the rats and decreased...... their head twitching. These manifestations were not inhibited by sumatriptan. Cilostazol also induced c-fos expression in the trigeminal nucleus caudalis. Locomotion, rearing, eating and drinking activity as well as the amount of wet dog shakes and mechanical sensitivity thresholds were unaltered. Discussion...

  7. Comparison of the effects of atropine and labetalol on trigeminocardiac reflex-induced hemodynamic alterations during percutaneous microballoon compression of the trigeminal ganglion. (United States)

    Chen, Chun-Yu; Luo, Chiao-Fen; Hsu, Yi-Chun; Chen, Jyi-Feng; Day, Yuan-Ji


    A significant abrupt drop in heart rate is the most frequent complication during percutaneous microballoon compression of the trigeminal ganglion. It is suggested that co-activation of the sympathetic and parasympathetic nervous systems plays an important role in this occurrence. We hypothesized that not only atropine, but also labetalol might be effective in preventing this cardiovascular reflex during percutaneous microballoon compression of the trigeminal ganglion. Patients who underwent percutaneous microballoon compression for trigeminal neuralgia between September 2007 and December 2009 were prospectively evaluated. The relationship between the hemodynamic changes and intraoperative use of atropine (0.01 mg/kg) or labetalol (0.05 mg/kg) was compared. One-way analysis of variance with Bartlett's and Tukey's post-tests was used, and a value of p compression for trigeminal neuralgia were studied, of whom 38 received atropine before ganglion compression, 36 received labetalol, and 45 received normal saline as a control. Of the patients who received normal saline, 31.3% had moderate bradycardia (heart rate compression. Of the patients who received labetalol, 16.7% had moderate bradycardia, 5.6% had severe bradycardia, and 2.8% had arrhythmia. Systemic blood pressure was markedly elevated straight after compression in all groups and tended to normalize 3 minutes afterwards. Both atropine and labetalol were able to lower the frequency of bradycardia. Neither of them could abolish episodes of bradycardia during the procedure. Patients receiving labetalol before microballoon compression were subject to a smaller change in hemodynamics. Our findings verified that the sympathetic and parasympathetic nervous systems may be involved in the complex interneuronal interaction of the trigeminocardiac reflex. Copyright © 2012. Published by Elsevier B.V.

  8. Topical dura mater application of CFA induces enhanced expression of c-fos and glutamate in rat trigeminal nucleus caudalis: attenuated by KYNA derivate (SZR72). (United States)

    Lukács, M; Warfvinge, K; Tajti, J; Fülöp, F; Toldi, J; Vécsei, L; Edvinsson, L


    Migraine is a debilitating neurological disorder where trigeminovascular activation plays a key role. We have previously reported that local application of Complete Freund's Adjuvant (CFA) onto the dura mater caused activation in rat trigeminal ganglion (TG) which was abolished by a systemic administration of kynurenic acid (KYNA) derivate (SZR72). Here, we hypothesize that this activation may extend to the trigeminal complex in the brainstem and is attenuated by treatment with SZR72. Activation in the trigeminal nucleus caudalis (TNC) and the trigeminal tract (Sp5) was achieved by application of CFA onto the dural parietal surface. SZR72 was given intraperitoneally (i.p.), one dose prior CFA deposition and repeatedly daily for 7 days. Immunohistochemical studies were performed for mapping glutamate, c-fos, PACAP, substance P, IL-6, IL-1β and TNFα in the TNC/Sp5 and other regions of the brainstem and at the C 1 -C 2 regions of the spinal cord. We found that CFA increased c-fos and glutamate immunoreactivity in TNC and C 1 -C 2 neurons. This effect was mitigated by SZR72. PACAP positive fibers were detected in the fasciculus cuneatus and gracilis. Substance P, TNFα, IL-6 and IL-1β immunopositivity were detected in fibers of Sp5 and neither of these molecules showed any change in immunoreactivity following CFA administration. This is the first study demonstrating that dural application of CFA increases the expression of c-fos and glutamate in TNC neurons. Treatment with the KYNA analogue prevented this expression.

  9. c-Fos induction in the brainstem following electrical stimulation of the trigeminal ganglion of chronically mandibular nerve-transected rats. (United States)

    Abe, T; Shimoda, T; Urade, M; Hasegawa, M; Sugiyo, S; Takemura, M


    Neuronal excitability in the trigeminal sensory nuclei (TSN) changes after nerve transection. We examined the effects of chronic transection of the trigeminal nerve on the c-Fos-immunoreactivity in the TSN induced 2 h after 10 min of electrical stimulation of the trigeminal ganglion (TG) at C-fiber activating condition (1.0 mA, 5 ms, 5 Hz) in urethane-anesthetized rats. In the non-transected control rats, stimulation of the TG induced c-Fos-immunoreactive cells (c-Fos-IR cells) mostly in superficial layers (VcI/II) of the nucleus caudalis (Vc) in its full extent along the dorsomedial-ventrolateral axis, but modestly in the rostral TSN above the obex, the principal, oral, and interpolar nuclei. Three days, 1, 2, or 3 weeks after transection of the inferior alveolar (IAN), infraorbital, or masseteric nerves, the stimulation of the TG induced c-Fos-IR cells in the central terminal fields of the transected nerve in the rostral TSN and magnocellular zone of the Vc. However, the number of c-Fos-IR cells in the VcI/II decreased inside the central terminal fields of the transected nerve and increased outside the fields. These results indicate that transection of the trigeminal nerve increases the excitability of TSN neurons that receive inputs from injured mechanoreceptors and uninjured nociceptors, but decreases it from injured nociceptors. The altered c-Fos responses may imply mechanisms of neuropathic pain seen after nerve injury.

  10. The enigma of site of action of migraine preventives: no effect of metoprolol on trigeminal pain processing in patients and healthy controls. (United States)

    Hebestreit, Julia M; May, Arne


    Beta-blockers are a first choice migraine preventive medication. So far it is unknown how they exert their therapeutic effect in migraine. To this end we examined the neural effect of metoprolol on trigeminal pain processing in 19 migraine patients and 26 healthy controls. All participants underwent functional magnetic resonance imaging (fMRI) during trigeminal pain twice: Healthy subjects took part in a placebo-controlled, randomized and double-blind study, receiving a single dose of metoprolol and placebo. Patients were examined with a baseline scan before starting the preventive medication and 3 months later whilst treated with metoprolol. Mean pain intensity ratings were not significantly altered under metoprolol. Functional imaging revealed no significant differences in nociceptive processing in both groups. Contrary to earlier findings from animal studies, we did not find an effect of metoprolol on the thalamus in either group. However, using a more liberal and exploratory threshold, hypothalamic activity was slightly increased under metoprolol in patients and migraineurs. No significant effect of metoprolol on trigeminal pain processing was observed, suggesting a peripheral effect of metoprolol. Exploratory analyses revealed slightly enhanced hypothalamic activity under metoprolol in both groups. Given the emerging role of the hypothalamus in migraine attack generation, these data need further examination.

  11. Application of Purified Botulinum Type A Neurotoxin to Treat Experimental Trigeminal Neuropathy in Rats and Patients with Urinary Incontinence and Prostatic Hyperplasia

    Directory of Open Access Journals (Sweden)

    Yoshizo Matsuka


    Full Text Available Type A neurotoxin (NTX of Clostridium botulinum was purified by a simple procedure using a lactose gel column. The toxicity of this purified toxin preparation was retained for at least 1 year at −30°C by supplementation with either 0.1% albumin or 0.05% albumin plus 1% trehalose. When purified NTX was used to treat 49 patients with urinary incontinence caused by either refractory idiopathic or neurogenic detrusor overactivity, 36 patients showed significant improvement in symptoms. These beneficial effects were also observed in cases of prostatic hyperplasia. The results obtained with NTX were similar to that of Botox. The effects of NTX on trigeminal neuralgia induced by infraorbital nerve constriction (IoNC in rats were also studied. Trigeminal ganglion neurons from ipsilateral to IoNC exhibited significantly faster onset of FM4-64 release than sham-operated contralateral neurons. Intradermal injection of NTX in the area of IoNC alleviated IoNC-induced pain behavior and reduced the exaggerated FM4-64 release in trigeminal ganglion neurons.

  12. [A case report of bilateral trigeminal sensory neuropathy as one of the initial manifestation of systemic scleroderma (the difficulties of early diagnosis of the primary disease)]. (United States)

    Grachev, Ju V; Anan'eva, L P; Tjurnikov, V M; Zaharova, A Ju


    The article describes the case of a patient with bilateral trigeminal sensory neuropathy (TSN), as a possible neurological manifestation of systemic scleroderma (SS). In this patient, intense non-paroxysmal facial pain caused by TSN, subjectively dominated over other manifestations of SS, including Raynaud's syndrome, for at least 1.5 years, thus hampering the diagnosis of the primary disease. In addition to pain, which was not relieved by analgesic medication, TSN was manifested by marked sensory deficit on the face (hypoesthesia / anesthesia) and bilateral sensory deficits in the oral cavity, including the anterior third of the tongue. TSN was also combined with disorders of taste perception. The assumption of rheumatic origin of TSN occurred during a primary neurological examination: a standard examination revealed generalized sensory polyneuropathy with bilateral involvement of the trigeminal nerve; the additional study identified no neurological signs of rheumatic diseases, including Raynaud's phenomenon. SS met all the criteria for the diagnosis (2013), high titers of nuclear ribonucleoprotein were determined as well. Thus, TSN as early and subjectively dominant manifestation of SS can complicate the diagnosis of primary rheumatic diseases. Therefore, in cases of distal sensory polyneuropathy with bilateral involvement of the trigeminal nerve, it is necessary to conduct an additional survey to identify the signs of possible rheumatic diseases: signs of vascular lesion (Raynaud's syndrome), lesions of skin, joints and muscles.

  13. Preoperative assessment of trigeminal neuralgia and hemifacial spasm using constructive interference in steady state-three-dimensional fourier transformation magnetic resonance imaging

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    Yamakami, Iwao; Kobayashi, Eiichi; Hirai, Shinji; Yamaura, Akira [Chiba Univ. (Japan). School of Medicine


    Results of microvascular decompression (MVD) for trigeminal neuralgia (TN) and hemifacial spasm (HFS) may be improved by accurate preoperative assessment of neurovascular relationships at the root entry/exit zone (REZ). Constructive interference in steady state (CISS)-three-dimensional Fourier transformation (3DFT) magnetic resonance (MR) imaging was evaluated for visualizing the neurovascular relationships at the REZ. Fourteen patients with TN and eight patients with HFS underwent MR imaging using CISS-3DFT and 3D fast inflow with steady-state precession (FISP) sequences. Axial images of the cerebellopontine angle (CPA) obtained by the two sequences were reviewed to assess the neurovascular relationships at the REZ of the trigeminal and facial nerves. Eleven patients subsequently underwent MVD. Preoperative MR imaging findings were related to surgical observations and results. CISS MR imaging provided excellent contrast between the cranial nerves, small vessels, and cerebrospinal fluid (CSF) in the CPA. CISS was significantly better than FISP for delineating anatomic detail in the CPA (trigeminal and facial nerves, petrosal vein) and abnormal neurovascular relationships responsible for TN and HFS (vascular contact and deformity at the REZ). Preoperative CISS MR imaging demonstrated precisely the neurovascular relationships at the REZ and identified the offending artery in all seven patients with TN undergoing MVD. CISS MR imaging has high resolution and excellent contrast between cranial nerves, small vessels, and CSF, so can precisely and accurately delineate normal and abnormal neurovascular relationships at the REZ in the CPA, and is a valuable preoperative examination for MVD. (author)

  14. Desarrollo y evaluación de una prueba de reacción en cadena de la polimerasa (PCR, utilizando la secuencia del gen hilA para diagnóstico de fiebre entérica por Salmonella spp.

    Directory of Open Access Journals (Sweden)

    Miryan Margot Sánchez


    Full Text Available El diagnóstico de fiebre entérica por Salmonella spp. se basa en el aislamiento de la bacteria en hemocultivos el cual consume tiempo, no siempre está disponible y tiene poca utilidad en pacientes con tratamiento antibiótico previo. Por consiguiente, se hace necesario el desarrollo de una prueba rápida, sensible y específica para el diagnóstico de fiebre entérica. Salmonella spp. utiliza el gen hilA (componente de la isla de patogenicidad I para invadir células epiteliales y producir infección. Al usar la secuencia de este gen se diseñó una prueba de PCR para detectar la bacteria en sangre y se evaluó su sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo, utilizando la metodología prueba de una prueba. La prueba de oro fue el hemocultivo. Se estudiaron 34 individuos con sintomatología de fiebre entérica con aislamiento de Salmonella serotipo Typhi en hemocultivos; 35 individuos con sepsis por otros bacilos Gram negativos aislados de hemocultivo (Klebsiella pneumoniae, 9; Serratia marcescens, 5; Escherichia coli, 4; Pseudomonas aeruginosa, 9; Providencia alcalifaciens, 4, y Enterobacter cloacae, 4 y 150 muestras de sangre de voluntarios asintomáticos. La sensibilidad, especificidad, valor pronóstico positivo y valor pronóstico negativo de la PCR fue del 100%. El número mínimo de UFC/ml que la PCR detecta en sangre es de 10.

  15. Comparison of P2X and TRPV1 receptors in ganglia or primary culture of trigeminal neurons and their modulation by NGF or serotonin

    Directory of Open Access Journals (Sweden)

    Giniatullin Rashid


    Full Text Available Abstract Background Cultured sensory neurons are a common experimental model to elucidate the molecular mechanisms of pain transduction typically involving activation of ATP-sensitive P2X or capsaicin-sensitive TRPV1 receptors. This applies also to trigeminal ganglion neurons that convey pain inputs from head tissues. Little is, however, known about the plasticity of these receptors on trigeminal neurons in culture, grown without adding the neurotrophin NGF which per se is a powerful algogen. The characteristics of such receptors after short-term culture were compared with those of ganglia. Furthermore, their modulation by chronically-applied serotonin or NGF was investigated. Results Rat or mouse neurons in culture mainly belonged to small and medium diameter neurons as observed in sections of trigeminal ganglia. Real time RT-PCR, Western blot analysis and immunocytochemistry showed upregulation of P2X3 and TRPV1 receptors after 1–4 days in culture (together with their more frequent co-localization, while P2X2 ones were unchanged. TRPV1 immunoreactivity was, however, lower in mouse ganglia and cultures. Intracellular Ca2+ imaging and whole-cell patch clamping showed functional P2X and TRPV1 receptors. Neurons exhibited a range of responses to the P2X agonist α, β-methylene-adenosine-5'-triphosphate indicating the presence of homomeric P2X3 receptors (selectively antagonized by A-317491 and heteromeric P2X2/3 receptors. The latter were observed in 16 % mouse neurons only. Despite upregulation of receptors in culture, neurons retained the potential for further enhancement of P2X3 receptors by 24 h NGF treatment. At this time point TRPV1 receptors had lost the facilitation observed after acute NGF application. Conversely, chronically-applied serotonin selectively upregulated TRPV1 receptors rather than P2X3 receptors. Conclusion Comparing ganglia and cultures offered the advantage of understanding early adaptive changes of nociception

  16. Trigeminal Neuralgia Treated With Stereotactic Radiosurgery: The Effect of Dose Escalation on Pain Control and Treatment Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Kotecha, Rupesh [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Kotecha, Ritesh [MidMichigan Medical Center, Midland, Michigan (United States); Modugula, Sujith [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Murphy, Erin S. [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (United States); Jones, Mark; Kotecha, Rajesh [MidMichigan Medical Center, Midland, Michigan (United States); Reddy, Chandana A. [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Suh, John H. [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (United States); Barnett, Gene H. [Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (United States); Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio (United States); Neyman, Gennady [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (United States); Machado, Andre; Nagel, Sean [Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio (United States); Chao, Samuel T., E-mail: [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (United States)


    Purpose: To analyze the effect of dose escalation on treatment outcome in patients undergoing stereotactic radiosurgery (SRS) for trigeminal neuralgia (TN). Methods and Materials: A retrospective review was performed of 870 patients who underwent SRS for a diagnosis of TN from 2 institutions. Patients were typically treated using a single 4-mm isocenter placed at the trigeminal nerve dorsal root entry zone. Patients were divided into groups based on treatment doses: ≤82 Gy (352 patients), 83 to 86 Gy (85 patients), and ≥90 Gy (433 patients). Pain response was classified using a categorical scoring system, with fair or poor pain control representing treatment failure. Treatment-related facial numbness was classified using the Barrow Neurological Institute scale. Log-rank tests were performed to test differences in time to pain failure or development of facial numbness for patients treated with different doses. Results: Median age at first pain onset was 63 years, median age at time of SRS was 71 years, and median follow-up was 36.5 months from the time of SRS. A majority of patients (827, 95%) were clinically diagnosed with typical TN. The 4-year rate of excellent to good pain relief was 87% (95% confidence interval 84%-90%). The 4-year rate of pain response was 79%, 82%, and 92% in patients treated to ≤82 Gy, 83 to 86 Gy, and ≥90 Gy, respectively. Patients treated to doses ≤82 Gy had an increased risk of pain failure after SRS, compared with patients treated to ≥90 Gy (hazard ratio 2.0, P=.0007). Rates of treatment-related facial numbness were similar among patients treated to doses ≥83 Gy. Nine patients (1%) were diagnosed with anesthesia dolorosa. Conclusions: Dose escalation for TN to doses >82 Gy is associated with an improvement in response to treatment and duration of pain relief. Patients treated at these doses, however, should be counseled about the increased risk of treatment-related facial numbness.

  17. Predictive Nomogram for the Durability of Pain Relief From Gamma Knife Radiation Surgery in the Treatment of Trigeminal Neuralgia

    International Nuclear Information System (INIS)

    Lucas, John T.; Nida, Adrian M.; Isom, Scott; Marshall, Kopriva; Bourland, John D.; Laxton, Adrian W.; Tatter, Stephen B.; Chan, Michael D.


    Purpose: To determine factors associated with the durability of stereotactic radiation surgery (SRS) for treatment of trigeminal neuralgia (TN). Methods and Materials: Between 1999 and 2008, 446 of 777 patients with TN underwent SRS and had evaluable follow-up in our electronic medical records and phone interview records. The median follow-up was 21.2 months. The Barrow Neurologic Institute (BNI) pain scale was used to determine pre- and post-SRS pain. Dose-volume anatomical measurements, Burchiel pain subtype, pain quality, prior procedures, and medication usage were included in this retrospective cohort to identify factors impacting the time to BNI 4-5 pain relapse by using Cox proportional hazard regression. An internet-based nomogram was constructed based on predictive factors of durable relief pre- and posttreatment at 6-month intervals. Results: Rates of freedom from BNI 4-5 failure at 1, 3, and 5 years were 84.5%, 70.4%, and 46.9%, respectively. Pain relief was BNI 1-3 at 1, 3, and 5 years in 86.1%, 74.3%, and 51.3% of type 1 patients; 79.3%, 46.2%, and 29.3% of type 2 patients; and 62.7%, 50.2%, and 25% of atypical facial pain patients. BNI type 1 pain score was achieved at 1, 3, and 5 years in 62.9%, 43.5%, and 22.0% of patients with type 1 pain and in 47.5%, 25.2%, and 9.2% of type 2 patients, respectively. Only 13% of patients with atypical facial pain achieved BNI 1 response; 42% of patients developed post-Gamma Knife radiation surgery (GKRS) trigeminal dysfunction. Multivariate analysis revealed that post-SRS numbness (hazard ratio [HR], 0.47; P<.0001), type 1 (vs type 2) TN (HR, 0.6; P=.02), and improved post-SRS BNI score at 6 months (HR, 0.009; P<.0001) were predictive of a durable pain response. Conclusions: The durability of SRS for TN depends on the presenting Burchiel pain type, the post-SRS BNI score, and the presence of post-SRS facial numbness. The durability of pain relief can be estimated pre- and posttreatment by using our

  18. Sensory abnormalities and masticatory function after microvascular decompression or balloon compression for trigeminal neuralgia compared with carbamazepine and healthy controls. (United States)

    Ichida, Michelle Cristina; de Almeida, Antonio Nogueira; da Nobrega, Jose Claudio Marinho; Teixeira, Manoel Jacobsen; de Siqueira, José Tadeu Tesseroli; de Siqueira, Silvia R D T


    Idiopathic trigeminal neuralgia (iTN) is a neurological condition treated with pharmacotherapy or neurosurgery. There is a lack of comparative papers regarding the outcomes of neurosurgery in patients with iTN. The objective of this study was to investigate sensory thresholds and masticatory function in 78 patients with iTN who underwent microvascular decompression (MVD) or balloon compression (BC), and compare these treatments with carbamazepine and 30 untreated healthy controls. The authors conducted a case-controlled longitudinal study. Patients were referred to 1 of 3 groups: MVD, BC, or carbamazepine. All patients were evaluated before and after treatment with a systematic protocol composed of a clinical orofacial questionnaire, Research Diagnostic Criteria for temporomandibular disorders, Helkimo indices, and a quantitative sensory-testing protocol (gustative, olfactory, cold, warm, touch, vibration, superficial, and deep pain thresholds). Both MVD and BC were effective at reducing pain intensity (p = 0.012) and carbamazepine doses (p sweet (p = 0.014) and salty (p = 0.003) thresholds. The sour threshold decreased (p = 0.003) and cold and warm thresholds increased (p sensorial and motor deficits after BC need to be included as targets directly associated with the success of the surgery and need to be assessed and relieved as goals in the treatment of iTN.

  19. Sensory trigeminal ULF-TENS stimulation reduces HRV response to experimentally induced arithmetic stress: A randomized clinical trial. (United States)

    Monaco, Annalisa; Cattaneo, Ruggero; Ortu, Eleonora; Constantinescu, Marian Vladimir; Pietropaoli, Davide


    Ultra Low Frequency Transcutaneous Electric Nervous Stimulation (ULF-TENS) is extensively used for pain relief and for the diagnosis and treatment of temporomandibular disorders (TMD). In addition to its local effects, ULF-TENS acts on the autonomic nervous system (ANS), with particular reference to the periaqueductal gray (PAG), promoting the release of endogenous opioids and modulating descending pain systems. It has been suggested that the PAG participates in the coupling between the emotional stimulus and the appropriate behavioral autonomic response. This function is successfully investigated by HRV. Therefore, our goal is to investigate the effects of trigeminal ULF-TENS stimulation on autonomic behavior in terms of HRV and respiratory parameters during an experimentally-induced arithmetic stress test in healthy subjects. Thirty healthy women between 25 and 35years of age were enrolled and randomly assigned to either the control (TENS stimulation off) or test group (TENS stimulation on). Heart (HR, LF, HF, LF/HF ratio, DET, RMSSD, PNN50, RR) and respiratory (BR) rate were evaluated under basal, T1 (TENS off/on), and stress (mathematical task) conditions. Results showed that HRV parameters and BR significantly changed during the arithmetic stress paradigm (psensory ULF-TENS reduces the autonomic response in terms of HRV and BR during acute mental stress in healthy subjects. Future directions of our work aim at applying the HRV and BR analysis, with and without TENS stimulation, to individuals with dysfunctional ANS among those with TMD. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Activation of Glycine and Extrasynaptic GABAA Receptors by Taurine on the Substantia Gelatinosa Neurons of the Trigeminal Subnucleus Caudalis

    Directory of Open Access Journals (Sweden)

    Thi Thanh Hoang Nguyen


    Full Text Available The substantia gelatinosa (SG of the trigeminal subnucleus caudalis (Vc has been known for the processing and transmission of orofacial nociceptive information. Taurine, one of the most plentiful free amino-acids in humans, has proved to be involved in pain modulation. In this study, using whole-cell patch clamp technique, we investigated the direct membrane effects of taurine and the action mechanism behind taurine-mediated responses on the SG neurons of the Vc. Taurine showed non-desensitizing and repeatable membrane depolarizations and inward currents which remained in the presence of amino-acid receptors blocking cocktail (AARBC with tetrodotoxin, indicating that taurine acts directly on the postsynaptic SG neurons. Further, application of taurine at different doses (10 μM to 3 mM showed a concentration dependent depolarizations and inward currents with the EC50 of 84.3 μM and 723 μM, respectively. Taurine-mediated responses were partially blocked by picrotoxin (50 μM and almost completely blocked by strychnine (2 μM, suggesting that taurine-mediated responses are via glycine receptor (GlyR activation. In addition, taurine (1 mM activated extrasynaptic GABAA receptor (GABAAR-mediated currents. Taken together, our results indicate that taurine can be a target molecule for orofacial pain modulation through the activation of GlyRs and/or extrasynaptic GABAARs on the SG neurons.

  1. Comparative efficacy and acceptability of antiepileptic drugs for classical trigeminal neuralgia: a Bayesian network meta-analysis protocol. (United States)

    Qin, Zongshi; Xie, Shang; Mao, Zhi; Liu, Yan; Wu, Jiani; Furukawa, Toshi A; Kwong, Joey S W; Tian, Jinhui; Liu, Zhishun


    Trigeminal neuralgia (TN) affects 4 to 28.9/100 000 people worldwide, and antiepileptic drugs such as carbamazepine and oxcarbazepine are the firstline treatment options. However, the efficacy and safety of other antiepileptic drugs remain unclear due to insufficient direct comparisons. To compare the efficacy and acceptability of all currently available antiepileptic agents for the treatment of patients with classical TN. We will search the PubMed, EMBASE, Cochrane Library and Web of Science databases for unpublished or undergoing research listed in registry platforms. We will include all randomised controlled trials comparing two different antiepileptic drugs or one antiepileptic drug with placebo in patients with classical TN. The primary outcomes will be the proportion of responders and the number of subjects who dropout during the treatment. The secondary outcomes will include the two primary outcomes but in the follow-up period, changes in the self-reporting assessment scale for neuralgia and quality of life assessment. In terms of network meta-analysis, we will fit our model to a Bayesian framework using the JAGS and pcnetmeta packages of the R project. This protocol will not disseminate any private patient data. The results of this review will be disseminated through peer reviewed publication. CRD42016048640. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. Toll-like receptor 4 signaling in neurons of trigeminal ganglion contributes to nociception induced by acute pulpitis in rats. (United States)

    Lin, Jia-Ji; Du, Yi; Cai, Wen-Ke; Kuang, Rong; Chang, Ting; Zhang, Zhuo; Yang, Yong-Xiang; Sun, Chao; Li, Zhu-Yi; Kuang, Fang


    Pain caused by acute pulpitis (AP) is a common symptom in clinical settings. However, its underlying mechanisms have largely remained unknown. Using AP model, we demonstrated that dental injury caused severe pulp inflammation with up-regulated serum IL-1β. Assessment from head-withdrawal reflex thresholds (HWTs) and open-field test demonstrated nociceptive response at 1 day post injury. A consistent up-regulation of Toll-like receptor 4 (TLR4) in the trigeminal ganglion (TG) ipsilateral to the injured pulp was found; and downstream signaling components of TLR4, including MyD88, TRIF and NF-κB, and cytokines such as TNF-α and IL-1β, were also increased. Retrograde labeling indicated that most TLR4 positve neuron in the TG innnervated the pulp and TLR4 immunoreactivity was mainly in the medium and small neurons. Double labeling showed that the TLR4 expressing neurons in the ipsilateral TG were TRPV1 and CGRP positive, but IB4 negative. Furthermore, blocking TLR4 by eritoran (TLR4 antagonist) in TGs of the AP model significantly down-regulated MyD88, TRIF, NF-κB, TNF-α and IL-1β production and behavior of nociceptive response. Our findings suggest that TLR4 signaling in TG cells, particularly the peptidergic TRPV1 neurons, plays a key role in AP-induced nociception, and indicate that TLR4 signaling could be a potential therapeutic target for orofacial pain.

  3. Satellite glial cells in human trigeminal ganglia have a broad expression of functional Toll-like receptors. (United States)

    Mitterreiter, Johanna G; Ouwendijk, Werner J D; van Velzen, Monique; van Nierop, Gijsbert P; Osterhaus, Albert D M E; Verjans, Georges M G M


    Toll-like receptors (TLRs) orchestrate immune responses to a wide variety of danger- and pathogen-associated molecular patterns. Compared to the central nervous system (CNS), expression profile and function of TLRs in the human peripheral nervous system (PNS) are ill-defined. We analyzed TLR expression of satellite glial cells (SGCs) and microglia, glial cells predominantly involved in local immune responses in ganglia of the human PNS and normal-appearing white matter (NAWM) of the CNS, respectively. Ex vivo flow cytometry analysis of cell suspensions obtained from human cadaveric trigeminal ganglia (TG) and NAWM showed that both SGCs and microglia expressed TLR1-5, TLR7, and TLR9, although expression levels varied between these cell types. Immunohistochemistry confirmed expression of TLR1-TLR4 and TLR9 by SGCs in situ. Stimulation of TG- and NAWM-derived cell suspensions with ligands of TLR1-TLR6, but not TLR7 and TLR9, induced interleukin 6 (IL-6) secretion. We identified CD45 LOW CD14 POS SGCs and microglia, but not CD45 HIGH leukocytes and CD45 NEG cells as the main source of IL-6 and TNF-α upon stimulation with TLR3 and TLR5 ligands. In conclusion, human TG-resident SGCs express a broad panel of functional TLRs, suggesting their role in initiating and orchestrating inflammation to pathogens in human sensory ganglia. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  4. Activation of Glycine and Extrasynaptic GABAA Receptors by Taurine on the Substantia Gelatinosa Neurons of the Trigeminal Subnucleus Caudalis (United States)

    Bhattarai, Janardhan Prasad; Park, Soo Joung; Han, Seong Kyu


    The substantia gelatinosa (SG) of the trigeminal subnucleus caudalis (Vc) has been known for the processing and transmission of orofacial nociceptive information. Taurine, one of the most plentiful free amino-acids in humans, has proved to be involved in pain modulation. In this study, using whole-cell patch clamp technique, we investigated the direct membrane effects of taurine and the action mechanism behind taurine-mediated responses on the SG neurons of the Vc. Taurine showed non-desensitizing and repeatable membrane depolarizations and inward currents which remained in the presence of amino-acid receptors blocking cocktail (AARBC) with tetrodotoxin, indicating that taurine acts directly on the postsynaptic SG neurons. Further, application of taurine at different doses (10 μM to 3 mM) showed a concentration dependent depolarizations and inward currents with the EC50 of 84.3 μM and 723 μM, respectively. Taurine-mediated responses were partially blocked by picrotoxin (50 μM) and almost completely blocked by strychnine (2 μM), suggesting that taurine-mediated responses are via glycine receptor (GlyR) activation. In addition, taurine (1 mM) activated extrasynaptic GABAA receptor (GABAAR)-mediated currents. Taken together, our results indicate that taurine can be a target molecule for orofacial pain modulation through the activation of GlyRs and/or extrasynaptic GABAARs on the SG neurons. PMID:24379976

  5. Hydrocephalus: an underrated long-term complication of microvascular decompression for trigeminal neuralgia. A single institute experience. (United States)

    Muratorio, Francesco; Tringali, G; Levi, V; Ligarotti, G K I; Nazzi, V; Franzini, A A


    Hydrocephalus is a common complication of posterior fossa surgery, but its real incidence after microvascular decompression (MVD) for idiopathic trigeminal neuralgia (TN) still remains unclear. The aim of this study was to focus on the potential association between MVD and hydrocephalus as a surgery-related complication. All patients who underwent MVD procedure for idiopathic TN at our institute between 2009 and 2014 were reviewed to search for early or late postoperative hydrocephalus. There were 259 consecutive patients affected by idiopathic TN who underwent MVD procedure at our institution between 2009 and 2014 (113 men, 146 women; mean age 59 years, range 30-87 years; mean follow-up 40.92 months, range 8-48 months). Nine patients (3.47 %) developed communicating hydrocephalus after hospital discharge and underwent standard ventriculo-peritoneal shunt. No cases of acute hydrocephalus were noticed. Our study suggests that late communicating hydrocephalus may be an underrated potential long-term complication of MVD surgery.

  6. Glycerol rhizotomy versus gamma knife radiosurgery for the treatment of trigeminal neuralgia: An analysis of patients treated at one institution

    International Nuclear Information System (INIS)

    Henson, Clarissa Febles; Goldman, H. Warren; Rosenwasser, Robert H.; Downes, M. Beverly; Bednarz, Greg; Pequignot, Edward C.; Werner-Wasik, Maria; Curran, Walter J.; Andrews, David W.


    Background: Medically refractory trigeminal neuralgia (TN) has been treated with a variety of minimally invasive techniques, all of which have been compared with microvascular decompression. For patients not considered good surgical candidates, percutaneous retrogasserian glycerol rhizotomy (GR) and gamma knife (GK) radiosurgery are two minimally invasive techniques in common practice worldwide and used routinely at Jefferson Hospital for Neuroscience. Using a common pain scale outcomes questionnaire, we sought to analyze efficacies and morbidities of both treatments. Methods and Materials: Between June 1994 and December 2002, 79 patients were treated with GR and 109 patients underwent GK for the treatment of TN. GR was performed with fluoroscopic guidance as an overnight inpatient procedure. GK was performed using a single 4-mm shot positioned at the root exit zone of the trigeminal nerve. Radiation doses of 70-90 Gy prescribed to the 100% isodose line were used. Treatment outcomes including pain response, pain recurrence, treatment failure, treatment-related side effects, and overall patient satisfaction with GK and GR were compared using a common outcomes scale. Using the Barrow Neurologic Institute pain scale, patients were asked to define their level of pain both before and after treatment: I, no pain and no pain medication required; I, occasional pain not requiring medication; IIIa, no pain and pain medication used; IIIb, some pain adequately controlled with medication; IV, some pain not adequately controlled with medication; and V, severe pain with no relief with medication. We used posttreatment scores of I, II, IIIa, and IIIb to identify treatment success, whereas scores of IV and V were considered treatment failure. Results were compiled from respondents and analyzed using SAS software. Statistical comparisons used log-rank test, univariate and multivariate logistic regression, Fisher's exact test, and Wilcoxon test with significance established at p < 0

  7. The cost-effectiveness of surgery for trigeminal neuralgia in surgically naïve patients: a retrospective study. (United States)

    Holland, Marshall; Noeller, Jennifer; Buatti, John; He, Wenzhuan; Shivapour, E Torage; Hitchon, Patrick W


    For 75% of patients with trigeminal neuralgia (TN), the pain can be controlled with medication. For those who fail medication therapy, surgical options include microvascular decompression (MVD), percutaneous radiofrequency rhizotomy (RFR), and stereotactic radiosurgery (SRS). Few studies have explored the relative cost-effectiveness of these interventions, particularly in surgically naïve patients. A retrospective chart review performed between January 2003 and January 2013 identified a total of 89 patients who underwent surgical treatment for TN (MVD=27, RFR=23, SRS=39). Outcome measures included facial pain (excellent=no pain, no medications; good=no pain, medications required; fair=>50% decrease in pain; and poor=RFR=76.2±16, and SRS=74.5±12 (pRFR=4700±2200, and SRS=39,300±6000 (pRFR=52%, and SRS=28% (pRFR=74%, and SRS=31% (pRFR=59±76, and SRS=35±25. Mean quality adjusted pain-free years were MVD=1.58, RFR=2.28, and SRS=0.99. Cost-effectiveness calculations in US dollars showed MVD=31,800, RFR=2100, and SRS=39,600 (pRFR was the least expensive procedure, provided immediate relief, but was associated with the highest rates of facial numbness and recurrence. Based on cost-effectiveness, considering both cost and outcome, RFR was the most cost-effective, followed by MVD, and finally SRS. Copyright © 2015 Elsevier B.V. All rights reserved.

  8. Tratamento famacológico da neuralgia do trigêmeo: revisão sistemática e metanálise Tratamiento famacológico de la neuralgia del trigémino: revisión sistemática y metanálisis Pharmacological treatment of trigeminal neuralgia: systematic review and metanalysis

    Directory of Open Access Journals (Sweden)

    Túlio César Azevedo Alves


    medicamentosa sistémica es considerada como el tratamiento de primera línea para esta enfermedad. El objetivo de este estudio fue de evaluar la eficacia, la seguridad y la tolerabilidad de los diversos tratamientos farmacológicos ofrecidos a los pacientes con neuralgia del trigémino, con la finalidad de suministrar evidencias para las recomendaciones de la práctica clínica e identificar las necesidades de pesquisas adicionales. MÉTODO: Fueron analizados ensayos clínicos aleatorios y controlados, publicados hasta julio de 2003, sobre el efecto analgésico de las drogas prescritas en el tratamiento de la neuralgia del trigémino. El análisis estadístico fue realizado con el auxilio del programa Review Manager 4.2.2 (Colaboración Cochrane, 2003. RESULTADOS: Los resultados de la metanálisis sugieren que la carbamazepina es más eficaz que el placebo. En tres estudios controlados comparando la lamotrigina, el topiramato y el cloridrato de proparacaína al placebo, solamente la lamotrigina se mostró superior a él. El dextrometafano fue comparado al lorazepam en dosis bajas, habiendo aumento del dolor con el uso de aquel fármaco. Tres estudios compararon la carbamazepina con la tizanidina, la tocainida y la pimozida, mostrándose apenas la pimozida superior a la carbamazepina. CONCLUSIONES: La carbamazepina continúa como droga de elección para el tratamiento de la neuralgia del trigémino, estando la lamotrigina y la pimozida indicadas en casos refractarios a la terapia convencional. Además, estudios adicionales son necesarios para que se establezcan futuras opciones terapéuticas.BACKGROUND AND OBJECTIVES: Trigeminal neuralgia is a syndrome of chronic pain, characterized by paroxysms of excruciating pain which dramatically affect patients' quality of life. Systemic drug therapy is the first line treatment for this disease. This study aimed at evaluating efficacy, safety and tolerability of several pharmacologic treatments offered to trigeminal neuralgia patients

  9. l-kynurenine combined with probenecid and the novel synthetic kynurenic acid derivative attenuate nitroglycerin-induced nNOS in the rat caudal trigeminal nucleus. (United States)

    Vámos, Eniko; Párdutz, Arpád; Varga, Hedvig; Bohár, Zsuzsanna; Tajti, János; Fülöp, Ferenc; Toldi, József; Vécsei, László


    Systemic administration of the nitric oxide (NO) donor nitroglycerin (NTG) triggers a delayed attack without aura in many migraineurs, but not in healthy volunteers. In rats, 4 h after the systemic administration of NTG (10 mg/kg bw, s.c.), the neurons of the caudal trigeminal nucleus (TNC) are activated and the expression of neuronal NO synthase (nNOS) in the same area is increased suggesting a self-amplifying process in the trigeminal system, which seems to be crucial in migraine pathogenesis. Kynurenic acid (KYNA) and its analogues may exert modulatory effects in many neuropathological conditions, probably via N-methyl-D-aspartate (NMDA) antagonism. Since NMDA receptors play a crucial role in trigeminal pain processing, the aim of our experiments was to compare the effects of L-kynurenine (L-KYN) combined with probenecid (PROB) or with 2-(2-N,N-dimethylaminoethylamine-1-carbonyl)-1H-quinolin-4-one hydrochloride alone, a newly synthetized KYNA derivative, on the NTG-induced nNOS expression in the rat TNC. Pretreatment with L-KYN (300 mg/kg bw, i.p.) together with PROB (200 mg/kg bw, i.p.) and KYNA derivative (300 mg/kg bw, i.p.) attenuated the NTG-induced nNOS expression in the rat TNC. Our data suggest that the stimulating effect of NTG, and thus of NO, on the expression of nNOS might be modulated by increasing the KYNA level in the brain, probably through the NMDA receptors. These data could help promote a better understanding of the pathogenesis of headaches and the action of antimigraine drugs.

  10. Zebrafish diras1 Promoted Neurite Outgrowth in Neuro-2a Cells and Maintained Trigeminal Ganglion Neurons In Vivo via Rac1-Dependent Pathway. (United States)

    Yeh, Chi-Wei; Hsu, Li-Sung


    The small GTPase Ras superfamily regulates several neuronal functions including neurite outgrowth and neuron proliferation. In this study, zebrafish diras1a and diras1b were identified and were found to be mainly expressed in the central nervous system and dorsal neuron ganglion. Overexpression of green fluorescent protein (GFP)-diras1a or GFP-diras1b triggered neurite outgrowth of Neuro-2a cells. The wild types, but not the C terminus truncated forms, of diras1a and diras1b elevated the protein level of Ras-related C3 botulinum toxin substrate 1 (Rac1) and downregulated Ras homologous member A (RhoA) expression. Glutathione S-transferase (GST) pull-down assay also revealed that diras1a and diras1b enhanced Rac1 activity. Interfering with Rac1, Pak1, or cyclin-dependent kinase 5 (CDK5) activity or with the Arp2/3 inhibitor prevented diras1a and diras1b from mediating the neurite outgrowth effects. In the zebrafish model, knockdown of diras1a and/or diras1b by morpholino antisense oligonucleotides not only reduced axon guidance but also caused the loss of trigeminal ganglion without affecting the precursor markers, such as ngn1 and neuroD. Co-injection with messenger RNA (mRNA) derived from mouse diras1 or constitutively active human Rac1 restored the population of trigeminal ganglion. In conclusion, we provided preliminary evidence that diras1 is involved in neurite outgrowth and maintains the number of trigeminal ganglions through the Rac1-dependent pathway.

  11. Immunoreactivity for Choline Acetyltransferase of Peripheral-Type (pChAT) in the Trigeminal Ganglion Neurons of the Non-Human Primate Macaca fascicularis

    International Nuclear Information System (INIS)

    Koga, Tsuneyuki; Bellier, Jean-Pierre; Kimura, Hiroshi; Tooyama, Ikuo


    Transcripts of the choline acetyltransferase (ChAT) gene reveal a number of different splice variants including ChAT of a peripheral type (pChAT). Immunohistochemical staining of the brain using an antibody against pChAT clearly revealed peripheral cholinergic neurons, but failed to detect cholinergic neurons in the central nervous system. In rodents, pChAT-immunoreactivity has been detected in cholinergic parasympathetic postganglionic and enteric ganglion neurons. In addition, pChAT has been observed in non-cholinergic neurons such as peripheral sensory neurons in the trigeminal and dorsal root ganglia. The common type of ChAT (cChAT) has been investigated in many parts of the brain and the spinal cord of non-human primates, but little information is available about the localization of pChAT in primate species. Here, we report the detection of pChAT immunoreactivity in trigeminal ganglion (TG) neurons and its co-localization with Substance P (SP) and/or calcitonin gene-related peptide (CGRP) in the cynomolgus monkey, Macaca fascicularis. Neurons positive for pChAT were observed in a rather uniform pattern in approximately half of the trigeminal neurons throughout the TG. Most pChAT-positive neurons had small or medium-sized cell bodies. Double-immunofluorescence staining showed that 85.1% of SP-positive cells and 74.0% of CGRP-positive cells exhibited pChAT immunoreactivity. Most pChAT-positive cells were part of a larger population of neurons that co-expressed SP and/or CGRP

  12. Effects of external trigeminal nerve stimulation (eTNS) on laser evoked cortical potentials (LEP): A pilot study in migraine patients and controls. (United States)

    Vecchio, Eleonora; Gentile, Eleonora; Franco, Giovanni; Ricci, Katia; de Tommaso, Marina


    Background Transcutaneous external supraorbital nerve stimulation has emerged as a treatment option for primary headache disorders, though its action mechanism is still unclear. Study aim In this randomized, sham-controlled pilot study we aimed to test the effects of a single external transcutaneous nerve stimulation session on pain perception and cortical responses induced by painful laser stimuli delivered to the right forehead and the right hand in a cohort of migraine without aura patients and healthy controls. Methods Seventeen migraine without aura patients and 21 age- and sex-matched controls were selected and randomly assigned to a real or sham external transcutaneous nerve stimulation single stimulation session. The external transcutaneous nerve stimulation was delivered with a self-adhesive electrode placed on the forehead and generating a 60 Hz pulse at 16 mA intensity for 20 minutes. For sham stimulation, we used 2 mA intensity. Laser evoked responses were recorded from 21 scalp electrodes in basal condition (T0), during external transcutaneous nerve stimulation and sham stimulation (T1), and immediately after these (T2). The laser evoked responses were analyzed by LORETA software. Results The real external transcutaneous nerve stimulation reduced the trigeminal N2P2 amplitude in migraine and control groups significantly in respect to placebo. The real stimulation was associated with lower activity in the anterior cingulate cortex under trigeminal laser stimuli. The pattern of LEP-reduced habituation was reverted by real and sham transcutaneous stimulation in migraine patients. Conclusions The present results could suggest that the external transcutaneous nerve stimulation may interfere with the threshold and the extent of trigeminal system activation, with a mechanism of potential utility in the resolution and prevention of migraine attacks.

  13. CGRP infusion in unanesthetized rats increases expression of c-Fos in the nucleus tractus solitarius and caudal ventrolateral medulla, but not in the trigeminal nucleus caudalis

    DEFF Research Database (Denmark)

    Bhatt, Deepak K; Ramachandran, Roshni; Christensen, Sarah Louise Tangsgaard


    infusion caused a significant dose-dependent fall in mean arterial blood pressure. No significant activation of c-Fos in the TNC at mRNA and protein levels was observed after CGRP infusion. A significant increase in c-Fos protein was observed in the NTS and CVLM in the brain stem. Zif268 expression...... sites in the brain stem for processing cardiovascular signals. We also investigated Zif268 protein expression (another immediate early gene) in TNC. The protein expression of p-ERK, p-CREB and c-Fos was analyzed in dura mater, trigeminal ganglion (TG) and TNC samples using Western blot. RESULTS: CGRP...

  14. Trigeminal neuralgia due to neurovascular conflicts from venous origin: an anatomical-surgical study (consecutive series of 124 operated cases). (United States)

    Dumot, Chloé; Sindou, Marc


    Veins as the source of trigeminal neuralgias (TN) lead to controversies. Only a few studies have specifically dealt with venous implication in neurovascular conflicts (NVC). The aim of this study was the anatomical-surgical description of the compressive veins found during micro-vascular decompression (MVD). Patients retained were those in whom a vein was considered compressive, alone, or in association with an artery. The study defined the type of vein involved, its situation along, the location around the root, and management. For this study, denomination of veins in relation with the root was revisited. Of the 326 consecutive patients who underwent MVD from 2005 to 2013, 124 (38.0 %) had a venous conflict, alone in 29 (8.9 %), or in association with an artery in 95 (29.1 %). The compressive veins belonged to one of the two venous systems described: the superficial or the deep superior petrosal venous system (sSPVS or dSPVS). A vein from sSPVS was found compressive in 81 cases (59.6 %), for the major part it was the pontine affluent of the superior petrosal vein (48 cases). The conflict was situated at TREZ in 28.4 %, mid-cisternal portion in 50.6 %, and porus in 8.6 %. The dSPVS was found compressive in 55 cases (40.4 %), almost always a transverse vein at porus (51 cases). Decompression was coagulation-division of the conflicting vein in 36.8 % and simple cleavage in the other. The study shows the frequent implication of veins in NVC as the source of TN. NVC are not only at TREZ but also at mid-cisternal portion and porus of Meckel cave.

  15. Characterization of neuronal populations in the human trigeminal ganglion and their association with latent herpes simplex virus-1 infection.

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    Sarah E Flowerdew

    Full Text Available Following primary infection Herpes simplex virus-1 (HSV-1 establishes lifelong latency in the neurons of human sensory ganglia. Upon reactivation HSV-1 can cause neurological diseases such as facial palsy, vestibular neuritis or encephalitis. Certain populations of sensory neurons have been shown to be more susceptible to latent infection in the animal model, but this has not been addressed in human tissue. In the present study, trigeminal ganglion (TG neurons expressing six neuronal marker proteins were characterized, based on staining with antibodies against the GDNF family ligand receptor Ret, the high-affinity nerve growth factor receptor TrkA, neuronal nitric oxide synthase (nNOS, the antibody RT97 against 200 kDa neurofilament, calcitonin gene-related peptide and peripherin. The frequencies of marker-positive neurons and their average neuronal sizes were assessed, with TrkA-positive (61.82% neurons being the most abundant, and Ret-positive (26.93% the least prevalent. Neurons positive with the antibody RT97 (1253 µm(2 were the largest, and those stained against peripherin (884 µm(2 were the smallest. Dual immunofluorescence revealed at least a 4.5% overlap for every tested marker combination, with overlap for the combinations TrkA/Ret, TrkA/RT97 and Ret/nNOS lower, and the overlap between Ret/CGRP being higher than would be expected by chance. With respect to latent HSV-1 infection, latency associated transcripts (LAT were detected using in situ hybridization (ISH in neurons expressing each of the marker proteins. In contrast to the mouse model, co-localization with neuronal markers Ret or CGRP mirrored the magnitude of these neuron populations, whereas for the other four neuronal markers fewer marker-positive cells were also LAT-ISH+. Ret and CGRP are both known to label neurons related to pain signaling.

  16. Presurgical visualization of the neurovascular relationship in trigeminal neuralgia with 3D modeling using free Slicer software. (United States)

    Han, Kai-Wei; Zhang, Dan-Feng; Chen, Ji-Gang; Hou, Li-Jun


    To explore whether segmentation and 3D modeling are more accurate in the preoperative detection of the neurovascular relationship (NVR) in patients with trigeminal neuralgia (TN) compared to MRI fast imaging employing steady-state acquisition (FIESTA). Segmentation and 3D modeling using 3D Slicer were conducted for 40 patients undergoing MRI FIESTA and microsurgical vascular decompression (MVD). The NVR, as well as the offending vessel determined by MRI FIESTA and 3D Slicer, was reviewed and compared with intraoperative manifestations using SPSS. The k agreement between the MRI FIESTA and operation in determining the NVR was 0.232 and that between the 3D modeling and operation was 0.6333. There was no significant difference between these two procedures (χ 2  = 8.09, P = 0.088). The k agreement between the MRI FIESTA and operation in determining the offending vessel was 0.373, and that between the 3D modeling and operation was 0.922. There were significant differences between two of them (χ 2  = 82.01, P = 0.000). The sensitivity and specificity for MRI FIESTA in determining the NVR were 87.2 % and 100 %, respectively, and for 3D modeling were both 100 %. The segmentation and 3D modeling were more accurate than MRI FIESTA in preoperative verification of the NVR and offending vessel. This was consistent with surgical manifestations and was more helpful for the preoperative decision and surgical plan.

  17. Corticofugal projections induce long-lasting effects on somatosensory responses in the trigeminal complex of the rat

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    Angel eNunez


    Full Text Available The sensory information flow at subcortical relay stations is controlled by the action of topographic connections from the neocortex. To determinate the functional properties of the somatosensory corticofugal projections to the principal (Pr5 and caudal spinal (Sp5C trigeminal nuclei, we performed unitary recordings in anesthetized rats. To examine the effect of these cortical projections we used tactile stimulation of the whisker and electrical stimulation of somatosensory cortices. Corticofugal anatomical projections to Pr5 and Sp5C nuclei were detected by using retrograde fluorescent tracers. Neurons projecting exclusively to Pr5 were located in the cingulate cortex while neurons projecting to both Sp5C and Pr5 nuclei were located in the somatosensory and insular cortices (>75% of neurons. Physiological results indicated that primary somatosensory cortex produced a short-lasting facilitating or inhibiting effects (< 5 minutes of tactile responses in Pr5 nucleus through activation of NMDA glutamatergic or GABAA receptors since effects were blocked by iontophoretically application of APV and bicuculline, respectively. In contrast, stimulation of secondary somatosensory cortex did not affect most of the Pr5 neurons; however both cortices inhibited the nociceptive responses in the Sp5C nucleus through activation of glycinergic or GABAA receptors because effects were blocked by iontophoretically application of strychnine and bicuculline, respectively. These and anatomical results demonstrated that the somatosensory cortices projects to Pr5 nucleus to modulate tactile responses by excitatory and inhibitory actions, while projections to the Sp5C nucleus control nociceptive sensory transmission by only inhibitory effects. Thus, somatosensory cortices may modulate innocuous and noxious inputs simultaneously, contributing to the perception of specifically tactile or painful sensations.

  18. Mild closed head injury promotes a selective trigeminal hypernociception: implications for the acute emergence of post-traumatic headache. (United States)

    Benromano, T; Defrin, R; Ahn, A H; Zhao, J; Pick, C G; Levy, D


    Headache is one of the most common symptoms following traumatic head injury. The mechanisms underlying the emergence of such post-traumatic headache (PTH) remain unknown but may be related to injury of deep cranial tissues or damage to central pain processing pathways, as a result of brain injury. A mild closed head injury in mice combined with the administration of cranial or hindpaw formalin tests was used to examine post-traumatic changes in the nociceptive processing from deep cranial tissues or the hindpaw. Histological analysis was used to examine post-traumatic pro-inflammatory changes in the calvarial periosteum, a deep cranial tissue. At 48 h after head injury, mice demonstrated enhanced nociceptive responses following injection of formalin into the calvarial periosteum, a deep cranial tissue, but no facilitation of the nociceptive responses following injection of formalin into an extracranial tissue, the hindpaw. Mice also showed an increase in the number of activated periosteal mast cells 48 h following mild head trauma, suggesting an inflammatory response. Our study demonstrates that mild closed head injury is associated with enhanced processing of nociceptive information emanating from trigeminal-innervated deep cranial tissues, but not from non-cranial tissues. Based on these finding as well as the demonstration of head injury-evoked degranulation of calvarial periosteal mast cells, we propose that inflammatory-evoked enhancement of peripheral cranial nociception, rather than changes in supraspinal pain mechanisms play a role in the initial emergence of PTH. Peripheral targeting of nociceptors that innervate the calvaria may be used to ameliorate PTH pain. © 2014 European Pain Federation - EFIC®

  19. Effects of cold temperatures on the excitability of rat trigeminal ganglion neurons that are not for cold-sensing (United States)

    Kanda, Hirosato; Gu, Jianguo G.


    Except a small population of primary afferent neurons for sensing cold to generate the sensations of innocuous and noxious cold, it is generally believed that cold temperatures suppress the excitability of other primary afferent neurons that are not for cold-sensing. These not-for-cold-sensing neurons include the majority of non-nociceptive and nociceptive afferent neurons. In the present study we have found that not-for-cold-sensing neurons of rat trigeminal ganglia (TG) change their excitability in several ways at cooling temperatures. In nearly 70% of not-for-cold-sensing TG neurons, the cooling temperature of 15°C increases their membrane excitability. We regard these neurons as cold-active neurons. For the remaining 30% of not-for-cold-sensing TG neurons, the cooling temperature of 15°C either has no effect (regarded as cold-ineffective neurons) or suppress (regarded as cold-suppressive neurons) their membrane excitability. For cold-active neurons, the cold temperature of 15°C increases their excitability as is evidenced by the increases in action potential (AP) firing numbers and/or reduction of AP rheobase when these neurons are depolarized electrically. The cold temperature of 15°C significantly inhibits M-currents and increases membrane input resistance of cold-active neurons. Retigabine, an M-current activator, abolishes the effect of cold temperatures on AP firing but not the effect of cold temperature on AP rheobase levels. The inhibition of M-currents and the increases of membrane input resistance are likely two mechanisms by which cooling temperatures increase the excitability of not-for-cold-sensing TG neurons. PMID:26709732

  20. The role of trigeminal nucleus caudalis orexin 1 receptor in orofacial pain-induced anxiety in rat. (United States)

    Bahaaddini, Mehri; Khatamsaz, Saeed; Esmaeili-Mahani, Saeed; Abbasnejad, Mehdi; Raoof, Maryam


    The relationship between anxiety and pain has received special attention. Orexins (A and B) are hypothalamic neuropeptides that have diverse functions in the regulation of different physiological and behavioral responses. This study was designed to evaluate the role of orexin 1 receptors (OX1R) within trigeminal nucleus caudalis (TNC) in anxiety following the induction of orofacial pain. The subcutaneous injection of capsaicin (CAP) into the rat upper lip region produced pain responses. OX1R agonist (orexin A) and antagonist (SB-334867) were microinjected into the TNC before the administration of CAP. Anxiety behaviors were investigated using elevated plus maze (EPM) and open-field tests. The results showed that CAP injection significantly decreases the percentage of time spent in the open arms of the EPM and the time spent in the center of the open field. Surprisingly, orexin (50, 100, and 150 pM/rat) significantly exaggerated the CAP effects, whereas SB-334867 (20, 40 nM/rat) significantly inhibited the CAP-induced anxiety. The CAP-injected group showed a significant decrease in the percentage of entries to open arms in the EPM and the number of visits in the center area of the open field compared with the control group. Orexin significantly potentiated the mentioned effects of CAP, whereas SB-334867 (40, 80 nM/rat) exerted a significant inhibitory effect on CAP-induced anxiety. The overall results indicated that the TNC OX1Rs play an important role in orofacial pain-induced anxiety.

  1. Brn3a regulates neuronal subtype specification in the trigeminal ganglion by promoting Runx expression during sensory differentiation

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    Raisa Eng S


    Full Text Available Abstract The transcription factor Brn3a, product of the pou4f1 gene, is expressed in most sensory neurons throughout embryogenesis. Prior work has demonstrated a role for Brn3a in the repression of early neurogenic genes; here we describe a second major role for Brn3a in the specification of sensory subtypes in the trigeminal ganglion (TG. Sensory neurons initially co-express multiple Trk-family neurotrophin receptors, but are later marked by the unique expression of TrkA, TrkB or TrkC. Maturation of these sensory subtypes is known to depend on the expression of Runx transcription factors. Newborn Brn3a knockout mice fail to express TrkC, which is associated in the TG with mechanoreceptors, plus a set of functional genes associated with nociceptor subtypes. In embryonic Brn3a-/- ganglia, the normal expression of Runx3 is never initiated in TrkC+ neurons, and Runx1 expression is greatly attenuated in TrkA+ nociceptors. These changes are accompanied by expanded expression of TrkB in neurons that abnormally express multiple Trks, followed by the loss of TrkC and TrkA expression. In transgenic embryos expressing a Brn3a-VP16 dominant transactivator, Runx3 mRNA expression is increased, suggesting that it is a direct regulatory target of Brn3a. Chromatin immunoprecipitation confirms that Brn3a binds in vivo to a conserved upstream enhancer element within histone H3-acetylated chromatin in the Runx3 locus. Together these data show that Brn3a acts upstream of the Runx factors, which then repress TrkB expression to allow establishment of the non-overlapping Trk receptor profiles and correct terminally differentiated phenotypes.


    Wang, Shuxing; Song, Li; Tan, Yonghui; Ma, Yuxin; Tian, Yinghong; Jin, Xu; Lim, Grewo; Zhang, Shuzhuo; Chen, Lucy; Mao, Jianren


    Objective To examine the hypothesis that glial activation would regulate the expression of the NR1 subunit of the N-methyl-D-aspartate receptor in the trigeminal subnucleus caudalis (Sp5C) after temporomandibular joint (TMJ) inflammation. Methods Inflammation of temporomandibular joint (TMJ) was produced in rats by injecting 50μl complete Freund's adjuvant (CFA) into unilateral TMJ space. Sham control rats received incomplete Freund's adjuvant (IFA) injection. Mechanical nociception in the affected and non-affected TMJ site was tested by using a digital algometer. Fractalkine, fluorocitrate, and/or MK801 were intracisternally administrated to examine the relationship between astroglial activation and NR1 upregulation. Results CFA TMJ injection resulted in persistent ipsilateral mechanical hyperalgesia 1, 3 and 5 days after CFA injection. The inflammation also induced significant upregulation of CX3CR1 and GFAP beginning on day 1, and of NR1 beginning on day 3, within the ipsilateral Sp5C. Intracisternal administration of fluorocitrate for 5 days blocked the development of mechanical hyperalgesia as well as the upregulation of GFAP and NR1 in the Sp5C. Conversely, intracisternal injection of fractalkine for 5 days exacerbated the expression of NR1 in Sp5C and mechanical hyperalgesia induced by TMJ inflammation. Moreover, once daily intracisternal fractalkine administration for five days in naïve rats induced the upregulation of NR1 and mechanical hyperalgesia. Conclusions These results suggest that astroglial activation contributes to the mechanism of TMJ pain through the regulation of NR1 expression in Sp5C. PMID:23110394

  3. Trigeminal, Visceral and Vestibular Inputs May Improve Cognitive Functions by Acting through the Locus Coeruleus and the Ascending Reticular Activating System: A New Hypothesis

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    Vincenzo De Cicco


    Full Text Available It is known that sensory signals sustain the background discharge of the ascending reticular activating system (ARAS which includes the noradrenergic locus coeruleus (LC neurons and controls the level of attention and alertness. Moreover, LC neurons influence brain metabolic activity, gene expression and brain inflammatory processes. As a consequence of the sensory control of ARAS/LC, stimulation of a sensory channel may potential influence neuronal activity and trophic state all over the brain, supporting cognitive functions and exerting a neuroprotective action. On the other hand, an imbalance of the same input on the two sides may lead to an asymmetric hemispheric excitability, leading to an impairment in cognitive functions. Among the inputs that may drive LC neurons and ARAS, those arising from the trigeminal region, from visceral organs and, possibly, from the vestibular system seem to be particularly relevant in regulating their activity. The trigeminal, visceral and vestibular control of ARAS/LC activity may explain why these input signals: (1 affect sensorimotor and cognitive functions which are not directly related to their specific informational content; and (2 are effective in relieving the symptoms of some brain pathologies, thus prompting peripheral activation of these input systems as a complementary approach for the treatment of cognitive impairments and neurodegenerative disorders.

  4. Gamma Knife Radiosurgery Treatment for Metastatic Melanoma of the Trigeminal Nerve and Brainstem: A Case Report and a Review of the Literature

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    Halloran E. Peterson


    Full Text Available Objective and Importance. Brainstem metastases (BSMs are uncommon but serious complications of some cancers. They cause significant neurological deficit, and options for treatment are limited. Stereotactic radiosurgery (SRS has been shown to be a safe and effective treatment for BSMs that prolongs survival and can preserve or in some cases improve neurological function. This case illustrates the use of repeated SRS, specifically Gamma Knife radiosurgery (GKRS for management of a unique brainstem metastasis. Clinical Presentation. This patient presented 5 years after the removal of a lentigo maligna melanoma from her left cheek with left sided facial numbness and paresthesias with no reported facial weakness. Initial MRI revealed a mass on the left trigeminal nerve that appeared to be a trigeminal schwannoma. Intervention. After only limited response to the first GKRS treatment, a biopsy of the tumor revealed it to be metastatic melanoma, not schwannoma. Over the next two years, the patient would receive 3 more GKRS treatments. These procedures were effective in controlling growth in the treated areas, and the patient has maintained a good quality of life. Conclusion. GKRS has proven in this case to be effective in limiting the growth of this metastatic melanoma without acute adverse effects.

  5. Amino acid specificity of fibers of the facial/trigeminal complex innervating the maxillary barbel in the Japanese sea catfish, Plotosus japonicus. (United States)

    Caprio, John; Shimohara, Mami; Marui, Takayuki; Kohbara, Jun; Harada, Shuitsu; Kiyohara, Sadao


    The Japanese sea catfish, Plotosus japonicus, possesses taste and solitary chemoreceptor cells (SCCs) located on the external body surface that detect specific water-soluble substances. Here, we identify two major fiber types of the facial/trigeminal complex that transmit amino acid information to the medulla. Both single and few fiber preparations respond to amino acid stimulation in the 0.1 μM to mM range. One fiber type responds best to glycine and l-alanine (i.e. Gly/Ala fibers) whereas the other fiber type is best stimulated by l-proline and glycine betaine (hereafter referred to only as betaine) (i.e. Pro/Bet fibers). We demonstrate that betaine, which does not alter the pH of the seawater and therefore does not activate the animals' highly sensitive pH sensors (Caprio et al., Science 344:1154-1156, 2014), is sufficient to elicit appetitive food search behavior. We further show that the amino acid specificity of fibers of the facial/trigeminal complex in P. japonicus is different from that in Ariopsis felis (Michel and Caprio, J. Neurophysiol. 66:247-260, 1991; Michel et al., J. Comp. Physiol. A. 172:129-138, 1993), a representative member of the only other family (Ariidae) of extant marine catfishes. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. para palmito

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    Francisco Paulo Chaimsohn


    Full Text Available Densidades de siembra, arreglos espaciales y fertilización en pejibaye (Bactris gasipaes cv Diamantes-10 para palmito. La investigación se llevó a cabo en la Estación Experimental Los Diamantes (Guápiles, Costa Rica, el 3 de octubre del 2003, cuyo objetivo fue la evaluación del efecto de diferentes densidades de siembra (3.333, 5.000 y 6.666 plantas/ha, arreglos espaciales, y diversos métodos de fertilización (química, orgánica, sobre el crecimiento de las plantas de pejibaye para producción de palmito. Se consideraron las variables diámetro y altura del tallo primario y el número de hojas y rebrotes como indicadores de producción. El período de evolución abarcó sólo los primeros 25 meses de crecimiento en el campo. El número de hojas, la altura y el diámetro del tallo no mostraron diferencias de respuesta relevantes. Sólo el número de rebrotes disminuyó al aumentar la densidad de la población, cuando se midió a los 15 meses de edad. El efecto de la fertilización se hizo evidente después de la primera cosecha, realizada a los 20 meses, debido al aumento de la competencia entre plantas, ahora más desarrolladas. Fue entonces cuando la fertilización química indujo la producción de un mayor número y vigor de los rebrotes. Sin embargo, las prácticas evaluadas 25 meses después de la siembra, no habían infl uido hasta ese momento en el número de palmitos cosechados, ni tampoco había afectado las características físicas de los sectores foliar y caulinar del palmito.

  7. Involvement of trigeminal transition zone and laminated subnucleus caudalis in masseter muscle hypersensitivity associated with tooth inflammation.

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    Kohei Shimizu

    Full Text Available A rat model of pulpitis/periapical periodontitis was used to study mechanisms underlying extraterritorial enhancement of masseter response associated with tooth inflammation. Periapical bone loss gradually increased and peaked at 6 weeks after complete Freund's adjuvant (CFA application to the upper molar tooth pulp (M1. On day 3, the number of Fos-immunoreactive (IR cells was significantly larger in M1 CFA rats compared with M1 vehicle (veh rats in the trigeminal subnucleus interpolaris/caudalis transition zone (Vi/Vc. The number of Fos-IR cells was significantly larger in M1 CFA and masseter (Mass capsaicin applied (M1 CFA/Mass cap rats compared with M1 veh/Mass veh rats in the contralateral Vc and Vi/Vc. The number of phosphorylated extracellular signal-regulated kinase (pERK-IR cells was significantly larger in M1 CFA/Mass cap and M1 veh/Mass cap rats compared to Mass-vehicle applied rats with M1 vehicle or CFA in the Vi/Vc. Pulpal CFA application caused significant increase in the number of Fos-IR cells in the Vi/Vc but not Vc on week 6. The number of pERK-IR cells was significantly lager in the rats with capsaicin application to the Mass compared to Mass-vehicle treated rats after pulpal CFA- or vehicle-application. However, capsaicin application to the Mass did not further affect the number of Fos-IR cells in the Vi/Vc in pulpal CFA-applied rats. The digastric electromyographic (d-EMG activity after Mass-capsaicin application was significantly increased on day 3 and lasted longer at 6 weeks after pulpal CFA application, and these increase and duration were significantly attenuated by i.t. PD98059, a MEK1 inhibitor. These findings suggest that Vi/Vc and Vc neuronal excitation is involved in the facilitation of extraterritorial hyperalgesia for Mass primed with periapical periodontitis or acute pulpal-inflammation. Furthermore, phosphorylation of ERK in the Vi/Vc and Vc play pivotal roles in masseter hyperalgesia after pulpitis or

  8. Cognitive effects of electro-acupuncture and pregabalin in a trigeminal neuralgia rat model induced by cobra venom

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    Chen RW


    Full Text Available Ruo-Wen Chen,1,2 Hui Liu,2 Jian-Xiong An,1,2 Xiao-Yan Qian,2 Yi-De Jiang,2 Doris K Cope,3 John P Williams,3 Rui Zhang,1 Li-Na Sun1 1Department of Anesthesiology, Weifang Medical University, Weifang City, Shandong, 2Department of Anesthesiology, Pain Medicine and Critical Care Medicine, Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing, China; 3Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Objective: The objective of this study was to investigate the effects of electro-acupuncture (EA and pregabalin on cognition impairment induced by chronic trigeminal neuralgia (TN in rats. Design: Controlled animal study. Setting: Department of Anesthesiology, Pain Medicine and Critical Care Medicine, Aviation General Hospital of China Medical University. Subjects: Forty adult male Sprague Dawley rats. Methods: Rats were randomly divided into four groups. The TN model was induced by administration of cobra venom to the left infraorbital nerve. On postoperative day 14, either EA or pregabalin was administered, free behavioral activities were observed. Spatial learning and memory abilities were determined in the Morris water maze. The ultrastructural alterations of the Gasserian ganglion, medulla oblongata and hippocampus were examined by electron microscopy. The changes on long-term potentiation were investigated. Results: After treatment, the exploratory behavior increased and the grooming behavior decreased (P<0.05 for the EA group and pregabalin group compared with the cobra venom group; moreover, demyelination of neurons in Gasserian ganglion and medulla oblongata was reversed. The number of platform site crossings, the average percentages of time in the target quadrant and the field excitatory postsynaptic potential slopes increased (P<0.05 in the EA group compared to the cobra venom group. However, the pregabalin group

  9. Fine structure of subepithelial "free" and corpuscular trigeminal nerve endings in anterior hard palate of the rat. (United States)

    Byers, M R; Yeh, Y


    Axonally transported protein labeled many trigeminal nerve endings in subepithelial regions of the anterior hard palate of the rat. Sensory endings were most numerous in the lamina propria near the tips of the palatal rugae where large connective tissue and epithelial papillae interdigitated. Two kinds of sensory ending were found there: "free" endings, and a variety of corpuscular endings. The "free" sensory endings consisted of bundles of unmyelinated axons separated from the connective tissue by relatively unspecialized Schwann cells covering part or all of their surface and a completely continuous basal lamina; they were commonly found running parallel to the epithelium or near corpuscular endings. The corpuscular sensory endings all had a specialized nerve form, specialized Schwann cells, and axonal fingers projecting into the corpuscular basal lamina or connective tissue. There were at least four distinct types of corpuscular ending: Ruffini-like endings were found among dense collagen bundles, and they had a flattened nerve ending with a flattened Schwann lamella on either side. Meissner endings had an ordered stack of flattened nerve terminals with flattened Schwann cells and much basal lamina within and around the corpuscle. Simple corpuscles were single nerve endings surrounded by several layers of concentric lamellar Schwann processes. Glomerular endings were found in lamina propria papillae or encircling epithelial papillae; they were a tangle of varied neural forms each of which had apposed flattened Schwann cells, and a layer of basal lamina of varied thickness. Fibroblasts often formed incomplete partitions around Meissner and simple corpuscles. The axoplasm of all kinds of subepithelial sensory endings contained numerous mitochondria and vesicles, as well as occasional multivesicular bodies and lysosomes; the axoplasm of all endings was pale with few microtubules and neurofilaments. The specialized lamellar Schwann cells had much pinocytotic

  10. Stereotactic radio surgery and radio frequency rhizotomy for trigeminal neuralgia in multiple sclerosis: A single institution experience. (United States)

    Holland, Marshall T; Teferi, Nahom; Noeller, Jennifer; Swenson, Andrea; Smith, Mark; Buatti, John; Hitchon, Patrick W


    For patients with medically unresponsive trigeminal neuralgia (TN), surgical options include micro vascular decompression (MVD), radiofrequency rhizotomy (RF), and stereotactic radio surgery (SRS). Multiple sclerosis (MS) is a demyelinating condition that can be associated with TN, but is not amenable to treatment with MVD. We sought to identify the outcome differences of patients with TN in MS undergoing SRS or RFR in an attempt to identify factors that may influence outcomes. We also evaluated cost outcomes, both initially and over time, based on the index procedure. We performed a retrospective review of our experience with 17 cases. A single institution retrospective chart review was performed. Since 1997, 17 patients with TN and MS have been treated at our institution. All patients underwent a preoperative MRI to rule out a compressive lesion. Patients either underwent SRS (n=7) or RFR (n=10) as their index procedure and were evaluated as a group based on this first procedure. Outcome measures included preoperative Expand Disability Status Score (EDSS) scores, pre- and postoperative facial pain and medication use, post-intervention facial numbness, need for subsequent procedures, and duration of follow-up. Charges for the index procedure, subsequent interventions, and total costs were tabulated and analyzed in 2017 US dollars, adjusting for inflation. The median age of patients at first operation in each group was 58.5±10.9 and 63.5±7.5 for SRS and RFR respectively. There were no significant differences in basic demographics. Overall, 71% of these patients had an excellent or good initial pain outcome. Over time, 60% of RFR and 29% of SRS patients required additional procedures to obtain satisfactory pain relief. The patients who underwent RFR as their index procedure required a significantly higher number of procedures to achieve adequate pain relief (RFR=2.7 vs SRS=2.0 [p=0.04]). The average index procedure costs in US dollars were significantly different

  11. Evidence of and experience with the use of onabotulinumtoxinA in trigeminal neuralgia and primary headaches other than chronic migraine. (United States)

    Santos-Lasaosa, S; Cuadrado, M L; Gago-Veiga, A B; Guerrero-Peral, A L; Irimia, P; Láinez, J M; Leira, R; Pascual, J; Porta-Etessam, J; Sánchez Del Río, M; Viguera Romero, J; Pozo-Rosich, P


    In the field of headaches, onabotulinumtoxinA (onabotA) is well established as a treatment for chronic migraine (CM). In recent years, it has been used increasingly to treat other primary headaches (high-frequency episodic migraine, trigeminal-autonomic cephalalgias, nummular headache) and trigeminal neuralgia. As this treatment will progressively be incorporated in the management of these patients, we consider it necessary to reflect, with a fundamentally practical approach, on the possible indications of onabotA, beyond CM, as well as its administration protocol, which will differ according to the type of headache and/or neuralgia. This consensus document was drafted based on a thorough review and analysis of the existing literature and our own clinical experience. The aim of the document is to serve as guidelines for professionals administering onabotA treatment. The first part will address onabotA's mechanism of action, and reasons for its use in other types of headache, from a physiopathological and clinical perspective. In the second part, we will review the available evidence and studies published in recent years. We will add an "expert recommendation" based on our own clinical experience, showing the best patient profile for this treatment and the most adequate dose and administration protocol. Treatment with onabotA should always be individualised and considered in selected patients who have not responded to conventional therapy. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Trigeminal Proprioception Evoked by Strong Stretching of the Mechanoreceptors in Müller's Muscle Induces Reflex Contraction of the Orbital Orbicularis Oculi Slow-Twitch Muscle Fibers. (United States)

    Matsuo, Kiyoshi; Ban, Ryokuya; Ban, Midori; Yuzuriha, Shunsuke


    The mixed orbicularis oculi muscle lacks an intramuscular proprioceptive system such as muscle spindles, to induce reflex contraction of its slow-twitch fibers. We evaluated whether the mechanoreceptors in Müller's muscle function as extrinsic mechanoreceptors to induce reflex contraction of the slow-twitch fibers of the orbicularis oculi in addition to those of the levator and frontalis muscles. We evaluated in patients with aponeurosis-disinserted blepharoptosis whether strong stretching of the mechanoreceptors in Müller's muscle from upgaze with unilateral lid load induced reflex contraction of the orbicularis oculi slow-twitch fibers and whether anesthesia of Müller's muscle precluded the contraction. We compared the electromyographic responses of the bilateral orbicularis oculi muscles to unilateral intraoperative direct stimulation of the trigeminal proprioceptive nerve with those to unilateral transcutaneous electrical stimulation of the supraorbital nerve. Upgaze with a unilateral 3-g lid load induced reflex contraction of the bilateral orbicularis oculi muscles with ipsilateral dominance. Anesthesia of Müller's muscle precluded the reflex contraction. The orbicularis oculi reflex evoked by stimulation of the trigeminal proprioceptive nerve differed from that by electrical stimulation of the supraorbital nerve in terms of the intensity of current required to induce the reflex, the absence of R1, and duration. The mechanoreceptors in Müller's muscle functions as an extramuscular proprioceptive system to induce reflex contraction of the orbital orbicularis oculi slow-twitch fibers. Whereas reflex contraction of the pretarsal orbicularis fast-twitch fibers functions in spontaneous or reflex blinking, that of the orbital orbicularis oculi slow-twitch fibers may factor in grimacing and blepharospasm.

  13. Decreased microRNA-125a-3p contributes to upregulation of p38 MAPK in rat trigeminal ganglions with orofacial inflammatory pain.

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    Yingchun Dong

    Full Text Available Orofacial inflammatory pain is a difficult clinical problem, and the specific molecular mechanisms for this pain remain largely unexplained. The present study aimed to determine the differential expression of microRNAs (miRNAs and disclose the underlying role of miR-125a-3p in orofacial inflammatory pain induced by complete Freund's adjuvant (CFA. Thirty-two differentially expressed miRNAs were first screened using a microarray chip in ipsilateral trigeminal ganglions (TGs following CFA injection into the orofacial skin innervated by trigeminal nerve, and a portion of them, including miR-23a*, -24-2*, -26a, -92a, -125a-3p, -183 and -299 were subsequently selected and validated by qPCR. The target genes were predicted based on the miRWalk website and were further analyzed by gene ontology (GO. Further studies revealed miR-125a-3p expression was down-regulated, whereas both the expression of p38 MAPK (mitogen-activated protein kinase alpha and CGRP (calcitonin gene-related peptide were up-regulated in ipsilateral TGs at different time points after CFA injection compared with control. Furthermore, mechanistic study revealed that miR-125a-3p negatively regulates p38 alpha gene expression and is positively correlated with the head withdrawal threshold reflecting pain. Luciferase assay showed that binding of miR-125a-3p to the 3'UTR of p38 alpha gene suppressed the transcriptional activity, and overexpression of miR-125a-3p significantly inhibited the p38 alpha mRNA level in ND8/34 cells. Taken together, our results show that miR-125a-3p is negatively correlated with the development and maintenance of orofacial inflammatory pain via regulating p38 MAPK.

  14. Fact Sheet: Trigeminal Neuralgia (United States)

    ... large number of conditions that can cause facial pain, obtaining a correct diagnosis is difficult, but finding the cause of the ... projects are exploring the mechanisms involved with chronic pain and ... diagnostic methods and treatments. Other research addresses TN through ...

  15. Dissecting the role of TRPV1 in detecting multiple trigeminal irritants in three behavioral assays for sensory irritation [v1; ref status: indexed,

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    CJ Saunders


    Full Text Available Polymodal neurons of the trigeminal nerve innervate the nasal cavity, nasopharynx, oral cavity and cornea. Trigeminal nociceptive fibers express a diverse collection of receptors and are stimulated by a wide variety of chemicals. However, the mechanism of stimulation is known only for relatively few of these compounds. Capsaicin, for example, activates transient receptor potential vanilloid 1 (TRPV1 channels. In the present study, wildtype (C57Bl/6J and TRPV1 knockout mice were tested in three behavioral assays for irritation to determine if TRPV1 is necessary to detect trigeminal irritants in addition to capsaicin. In one assay mice were presented with a chemical via a cotton swab and their response scored on a 5 level scale. In another assay, a modified two bottle preference test, which avoids the confound of mixing irritants with the animal’s drinking water, was used to assess aversion. In the final assay, an air dilution olfactometer was used to administer volatile compounds to mice restrained in a double-chambered plethysmograph where respiratory reflexes were monitored. TRPV1 knockouts showed deficiencies in the detection of benzaldehyde, cyclohexanone and eugenol in at least one assay. However, cyclohexanone was the only substance tested that appears to act solely through TRPV1.

  16. Frequency-Dependent Habituation Deficit of the Nociceptive Blink Reflex in Aura With Migraine Headache. Can Migraine Aura Modulate Trigeminal Excitability? (United States)

    Perrotta, Armando; Anastasio, Maria Grazia; De Icco, Roberto; Coppola, Gianluca; Ambrosini, Anna; Serrao, Mariano; Sandrini, Giorgio; Pierelli, Francesco


    To study the influence of the migraine aura on the trigeminal nociception, we investigated the habituation of the nociceptive blink reflex (nBR) R2 responses in aura with migraine headache (AwMH) and comparatively in migraine without aura (MWoA) and healthy subjects (HS). A clear deficit of habituation in trigeminal nociceptive responses has been documented in MWoA; however, similar data in MWA are lacking. Seventeen AwMH, 29 MWoA, and 30 HS were enrolled and a nonrandomized clinical neurophysiological study examining nBR habituation by clinical diagnosis was devised. We delivered a series of 26 electrical stimuli, at different stimulation frequencies (SF) (0.05, 0.1, 0.2, 0.3, 0.5, and 1 Hz), subsequently subdivided in five blocks of five responses for each SF. The mean area values of the second to the fifth block expressed as the percentage of the mean area value of the first block were taken as an index of habituation for each SF. A significant lower mean percentage decrease of the R2 area across all blocks was found at 1, 0.5, 0.3, and 0.2 Hz SF in MWoA and at 0.3 and 0.2 Hz SF in AwMH, when compared to HS. In the most representative fifth block of responses, we found in MWoA vs HS at 1 Hz, 57.0 ± 27.8 vs 30.6 ± 12.0; at 0.5 Hz, 54.8 ± 26.1 vs 32.51 ± 17.7; at 0.3 Hz, 44.7 ± 21.6 vs 27.6 ± 13.2; at 0.2 Hz, 61.3 ± 29.5 vs 32.6 ± 18.0, and in AwMH vs HS at 0.3 Hz, 52.7 ± 24.7 vs 27.6 ± 13.2; at 0.2 Hz, 69.3 ± 38.6 vs 32.6 ± 18.0 as mean ± SD of the R2 area percentage of the first block, respectively. Interestingly, AwMH subjects did not show differences in mean percentage decrease of the R2 area at 1 and 0.5 Hz SF when compared to HS. No differences between groups were found at 0.1 and 0.05 Hz SF. We demonstrated in AwMH a deficit of habituation of the nBR R2 responses after repeated stimulations, although less pronounced than that observed in MWoA of comparable clinical severity. We hypothesize

  17. Is There a Safe and Effective Way to Treat Trigeminal Neuralgia Associated with Vertebrobasilar Dolichoectasia? Presentation of 8 Cases and Literature Review. (United States)

    Vanaclocha, Vicente; Herrera, Juan Manuel; Martínez-Gómez, Deborah; Rivera-Paz, Marlon; Calabuig-Bayo, Cristina; Vanaclocha, Leyre


    Surgical treatment of trigeminal neuralgia (TN) associated with vertebrobasilar dolichoectasia is challenging. We analyze the treatments for this disease, discussing the advantages and drawbacks, and present our own technique and series. This retrospective study covered the period January 2006 through January 2016. Vertebrobasilar dolichoectasia deviation from midline, basilar artery (BA) and vertebral artery diameter, and BA apex distance above the posterior clinoid process were measured on preoperative and postoperative magnetic resonance imaging. The BA was repositioned and kept in place with coagulation of the clival dura, Teflon pledgets, and fibrin glue. We also performed a thorough literature review using PubMed. Our cases included 5 men and 3 women with mean age 64.88 years ± 10.32 (range, 48-81 years); 7 cases were TN, and 1 case was painful tic convulsif. Pain was on the left side in 6 cases and on the right in 2 cases. All cases affected cranial nerve V 2 and/or V 3 divisions. Both V 2 and V 3 were affected in 4 cases, V 3 was affected in 3 cases, and V 2 was affected in 1 case. Hypertension was present in 5 cases. TN disappeared postoperatively in all cases. One patient took clonazepam 2 mg/24 hours for 3 months because of facial dysesthesia. Postoperative complications included hearing loss in 1 patient; facial paresis plus diplopia in 1 patient, which resolved in 3 months; and arterial hypertension. Postoperative arterial hypertension improved in all affected patients, although only 2 patients discontinued antihypertensive medications. Mean follow-up time was 56.50 months ± 40.08 (range, 14 months to 9 years 9 months). No patient showed pain recurrence. TN associated with vertebrobasilar dolichoectasia can be treated surgically with minimal morbidity. BA repositioning has the highest success rate. Our technique of inducing a dural scar to fix the BA in its new position away from the trigeminal nerve is simple, not technically demanding, and highly

  18. Chronic tooth pulp inflammation induces persistent expression of phosphorylated ERK (pERK) and phosphorylated p38 (pp38) in trigeminal subnucleus caudalis (United States)

    Worsley, M.A.; Allen, C.E.; Billinton, A.; King, A.E.; Boissonade, F.M.


    Background Extracellular signal-regulated kinase (ERK) and p38 mitogen-activated protein kinase are transiently phosphorylated (activated) in the spinal cord and trigeminal nucleus by acute noxious stimuli. Acute stimulation of dental pulp induces short-lived ERK activation in trigeminal subnucleus caudalis (Vc), and p38 inhibition attenuates short-term sensitization in Vc induced by acute pulpal stimulation. We have developed a model to study central changes following chronic inflammation of dental pulp that induces long-term sensitization. Here, we examine the effects of chronic inflammation and acute stimulation on the expression of phosphorylated ERK (pERK), phosphorylated p38 (pp38) and Fos in Vc. Results Chronic inflammation alone induced bilateral expression of pERK and pp38 in Vc, but did not induce Fos expression. Stimulation of both non-inflamed and inflamed pulps significantly increased pERK and pp38 bilaterally; expression was greatest in inflamed, stimulated animals, and was similar following 10-min and 60-min stimulation. Stimulation for 60 min, but not 10 min, induced Fos in ipsilateral Vc; Fos expression was significantly greater in inflamed, stimulated animals. pERK was present in both neurons and astrocytes; pp38 was present in neurons and other non-neuronal, non-astrocytic cell types. Conclusions This study provides the first demonstration that chronic inflammation of tooth pulp induces persistent bilateral activation of ERK and p38 within Vc, and that this activation is further increased by acute stimulation. This altered activity in intracellular signaling is likely to be linked to the sensitization that is seen in our animal model and in patients with pulpitis. Our data indicate that pERK and pp38 are more accurate markers of central change than Fos expression. In our model, localization of pERK and pp38 within specific cell types differs from that seen following acute stimulation. This may indicate specific roles for different cell types in

  19. Expression of the transient receptor potential channels TRPV1, TRPA1 and TRPM8 in mouse trigeminal primary afferent neurons innervating the dura (United States)


    Background Migraine and other headache disorders affect a large percentage of the population and cause debilitating pain. Activation and sensitization of the trigeminal primary afferent neurons innervating the dura and cerebral vessels is a crucial step in the “headache circuit”. Many dural afferent neurons respond to algesic and inflammatory agents. Given the clear role of the transient receptor potential (TRP) family of channels in both sensing chemical stimulants and mediating inflammatory pain, we investigated the expression of TRP channels in dural afferent neurons. Methods We used two fluorescent tracers to retrogradely label dural afferent neurons in adult mice and quantified the abundance of peptidergic and non-peptidergic neuron populations using calcitonin gene-related peptide immunoreactivity (CGRP-ir) and isolectin B4 (IB4) binding as markers, respectively. Using immunohistochemistry, we compared the expression of TRPV1 and TRPA1 channels in dural afferent neurons with the expression in total trigeminal ganglion (TG) neurons. To examine the distribution of TRPM8 channels, we labeled dural afferent neurons in mice expressing farnesylated enhanced green fluorescent protein (EGFPf) from a TRPM8 locus. We used nearest-neighbor measurement to predict the spatial association between dural afferent neurons and neurons expressing TRPA1 or TRPM8 channels in the TG. Results and conclusions We report that the size of dural afferent neurons is significantly larger than that of total TG neurons and facial skin afferents. Approximately 40% of dural afferent neurons exhibit IB4 binding. Surprisingly, the percentage of dural afferent neurons containing CGRP-ir is significantly lower than those of total TG neurons and facial skin afferents. Both TRPV1 and TRPA1 channels are expressed in dural afferent neurons. Furthermore, nearest-neighbor measurement indicates that TRPA1-expressing neurons are clustered around a subset of dural afferent neurons. Interestingly, TRPM

  20. Polysialylated-neural cell adhesion molecule (PSA-NCAM in the human trigeminal ganglion and brainstem at prenatal and adult ages

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    Melis Tiziana


    Full Text Available Abstract Background The polysialylated neuronal cell adhesion molecule (PSA-NCAM is considered a marker of developing and migrating neurons and of synaptogenesis in the immature vertebrate nervous system. However, it persists in the mature normal brain in some regions which retain a capability for morphofunctional reorganization throughout life. With the aim of providing information relevant to the potential for dynamic changes of specific neuronal populations in man, this study analyses the immunohistochemical occurrence of PSA-NCAM in the human trigeminal ganglion (TG and brainstem neuronal populations at prenatal and adult age. Results Western blot analysis in human and rat hippocampus supports the specificity of the anti-PSA-NCAM antibody and the immunodetectability of the molecule in postmortem tissue. Immunohistochemical staining for PSA-NCAM occurs in TG and several brainstem regions during prenatal life and in adulthood. As a general rule, it appears as a surface staining suggestive of membrane labelling on neuronal perikarya and proximal processes, and as filamentous and dot-like elements in the neuropil. In the TG, PSA-NCAM is localized to neuronal perikarya, nerve fibres, pericellular networks, and satellite and Schwann cells; further, cytoplasmic perikaryal staining and positive pericellular fibre networks are detectable with higher frequency in adult than in newborn tissue. In the adult tissue, positive neurons are mostly small- and medium-sized, and amount to about 6% of the total ganglionic population. In the brainstem, PSA-NCAM is mainly distributed at the level of the medulla oblongata and pons and appears scarce in the mesencephalon. Immunoreactivity also occurs in discretely localized glial structures. At all ages examined, PSA-NCAM occurs in the spinal trigeminal nucleus, solitary nuclear complex, vestibular and cochlear nuclei, reticular formation nuclei, and most of the precerebellar nuclei. In specimens of different age

  1. Treatment of trigeminal ganglion neurons in vitro with NGF, GDNF or BDNF: effects on neuronal survival, neurochemical properties and TRPV1-mediated neuropeptide secretion

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    Patwardhan Amol M


    Full Text Available Abstract Background Nerve growth factor (NGF, glial cell line-derived neurotrophic factor (GDNF and brain-derived neurotrophic factor (BDNF all play important roles in the development of the peripheral sensory nervous system. Additionally, these growth factors are proposed to modulate the properties of the sensory system in the adult under pathological conditions brought about by nerve injury or inflammation. We have examined the effects of NGF, GDNF and BDNF on adult rat trigeminal ganglion (TG neurons in culture to gain a better understanding of how these growth factors alter the cytochemical and functional phenotype of these neurons, with special attention to properties associated with nociception. Results Compared with no growth factor controls, GDNF, at 1 and 100 ng/ml, significantly increased by nearly 100% the number of neurons in culture at 5 days post-plating. A significant, positive, linear trend of increasing neuron number as a function of BDNF concentration was observed, also peaking at nearly 100%. NGF treatment was without effect. Chronic treatment with NGF and GDNF significantly and concentration-dependently increased 100 nM capsaicin (CAP-evoked calcitonin gene-related peptide (CGRP release, reaching approximately 300% at the highest concentration tested (100 ng/ml. Also, NGF and GDNF each augmented anandamide (AEA- and arachidonyl-2-chloroethylamide (ACEA-evoked CGRP release, while BDNF was without effect. Utilizing immunohistochemistry to account for the proportions of TRPV1- or CGRP-positive neurons under each growth factor treatment condition and then standardizing evoked CGRP release to these proportions, we observed that NGF was much more effective in enhancing CAP- and 50 mM K+-evoked CGRP release than was GDNF. Furthermore, NGF and GDNF each altered the concentration-response function for CAP- and AEA-evoked CGRP release, increasing the Emax without altering the EC50 for either compound. Conclusions Taken together, our

  2. Dedicated Linear Accelerator Radiosurgery for Trigeminal Neuralgia: A Single-Center Experience in 179 Patients With Varied Dose Prescriptions and Treatment Plans

    International Nuclear Information System (INIS)

    Smith, Zachary A.; Gorgulho, Alessandra A.; Bezrukiy, Nikita; McArthur, David; Agazaryan, Nzhde; Selch, Michael T.; De Salles, Antonio A.F.


    Purpose: Dedicated linear accelerator radiosurgery (D-LINAC) has become an important treatment for trigeminal neuralgia (TN). Although the use of gamma knife continues to be established, few large series exist using D-LINAC. The authors describe their results, comparing the effects of varied target and dose regimens. Methods and Materials: Between August 1995 and January 2008, 179 patients were treated with D-LINAC radiosurgery. Ten patients (5.58%) had no clinical follow-up. The median age was 74.0 years (range, 32-90 years). A total of 39 patients had secondary or atypical pain, and 130 had idiopathic TN. Initially, 28 patients received doses between 70 and 85 Gy, with the 30% isodose line (IDL) touching the brainstem. Then, using 90 Gy, 82 consecutive patients were treated with a 30% IDL and 59 patients with a 50% IDL tangential to the pons. Results: Of 169 patients, 134 (79.3%) experienced significant relief at a mean of 28.8 months (range, 5-142 months). Average time to relief was 1.92 months (range, immediate to 6 months). A total of 31 patients (19.0%) had recurrent pain at 13.5 months. Of 87 patients with idiopathic TN without prior procedures, 79 (90.8%) had initial relief. Among 28 patients treated with 70 Gy and 30% IDL, 18 patients (64.3%) had significant relief, and 10 (35.7%) had numbness. Of the patients with 90 Gy and 30% IDL at the brainstem, 59 (79.0%) had significant relief and 48.9% had numbness. Among 59 consecutive patients with similar dose but the 50% isodoseline at the brainstem, 49 patients (88.0%) had excellent/good relief. Numbness, averaging 2.49 on a subjective scale of 1 to 5, was experienced by 49.7% of the patients, Conclusions: Increased radiation dose and volume of brainstem irradiation may improve clinical outcomes with the trade-off of trigeminal dysfunction. Further study of the implications of dose and target are needed to optimize outcomes and to minimize complications.

  3. Effect of static magnetic field on pain level and expression of P2X3 receptors in the trigeminal ganglion in mice following experimental tooth movement. (United States)

    Zhu, Yafen; Wang, Shengguo; Long, Hu; Zhu, Jingyi; Jian, Fan; Ye, Niansong; Lai, Wenli


    Recent research has demonstrated that static magnetic fields (SMF) can generate an analgesic effect in different conditions. The present study explored effects of SMF on pain levels and expressions of P2X3 receptors in trigeminal ganglion (TG) in mice after experimental tooth movement (tooth movement induced by springs between teeth). Experiments were performed in male mice (body mass: 25-30 g) and divided into SMF + force group, force group, and no force group. Exposure time was over 22 h per day. Mouse Grimace Scale was used for evaluating orofacial pain levels during experimental tooth movement at 4 h and 1, 3, 7, and 14 days. Meanwhile, expression levels of P2X3 receptors in the TG were evaluated by immunohistochemistry and western blotting at same time points. We finally found that during experimental tooth movement, pain levels of mice peaked at 3 days, and then decreased. While pain levels of mice were reduced in the SMF environment at 4 h, 1 and 3 days, there was a significant difference at 1 and 3 days. Meanwhile, under the action of SMF, expression levels of P2X3 receptors in TG were significantly lower at 4 h, 3 and 7 days. These results suggest that SMF can reduce pain levels in mice, and down-regulate P2X3 receptors in TG. Bioelectromagnetics. 38:22-30, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  4. Chronic progressive deficits in neuron size, density and number in the trigeminal ganglia of mice latently infected with herpes simplex virus. (United States)

    Dosa, Sandor; Castellanos, Karla; Bacsa, Sarolta; Gagyi, Eva; Kovacs, S Krisztian; Valyi-Nagy, Klara; Shukla, Deepak; Dermody, Terence S; Valyi-Nagy, Tibor


    Numerous epidemiological studies have proposed a link between herpes simplex virus (HSV) infection and several common chronic neuropsychiatric and neurodegenerative diseases. Experimental HSV infection of mice can lead to chronic behavioral and neurological deficits and chronic pain. While neuron injury and loss are well-documented consequences of the acute phase of infection, the pathologic consequences of latent HSV infection are poorly understood. To determine whether latent HSV infection can cause neuronal injury in mice, trigeminal ganglia (TG) derived from adult BALB/c mice 1, 12 and 31 weeks after corneal HSV type 1 (HSV-1) inoculation were analyzed for evidence of productive or latent HSV-1 infection, inflammation and changes in neuron size, density and number. We found that latent HSV-1 infection between 12 and 31 weeks after corneal virus inoculation was associated with inflammation and progressive deficits in mean neuron diameter, neuronal nucleus diameter, neuron density and neuron number in the TG relative to mock-infected controls. The extent of neuronal injury during latent infection correlated with the extent of inflammation. These studies demonstrate that latent HSV infection is associated with progressive neuronal pathology and may lead to a better understanding of the role of HSV infections in chronic neurological diseases. © 2011 The Authors. Brain Pathology © 2011 International Society of Neuropathology.

  5. Long-term outcome of percutaneous balloon compression for trigeminal neuralgia patients elder than 80 years: A STROBE-compliant article. (United States)

    Ying, Xiang; Wang, Hao; Deng, Shanghua; Chen, Yinggao; Zhang, Jie; Yu, Wenhua


    This article evaluates the long-term outcome of percutaneous balloon compression (PBC) for trigeminal neuralgia (TN) patients elder than 80 years. A total of 138 elderly patients aged above 80 years with primary TN, who were admitted to Neurosurgery Department, Hangzhou First People's Hospital from January 2007 to December 2011 for PBC treatment, were retrospectively analyzed in this study. The postoperative cure rate of immediate pain was 98.6% (Barrow Neurological Institute [BNI] classes I, II); according to the follow-up, the pain cure rates at 1, 2, 3, 4, and 5 years after surgery were 93.5%, 90.4%, 84.7%, 80.4%, and 72.9%, respectively. In our group, postoperative diplopia was reported in 1 case, masticatory muscle weakness in 3 cases, and herpes labialis in 19 cases. A total of 100% of pain-cured patients exhibited facial numbness and facial hypoesthesia. No serious complications occurred in this group of patients. PBC is an effective and safe procedure for TN treatment and can be employed as the preferred regimen for elderly TN patients aged above 80 years in poorer physical condition.

  6. Descripción de las propiedades funcionales del sistema nociceptivo trigeminal en relación con el dolor pulpar

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    Andrés O Pérez Ruíz

    Full Text Available El sistema trigeminal nociceptivo es un componente del sistema sensorial somestésico que tiene la capacidad de discriminar cuatro variables básicas de los estímulos que provocan daño tisular, ellas son: cualidad, curso temporal, localización e intensidad. Las fibras A delta y C, vinculadas a la nocicepción están presentes en la pulpa dental. Se utilizan varias clasificaciones del dolor, atendiendo a diversos criterios: calidad de la sensación, velocidad de transmisión por las fibras, en relación con el lugar del cuerpo donde se exprese, y a la ubicación del nociceptor. La evolución de las condiciones pulpares se clasifican como: pulpitis reversible, pulpitis transicional, pulpitis irreversible y pulpa necrótica.Según su cualidad, el dolor pulpar puede ser punzante o continuo; atendiendo a su aparición, provocado o espontáneo; por su curso, intermitente o continuo; por su localización puede ser limitado a una región, irradiado y referido; y en relación con su intensidad se considera leve, moderado o severo. La capacidad del sistema sensorial nociceptivo en cuanto a discriminar la modalidad, curso temporal, localización e intensidad del estímulo, permite conocer las diferentes etapas de un proceso inflamatorio pulpar.

  7. Vestigial-like 3 is a novel Ets1 interacting partner and regulates trigeminal nerve formation and cranial neural crest migration

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    Emilie Simon


    Full Text Available Drosophila Vestigial is the founding member of a protein family containing a highly conserved domain, called Tondu, which mediates their interaction with members of the TEAD family of transcription factors (Scalloped in Drosophila. In Drosophila, the Vestigial/Scalloped complex controls wing development by regulating the expression of target genes through binding to MCAT sequences. In vertebrates, there are four Vestigial-like genes, the functions of which are still not well understood. Here, we describe the regulation and function of vestigial-like 3 (vgll3 during Xenopus early development. A combination of signals, including FGF8, Wnt8a, Hoxa2, Hoxb2 and retinoic acid, limits vgll3 expression to hindbrain rhombomere 2. We show that vgll3 regulates trigeminal placode and nerve formation and is required for normal neural crest development by affecting their migration and adhesion properties. At the molecular level, vgll3 is a potent activator of pax3, zic1, Wnt and FGF, which are important for brain patterning and neural crest cell formation. Vgll3 interacts in the embryo with Tead proteins but unexpectedly with Ets1, with which it is able to stimulate a MCAT driven luciferase reporter gene. Our findings highlight a critical function for vgll3 in vertebrate early development.

  8. Subvenciones para instituciones

    International Development Research Centre (IDRC) Digital Library (Canada)


    Subvenciones para instituciones Directrices para gastos de proyectos aceptables. GFAPE-09-2015. 2 ... más de 5.000 CAD. Los costos pueden incluir el precio base de compra, costos de transporte y otros ... personas que recogen datos e información o que trabajan de manera eventual, el mantenimiento y la operación de ...

  9. The mechanism of functional up-regulation of P2X3 receptors of trigeminal sensory neurons in a genetic mouse model of familial hemiplegic migraine type 1 (FHM-1.

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    Swathi K Hullugundi

    Full Text Available A knock-in (KI mouse model of FHM-1 expressing the R192Q missense mutation of the Cacna1a gene coding for the α1 subunit of CaV2.1 channels shows, at the level of the trigeminal ganglion, selective functional up-regulation of ATP -gated P2X3 receptors of sensory neurons that convey nociceptive signals to the brainstem. Why P2X3 receptors are constitutively more responsive, however, remains unclear as their membrane expression and TRPV1 nociceptor activity are the same as in wildtype (WT neurons. Using primary cultures of WT or KI trigeminal ganglia, we investigated whether soluble compounds that may contribute to initiating (or maintaining migraine attacks, such as TNFα, CGRP, and BDNF, might be responsible for increasing P2X3 receptor responses. Exogenous application of TNFα potentiated P2X3 receptor-mediated currents of WT but not of KI neurons, most of which expressed both the P2X3 receptor and the TNFα receptor TNFR2. However, sustained TNFα neutralization failed to change WT or KI P2X3 receptor currents. This suggests that endogenous TNFα does not regulate P2X3 receptor responses. Nonetheless, on cultures made from both genotypes, exogenous TNFα enhanced TRPV1 receptor-mediated currents expressed by a few neurons, suggesting transient amplification of TRPV1 nociceptor responses. CGRP increased P2X3 receptor currents only in WT cultures, although prolonged CGRP receptor antagonism or BDNF neutralization reduced KI currents to WT levels. Our data suggest that, in KI trigeminal ganglion cultures, constitutive up-regulation of P2X3 receptors probably is already maximal and is apparently contributed by basal CGRP and BDNF levels, thereby rendering these neurons more responsive to extracellular ATP.

  10. The Role of LAT in Increased CD8+ T Cell Exhaustion in Trigeminal Ganglia of Mice Latently Infected with Herpes Simplex Virus 1▿ (United States)

    Allen, Sariah J.; Hamrah, Pedram; Gate, David; Mott, Kevin R.; Mantopoulos, Dimosthenis; Zheng, Lixin; Town, Terrence; Jones, Clinton; von Andrian, Ulrich H.; Freeman, Gordon J.; Sharpe, Arlene H.; BenMohamed, Lbachir; Ahmed, Rafi; Wechsler, Steven L.; Ghiasi, Homayon


    Herpes simplex virus (HSV) infection is a classic example of latent viral infection in humans and experimental animal models. The HSV-1 latency-associated transcript (LAT) plays a major role in the HSV-1 latency reactivation cycle and thus in recurrent disease. Whether the presence of LAT leads to generation of dysfunctional T cell responses in the trigeminal ganglia (TG) of latently infected mice is not known. To address this issue, we used LAT-positive [LAT(+)] and LAT-deficient [LAT(−)] viruses to evaluate the effect of LAT on CD8 T cell exhaustion in TG of latently infected mice. The amount of latency as determined by quantitative reverse transcription-PCR (qRT-PCR) of viral DNA in total TG extracts was 3-fold higher with LAT(+) than with LAT(−) virus. LAT expression and increased latency correlated with increased mRNA levels of CD8, PD-1, and Tim-3. PD-1 is both a marker for exhaustion and a primary factor leading to exhaustion, and Tim-3 can also contribute to exhaustion. These results suggested that LAT(+) TG contain both more CD8+ T cells and more CD8+ T cells expressing the exhaustion markers PD-1 and Tim-3. This was confirmed by flow cytometry analyses of expression of CD3/CD8/PD-1/Tim-3, HSV-1, CD8+ T cell pentamer (specific for a peptide derived from residues 498 to 505 of glycoprotein B [gB498–505]), interleukin-2 (IL-2), and tumor necrosis factor alpha (TNF-α). The functional significance of PD-1 and its ligands in HSV-1 latency was demonstrated by the significantly reduced amount of HSV-1 latency in PD-1- and PD-L1-deficient mice. Together, these results may suggest that both PD-1 and Tim-3 are mediators of CD8+ T cell exhaustion and latency in HSV-1 infection. PMID:21307196

  11. The expression of Toll-like receptor 4, 7 and co-receptors in neurochemical sub-populations of rat trigeminal ganglion sensory neurons. (United States)

    Helley, M P; Abate, W; Jackson, S K; Bennett, J H; Thompson, S W N


    The recent discovery that mammalian nociceptors express Toll-like receptors (TLRs) has raised the possibility that these cells directly detect and respond to pathogens with implications for either direct nociceptor activation or sensitization. A range of neuronal TLRs have been identified, however a detailed description regarding the distribution of expression of these receptors within sub-populations of sensory neurons is lacking. There is also some debate as to the composition of the TLR4 receptor complex on sensory neurons. Here we use a range of techniques to quantify the expression of TLR4, TLR7 and some associated molecules within neurochemically-identified sub-populations of trigeminal (TG) and dorsal root (DRG) ganglion sensory neurons. We also detail the pattern of expression and co-expression of two isoforms of lysophosphatidylcholine acyltransferase (LPCAT), a phospholipid remodeling enzyme previously shown to be involved in the lipopolysaccharide-dependent TLR4 response in monocytes, within sensory ganglia. Immunohistochemistry shows that both TLR4 and TLR7 preferentially co-localize with transient receptor potential vallinoid 1 (TRPV1) and purinergic receptor P2X ligand-gated ion channel 3 (P2X3), markers of nociceptor populations, within both TG and DRG. A gene expression profile shows that TG sensory neurons express a range of TLR-associated molecules. LPCAT1 is expressed by a proportion of both nociceptors and non-nociceptive neurons. LPCAT2 immunostaining is absent from neuronal profiles within both TG and DRG and is confined to non-neuronal cell types under naïve conditions. Together, our results show that nociceptors express the molecular machinery required to directly respond to pathogenic challenge independently from the innate immune system. Copyright © 2015 IBRO. Published by Elsevier Ltd. All rights reserved.

  12. Effects of cold temperatures on the excitability of rat trigeminal ganglion neurons that are not for cold sensing. (United States)

    Kanda, Hirosato; Gu, Jianguo G


    Aside from a small population of primary afferent neurons for sensing cold, which generate sensations of innocuous and noxious cold, it is generally believed that cold temperatures suppress the excitability of primary afferent neurons not responsible for cold sensing. These not-for-cold-sensing neurons include the majority of non-nociceptive and nociceptive afferent neurons. In this study we have found that the not-for-cold-sensing neurons of rat trigeminal ganglia (TG) change their excitability in several ways at cooling temperatures. In nearly 70% of not-for-cold-sensing TG neurons, a cooling temperature of 15°C increases their membrane excitability. We regard these neurons as cold-active neurons. For the remaining 30% of not-for-cold-sensing TG neurons, the cooling temperature of 15°C either has no effect (cold-ineffective neurons) or suppress their membrane excitability (cold-suppressive neurons). For cold-active neurons, the cold temperature of 15°C increases their excitability as is evidenced by increases in action potential (AP) firing numbers and/or the reduction in AP rheobase when these neurons are depolarized electrically. The cold temperature of 15°C significantly inhibits M-currents and increases membrane input resistance of cold-active neurons. Retigabine, an M-current activator, abolishes the effect of cold temperatures on AP firing, but not the effect of cold temperature on AP rheobase levels. The inhibition of M-currents and the increases of membrane input resistance are likely two mechanisms by which cooling temperatures increase the excitability of not-for-cold-sensing TG neurons. This article is part of the special article series "Pain". © 2015 International Society for Neurochemistry.

  13. Evaluation of polyvinyl caprolactam-polyvinyl acetate-polyethylene glycol graft copolymer nanomicelle for trigeminal ganglion neurons delivering with intranasal administration. (United States)

    Li, Mengshuang; Xin, Meng; Song, Kaichao; Sun, Fengyuan; Hou, Yuzhen; Li, Jun; Wu, Xianggen


    Purpose How to deliver enough medical agents to the trigeminal ganglion (TG) neurons conveniently still remains a challenge in pharmaceutics and clinics. The purpose of this study was to reveal that intranasal administration of polyvinyl caprolactam-polyvinyl acetate-polyethylene glycol graft copolymer (PVCL-PVA-PEG) nanomicelle formulation could efficiently deliver agent to TG neurons in mice. Methods Ocular topical or intranasal administration of nanomicelle coumarin-6 was performed in mice, and tissue distribution after administration (0.25, 1, 2, 4, 6, 8, and 10 h) was analyzed. Fluoro-Gold was used as a retrograde tracer to identify corneal and nasal neurons in the TG. Pharmacokinetic profiles after ocular topical or intranasal administration were explored in detail. Results Coumarin-6 levels in the TG neurons were significantly higher in intranasal administration groups than in topical administration groups, and the difference was statistically significant (P < 0.05) at all time points except for 10 h. Interestingly, in cornea, coumarin-6 was detected after intranasal administration. For intranasal administration groups, it was also interestingly found that coumarin-6 levels in the TG neurons were much higher than that in the brain, suggesting that the TG neurons was a target tissue after the intranasal administration of nanomicelle coumarin-6. These levels also indicated the safety of brain tissue after intranasal administration. Using Fluoro-Gold tract tracing techniques, coumarin-6 was detected in TG neurons after either ocular topical or intranasal administration of nanomicelle coumarin-6, indicating the high colocalization of corneal and nasal neurons in the TG. Conclusions Intranasal administration of PVCL-PVA-PEG nanomicelle formulation could efficiently deliver to TG neurons, and it might be a promising therapy for pathological TG neurons.

  14. Systematic and quantitative mRNA expression analysis of TRP channel genes at the single trigeminal and dorsal root ganglion level in mouse

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    Vandewauw Ine


    Full Text Available Abstract Background Somatosensory nerve fibres arising from cell bodies within the trigeminal ganglia (TG in the head and from a string of dorsal root ganglia (DRG located lateral to the spinal cord convey endogenous and environmental stimuli to the central nervous system. Although several members of the transient receptor potential (TRP superfamily of cation channels have been implicated in somatosensation, the expression levels of TRP channel genes in the individual sensory ganglia have never been systematically studied. Results Here, we used quantitative real-time PCR to analyse and compare mRNA expression of all TRP channels in TG and individual DRGs from 27 anatomically defined segments of the spinal cord of the mouse. At the mRNA level, 17 of the 28 TRP channel genes, TRPA1, TRPC1, TRPC3, TRPC4, TRPC5, TRPM2, TRPM3, TRPM4, TRPM5, TRPM6, TRPM7, TRPM8, TRPV1, TRPV2, TRPV4, TRPML1 and TRPP2, were detectable in every tested ganglion. Notably, four TRP channels, TRPC4, TRPM4, TRPM8 and TRPV1, showed statistically significant variation in mRNA levels between DRGs from different segments, suggesting ganglion-specific regulation of TRP channel gene expression. These ganglion-to-ganglion differences in TRP channel transcript levels may contribute to the variability in sensory responses in functional studies. Conclusions We developed, compared and refined techniques to quantitatively analyse the relative mRNA expression of all TRP channel genes at the single ganglion level. This study also provides for the first time a comparative mRNA distribution profile in TG and DRG along the entire vertebral column for the mammalian TRP channel family.

  15. Expression and function of a CP339,818-sensitive K+ current in a subpopulation of putative nociceptive neurons from adult mouse trigeminal ganglia (United States)

    Sforna, Luigi; D'Adamo, Maria Cristina; Servettini, Ilenio; Guglielmi, Luca; Pessia, Mauro; Franciolini, Fabio


    Trigeminal ganglion (TG) neurons are functionally and morphologically heterogeneous, and the molecular basis of this heterogeneity is still not fully understood. Here we describe experiments showing that a subpopulation of neurons expresses a delayed-rectifying K+ current (IDRK) with a characteristically high (nanomolar) sensitivity to the dihydroquinoline CP339,818 (CP). Although submicromolar CP has previously been shown to selectively block Kv1.3 and Kv1.4 channels, the CP-sensitive IDRK found in TG neurons could not be associated with either of these two K+ channels. It could neither be associated with Kv2.1 channels homomeric or heteromerically associated with the Kv9.2, Kv9.3, or Kv6.4 subunits, whose block by CP, tested using two-electrode voltage-clamp recordings from Xenopus oocytes, resulted in the low micromolar range, nor to the Kv7 subfamily, given the lack of blocking efficacy of 3 μM XE991. Within the group of multiple-firing neurons considered in this study, the CP-sensitive IDRK was preferentially expressed in a subpopulation showing several nociceptive markers, such as small membrane capacitance, sensitivity to capsaicin, and slow afterhyperpolarization (AHP); in these neurons the CP-sensitive IDRK controls the membrane resting potential, the firing frequency, and the AHP duration. A biophysical study of the CP-sensitive IDRK indicated the presence of two kinetically distinct components: a fast deactivating component having a relatively depolarized steady-state inactivation (IDRKf) and a slow deactivating component with a more hyperpolarized V1/2 for steady-state inactivation (IDRKs). PMID:25652918

  16. VGLUT1 or VGLUT2 mRNA-positive neurons in spinal trigeminal nucleus provide collateral projections to both the thalamus and the parabrachial nucleus in rats. (United States)

    Zhang, Chun-Kui; Li, Zhi-Hong; Qiao, Yu; Zhang, Ting; Lu, Ya-Cheng; Chen, Tao; Dong, Yu-Lin; Li, Yun-Qing; Li, Jin-Lian


    The trigemino-thalamic (T-T) and trigemino-parabrachial (T-P) pathways are strongly implicated in the sensory-discriminative and affective/emotional aspects of orofacial pain, respectively. These T-T and T-P projection fibers originate from the spinal trigeminal nucleus (Vsp). We previously determined that many vesicular glutamate transporter (VGLUT1 and/or VGLUT2) mRNA-positive neurons were distributed in the Vsp of the adult rat, and most of these neurons sent their axons to the thalamus or cerebellum. However, whether VGLUT1 or VGLUT2 mRNA-positive projection neurons exist that send their axons to both the thalamus and the parabrachial nucleus (PBN) has not been reported. Thus, in the present study, dual retrograde tract tracing was used in combination with fluorescence in situ hybridization (FISH) for VGLUT1 or VGLUT2 mRNA to identify the existence of VGLUT1 or VGLUT2 mRNA neurons that send collateral projections to both the thalamus and the PBN. Neurons in the Vsp that send collateral projections to both the thalamus and the PBN were mainly VGLUT2 mRNA-positive, with a proportion of 90.3%, 93.0% and 85.4% in the oral (Vo), interpolar (Vi) and caudal (Vc) subnucleus of the Vsp, respectively. Moreover, approximately 34.0% of the collateral projection neurons in the Vc showed Fos immunopositivity after injection of formalin into the lip, and parts of calcitonin gene-related peptide (CGRP)-immunopositive axonal varicosities were in direct contact with the Vc collateral projection neurons. These results indicate that most collateral projection neurons in the Vsp, particularly in the Vc, which express mainly VGLUT2, may relay orofacial nociceptive information directly to the thalamus and PBN via axon collaterals.

  17. De Novo Herpes Simplex Virus VP16 Expression Gates a Dynamic Programmatic Transition and Sets the Latent/Lytic Balance during Acute Infection in Trigeminal Ganglia. (United States)

    Sawtell, Nancy M; Thompson, Richard L


    The life long relationship between herpes simplex virus and its host hinges on the ability of the virus to aggressively replicate in epithelial cells at the site of infection and transport into the nervous system through axons innervating the infection site. Interaction between the virus and the sensory neuron represents a pivot point where largely unknown mechanisms lead to a latent or a lytic infection in the neuron. Regulation at this pivot point is critical for balancing two objectives, efficient widespread seeding of the nervous system and host survival. By combining genetic and in vivo in approaches, our studies reveal that the balance between latent and lytic programs is a process occurring early in the trigeminal ganglion. Unexpectedly, activation of the latent program precedes entry into the lytic program by 12 -14hrs. Importantly, at the individual neuronal level, the lytic program begins as a transition out of this acute stage latent program and this escape from the default latent program is regulated by de novo VP16 expression. Our findings support a model in which regulated de novo VP16 expression in the neuron mediates entry into the lytic cycle during the earliest stages of virus infection in vivo. These findings support the hypothesis that the loose association of VP16 with the viral tegument combined with sensory axon length and transport mechanisms serve to limit arrival of virion associated VP16 into neuronal nuclei favoring latency. Further, our findings point to specialized features of the VP16 promoter that control the de novo expression of VP16 in neurons and this regulation is a key component in setting the balance between lytic and latent infections in the nervous system.

  18. Differential involvement of trigeminal transition zone and laminated subnucleus caudalis in orofacial deep and cutaneous hyperalgesia: the effects of interleukin-10 and glial inhibitors. (United States)

    Shimizu, Kohei; Guo, Wei; Wang, Hu; Zou, Shiping; LaGraize, Stacey C; Iwata, Koichi; Wei, Feng; Dubner, Ronald; Ren, Ke


    In addition to caudal subnucleus caudalis (Vc) of the spinal trigeminal complex, recent studies indicate that the subnuclei interpolaris/caudalis (Vi/Vc) transition zone plays a unique role in processing deep orofacial nociceptive input. Studies also suggest that glia and inflammatory cytokines contribute to the development of persistent pain. By systematically comparing the effects of microinjection of the antiinflammatory cytokine interleukin (IL)-10 and two glial inhibitors, fluorocitrate and minocycline, we tested the hypothesis that there was a differential involvement of Vi/Vc and caudal Vc structures in deep and cutaneous orofacial pain. Deep or cutaneous inflammatory hyperalgesia, assessed with von Frey filaments, was induced in rats by injecting complete Freund's adjuvant (CFA) into the masseter muscle or skin overlying the masseter, respectively. A unilateral injection of CFA into the masseter or skin induced ipsilateral hyperalgesia that started at 30 min, peaked at 1 d and lasted for 1-2 weeks. Secondary hyperalgesia on the contralateral site also developed in masseter-, but not skin-inflamed rats. Focal microinjection of IL-10 (0.006-1 ng), fluorocitrate (1 microg), and minocycline (0.1-1 microg) into the ventral Vi/Vc significantly attenuated masseter hyperalgesia bilaterally but without an effect on hyperalgesia after cutaneous inflammation. Injection of the same doses of these agents into the caudal Vc attenuated ipsilateral hyperalgesia after masseter and skin inflammation, but had no effect on contralateral hyperalgesia after masseter inflammation. Injection of CFA into the masseter produced significant increases in N-methyl-D-aspartate (NMDA) receptor NR1 serine 896 phosphorylation and glial fibrillary acidic protein (GFAP) levels, a marker of reactive astrocytes, in Vi/Vc and caudal Vc. In contrast, cutaneous inflammation only produced similar increases in the Vc. These results support the hypothesis that the Vi/Vc transition zone is involved in

  19. Oro para Colombia


    Rubio Forero, María Claudia


    Las mujeres han debido atravesar un largo camino partiendo de la discriminación hasta empezar un proceso de equidad en la sociedad y en el deporte, de esta manera llegar a ser parte de un evento como los Juegos Olímpicos. Esta tesis toma el caso de tres atletas colombianas y describe su proceso de formación para lograr dos medallas de oro para el país.

  20. Estrategias para negociaciones exitosas.

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    José B. Parra V


    Full Text Available Las estrategias de negociación son herramientas para disminuir conflictos o para intercambiar bienes y servicios. Una negociación exitosa crea relaciones de solidaridad y propicia reciprocidad, cooperación y confianza para quienes tendrán relaciones permanentes de negociación con beneficios para ambas partes. Una estrategia de negociación exitosa requiere manejar el desarrollo del ambiente social del grupo de personas, con la finalidad de tener presente las fronteras que no pueden irrumpirse. Otro aspecto importante, es el lenguaje corporal utilizado por las personas y las tácticas que se practican. El manejo de esta información permite diseñar diferentes modelos de negociaciones para cada caso específico. Este documento propone la utilización de la herramienta MONACO, diseñada por los autores, que es un software útil para encontrar los mejores tácticas posibles dentro de una negociación; basándose en el lenguaje corporal que muestra el negociante oponente durante cada oferta monetaria. El uso de este software da al negociador la oportunidad de manejar las negociaciones con mayor control, el negociador que usa el software puede elegir una estrategia de acuerdo a las relaciones que espera mantener con el negociador oponente.

  1. ["An Italian Court recognizes the occupational origin of a trigeminal neuroma in a mobile telephone user: a case-study of the complex relationships between science and laws"]. (United States)

    Lagorio, Susanna; Vecchia, P


    Scientific knowledge is essential for the resolution of disputes in law and administrative applications (such as toxic tort litigation and workers' compensation) and provides essential input for public policy decisions. There are no socially agreed-upon rules for the application of this knowledge except in the law. On a practical level, the legal system lacks the ability to assess the validity of scientific knowledge that can be used as evidence and therefore relies heavily on expert opinion. A key issue is how to ensure that professionals in any field provide judges with sound advice, based on relevant and reliable scientific evidence. The search for solutions to this problem seems particularly urgent in Italy, a country where a number of unprecedented verdicts of guilt have been pronounced in trials involving personal injuries from exposure to electromagnetic fields. An Italian Court has recently recognized the occupational origin of a trigeminal neuroma in a mobile telephone user, and ordered the Italian Workers' Compensation Authority (INAIL) to award the applicant compensation for a high degree (80%) of permanent disability. We describe and discuss the salient aspects of this sentence as a case-study in the framework of the use (and misuse) of scientific evidence in toxic-tort litigations. Based on the motivations of the verdict, it appears that the judge relied on seriously flawed expert testimonies. The "experts" who served in this particular trial were clearly inexperienced in forensic epidemiology in general, as well as in the topic at hand. Selective overviews of scientific evidence concerning cancer risks from mobile phone use were provided, along with misleading interpretations of findings from relevant epidemiologic studies (including the dismissal of the Interphone study results on the grounds of purported bias resulting from industry funding). The necessary requirements to proceed to causal inferences at individual level were not taken into account

  2. Comparison between DNA Detection in Trigeminal Nerve Ganglia and Serology to Detect Cattle Infected with Bovine Herpesviruses Types 1 and 5. (United States)

    Puentes, Rodrigo; Campos, Fabrício Souza; Furtado, Agustin; Torres, Fabrício Dias; Franco, Ana Cláudia; Maisonnave, Jacqueline; Roehe, Paulo Michel


    Bovine herpesviruses (BoHVs) types 1 (BoHV-1) and 5 (BoHV-5) are alphaherpesviruses of major importance to the bovine production chain. Such viruses are capable of establishing latent infections in neuronal tissues. Infected animals tend to develop a serological response to infection; however, such response-usually investigated by antibody assays in serum-may eventually not be detected in laboratory assays. Nevertheless, serological tests such as virus neutralization (VN) and various enzyme-linked immunosorbent assays (ELISAs) are widely employed to check individual or herd status of BoHV infections. The correlation between detection of antibodies and the presence of viral nucleic acids as indicatives of infection in infected cattle has not been deeply examined. In order to investigate such correlation, 248 bovine serum samples were tested by VN to BoHV-1 and BoHV-5, as well as in a widely employed (though not type-differential) gB ELISA (IDEXX IBR gB X2 Ab Test) in search for antibodies to BoHVs. Immediately after blood withdrawal, cattle were slaughtered and trigeminal ganglia (TG) excised for DNA extraction and viral nucleic acid detection (NAD) by nested PCR. Neutralizing antibodies to BoHV-1 and/or BoHV-5 were detected in 44.8% (111/248) of sera, whereas the gB ELISA detected antibodies in 51.2% (127/248) of the samples. However, genomes of either BoHV-1, BoHV-5, or both, were detected in TGs of 85.9% (213/248) of the animals. These findings reveal that the assays designed to detect antibodies to BoHV-1 and/or BoHV-5 employed here may fail to detect a significant number of latently infected animals (in this study, 35.7%). From such data, it is clear that antibody assays are poorly correlated with detection of viral genomes in BoHV-1 and BoHV-5-infected animals.

  3. Local CD4 and CD8 T-cell reactivity to HSV-1 antigens documents broad viral protein expression and immune competence in latently infected human trigeminal ganglia.

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    Monique van Velzen


    Full Text Available Herpes simplex virus type 1 (HSV-1 infection results in lifelong chronic infection of trigeminal ganglion (TG neurons, also referred to as neuronal HSV-1 latency, with periodic reactivation leading to recrudescent herpetic disease in some persons. HSV-1 proteins are expressed in a temporally coordinated fashion during lytic infection, but their expression pattern during latent infection is largely unknown. Selective retention of HSV-1 reactive T-cells in human TG suggests their role in controlling reactivation by recognizing locally expressed HSV-1 proteins. We characterized the HSV-1 proteins recognized by virus-specific CD4 and CD8 T-cells recovered from human HSV-1-infected TG. T-cell clusters, consisting of both CD4 and CD8 T-cells, surrounded neurons and expressed mRNAs and proteins consistent with in situ antigen recognition and antiviral function. HSV-1 proteome-wide scans revealed that intra-TG T-cell responses included both CD4 and CD8 T-cells directed to one to three HSV-1 proteins per person. HSV-1 protein ICP6 was targeted by CD8 T-cells in 4 of 8 HLA-discordant donors. In situ tetramer staining demonstrated HSV-1-specific CD8 T-cells juxtaposed to TG neurons. Intra-TG retention of virus-specific CD4 T-cells, validated to the HSV-1 peptide level, implies trafficking of viral proteins from neurons to HLA class II-expressing non-neuronal cells for antigen presentation. The diversity of viral proteins targeted by TG T-cells across all kinetic and functional classes of viral proteins suggests broad HSV-1 protein expression, and viral antigen processing and presentation, in latently infected human TG. Collectively, the human TG represents an immunocompetent environment for both CD4 and CD8 T-cell recognition of HSV-1 proteins expressed during latent infection. HSV-1 proteins recognized by TG-resident T-cells, particularly ICP6 and VP16, are potential HSV-1 vaccine candidates.

  4. Differential involvement of trigeminal transition zone and laminated subnucleus caudalis in orofacial deep and cutaneous hyperalgesia: the effects of interleukin-10 and glial inhibitors

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    LaGraize Stacey C


    Full Text Available Abstract Background In addition to caudal subnucleus caudalis (Vc of the spinal trigeminal complex, recent studies indicate that the subnuclei interpolaris/caudalis (Vi/Vc transition zone plays a unique role in processing deep orofacial nociceptive input. Studies also suggest that glia and inflammatory cytokines contribute to the development of persistent pain. By systematically comparing the effects of microinjection of the antiinflammatory cytokine interleukin (IL-10 and two glial inhibitors, fluorocitrate and minocycline, we tested the hypothesis that there was a differential involvement of Vi/Vc and caudal Vc structures in deep and cutaneous orofacial pain. Results Deep or cutaneous inflammatory hyperalgesia, assessed with von Frey filaments, was induced in rats by injecting complete Freund's adjuvant (CFA into the masseter muscle or skin overlying the masseter, respectively. A unilateral injection of CFA into the masseter or skin induced ipsilateral hyperalgesia that started at 30 min, peaked at 1 d and lasted for 1-2 weeks. Secondary hyperalgesia on the contralateral site also developed in masseter-, but not skin-inflamed rats. Focal microinjection of IL-10 (0.006-1 ng, fluorocitrate (1 μg, and minocycline (0.1-1 μg into the ventral Vi/Vc significantly attenuated masseter hyperalgesia bilaterally but without an effect on hyperalgesia after cutaneous inflammation. Injection of the same doses of these agents into the caudal Vc attenuated ipsilateral hyperalgesia after masseter and skin inflammation, but had no effect on contralateral hyperalgesia after masseter inflammation. Injection of CFA into the masseter produced significant increases in N-methyl-D-aspartate (NMDA receptor NR1 serine 896 phosphorylation and glial fibrillary acidic protein (GFAP levels, a marker of reactive astrocytes, in Vi/Vc and caudal Vc. In contrast, cutaneous inflammation only produced similar increases in the Vc. Conclusion These results support the hypothesis

  5. Tiempo para un cambio (United States)

    Woltjer, L.


    En la reunion celebrada en diciembre dei ano pasado informe al Consejo de mi deseo de terminar mi contrato como Director General de la ESO una vez que fuera aprobado el proyecto dei VLT, que se espera sucedera hacia fines de este aAo. Cuando fue renovada mi designacion hace tres aAos, el Consejo conocia mi intencion de no completar los cinco aAos dei contrato debido a mi deseo de disponer de mas tiempo para otras actividades. Ahora, una vez terminada la fase preparatoria para el VLT, Y habiendose presentado el proyecto formalmente al Consejo el dia 31 de marzo, y esperando su muy probable aprobacion antes dei termino de este ano, me parece que el 10 de enero de 1988 presenta una excelente fecha para que se produzca un cambio en la administracion de la ESO.

  6. Instrucciones para autores


    Martinez, Ana


    Instrucciones para autoresNota preliminar: ¡Es de suma importancia que antesde enviar cualquier documento a la Revista GeologíaColombiana, lea y cumpla cuidadosamente cada uno delos subíndices de las Normas para autores!A partir del Volumen 35 (2010) recibimos artículosprincipalmente a través del sistema digital en quiere enviar un artículo, por favor regístrese comoAutor en el menú INGRESAR (aquí pueden registrarsetambién evaluadores u...

  7. Master Plan para UNIMAK


    Llorente Moreno, Francisco; Navarrete Mancebo, Gonzalo; Cruz Pinilla, Javier de la; García Méndez, María; Lacastagneratte de Figueiredo, Laura


    El Master Plan de UNIMAK se presenta como una apuesta a futuro, no solo para la Universidad de Makeni, sino también para la propia ciudad de Makeni. Se pretende potencias la Universidad como una referencia a nivel regional y como desencadenante de la estructura de trazado de la ciudad. El proyecto plantea potencial la dualidad que existe entre la infraestructura viaria y la red verde , existente en la ciudad, introduciéndola en el nuevo desarrollo del campus universitario y dotándola de la i...

  8. alternativas para promoverla

    Directory of Open Access Journals (Sweden)

    Carlos Muñoz Izquierdo


    Finalmente, se analizan las políticas que han sido aplicadas con el fin de combatir ese problema, y se sugieren algunos cursos de acción que se consideran potencialmente más eficaces para lograr ese propósito.

  9. Silo para cereales. Bandholm

    Directory of Open Access Journals (Sweden)

    Editorial, Equipo


    Full Text Available El silo de Bandholm, para cereales, construido en la isla de Lolland, tiene una capacidad de 13 a 14.000 toneladas. Esta estructura se ha subdividido en células individuales de unas 400 toneladas de capacidad cada una. La obra ha sido proyectada y construida por Christiani & Nielsen.

  10. Instrucciones para autores y autoras


    Casa de la Mujer, Revista


    Le recomendamos leer este documento a profundidad para queconozca las políticas y normas para postular a consideración su escrito.Estas instrucciones se organizan en tres apartados: I. Datos básicos,II. Políticas y III. Lineamientos para presentar el escrito; para la citacióny referenciación con APA se ofrece el documento titulado Guía dereferenciación y citación con APA.

  11. SU-F-T-647: Linac-Based Stereotactic Radiosurgery (SRS) in the Treatment of Trigeminal Neuralgia: Detailed Description of SRS Procedural Technique and Reported Clinical Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Pokhrel, D; Sood, S; Badkul, R; Jiang, H; Stepp, T; Camarata, P; Wang, F [University of Kansas Hospital, Kansas City, KS (United States)


    Purpose: SRS is an effective non-invasive alternative treatment modality with minimal-toxicity used to treat patients with medically/surgically refractory trigeminal neuralgia root(TNR) or those who may not tolerate surgical intervention. We present our linac-based SRS procedure for TNR treatment and simultaneously report our clinical outcomes. Methods: Twenty-eight TNR-patients treated with frame-based SRS at our institution (2009–2015) with a single-fraction point-dose of 60-80Gy to TNR were included in this IRB-approved study. Experienced neurosurgeon and radiation oncologist delineated the TNR on 1.0mm thin 3D-FIESTA-MRI that was co-registered with 0.7mm thin planning-CT. Treatment plans were generated in iPlan (BrainLAB) with a 4-mm diameter cone using 79 arcs with differential-weighting for Novalis-TX 6MV-SRS(1000MU/min) beam and optimized to minimize brainstem dose. Winston-Lutz test was performed before each treatment delivery with sub-millimeter isocenter accuracy. Quality assurance of frame placement was maintained by helmet-bobble-measurement before simulation-CT and before patient setup at treatment couch. OBI-CBCT scan was performed for patient setup verification without applying shifts. On clinical follow up, treatment response was assessed using Barrow Neurological Institute Pain Intensity Score(BNI-score:I–V). Results: 26/28 TNR-patients (16-males/10-females) who were treated with following single-fraction point-dose to isocenter: 80Gy(n=22),75Gy(n=1),70Gy(n=2) and 60Gy(n=1, re-treatment) were followed up. Median follow-up interval was 8.5-months (ranged:1–48.5months). Median age was 70-yr (ranged:43–93-yr). Right/left TNR ratio was 15/11. Delivered total # of average MUs was 19034±1204. Average beam-on-time: 19.0±1.3min. Brainstem max-dose and dose to 0.5cc were 13.3±2.4Gy (ranged:8.1–16.5Gy) and 3.6±0.4Gy (ranged:3.0–4.9Gy). On average, max-dose to optic-apparatus was ≤1.2Gy. Mean value of max-dose to eyes/lens was 0.26Gy/0.11Gy

  12. ParaChoice Model.

    Energy Technology Data Exchange (ETDEWEB)

    Heimer, Brandon Walter [Sandia National Lab. (SNL-CA), Livermore, CA (United States); Levinson, Rebecca Sobel [Sandia National Lab. (SNL-CA), Livermore, CA (United States); West, Todd H. [Sandia National Lab. (SNL-CA), Livermore, CA (United States)


    Analysis with the ParaChoice model addresses three barriers from the VTO Multi-Year Program Plan: availability of alternative fuels and electric charging station infrastructure, availability of AFVs and electric drive vehicles, and consumer reluctance to purchase new technologies. In this fiscal year, we first examined the relationship between the availability of alternative fuels and station infrastructure. Specifically, we studied how electric vehicle charging infrastructure affects the ability of EVs to compete with vehicles that rely on mature, conventional petroleum-based fuels. Second, we studied how the availability of less costly AFVs promotes their representation in the LDV fleet. Third, we used ParaChoice trade space analyses to help inform which consumers are reluctant to purchase new technologies. Last, we began analysis of impacts of alternative energy technologies on Class 8 trucks to isolate those that may most efficaciously advance HDV efficiency and petroleum use reduction goals.

  13. Resina pet para recipientes


    Montenegro, Ricardo Sá Peixoto; Monteiro Filha, Dulce Corrêa; Pan, Simon Shi Koo


    O mercado potencial de resina PET para recipientes é grande, com ampla expectativa de expansão. A nível mundial, esta ocorrendo um ciclo de expansão que deverá levar a uma sobrecapacidade, pressionando os preços para baixo. No Brasil, a escassez de resina PET tem retardado sua maior utilização em recipientes, notadamente de bebidas carbonatadas e em mercados em desenvolvimento, como o de óleo comestível e água mineral. Com a entrada em operação da fábrica da Nitrocarbono e da expansão da Rhod...

  14. Educando para la ignorancia

    Directory of Open Access Journals (Sweden)

    Miguel Durán


    Full Text Available Más que describir una situación particular, los autores buscan con este escrito motivar al estudiante para que asuma posiciones críticas; así como dar un campanazo de alerta a los profesores, en relación a los conocimientos que transmiten a sus alumnos y la forma en que lo hacen; todo con el ánimo de generar verdaderos espacios de reflexión en la universidad.


    Directory of Open Access Journals (Sweden)

    César Alfonso Defrancisco-Larrañaga


    Full Text Available El planeta no atraviesa por su mejor momento en materia de conservación y renovación de sus recursos naturales. Claramente en los últimos tiempos los recursos hídricos han venido haciéndose cada vez menores; el hombre ha notado con preocupación y vivido en carne propia este fenómeno, que de no ser tratado a tiempo, podría atentar contra la existencia misma. Esto lo ha alentado a buscar métodos que sirvan como solución para contrarrestar éste mal y crear conciencia entre sus iguales, para así poder garantizar su permanencia y la de su entorno durante muchas generaciones. En países desarrollados del continente europeo y en algunos lugares de América del norte, el uso de sistemas de reutilización y tratamiento de aguas grises y aprovechamiento de las aguas lluvias se ha convertido en una constante y nos están dando las pautas para poder seguir el ejemplo y así de esta manera poder aportar a la causa ambiental y a su vez crear un ahorro en nuestros gastos mensuales de consumo.

  16. Bullying: Conhecer para Prevenir

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    Elisabete Fernandes


    Full Text Available O bullying é um fenómeno que suscita a apreensão de toda a sociedade. Deste modo, enquanto pais, educadores e profissionais, devemos reconhecer que a violência entre pares em meio escolar afeta gravemente o desenvolvimento saudável das crianças. Conhecer e identificar as causas que estão na origem do bullying, bem como as consequências que este comportamento acarreta no desenvolvimento psicossocial dos seus alvos, é fundamental para melhor intervir. Proteger as crianças e jovens de hoje contribui para potenciar um futuro sem violência, através da existência de adultos equilibrados. Assim, a criação e implementação de estratégias de prevenção do bullying em contexto escolar constitui-se como dever social, porquanto só através de diversificadas conjugações de esforços será possível contribuir para um amanhã mais seguro.

  17. para mejorar el %R

    Directory of Open Access Journals (Sweden)

    Alfredo Díaz Mata


    Full Text Available En este trabajo se revisan dos indicadores técnicos bursátiles que están estrechamente relacionados, el oscilador estocástico %K de Lane y el oscilador %R de Williams; asimismo, se evalúa el uso de dos mecanismos asociados con el primero y que no suelen utilizarse con el %R: el proceso de frenado (slowing y el uso de un promedio móvil del propio oscilador estocástico como disparadores de señales de compra y de venta. Realizando simulaciones con 27 acciones y el Índice de Precios y Cotizaciones de la Bolsa Mexicana de Valores se verifica la hipótesis principal y se comprueba que, efectivamente, en muchos casos, el uso del proceso de frenado con el oscilador %R de Williams permite tomar mejores decisiones. Por otro lado, se concluye que de los dos disparadores de señales el que mejor funciona, tanto para %K como para %R es el uso de cotas inferior y superior. Este artículo surgió en el curso de una investigación sobre el análisis técnico bursátil de acciones que se puede realizar en su totalidad por computadora y que, esencialmente, excluye el análisis gráfico. Uno de los propósitos del estudio es determinar si es posible, y bajo qué mecanismos, establecer un sistema de análisis bursátil que le permita al inversionista tomar decisiones de inversión en acciones en la Bolsa Mexicana de Valores sin tener que emplear la considerable cantidad de tiempo que es necesario para el análisis gráfico tradicional. Durante este estudio se realizó un análisis preliminar de unos 120 indicadores técnicos para, por un lado, conocerlos con cierto detalle y, por otra parte, aislar aquellos que prometían ser de utilidad para el objetivo de la investigación. Fue en este proceso cuando se detectó que existen dos indicadores que están relacionados y que permiten un análisis por separado que tiene, cuando menos, dos ventajas. En primer lugar está el placer que da a quien gusta de estos temas encontrarse con indicadores que, de acuerdo

  18. Inmunopotenciadores para la acuicultura

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    Rocmira Pérez


    Full Text Available La acuicultura es una de las actividades económicas de mayor crecimiento para la producción de alimentos. Uno de sus principales retos es la obtención de grandes volúmenes de producción con la mayor calidad posible. Esto conlleva a una reducción de la aplicación de antibióticos y productos quimioterapéuticos. Una de las estrategias más prometedoras es la aplicación de inmunopotenciadores, principalmente en los cultivos intensivos. El objetivo de este trabajo fue revisar los principales inmunopotenciadores, así como las tendencias y retos de su uso mundial. Se resumen las particularidades moleculares y funcionales de los mismos y se hace énfasis en los más estudiados: levamisol, ß-glucanos, lipopolisacárido, vitamina C, extractos de plantas y hormonas. Todos estos compuestos de naturaleza heterogénea inciden mayoritariamente en los componentes de la inmunidad innata de los peces, fortaleciendo y potenciando la resistencia a enfermedades; adicionalmente algunos de ellos tienen funciones antiestrés y favorecen su crecimiento. Se concluye que los inmunopotenciadores constituyen una estrategia viable para reducir las pérdidas por problemas sanitarios en el sector de la acuicultura; pero aún quedan por solucionar aspectos como la vía de administración y la etapa de inmunización adecuada para cada especie y tipo de cultivo.

  19. Democracia para ciudadanos ciborgs

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    Juan Varela


    Full Text Available Enumera los instrumentos imprescindibles de la ciberpolítica para campañas electorales en España, cuando se renovaron los cargos municipales. La política vuelve a ser personal cuando ciudadanos y políticos se hablan cara a cara y cita varios ejemplos, reconociendo la recuperación de la comunicación directa. La ciberdemocracia es muy exigente. Los políticos prefieren la magia de la imagen. La sociedad no sabe como detener la propaganda viral que bombardea a los buscadores de red.

  20. Para pensar o afeto

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    Aluisio Pereira de Menezes

    Full Text Available Apresentação de um conjunto de formulações relativas ao “afeto” anteriores ao surgimento da psicanálise. Dificuldade da psicanálise em construir uma concepção propriamente psicanalítica. Contribuição da fenomenologia de Husserl para o estudo do afeto. Atualidade das concepções do afeto marcadas pelas neurociências. As maneiras principais de ver o problema da conceituação do afeto no pensamento psicanalítico.

  1. Nombrados para el mal


    Lara, Claudio; Sanchez, Mariela


    El presente trabajo se encuentra inscripto en la investigación Las vicisitudes del lazo amoroso en la época actual en el Gran La Plata. En ella, nuestro rasgo de investigación fue establecer algunas coordenadas para pensar que los signos de la Declinación del Nombre del Padre deben leerse en la transformación del registro del amor, dejando por fuera el registro que más desarrollos ha tenido dentro del campo del psicoanálisis: el de los ideales y el de la autoridad. La propuesta es que si El n...

  2. Bullying: Conhecer para Prevenir


    Elisabete Fernandes; Sónia Henriques; Susana Mendes; Esperança Ribeiro


    O bullying é um fenómeno que suscita a apreensão de toda a sociedade. Deste modo, enquanto pais, educadores e profissionais, devemos reconhecer que a violência entre pares em meio escolar afeta gravemente o desenvolvimento saudável das crianças. Conhecer e identificar as causas que estão na origem do bullying, bem como as consequências que este comportamento acarreta no desenvolvimento psicossocial dos seus alvos, é fundamental para melhor intervir. Proteger as crianças e jovens de hoje contr...

  3. Paisajismo para La Reserva




    El paisaje de Santiago está fuertemente determinado por el ejercicio de una voluntad. En un secano, con cuatro meses lluviosos y una sequía larga, los santiaguinos han construido a través de los años un jardín de riego soportado por múltiples dispositivos: acequias, canales, pozos y estanques. Es posible inaugurar para la ciudad otra manera de ejercer esa voluntad de paisaje: no una transformación impositiva, sino la comprensión de los procesos y relaciones naturales entre lluvia, torrentes, ...

  4. Cristalizadores para soro concentrado


    TULER PERRONE, Italo; Simeão, Moise; Schuck, Pierre; Stephani, Rodrigo; De Carvahlo, Antonio Fernandes


    Na industria de secagem de lacteos observa-se que a secagem do soro é mais complicada do que a secagem do leite. São frequentes as adesões dentro do spray dryer, ciclones e tubulações, assim como o empedramento do produto durante o processamento ou durante a estocagem e o transporte. Ao buscarmos mecanismos para maior controle e padronização da tecnologia de produção do soro em pó nos deparamos com diversos requisitos de qualidade como: acidez e pH do soro, microbiota contaminante, teor de sa...

  5. "Colaborar para Competir"

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    Martha Liliana Hijuelos-Cárdenas


    Full Text Available De acuerdo con Michael Porter, los Clusters se definen como “Una agrupación de empresas e instituciones relacionadas entre sí, pertenecientes a un mismo sector o segmento de mercado, que se encuentran próximas geográficamente y que colaboran para ser más competitivas”. Los Clusters son en última instancia una herramienta de competitividad basada en la cooperación de sus miembros, y es una de las estrategias recientes, en el país, para incrementar la productividad y competitividad y las apuestas productivas desde el nivel local. Y es precisamente esta cercanía geográfica de las empresas de un mismo sector, lo que a la vez que genera la competencia entre ellas, también les facilita el acceso a insumos y a conocimientos específicos y en última instancia les permite promover la innovación.

  6. Principios teatrales para docentes

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    R. Irene Arroyo Zúñiga


    Full Text Available Este trabajo pretende dar herramientas a los docentes para que puedan utilizarlas como parte de las actividades dentro de un plan de elección, en cualquier disciplina. Además encontrará una exposición de los elementos que componen el arte de la representación escénica, como son: 1. Expresión corporal; es la capacidad de expresar emociones partiendo únicamente de nuestro cuerpo. 2. Impostación; es la habilidad de proyectar la voz sin lastimar las cuerdas vocales. 3. Dicción; es la pronunciación correcta de las palabras. 4. Actuación; es la posibilidad de crear un personaje partiendo de los recursos expresivos y de la forma natural en que el alumno acostumbra a reaccionar. Técnica de improvisación, en éste artículo propongo una serie de seis pasos que pueden ser de gran ayuda a la hora de usar el teatro como recurso didáctico. El teatro a lo largo de la historia ha sido usado para transmitir conocimientos, valores, creencias y todo aspecto inherente a los individuos y su entorno social. Por lo tanto debemos aprovechar al máximo los beneficios que nos ofrece el teatro como educadores

  7. para las lenguas

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    Manuel Tost Planet


    Full Text Available La publicación del Marco común europeo de referencia para las lenguas, del Consejo de Europa –aún poco conocido en nuestro país– está teniendo ya una notable influencia en todos los ámbitos de la enseñanza de las lenguas y de un modo particular en la elaboración de materiales de nueva generación para el aprendizaje de las lenguas extranjeras. Tras presentar elementos contextuales de la situación del FLE en nuestro país, que tienen, pensamos, una cierta relevancia, en esta contribución se describen precisamente algunos aspectos fragmentarios de dicho Marco y se evocan, por último, los principales ejes en torno a los cuales se mueve la actual innovación didáctica, en lo que se refiere más concretamente a las actividades de aprendizaje en el aula de idiomas.

  8. Serie: Madera para construcción Acabados para madera


    Sáenz-Muñoz, Marta


    Durante mucho tiempo, la madera ha sido utilizada como material de construcción para resolver principalmente objetivos estructurales; sin embargo, actualmente, el uso de la madera ha tomado mucho auge en la estética de las construcciones, para brindar apariencia y calidez. En la actualidad, el mercado ofrece una amplia gama productos para dar diversos “acabados” a la madera, los cuales sirven para resaltar la belleza de algunas de ellas, realzar características como el color y la veta, o bien...

  9. Contratados peninsulares para Cuba

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    Iglesias García, Fe


    Full Text Available Not available.

    Ante las presiones británicas, la metrópoli española y los ideólogos de los hacendados cubanos tuvieron que dar, desde la tercera década del siglo XIX, una respuesta a la previsible escasez de mano de obra esclava. El artículo estudia los sistemas de contrata implantados en la isla para abastecer de mano de obra blanca y barata a Cuba, deteniéndose particularmente la autora en el estudio de las condiciones de semiesclavitud que se escondían en las mencionadas contratas y en el perfil de los inmigrantes (profesiones, sexo, edad, procedencia....

  10. Sustantivos para definir homofobia


    Campo Árias, Adalberto; Herazo, Edwin; Oviedo, Heidi


    Introducción. El término ‘homofobia’ es un concepto que se introdujo en el contexto académico hace más de 40 años. Sin embargo, la acepción ha tenido reparos y cambios en el tiempo. Objetivo. Revisar los sustantivos usados en los últimos doce años para definir homofobia. Metodología. Se realizó una búsqueda sistemática en Medline a través de Pubmed de publicaciones tipo editorial, cartas al editor, comentarios y entrevista en español o inglés. Se realizó un análisis cualitativo (teoría fundam...

  11. Bases para proyectiles dirigidos

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    Editorial, Equipo


    Full Text Available Aunque actualmente no se ha llegado a una línea general de métodos o sistemas que gobiernen un tipo característico de rampa y servicios auxiliares necesarios para el lanzamiento al espacio de proyectiles dirigidos a grandes alturas y distancias, las experiencias obtenidas en diferentes ensayos, utilizando distintos tipos de proyectiles y trayectorias balísticas, han sentado toda una serie de procedimientos, datos y conclusiones de gran valor balístico que, aun teniendo en cuenta la continua evolución del proyectil, sus formas, combustibles y alcances, se conocen ya, con bastante aproximación, las condiciones mínimas que ha de reunir una base dedicada a este tipo de lanzamientos.

  12. Registrar para avanzar

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    Laia Matarranz Torres


    Full Text Available El farmacéutico comunitario es un profesional sanitario con un enorme potencial para mejorar no solo el uso de los medicamentos (detectando, por ejemplo, resultados negativos de la medicación, sino también la prevención de enfermedades y la promoción de la salud pública. Sin duda, el desarrollo y el impulso que están teniendo los servicios profesionales farmacéuticos (SPF desde hace años pueden contribuir decisivamente a que este potencial se consolide de una forma definitiva, obteniendo el reconocimiento del conjunto del sistema sanitario, incluyendo tanto a otros profesionales de la salud (médicos, enfermería, medicina especializada… como a la Administración y, por supuesto, a los propios pacientes beneficiarios de estos servicios. Es cierto que la figura del farmacéutico y su ejercicio sanitario han estado tradicionalmente bien considerados por la población, pero no es menos verdad que la integración de la actividad asistencial de la farmacia comunitaria en el Sistema Nacional de Salud (SNS es, cuanto menos mejorable, y que, incluso, algunas manifestaciones ponen en entredicho de vez en cuando la labor científico-asistencial de las farmacias o generan dudas sobre su capacidad para formar parte de pleno derecho de los equipos de salud que deben trabajar de forma coordinado en la mejora de la atención sanitaria de los pacientes.

  13. Anestesia congênita de córnea associada à anestesia de ramo do trigêmio: relato de caso Congenital corneal anesthesia related to trigeminal anesthesia: case report

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    Miguel José Calix Netto


    Full Text Available A anestesia corneana por ser uma condição rara, freqüentemente é confundida ou não diagnosticada durante o exame de rotina do segmento anterior. Relato de caso de um paciente de 18 anos encaminhado ao ambulatório de córnea e doenças externas com quadro clinico de síndrome de olho seco e com diagnóstico provável de síndrome de Sjögren. Era amblíope de olho direito devido à opacidade corneana no eixo visual secundária a trauma com unha na infância. Foi pesquisada sensibilidade corneana que era ausente em ambos os olhos; olho seco grave e com BUT (tempo de quebra do filme lacrimal menor que 4 segundos. Foi feito diagnóstico de anestesia corneana congênita associada a hipoestesia do nervo trigêmio pela avaliação neurológica da sensibilidade facial e movimentos bruscos do queixo que evidenciavam alterações sensoriais do nervo. O oftalmologista geral e principalmente o especialista em segmento anterior devem ter como rotina a pesquisa da sensibilidade corneana no exame do segmento anterior.Corneal anesthesia is a rare condition, therefore its diagnosis is frequently impaired or it is not noticed during the anterior segment examination. Case report of a 18-year-old patient referred to our Corneal and External Disease Department who complained of dry eye symptoms and with a suspicion of Sjögren's syndrome. She had amblyopia of the right eye, consequence of corneal leucoma over the visual axis secondary to a fingernail traumatism inflicted by herself in childhood. On the ophthalmologic examination corneal sensitivity was absent in both eyes. Severe dry eye and breakup time less than four seconds. Diagnosis of congenital corneal anesthesia was established, secondary to trigeminal anesthesia found on neurological evaluation of facial sensitivity. She also showed sudden movements of the chin which evidenced sensorial pathology of the trigeminal nerve. The general ophthalmologist and specially anterior segment specialists must

  14. The para-petroleum industry

    International Nuclear Information System (INIS)


    The para-petroleum industry includes societies that realize studies and installations for the deposits exploitation. This document presents the situation of the para-petroleum industry in 2001, the world investment growth of the activity, the french societies financial results and an inventory of the main operations in the amalgamation domain. (A.L.B.)

  15. para promover la salud

    Directory of Open Access Journals (Sweden)

    Ma. del Consuelo Chapela


    Full Text Available Hablar de educación a distancia sustentada en el desarrollo de la cibernética obliga a reflexionar sobre sus definiciones, objetivos y medios, especialmente si pensamos en las necesidades de la fracción de población que no tiene acceso a las posibilidades que ofrece el desarrollo tecnológico. En este trabajo se presenta e ilustra con un ejemplo práctico, una perspectiva sobre las posibilidades de la educación a distancia desde las necesidades de la promoción de la salud entre grupos de población marginada en el mundo virtual. Se propone la creación de bibliotecas itinerantes regionales que pongan a disposición de la población con acceso limitado a la información, la tecnología comunicativa necesaria para apoyar los trabajos de promoción de la salud.

  16. Para-bosons and Para-fermions in Quantum Mechanics

    International Nuclear Information System (INIS)

    Cattani, M.S.D.; Fernandes, N.C.


    Within the framework of the ordinary quantum mechanics, a detailed study of the energy eigenfunctions of N identical particles using the irreducible representations of the permutation group in the Hilbert space is performed. It is shown that the para-states, as occurs with the boson and fermion states, are compatible with the postulates of quantum mechanics and with the principle of indistinguishability. A mathematical support for the existence of para-bosons and para-fermions is given. Gentile's quantum statistics is, in a certain sense, justified. (Author) [pt

  17. Marcadores para la Realidad Aumentada para fines educativos

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    María Reina Zarate Nava


    Full Text Available La Realidad Aumentada (AR es considerada por algunos expertos como la tecnología en crecimiento para el 2014, en diferentes sectores: ingeniería, educación, juegos y negocios, siendo este último el más usado en él 2013. Sin embargo en el sector educativo la AR se presenta en algunos proyectos que se han desarrollado para diferentes áreas de las ciencias, como Química, Física y Matemáticas, lo anterior con el objetivo de facilitar el proceso de Enseñanza-Aprendizaje. En el presente artículo se presenta el modelo de patrones utilizado para un Proyecto AR enfocado en Química, el cual presenta un conjunto de patrones que fueron valorados para facilitar el rastreo de los objetos y a su vez el entendimiento de algunos materiales de los laboratorios de Química I.

  18. Una agenda para educadores

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    Robert O. McClintock


    Full Text Available Las instituciones educativas constituyen los principales factores en la construcción social de un nuevo sistema educativo. Las escuelas y los educadores controlan y producen propiedad intelectual de una extraordinaria profundidad y amplitud. Los cambios producidos por las tecnologías digitales están consiguiendo que el acceso y la producción de conocimiento sea más accesible y universal. Lo que es, a la vez, un gran logro de apertura curricular, pero también un grave peligro de perder la perspectiva eminentemente “educativa” de la transmisión del conocimiento en la escuela. Los nuevos recursos permiten a los educadores romper el ciclo de reproducción en los logros educativos, acercarse al medio y a la familia y transformar la escuela. Los educadores y las escuelas deben asumir el reto de constituir comunidades de aprendizaje. Así como de atreverse a producir y difundir ese conocimiento con soporte digital. Lo contrario sería una terrible abdicación. El artículo traza un recorrido histórico sobre esta función de la escuela y su adaptación a los medios y recursos de cada época. Tras lo cual, aboga por asumir el desafío actual de las TICs, para renovar el vínculo progresista con la posteridad y construir un mejor futuro. Los nuevos recursos permiten a los educadores romper el ciclo de reproducción en los logros educativos, acercarse al medio y a la familia y transformar la escuela.

  19. Uma ferramenta para planejamento de estudos para concursos

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    Leonardo Pimentel


    Full Text Available De acordo com a constituição brasileira, a única forma de se tornar um empregado do governo é passar em um concurso público. O exame de conhecimento do cargo é um dos componentes mais importantes de um concurso. Estudar para esse exame é uma tarefa que requer planejamento. Um meio de obter um bom planejamento é construir uma grade de horários que relacione as matérias a serem estudadas com os respectivos horários disponíveis para o estudo. Esse tipo de problema se assemelha bastante à gerência de projetos, em que se procura estabelecer a distribuição das atividades ao longo do tempo disponível. Assim, torna-se interessante explorar a dinâmica de estudos para concursos como um projeto. O presente trabalho apresenta a ferramenta de apoio ao estudos - Passe-me, baseada no ciclo PDCA (do inglês, Plan-Do-Check-Act. Por se tratar de uma ferramenta web, o tempo de resposta para produzir uma grade de estudos é fundamental. A ferramenta faz uso de algoritmo genético para calcular a grade de horários priorizando a velocidade de resposta. A ferramenta foi avaliada em diferentes cenários de uso e obteve desempenho satisfatório durante a produção da grade de estudos.

  20. Masterplan para UNIMAK y Estrategias para la ciudad de Makeni


    Bacete Cebrian, Laura


    El proyecto se desarrolla en tres escalas. Por un lado están las propuestas a nivel ciudad muy relacionadas con la siguiente escala, la de la universidad, y por último hay una escala de detalle, tanto para ciudad como para universidad. Se plantea la creación de unos nodos interconectados por los corredores verdes de la ciudad que den servicios básicos a la ciudad tales gestión de residuos, equipamientos públicos, puntos de agua, saneamiento...)

  1. Mutations Inactivating Herpes Simplex Virus 1 MicroRNA miR-H2 Do Not Detectably Increase ICP0 Gene Expression in Infected Cultured Cells or Mouse Trigeminal Ganglia. (United States)

    Pan, Dongli; Pesola, Jean M; Li, Gang; McCarron, Seamus; Coen, Donald M


    Herpes simplex virus 1 (HSV-1) latency entails the repression of productive ("lytic") gene expression. An attractive hypothesis to explain some of this repression involves inhibition of the expression of ICP0, a lytic gene activator, by a viral microRNA, miR-H2, which is completely complementary to ICP0 mRNA. To test this hypothesis, we engineered mutations that disrupt miR-H2 without affecting ICP0 in HSV-1. The mutant virus exhibited drastically reduced expression of miR-H2 but showed wild-type levels of infectious virus production and no increase in ICP0 expression in lytically infected cells, which is consistent with the weak expression of miR-H2 relative to the level of ICP0 mRNA in that setting. Following corneal inoculation of mice, the mutant was not significantly different from wild-type virus in terms of infectious virus production in the trigeminal ganglia during acute infection, mouse mortality, or the rate of reactivation from explanted latently infected ganglia. Critically, the mutant was indistinguishable from wild-type virus for the expression of ICP0 and other lytic genes in acutely and latently infected mouse trigeminal ganglia. The latter result may be related to miR-H2 being less effective in inhibiting ICP0 expression in transfection assays than a host microRNA, miR-138, which has previously been shown to inhibit lytic gene expression in infected ganglia by targeting ICP0 mRNA. Additionally, transfected miR-138 reduced lytic gene expression in infected cells more effectively than miR-H2. While this study provides little support for the hypothesis that miR-H2 promotes latency by inhibiting ICP0 expression, the possibility remains that miR-H2 might target other genes during latency. Herpes simplex virus 1 (HSV-1), which causes a variety of diseases, can establish lifelong latent infections from which virus can reactivate to cause recurrent disease. Latency is the most biologically interesting and clinically vexing feature of the virus. Ever since

  2. The herpes simplex virus 1 latency-associated transcript promotes functional exhaustion of virus-specific CD8+ T cells in latently infected trigeminal ganglia: a novel immune evasion mechanism. (United States)

    Chentoufi, Aziz A; Kritzer, Elizabeth; Tran, Michael V; Dasgupta, Gargi; Lim, Chang Hyun; Yu, David C; Afifi, Rasha E; Jiang, Xianzhi; Carpenter, Dale; Osorio, Nelson; Hsiang, Chinhui; Nesburn, Anthony B; Wechsler, Steven L; BenMohamed, Lbachir


    Following ocular herpes simplex virus 1 (HSV-1) infection of C57BL/6 mice, HSV-specific (HSV-gB(498-505) tetramer(+)) CD8(+) T cells are induced, selectively retained in latently infected trigeminal ganglia (TG), and appear to decrease HSV-1 reactivation. The HSV-1 latency-associated transcript (LAT) gene, the only viral gene that is abundantly transcribed during latency, increases reactivation. Previously we found that during latency with HSV-1 strain McKrae-derived viruses, more of the total TG resident CD8 T cells expressed markers of exhaustion with LAT(+) virus compared to LAT(-) virus. Here we extend these findings to HSV-1 strain 17syn+-derived LAT(+) and LAT(-) viruses and to a virus expressing just the first 20% of LAT. Thus, the previous findings were not an artifact of HSV-1 strain McKrae, and the LAT function involved mapped to the first 1.5 kb of LAT. Importantly, to our knowledge, we show here for the first time that during LAT(+) virus latency, most of the HSV-1-specific TG resident CD8 T cells were functionally exhausted, as judged by low cytotoxic function and decreased gamma interferon (IFN-γ) and tumor necrosis factor alpha (TNF-α) production. This resulted in LAT(-) TG having more functional HSV-gB(498-505) tetramer(+) CD8(+) T cells compared to LAT(+) TG. In addition, LAT expression, in the absence of other HSV-1 gene products, appeared to be able to directly or indirectly upregulate both PD-L1 and major histocompatibility complex class I (MHC-I) on mouse neuroblastoma cells (Neuro2A). These findings may constitute a novel immune evasion mechanism whereby the HSV-1 LAT directly or indirectly promotes functional exhaustion (i.e., dysfunction) of HSV-specific CD8(+) T cells in latently infected TG, resulting in increased virus reactivation.

  3. Taller para desarrollar la creatividad




    [ES] Partimos de la base de que la creatividad es una capacidad realmente valiosa, no solo para el ámbito artístico, si no para cualquier aspecto de la vida. Este proyecto está enfocado a un taller diseñado para que a partir de técnicas de expresión gráfico-plásticas podamos estimular y desarrollar la creatividad, principalmente en niños de tercer ciclo de primaria. Con este proyecto relacionamos el arte y la creatividad que se asocia a esté con la educación. Martínez Guerola, B. (2015). T...

  4. Estrategias Digitales Para Los Negocios


    Sánchez, Nicolás David; Porras, María Paula


    Este trabajo es para fines institucionales de la Universidad del Rosario. A lo largo del segundo semestre del año 2016 entendimos la importancia de los medios digitales para las empresas, por lo cual el profesor Juan Manuel Méndez nos dio el caso de las bicicletas de Nairo Quintana con el cual teníamos que desarrollar un plan de estrategias digitales acorde con el contexto actual del sector de las bicicletas, en donde se creara y desarrollara la marca de la agencia digital creada por los estu...

  5. CODIFEXA - Colecciones Digitales para Exactas


    Olguín, Luis Alberto; Klenzi, Raúl O.


    La construcción de repositorios institucionales (RI) por parte de facultades de universidades argentinas es cada vez más significativa, pero para que este tipo de emprendimientos – generalmente con presupuestos ajustados – tenga sustentabilidad en el tiempo es necesario “mostrar que es útil” para la institución - los docentes en particular - en el sentido que permite aumentar la visibilidad de la producción científica local y por ende el impacto entre sus pares. El proyecto que aquí descri...

  6. Dramatizar: levantarse para jugar, sentarse para escuchar un cuento


    Gorria Serrano, Guillermo


    En el presente trabajo abordaremos la educación infantil, de una manera ambiciosa a través del movimiento y de la dramatización. Lo que proponemos es una educación basada en la naturaleza del niño como animal y apoyada con palabras de Rudolf Steiner, basándonos en cómo juegan todos los animales al ser educados, en cómo se imitan los unos a otros, entre mayores y pequeños. Es la base para un modelo pedagógico basado en el juego, el movimiento y la dramatización, para que los niños dejen un bue...


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    Full Text Available Este artículo pretende exponer el modelo básico que sustenta el desarrollo de multas óptimas; en él se muestra la forma de desincentivar los intereses del violador de la normatividad ambiental, e igualmente el método para alcanzar efectos compensatorios sobre los daños cometidos al medio ambiente. El desarrollo del tema sobre sanciones pecuniarias (multas y penalidades (encarcelamiento toma la relación contractual entre el agente (la empresa y el principal (La entidad reguladora para, a través de esta relación, entrar en la determinación de un diseño eficaz de sanciones. Se utilizara el modelo de agente-principal para examinar los efectos de las sanciones corporativas e individuales sobre los incentivos de cumplimiento en el contexto ambiental; además se emplearán los conceptos de bienes públicos, bienes comunes y externalidades como categorías de análisis que permiten la identificación y valoración de daños ambientales.


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    Marino Valencia Rodríguez


    Full Text Available La creciente importancia del conocimiento, como nuevo factor de producción, hace que la creación y transferencia se convierta en una de las principales prioridades de las organizaciones. El presente artículo describe tanto los fundamentos de la teoría de los recursos y capacidades de la empresa como el enfoque de la gestión del conocimiento, con sus procesos de generación y transferencia del conocimiento. Estos sirven de guía básica teórica para alcanzar el siguiente objetivo: Diseñar un modelo de generación y transferencia de conocimiento para los procesos de dirección, gestión humana y del conocimiento para PyMES, con el fin de que éstas alcancen mayores niveles de competitividad. El modelo se diseña, a partir del direccionamiento estratégico de la organización. Está conformado por tres etapas, articuladas con elementos y actividades. Las acciones se enfocan en dos factores clave de éxito: la cultura organizacional y la formación. La utilización del modelo permitirá a las PyMES optimizar los recursos y capacidades disponibles, lo cual se refleja en el desempeño del trabajador y en el fortalecimiento de la cultura organizacional.

  9. FRANQUICIAS. Una Alternativa para Emprendedores

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    Jorge Enrique Silva Duarte


    Full Text Available Este artículo presenta las ventajas de las franquicias como alternativa de negocios. Para un emprendedor exitoso ya establecido es más rentable permitir el uso de su conocimiento explícito mediante el formato de negocio de su firma y recibir regalías mensuales sobre las ventas brutas, que invertir en la apertura de cada nuevo punto. Igualmente, para quien desee iniciarse como empresario, la modalidad de franquicia es muy interesante: en primer lugar, porque empieza con un negocio ya probado, utiliza la imagen extendida de la franquicia y recibe un apoyo corporativo del franquiciador; adicionalmente, detrás del formato de negocio que contrata, está el capital relacional, en otras palabras, la experticia del franquiciador, el conocimiento del mercado, la base de clientes y de proveedores y el capital humano.

  10. Encuestas para llegar al poder

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    Luis Eladio Proaño


    Full Text Available Las encuestas son parte fundamental de los procesos políticos. Pero en América Latina apenas se utilizan. Además, la mayoría de la población las considera sospechosas. Un director de campaña moderno, necesita datos precisos para que su candidato tenga posibilidades ciertas de ganar. Con las encuestas sí se puede.

  11. Argumentos para repensar el "desarrollo"

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    María Luisa Eschenhagen


    Full Text Available Con este trabajo se quiere hacer una aproximación al problema desde una perspectiva diferente, considerando nuevos argumentos que hasta hace muy poco tiempo no se habían tenido en cuenta y que se vienen formulando de una manera muy interesante en los últimos años. El objetivo del artículo es presentar tres argumentos para señalar la necesidad de repensar, desde sus fundamentos, el concepto de desarrollo.

  12. Diagramas de Bianchi para Susy

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    Sara Cruz y Cruz


    Full Text Available Se revisa el origen de los solitones como soluciones de la ecuación de Korteweg-de Vries y su presencia en la formulación supersimétrica de la Mecánica Cuántica. Se introducen los diagramas de Bianchi como una herramienta simbólica para construir socios supersimétricos de un Hamiltoniano dado.

  13. Financiamiento para construir la finca.

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    Túpac Barahona.


    Full Text Available Las instituciones financieras convencionales y no convencionales tienden a excluir de los servicios de crédito a los sectores más frágiles del campesinado, por considerarlos clientes altamente riesgosos. En este artículo, se discute el sentido económico y social que tendrían que desarrollar esquemas de financiamiento para campesinos con economías débiles, pero con un potencial de desarrollo latente.

  14. The Herpes Simplex Virus Latency-Associated Transcript Gene Is Associated with a Broader Repertoire of Virus-Specific Exhausted CD8+ T Cells Retained within the Trigeminal Ganglia of Latently Infected HLA Transgenic Rabbits (United States)

    Srivastava, Ruchi; Dervillez, Xavier; Khan, Arif A.; Chentoufi, Aziz A.; Chilukuri, Sravya; Shukr, Nora; Fazli, Yasmin; Ong, Nicolas N.; Afifi, Rasha E.; Osorio, Nelson; Geertsema, Roger; Nesburn, Anthony B.


    ABSTRACT Persistent pathogens, such as herpes simplex virus 1 (HSV-1), have evolved a variety of immune evasion strategies to avoid being detected and destroyed by the host's immune system. A dynamic cross talk appears to occur between the HSV-1 latency-associated transcript (LAT), the only viral gene that is abundantly transcribed during latency, and the CD8+ T cells that reside in HSV-1 latently infected human and rabbit trigeminal ganglia (TG). The reactivation phenotype of TG that are latently infected with wild-type HSV-1 or with LAT-rescued mutant (i.e., LAT+ TG) is significantly higher than TG latently infected with LAT-null mutant (i.e., LAT− TG). Whether LAT promotes virus reactivation by selectively shaping a unique repertoire of HSV-specific CD8+ T cells in LAT+ TG is unknown. In the present study, we assessed the frequency, function, and exhaustion status of TG-resident CD8+ T cells specific to 40 epitopes derived from HSV-1 gB, gD, VP11/12, and VP13/14 proteins, in human leukocyte antigen (HLA-A*0201) transgenic rabbits infected ocularly with LAT+ versus LAT– virus. Compared to CD8+ T cells from LAT– TG, CD8+ T cells from LAT+ TG (i) recognized a broader selection of nonoverlapping HSV-1 epitopes, (ii) expressed higher levels of PD-1, TIM-3, and CTLA-4 markers of exhaustion, and (iii) produced less tumor necrosis factor alpha, gamma interferon, and granzyme B. These results suggest a novel immune evasion mechanism by which the HSV-1 LAT may contribute to the shaping of a broader repertoire of exhausted HSV-specific CD8+ T cells in latently infected TG, thus allowing for increased viral reactivation. IMPORTANCE A significantly larger repertoire of dysfunctional (exhausted) HSV-specific CD8+ T cells were found in the TG of HLA transgenic rabbits latently infected with wild-type HSV-1 or with LAT-rescued mutant (i.e., LAT+ TG) than in a more restricted repertoire of functional HSV-specific CD8+ T cells in the TG of HLA transgenic rabbits latently

  15. requisito para pensar la paz

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    Jaidivi Núñez Varón


    Full Text Available Este documento señala puntos de discusión para reflexionar sobre cómo la justicia basada en la construcción social tiene la posibilidad de convertirse en un requisito para pensar la paz. El análisis inicia desde algunos horizontes planteados por la sociología jurídica, la antropología jurídica, la psicología social y el derecho. El objetivo es permitir que el lector tenga preguntas que contribuyan para pensar la paz en un país que tiene la coyuntura del conflicto armado y que cuestiona la justicia desde el escalamiento de la violencia en el espacio cotidiano. Se señalan algunos puntos de la relación entre la justicia y la paz desde la construcción del Estado, identificando los momentos y características de la conexión de estos dos conceptos en el curso de los acontecimientos históricos. Se presenta la concepción de la justicia a través de la óptica del pensamiento complejo y se plantea una discusión de cómo pensar la paz desde la construcción social.

  16. Estrategia para la sustentabilidad ambiental

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    Cecilia Erbiti


    Full Text Available En el contexto de los postulados conceptuales y metodológicos de la planificación estratégica y de sustentabilidad ambiental, el objetivo de esta investigación es describir el proceso de formulación del Plan de Ordenamiento Territorial del Municipio de Tandil (POTM y analizar su potencialidad para avanzar hacia la sustentabilidad ambiental del sistema. Los resultados de la misma muestran que el POTM no sólo prioriza principios, objetivos y estrategias que materializan las diferentes manifestaciones de la sustentabilidad (económica, social, ecológica y política, sino que la totalidad del Plan se fundamenta en el concepto de desarrollo sostenible y, con ello, se establecen prioridades de actuación que posibilitarán la gestión ambiental urbana. Si bien el POTM muestra una gran potencialidad para avanzar hacia la sustentabilidad del territorio, la implementación y cumplimiento del mismo constituye un fuerte desafío para las autoridades de aplicación.

  17. para asegurar un hijo sano

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    Carmen Amarilis Guerra de Castillo


    Full Text Available Esta investigación etnográfica focalizada exploró las creencias, los valores, los hábitos y los padrones comportamentales de las embarazadas diabéticas atendidas en el Hospital Doctor Enrique Tejera, quienes residen en tres comunidades urbanas pobres de la ciudad de Valencia - Venezuela, con el objetivo de encontrar el significado del cuidado de si para dichas grávidas. Se utilizó como referencial teórico el Modelo del Análisis de la Salud y la Teoría Antropológica de la Salud, siendo fundamentales para revelar aquello que estaba implícito en el comportamiento de las mujeres con relación a su cuidado. Surgieron tres temas: la salud y la enfermedad - valores culturales del cuidado de si; las prácticas del cuidado de la salud y cuidándose en el embarazo garantiza tener un hijo más saludable. Los temas culturales revelaron que las creencias, los valores, los hábitos y los patrones culturales comportamentales, conforme las tres maneras de acción identificadas, pueden ser preservadas, acomodadas y re-estructuradas para proporcionar un cuidado culturalmente congruente.

  18. Nueva Sede para la Academia

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    Mario Camacho Pinto


    Full Text Available

    Una nueva sede adecuadamente dotada siempre estuvo en la mente de nuestros expresidentes Académicos César Augusto Pantoja, Hernando Groot, Pablo Gómez Martínez, Jorge Cavelier Gaviria y Efraim Otero-Ruiz, con quienes me tocó en suerte trabajar 12 años consecutivos, cerca de ellos a través de mi cargo de Coordinardor de la Comisión Permanente de Biblioteca y Publicaciones y de la Revista MEDICINA que se ha venido publicando sin interrupciones dentro de un compañerismo ejemplar; además de otras distinciones operativas que me inducen a expresar gratitud.

    Ahora, además, como Secretario de la Coporación por elección unánime de la Asamblea hace dos años, he sido testigo ático de una intensa, inteligente e inagotable actividad que nuestro Presidente Académico Juan Jacobo Muñoz Delgado quien siempre con el visto bueno de la Junta Directiva, mediante un acelerado ritmo de trabajo se impuso la tarea de convertir en realidad inmediata tan anhelada y necesaria idea.

    En efecto, la nueva sede fue inaugurada oficialmente el día 2 de septiembre de 1993.

    Este Editorial es la constancia escrita de tal febril actividad que para proporcionar evidencia a los lectores de “MEDICINA” resumo en breves incisos que muestran el tránsito a un estado con superávit de excepción para esta clase de instituciones:

    1. Terminación de la obra ya iniciada de la remodelación arquitectónica, tanto exterior de seguridad y aspecto como interior con suficientes y modernas instalaciones.

    2. Cerramiento total con altas y elegantes rejas metálicas y doble portería por la calle 69 y la carrera 7a.

    3. Aparcadero lujosamente adoquinado, amplio y seguro para 30 automóviles.

    4. Decoración interior estéticamente consultada, bien lograda en cortinas y clásicas lámparas de cristal obsequiadas por conocidos académicos. Un par de originales urnas precolombianas en el hall de entrada.

    5. Zona social doble, amplia



    Gómez-Eguílar, Javier


    A lo largo del trabajo vamos a exponer nuestra propia idea de negocio de una nueva empresa, llamada GAMERINET, que se dedique a la venta de videojuegos de ordenador en descarga digital a través de nuestra web. Para ello vamos a ver una breve introducción a este sector de negocio y su historia, haremos un análisis de las condiciones actuales del sector, a través del análisis del entorno específico (5 Fuerzas de Porter) y del análisis del entorno general (Análisis PEST). Posterio...



    Richart Vázquez-Román; Edna M. Valenzuela-Acosta; Florianne Castillo-Borja


    En este trabajo se desarrollan dos modelos predictivos de la temperatura normal de punto de inflamación. Los modelos propuestos consideran términos adimensionales en su expresión, los cuales han reducido el error en la predicción de la temperatura del punto de inflamación para alcanos. Se observó que la relación entre la temperatura en el punto de inflamación y la de ebullición aparentemente tienen poca variabilidad por lo cual se puede deducir una regla heurística. La dispersión del error co...


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    Janes Siqueira


    Full Text Available O trabalho que apresentamos é parte da pesquisa com os estudantes das licenciaturas e da pedagogia da Universidade de Santa Cruz do Sul-UNISC-RS-Brasil. Este está inserido na linha de pesquisa: educação, trabalho e emancipação. Queremos compreender, à luz do materialismo histórico e dialético e das categorias da crítica da economia política, os significados atribuídos pelos estudantes universitários ao fenômeno trabalho e estudo. É uma pesquisa preferentemente qualitativa de natureza dialética. Para Marx, a essência da realidade humana reside no trabalho, mas a fonte de toda a riqueza está na natureza. Logo, trabalho, natureza e sociedade estão em relação dialética. Trabalho, portanto, é a ideia central articuladora, e natureza e sociedade devem ser estudadas em conexão com o trabalho. Marx trata o trabalho, no modo de produção capitalista, como impedimento ao desenvolvimento humano. Propõe o mesmo como um ato de criação e auto-expressão humana que não deve ter um valor. A compreensão dessa premissa é necessária para que os trabalhadores possam significar e ressignificar o trabalho para além da ideologia dominante. Algumas categorias aparecem como relevantes para a análise: condições de trabalho e de estudo, necessidade de formação, predominância do trabalho sobre o estudo, dificuldade de conciliar tempo de estudo e de trabalho. Na relação com o objeto de estudo, ressaltaremos a crise estrutural do capital, a desregulamentação das leis do trabalho e sua flexibilização e as contradições entre trabalho e estudo bem como quais possibilidades emancipatórias são visualizadas ou sonhadas pelos trabalhadores-estudantes. PALAVRAS-CHAVE: contradições entre trabalho e educação, condições e significados, realidade e possibilidades.

  2. Development of DNA probe for detection of Aujeszky's disease virus Desenvolvimento de uma sonda de DNA para a detecção do vírus da doença de Aujeszky

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    A.L. Cândido


    Full Text Available A DNA hybridization dot-blot assay using a radioactive and a non-radioactive probe has been developed for the detection of Aujeszky's disease virus (ADV. The Bam H I 7 fragment of ADV genomic DNA was labeled by nick translation using 32P-dCTP and the 196bp polymerase chain reaction (PCR gG glycoprotein gene amplified fragment was also labeled by nick translation but using biotin d-7-dATP. This technique provides a fast and effective means of detecting acute cases of ADV infection but it was unable to detect ADV nucleic acid sequences in trigeminal nerve ganglia of latent infected pigs and mice.Uma sonda radioativa e uma outra biotinilada foram produzidas para detecção do vírus da doença de Aujeszky (VDA. O fragmento de Bam H I 7 do DNA genômico do VDA foi marcado por "nick translation" empregando P32dCTP e um fragmento de 196pb, resultante de uma amplificação pela reação em cadeia pela polimerase marcado com biotina 7-dATP. Essas sondas, de uma maneira rápida e específica, prestaram-se para a detecção da infecção aguda pelo VDA. Entretanto, não se mostraram sensíveis o suficiente para detectar seqüências genômicas de VDA no gânglio trigêmio de suínos e camundongos com infecção latente.


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    Richart Vázquez-Román


    Full Text Available En este trabajo se desarrollan dos modelos predictivos de la temperatura normal de punto de inflamación. Los modelos propuestos consideran términos adimensionales en su expresión, los cuales han reducido el error en la predicción de la temperatura del punto de inflamación para alcanos. Se observó que la relación entre la temperatura en el punto de inflamación y la de ebullición aparentemente tienen poca variabilidad por lo cual se puede deducir una regla heurística. La dispersión del error con la regla heurística se reduce al incorporar las energías de evaporación y reacción en la correlación. Se desarrolló un método basado en contribución de grupos combinada con los grupos adimensionales propuestos para reducir aún más el error en la predicción de la temperatura del punto de inflamación, incluyendo la capacidad de distinguir la diferencia entre los isómeros. Los resultados obtenidos de los modelos propuestos son aceptables y mejoran a las correlaciones de uso actual.

  4. Agenda para la Reforma Monetaria

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    Jane D'Arista


    Full Text Available El papel de la política monetaria en la creación de las condiciones que culminaron en la crisis actual y el fracaso de los esfuerzos de la Fed para descongelar el crédito en 2008 y 2009 son componentes críticos en el análisis que se requiere como fundamento para el contexto de reforma. Esta colaboración argumenta que la conexión entre la liquidez excedente, el crecimiento de la deuda, las burbujas de activos creadas por la deuda y la crisis financiera que se generó, son desenlaces de los fracasos en la política monetaria y regulatoria, que reflejan un debilitamiento substancial en la habilidad de la Fed de instrumentar iniciativas contra cíclicas. Se argumenta que el grado de efectividad de la política monetaria puede -y debe- ser restaurada y se propone un nuevo sistema de manejo de reservas que puede acceder a reservas contra activos y no contra depósitos y que aplica requerimientos de reservas a todos segmentos del sector financiero. Se concluye que un cambio en el sistema actual de implementación de la política monetaria es necesario para terminar con la contracción crediticia, confrontar el impacto de la crisis actual sobre el sector financiero y la economía y asegurar el éxito de cualquier estímulo fiscal que se emprenda.

  5. Nuevo nombre para antiguos conceptos

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    Alexandra Ayala Marín


    Full Text Available El periodismo cívico, público o comunitario son tres denominaciones para un mismo fenómeno surgido en los E.U. y que va difundiéndose por América Latina, precisamente donde su esencia (el protagonismo y la participación real del perceptor en los procesos comunicacionales surgió y se desarrolló hace décadas. La autora al entrevistar a Carlos Alvares Teijeiro, uno de los estudiosos del tema, ofrece algunos aspectos de esta (nueva? práctica periodística que tiene que ver con la democracia

  6. Turismo accesible, turismo para todos


    Núñez Bello, Miguel


    El sector turístico representa el 10,2 por ciento del Producto Interior Bruto (PIB) y el 11,5 por ciento del empleo en España. La actividad turística y sus grandes beneficios han posibilitado que nuestro país sea destino y referencia en este sector. ¿Lo es también en turismo accesible? El turismo para todos no puede ser excluyente bajo ninguna razón o circunstancia. Amparado en el derecho y la Constitución, la sensibilidad que se percibe no puede quedar solo en buenas palabras sino en actuaci...

  7. Mandevilla (Apocynaceae, Mesechiteae para Brasil

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    J. Francisco Morales


    Full Text Available Se describen dos nuevas especies de Mandevilla (Apocynoideae, Mesechiteae subgénero Exothostemon, endémicas de Brasil. Mandevilla abortiva se encuentra relacionada con un grupo de especies conformado por M. huberi, M. obtusifolia y M. pachyphylla, discutiéndose sus afinidades con esos taxones. Mandevilla clandestina ha sido confundida por largo tiempo con M. scabra, diferenciándose por sus flores más pequeñas. Se incluyen descripciones completas, ilustraciones y el listado de especímenes examinados para ambos taxones.

  8. Entre velos: Maya para contrabajo


    Rosa María Rodríguez Hernández


    Maya para contrabajo se materializa a partir de una imagen de Pepe Romero, cuyo texto interpreta a La decadencia de la mentira de Oscar Wilde. La estructura de Maya es binaria, especular y asimétrica; su poética obedece al juego verdad/mentira que subyace en la obra artística y en la vivencia del artista. Maya trae a la memoria las voces de los Upanishad, Schopenhauer, Shakespeare y Beethoven, influencias éstas en la obra de Wagner y, todas ellas, en la de Eliot. Los aspectos gestuales y visu...

  9. Pequenos para idade gestacional: fator de risco para mortalidade neonatal

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    Almeida Márcia Furquim de


    Full Text Available OBJETIVO: Estudar as variáveis contempladas na Declaração de Nascimento (DN como possíveis fatores de risco para nascimentos pequenos para a idade gestacional (PIG e o retardo de crescimento intra-uterino como fator de risco para a mortalidade neonatal. MATERIAL E MÉTODO: As variáveis existentes na DN foram obtidas diretamente de prontuários hospitalares. Os dados referem-se a uma coorte de nascimentos obtida por meio da vinculação das declarações de nascimento e óbito, correspondendo a 2.251 nascimentos vivos hospitalares, de mães residentes, ocorridos no Município de Santo André, Região Metropolitana de São Paulo, no período de l/1 a 30/6/1992, e aos óbitos neonatais verificados nessa coorte. RESULTADOS: Obteve-se a proporção de 4,3% de nascimentos PIG, significativamente maior entre os recém-nascidos de pré-termo e pós-termo, entre os nascimentos cujas mães tinham mais de 35 anos de idade e grau de instrução inferior ao primeiro grau completo. Os recém-nascidos PIG apresentam maior risco de morte neonatal que aqueles que não apresentavam sinais de retardo de crescimento intra-uterino. CONCLUSÕES: Em áreas com menor freqüência de baixo peso ao nascer, é importante investigar a presença de retardo de crescimento intra-uterino entre os nascimentos prematuros e não apenas nos nascimentos de termo. O registro da data da última menstruação (ou da idade gestacional em semanas não agregadas na DN facilitaria a detecção de PIGs na população de recém-nascidos.

  10. Edificio para viviendas, en Barcelona

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    Barba Corsini, F.


    Full Text Available This building has a garage basement, a ground floor with a communed playing zone for all the children of the block, and the entrance vestibule. The rest of the building is occupied with apartments, of about 200 m2 each, which are functionally designed, and are suitable for medium sized average income families. Special attention has been given to the external facades, which, among other things, are of extremely simple design.El edificio contiene: en el sótano, un guardacoches; en la planta baja, una zona de juegos común para los niños de todas las viviendas, además de los vestíbulos. El resto de la superficie edificada está destinado a viviendas, de unos 200 m2, construidos con distribución funcional y adecuada para familias medias ya constituidas. Fue dedicada una especial atención a la composición de las fachadas, que ofrecen, entre otros atractivos, el de su elegante sencillez.

  11. Para onde vai a Geografia?

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    Angélica Karina Dillenburg Horii


    Full Text Available O presente artigo aborda a evolução da Geografia enquanto pensamento científico, analisando seu objeto de estudo e suas categorias de análise durante todo o percurso da criação desse saber. Observa primeiramente a formação da Geografia Clássica, que teve seus princípios já instituídos na Antiguidade com Ptolomeu e Estrabão, desdobrando-se no período Iluminista com Ritter e Humboldt que fornecerão uma nova temporalidade a essa ciência. Atinge seu ápice na Modernidade Industrial com a racionalidade de Kant, onde Ratzel e La Blache utilizarão o determinismo e o possibilismo para constituir um discurso científico para a Geografia. Finaliza apontando a nova compreensão do mundo, conhecida como pós-modernismo por David Harvey (1992 ou por Milton Santos (1996 como Globalização, que junto a outros geógrafos e pesquisadores, indicam caminhos de análise dessa ciência na compreensão do seu objeto de estudo. Um diálogo entre os autores na construção do pensamento geográfico.

  12. Aprender para la vida o para el placer

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    Diobaldo César Heredia Gutiérrez


    Full Text Available El proceso enseñanza aprendizaje, se corresponde con un sistema comunicativo por excelenciaque requiere una alta dosis de amor que garantice el disfrute o goce de los participantes, enun interactuar de búsqueda y descubrimiento satisfactorio. Para imprimirle un alto grado de calidad, esdeseable la participación de estudiantes y docentes más emprendedores y críticos y menos académicoso dependientes, por ello el aprendizaje autónomo es clave, el logro u objetivo, entonces, es estudiantesque aprendan como si fueran a enseñar y docentes investigadores, proactivos y expertos en las materiasque enseñan.

  13. Internet como instrumento para la Yihad

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    Alfonso Merlos García


    Full Text Available Las extraordinarias ventajas que ofrece Internet lo han convertido en un instrumento clave y dinámico en la estrategia de los yihadistas. Los medios de comunicación, la clase política y las agencias de seguridad e información han tendido a concentrar sus esfuerzos en la neutralización del ciberterrorismo sin prestar suficiente atención a los múltiples usos de Internet que están haciendo los neosalafistas: para la propaganda y para la guerra psicológica, para el reclutamiento y para la financiación, para la documentación y para la planificación de atentados. Las democracias deberían considerar el coste que tendrá la derrota frente al movimiento yihadista globalizado en la batalla por el ciberespacio

  14. Inteligencia Emocional para tiempos de crisis


    Fernández-Berrocal, Pablo


    La Inteligencia Emocional se concibe como un conjunto de habilidades, tanto básicas como complejas, dirigidas a “unificar las emociones y el razonamiento”, esto es, usar las emociones para facilitar el razonamiento y los procesos de pensamiento, y usar nuestro razonamiento para pensar de forma inteligente acerca de nuestras emociones (Mayer y Salovey, 1997). En concreto, la IE se define como una habilidad mental que incluye “la capacidad para percibir, valorar y expresar las emociones con...

  15. Software hipermedia para apoyo de evaluaciones automatizadas


    Grosclaude, Eduardo


    Las organizaciones educativas requieren adecuado soporte informático para la optimización de procesos colaborativos en la enseñanza. Se necesita definir una arquitectura de desarrollo de estas aplicaciones sobre sistemas distribuidos. Se presentan los objetivos de un proyecto de investigación sobre Software para Procesos Colaborativos, en el marco del cual se han desarrollado dos aplicaciones experimentales para apoyar la evaluación automatizada. Se describen estas aplicaciones, sus resultado...

  16. Sistema de realidad aumentada para aplicaciones Android


    Fernández Sánchez, Natalia Mercedes


    El objetivo principal de este proyecto es la creación de un sistema de realidad aumentada para el sistema operativo Android con idea de que sea utilizado para la creación de un videojuego, pero que a su vez sea lo suficientemente versátil como para poder utilizarse en otro tipo de aplicaciones. De este objetivo principal podemos obtener los objetivos secundarios: - Conocer las características que ofrecen los teléfonos móviles y como éstas pueden ser aprovechadas para la crea...

  17. Adesao ao guia alimentar para populacao brasileira

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    Eliseu Verly Junior


    Full Text Available OBJETIVO : Analisar a adesão ao Guia Alimentar para População Brasileira. MÉTODOS : Amostra composta por participantes do Inquérito de Saúde de São Paulo (n = 1.661 que preencheram dois recordatórios de 24 horas. Foi utilizado modelo bivariado de efeito misto para a razão entre o consumo de energia do grupo de alimentos e o consumo calórico total. A razão estimada foi utilizada para calcular o percentual de indivíduos com consumo abaixo ou acima da recomendação. RESULTADOS : Pelo menos 80,0% da população consome abaixo do recomendado para: leite e derivados; frutas e sucos de frutas; e cereais, tubérculos e raízes; aproximadamente 60,0% para legumes e verduras; 30,0% para feijões; e 8,0% para carnes e ovos. Adolescentes apresentaram a maior inadequação para legumes e verduras (90,0%, e o estrato de maior renda foi associado à menor inadequação para óleos, gorduras e sementes oleaginosas (57,0%. CONCLUSÕES : Foi observado consumo inadequado dos grupos de alimentos relacionados com aumento do risco de doenças crônicas.

  18. Paisajes para un desarrollo sustentable y participativo

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    Rafael Mata Olmo


    Para terminar, el texto recoge una experiencia de proyecto territorial de paisaje, la del Plan Insular de Menorca (Islas Baleares, España, aprobado en 2003. Se sintetizan sus determinaciones sobre la protección de determinados terrenos por sus altos valores paisajísticos, sus directrices para que las políticas sectoriales (turismo, agricultura, infraestructuras, etc. incorporen criterios paisajísticos, y sus iniciativas para la gestión y mejora del paisaje y para el fomento del acceso público a su contemplación y disfrute.

  19. Programa de Seguridad y Desalojo para Instituciones


    Duque Escobar, Gonzalo


    El siguiente Programa de Seguridad y Desalojo ha sido adaptado de uno similar, desarrollado en Venezuela, para instituciones educativas. Se trata de una metodología desarrollada por del FUNDARIS útil para proceder a desarrollar simulacros con base en tres (3) actividades: la planeación, la ejecución y la evaluación. Esta propuesta adaptada para el programa de gestión del riesgo sísmico en el Eje Cafetero, adelantado por la UN y el CINEP, hace parte del curriculum para el Curso Internacional d...

  20. Profesiones emergentes para los comunicadores

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    Manuel Ortiz Marín


    Full Text Available Señala el autor que en México se ha iniciado una lenta pero segura transformación del campo profesional de la comunicación. La carrera de Comunicación ocupa el octavo lugar entre las carreras más demandadas en la Educación Superior de México, que con la fuerte avalancha tecnológica y el surgimiento de la apertura de nuevos espacios sociales y político-económicos han impulsado otras formas de hacer comunicación. Dos son los campos más opcionados: medios de comunicación masiva, y lo organizacional y la publicidad, aunadas al surgimiento del marketing político. Hoy se demanda del profesional nuevas y dinámicas competencias para enfrentar escenarios laborales antes no explorados.

  1. para su puesta en marcha

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    Sergio Franco Maass


    Full Text Available Los sistemas de información geográfica (SIG tienen una gran aplicación en la gestión municipal; permiten cumplir con dos objetivos fundamentales: el registro de información territorial y el análisis de problemas territoriales específicos. Con el fin de determinar la viabilidad de este tipo de tecnologías en el ámbito municipal, se enfrentó el problema de la localización de instalaciones para la disposición final de residuos sólidos urbanos en el municipio de Toluca, Estado de México. Se identifican ciertos aspectos que limitan la práctica de los SIG: la diversidad entre los municipios, los problemas administrativos, las deficiencias de la información y la carencia de recursos humanos, técnicos y financieros.

  2. Comunicadores para la informaclon ambiental

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    Luz Marina Cabrera Morillo


    Full Text Available La Red Colombiana de Formación Ambiental en convenio con la Corporación Autónoma de los Valles del Sinú y del San Jorge y con el apoyo del Politécnico Grancolombiano, desarrolló un diplomado en Periodismo Ambiental en la ciudad de Montería, Departamento de Córdoba. La experiencia que ha contribuido a fortalecer la construcción de la cultura ambiental en la región; le ha permitido mayor visibilidad a los proyectos de la Corporación y facilitado la participación ciudadana. Este documento presenta el contexto de la formación de los comunicadores para la información ambiental, las características del diplomado y establece algunos de los logros alcanzados.

  3. Tipologia para a contabilidade ambiental

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    Nazlhe Faride Chein Schekaiban


    Full Text Available Este artigo revê a visão, as propostas e o desenvolvimento da contabilidade ambiental, refletindo sobre suas implicações, com a finalidade de descobrir e encontrar sua importância e situação. Para se chegar a esse resultado foi preciso realizar uma revisão epistemológica moldada e processo reflexivo de sustentabilidade e da aproximação ao usuário, da percepção da realidade contábil no México e da gerência interna das organizações. As conclusões mostram a contabilidade ambiental no México fora da re-alidade operativa do modelo contábil regional, aumentando a importância de se criar uma cultura capaz de examinar o controle da missão deste tipo de contabilidade.

  4. Una minga para el posdesarrollo

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    Arturo Escobar


    Full Text Available El artículo sintetiza algunas conclusiones a las que han llegado movimientos sociales y académicos en las últimas dos décadas al reflexionar sobre la globalización y sus implicaciones; el modelo dominante, basado en las nociones de "desarrollo" y "modernidad", ha entrado en crisis. Por lo tanto, se hace necesario avanzar en una transición cultural que se pueda comprender como un cambio de época y no sólo como una época de cambios. Para llevar a cabo esta transformación, se deben resolver las con-tradicciones existentes entre el neodesarrollismo y el postdesarrollo, por supuesto, a favor de éste último.

  5. Olhar para "Talco de vidro"

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    Lielson Zeni


    Full Text Available Aqui se busca uma forma de olhar para as histórias em quadrinhos emprestando as lentes e olhares de Maurice Merleau-Ponty. O objeto em estudo é a obra de Marcello Quintanilha, mais especificamente o álbum Talco de Vidro. Através das ideias propostas por Merleau-Ponty, tentou-se entender os mecanismos de corte, interrupção típica das HQs como um espaço entre, um lugar onde a imaginação do leitor possa ser ativada e as significações surjam. Tudo isso é levado em conta tendo por fundo a história de Rosângela, personagem de Talco de Vidro que enxerga o mundo de uma maneira bastante particular.

  6. Entre velos: Maya para contrabajo

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    Rosa María Rodríguez Hernández


    Full Text Available Maya para contrabajo se materializa a partir de una imagen de Pepe Romero, cuyo texto interpreta a La decadencia de la mentira de Oscar Wilde. La estructura de Maya es binaria, especular y asimétrica; su poética obedece al juego verdad/mentira que subyace en la obra artística y en la vivencia del artista. Maya trae a la memoria las voces de los Upanishad, Schopenhauer, Shakespeare y Beethoven, influencias éstas en la obra de Wagner y, todas ellas, en la de Eliot. Los aspectos gestuales y visuales de Maya entrelazan con la danza de Pina Bausch y con la retórica (hypotiposis.


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    Renata Seidel


    Full Text Available Se ofrece un amplio análisis sobre la industria electoral, recordando que un candidato a presidente es "un producto para la venta". Se Desmenuzan las estrategias utilizadas en el plebiscito chileno,las elecciones norteamericanas con el NO a BUSH. El Mercadeo Social es una nueva metodología utilizada en proyectos de desarrollo a nivel de campo por ello se hace un esclarecimiento y clarifica el vínculo con la comunicación. Se agrega temas como: Los modelos de recepción de mensajes cuyos marcos conceptuales y metodologías aún no se han adaptado al potencial de esta línea de trabajo.Se analiza la agonía de las radios mineras en Bolivia en la que 42 años de historia y heroísmo se desmoronan.

  8. Perbedaan Atypical Odontalgia Dengan Trigeminal Neuralgia


    Nasution, Eldelina Ariani


    Suatu aspek yang paling menjadi tantangan dan manfaat bagi dokter adalah mendiagnosa dan merawat rasa nyeri. Diperkirakan 22% populasi umum mengalami rasa nyeri orofasial pada periode 6 bulan sekali. Selain itu, rasa nyeri yang menetap dan kronik lebih banyak terjadi di regio kepala dan leher daripada di bagian tubuh yang lain. Dalam mendiagnosa rasa nyeri orofasial sering terjadi kesalahan.1 Menurut Asosiasi Internasional untuk penelitian rasa nyeri (International Association for Study o...

  9. Registro de Aedes albopictus em áreas epizoóticas de febre amarela das Regiões Sudeste e Sul do Brasil (Díptera:Culicidae)


    GOMES, Almério de Castro; TORRES, Maria Amélia Nascimento; GUTIERREZ, Márcia Fonseca de Castro; LEMOS, Francisco Leopoldo; LIMA, Mauro Lúcio Nascimento; MARTINS, Jaqueline Frasson; COSTA, Zouraide Guerra Antunes


    Durante estudo biológico e ecológico sobre mosquitos levado a cabo em área com registro de epidemia de febre amarela silvestre e epizootia em macacos, foram encontrados adultos de Aedes Albopictus. A tendência da espécie para invadir ambiente extradomiciliar potencializa a chance de infecção natural, ao tempo em que evolui para formar um elo entre focos naturais de vírus e o ambiente urbano. Esta Nota Técnica representa um alerta aos gestores dos três poderes públicos sobre perspectivas de mu...

  10. Trabalhar para estudar/estudar para trabalhar: realidade e possibilidades

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    Janes Teresinha fraga Siqueira


    Full Text Available O trabalho que apresentamos é parte da pesquisa, ainda não concluída, com os estudantes das licenciaturas e da pedagogia da Universidade de Santa Cruz do Sul- UNISC-RS-Brasil. Este está inserido na linha de pesquisa: educação, trabalho e emancipação do mestrado em educação desta Universidade. Queremos compreender, à luz do materialismo histórico e dialético e das categorias da crítica da economia política, os significados atribuídos pelos estudantes universitários ao fenômeno trabalho e estudo. É uma pesquisa preferentemente qualitativa de natureza dialética. Para Marx, a essência da realidade humana reside no trabalho, mas a fonte de toda a riqueza está na natureza. Logo trabalho, natureza e sociedade estão em relação dialética. Trabalho, portanto, é a ideia central articuladora, e natureza e sociedade devem ser estudadas em conexão com o trabalho. Marx trata o trabalho, no modo de produção capitalista, como um impedimento ao desenvolvimento humano. Propõe omesmo como um ato de criação e auto-expressão humana que não deve ter um valor. A compreensão dessa premissa é necessária para que os trabalhadores possam significar e ressignificar o trabalho para além da ideologia dominante. Algumas categorias aparecem como relevantes para a análise: condições de trabalho e de estudo, necessidade de formação, predominância do trabalho sobre o estudo, dificuldade deconciliar tempo de estudo e de trabalho. Na relação com o objeto de estudo, ressaltaremos a crise estrutural do capital, a desregulamentação das leis do trabalho e sua flexibilização e as contradições entre trabalho e estudo bem como quais possibilidades emancipatórias são visualizadas ou sonhadas pelos trabalhadores estudantes.Resume Ce travail constitue une partie de la recherche entreprise avec les étudiants du cours de pédagogie de l´Universidade de Santa Cruz do Sul – UNISC – RS – Brésil. Il est intégré dans le champ de

  11. Riesgos y oportunidades para el periodismo audiovisual

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    Alberto García Avilés


    Full Text Available Muchas empresas informativas han puesto en marcha diversas fórmulas para que las redacciones de distintos medios compartan recursos, trabajen conjuntamente en las coberturas y produzcan noticias para diversos soportes. Refiere lo que debe ser el periodista polivalente y su formación

  12. Cubierta de madera para una nave industrial

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    Hossdorf, Heinz


    Full Text Available Para la ampliación de los talleres de Hans Schmidlin, de Basilea, Suiza, dedicados a la prefabricación de elementos de construcción de madera y metales ligeros para fachadas, se ha construido una nueva nave, rectangular, de 49x55,4 m en planta.

  13. McPhone para iPhone


    Beristain Villar, Iker


    Diseño e implementación de una aplicación "McPhone" para dispositivos móviles, que mejora y evoluciona el sistema de realizar pedidos en un restaurante de comida rápida. Un desarrollo para dispositivos Apple, es decir, Iphone bajo iOS. Idioma Español.

  14. Programa de conservacion para aves migratorias neotropicales (United States)

    Deborah Finch; Marcia Wilson; Roberto Roca


    Mas de 250 especies de aves terrestres migran a Norte America durante la epoca reproductiva para aprovechar los sistemas templados. No obstante, las aves migratorias neotropicales pasan la mayor parte de su ciclo de vida en los habitat tropicales y subtropicales de paises latinoamericanos y caribefios donde viven en una asociacion cercana con las aves residentes. Para...

  15. Criterios para seleccionar proveedor de servicios gestionados




    Los servicios gestionados abarcan una gama de capacidades , creando opcionespara las organizaciones de TI que buscan beneficiarse de forma externa prestado servicios que les permiten centrarse en más negocios temas y funciones estratégicas y actividades. el Cloud Computing aumenta esta gama de opciones, que proporciona un mayor potencial que nunca para las organizaciones de TI para transformar .

  16. Recursos para un aprendizaje significativo

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    Full Text Available RESUMEN: Partimos del supuesto de que una de las cuestiones que más preocupa al profesorado en su práctica educativa radica en que el aprendizaje de sus alumnos sea significativo. Somos conscientes de que, para conseguir este tipo de aprendizaje, es necesario introducir una serie de cambios en la dinámica de la clase. Comenzamos diferenciando el aprendizaje maquinal del significativo. Continuamos aclarando una confusión muy extendida entre muchos educadores, que creen que el aprendizaje por recepción es repetitivo y que el efectuado por descubrimiento es forzosamente significativo. Posteriormente, planteamos una serie de interrogantes para aclarar algunas cuestiones que le pueden ser útiles a los educadores en su práctica cotidiana. Terminamos presentando la estrategia de organización, que cuenta con dos instrumentos, a nuestro juicio muy eficaces, para ayudar a los estudiantes, a aprender de manera significativa: los mapas conceptuales y la técnica heurística V.ABSTRACT: We start from the assumption that one of the questions that most worry the teaching staff in its educational practice consists in that its pupils' learning is significant. We are aware that, to obtain this kind of learning, it is necessary to introduce a series of changes in the classroom dynamics. We begin by making a distinction between mechanical and significant learning. We continué making clear a very extended confusión amongst many teachers, who believe that learning by reception is repetitive and that the one done by serendipity is necessarily significant. Afterwards, we créate a series of questions to clarify with some answers that can be useful to teachers in their everyday practice. We finish showing the organization strategy, which has two instruments, that in our opinión are very effective, to help students learning in a significant way: conceptual maps and the V heuristic technique.RÉSUMÉ: Nous partons de la supposition de qu'une des questions que

  17. El Ensayo, Para Formar Profesionales Reflexivos

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    Nestor Perico-Granados


    Full Text Available El presente artículo es producto de investigación, como resultado de la reflexión hecha a lo largo de muchos años de experiencia profesional y docente en diferentes universidades estudiando, redactando y evaluando ensayos. Presenta la importancia del ensayo como instrumento y dispositivo de la formación en la educación y especialmente se hace hincapié en la incidencia que tiene cuando se trabaja de manera apropiada, para prestar un servicio en la formación reflexiva. Se dan unas pautas para una aproximación a su definición y precisa los elementos fundamentales y otros complementarios para su elaboración. Desarrolla un primer proceso para escribir un ensayo, a través de la jerarquización de las ideas. Finalmente, se proponen unas conclusiones que pueden ser útiles para quienes quieran escribir ensayos.

  18. Modelos para estimar as exigências de energia metabolizável para poedeiras


    Sakomura,Nilva Kazue; Basaglia,Roberta; Sá-Fortes,Cristina M. L.; Fernandes,João Batista K.


    Objetivou-se, com este trabalho, elaborar um modelo para estimar as exigências de energia metabolizável (EM) para poedeiras leves da linhagem Lohmann LSL, utilizando-se o método fatorial. Para determinar o efeito da temperatura sobre as exigências de EM para mantença, foram conduzidos experimentos em câmaras climáticas com temperaturas constantes de 12, 22 e 31ºC, utilizando a técnica do abate comparativo. A exigência de energia líquida para o ganho de peso foi determinada por meio da regress...

  19. Una red para la gente

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    Raúl Trejo Delarbre


    Full Text Available La próxima Cumbre Mundial de la Sociedad de la Información ha revitalizado, en numerosos países, el debate acerca de las nuevas tecnologías de la comunicación y los usos que pueden tener. Lamentablemente en México hemos estado casi del todo ajenos a esa intensa, extensa y en otras latitudes fructífera discusión. Ni los especialistas interesados en estos temas, ni la sociedad que es a la postre beneficiaria o damnificada según sea el empleo de tales tecnologías, ni los organismos del Estado a cargo de tales asuntos, han propiciado la reflexión colectiva que nos podría permitir tanto afinar las posiciones de nuestro país rumbo a la cumbre de Ginebra y Túnez como deliberar, en ese contexto, acerca de lo mucho que nos falta para tener un país auténticamente imbricado en la construcción de una auténtica Sociedad de la Información.

  20. Periodistas para la era digital

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    Fernando Villalobos G.


    Full Text Available La formación de los periodistas del siglo XXI en la era digital se concibe como un reto y el mayor desafío. Los medios digitales demandan especialización y dominio de las nuevas tecnologías. Las universidades, principales gestores de este cambio, en la sociedad del conocimiento, requieren trabajar en la reformulación de nuevos pensum y en tres terrenos fundamentales: el perfil del egresado, el estilo pedagógico y el nuevo modo de relacionarse con el mundo exterior. Se necesita de una oferta académica referida al ciberperiodismo y a la cibercomunicación. La profesión periodística, y específicamente la formación de los comunicadores registra cambios importantes debido a las nuevas tecnologías, ahora el aula es el mundo globalizado e interconectado por la gran autopista de la información, por ello, la formación del comunicador social, demanda renovadas prácticas educativas. Las universidades deben repensar el papel que están obligadas a desempeñar, reformular los pensum académicos y ofertar la cibercomunicación y el ciberperiodismo para estar al día de las grandes transformaciones.

  1. Residencia para familias - Anglet (Francia

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    Hébrard, J. R.


    Full Text Available This residential hotel has 806 beds, which can be increased to 1,100 by adding some double beds. Its size and colour blends well with the picturesque surrounding, known as «Chambre d'Amour». The hotel involves 120 large apartments, and 50 smaller one, as well as 25 rooms for the staff, and flats for the manager and other senior officials. There is a hall, large living room, bar, rooms for playing games, nursery, and an additional hostel with 40 flats and staff rooms. The design is of a linear, continuous style, emphasizing its horizontal extension, though contrast is provided by a higher block, housing the vertical circulation facilities.Con un total de 806 plazas hoteleras, ampliables a 1.100 (si se utilizan literas, este conjunto, por su volumen y color se integra en el pintoresco paisaje del paraje conocido por «Chambre d'Amour». Comprende: 120 apartamentos; 50 más pequeños; 25 habitaciones para empleados; los apartamentos del director, gobernanta y recepcionistas; las zonas de vida en común: hall, salón, bar, sala de juegos y guardería; un albergue con 40 apartamentos; y las dependencias de la administración. Presenta un volumen lineal y continuo, modelando una composición de ritmo horizontal predominante, a la que le imprime gran variedad el cuerpo vertical de hormigón visto que contiene las circulaciones verticales.

  2. Um lugar para a Filosofia?

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    Samir Dessbesel Ferreira


    Full Text Available De que modo pode a Filosofia integrar-se às demais disciplinas da grade curricular dos cursos técnicos do IFSul? E como se insere uma disciplina como essa em instituições de ensino que têm tradicionalmente como foco o ensino tecnológico e profissionalizante, como são os Institutos Federais? Primeiramente, a Filosofia poderia contribuir na formação do profissional egresso, desenvolvendo-lhe competências relacionadas ao filosofar, em especial as relacionadas ao raciocínio abstrato e à comunicação, o que poderia vir a fazer a diferença no mercado de trabalho. Assim, os Institutos Federais ofereceriam um ensino de excelência com o objetivo de formar o técnico mais bem qualificado possível ao mercado de trabalho. Todavia, o aparelhamento técnico de nossos jovens, embora essencial para o desenvolvimento do País, não pode apresentar-se como a preocupação prioritária dos educadores, pois é fundamental considerar-se a formação integral da pessoa humana. Qual educação, afinal, queremos? E qual o papel da escola pública em nossa sociedade? O direcionamento unilateral à qualificação profissional pode levar-nos à formação de uma espécie de “superpeão”. A escola não pode ser serva do mercado. Ela tem o papel maior de agente de questionamento e transformação da sociedade. A concepção de Ensino Médio Técnico-Integrado nos parece orientar-se antes para a formação “integral” do cidadão, da pessoa em sua totalidade. O trabalho não é apenas uma relação econômica, mas também ética, política e estética. Deve ser uma forma de realização, de humanização do mundo, e não de coisificação do homem. É sempre possível pensar nossos espaços de educação formal como um compartilhar humano de sentidos, de afetos, de vivências, de posturas, de identidades. A esses espaços deverá a qualificação técnica sempre agregar-se, jamais sobrepor-se.

  3. pipetas usadas para I. A.

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    J. Castañeda


    Full Text Available La vagina y cerviz de las cerdas son estimuladas físicamente durante la inseminación. Este contacto puede afectar características reproductivas tales como el transporte espermático y el proceso de ovulación. En el presente trabajo se evaluaron desde el punto de vista económico y reproductivo, tres tipos de pipetas utilizadas para I. A. de cerdas de diferente material y forma. Se utilizaron 120 animales multíparos asignados de acuerdo a su orden de entrada al celo, en forma sucesiva a uno de tres grupos experimentales: 1 I. A. mediante pipeta reusable de hule tipo Melrose ( Medata, 2 I. A. con pipeta desechable de punta plástica en espiral y 3 I. A. con pipeta desechable con punta de poliestireno redonda (Medi chimica. No se encontró diferencia (P>0.05 entre los porcentajes de gestación, parición y promedio de lechones nacidos vivos por parto, en el tiempo de aplicación del semen, ni en el volumen del mismo, arrojado por las cerdas en los 10 min. posteriores a la I. A. Los valores promedio fueron de: 91.7%, 86.7%, 10.4 ± 2.8, 7.8 ± 2.6 min. y 10.4 ± 11.3 ml, respectivamente. El análisis de regresión, no mostró significancia en cuanto a paridad en ninguna de las variables estudiadas (P>0.05. Se concluye que las pipetas evaluadas no difieren en su efecto sobre el desarrollo reproductivo de la piara. Sin embargo, la pipeta reusable tipo Melrose ofrece ventaja económica bajo las condiciones del presente estudio

  4. Guión informativo para radio


    Borja Bonilla, Jhonatan Marcelo


    El presente trabajo investigativo bibliográfico y práctico, sobre el tema "GUION INFORMATIVO PARA RADIO" tiene como objetivo principal crear una guía tanto para los alumnos de comunicación social como para los comunicadores en la práctica. Después de varias entrevistas realizadas a diferentes comunicadores de las radios, se ha tomado en cuenta que en la ciudad de Cuenca se desconoce la necesidad de trabajar con guiones. Por tal motivo es importante realizar y profundizar en esta tesis sobr...

  5. Modelo computacional para projeto de compressores axiais


    Fernando de Oliveira Lopes


    Resumo: Este trabalho apresenta o desenvolvimento de um programa computacional para modelagem inicial de compressores axiais de vários estágios pertencentes ao conjunto de turbinas a gás. O desenvolvimento do programa se baseia na metodologia adotada por Saravanamutto et al. (2001), faz uso da Primeira Lei da Termodinâmica para cálculo de potência consumida pelo compressor e da Segunda Lei da Termodinâmica para determinar o grau de irreversibilidade do sistema. O programa calcula a quantidade...

  6. Desafios e Tecnologias para Cidades do Futuro

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    Antonio Mendes Silva Filho


    Full Text Available Este artigo trata questões apresentadas em palestra deste autor onde foi discutido os atuais desafios das cidades urbanas e é feito prospecto destacando tecnologias que podem prover suporte a essa demanda. Nesse sentido, apresenta-se um diagnóstico da situação atual das cidades em função do processo de urbanização e apontam-se desafios a serem enfrentados pela sociedade para dotarem as cidades de infra-estrutura adequada para (possíveis cenários futuros de modo a torná-las prontas para atender esta demanda.

  7. Un reto para adolescentes, confrontando imposiciones.



    a) Título, b) párrafo de apertura, c) desarrollo o redacción del caso, d) párrafo de cierre, e) notas de enseñanza: resumen del caso, objetivos temas relacionados, actividades previas para el alumno, actividades para el profesor, actividades durante la sesión para el alumno, uso de pizarrón, distribución del tiempo, análisis del caso, epílogo del caso, f) anexos y g) referencias.

  8. Plan de marketing para BMW Lifestyle


    Mendoza Cuadra, Mónica; Rodríguez Bandach, Hurr; Rubatto García, Rodolfo


    Perú representa para BMW la tercera plaza más importante de la región, liderando por 14 años consecutivos las ventas del segmento de autos de lujo (para ser considerados en el segmento de lujo, premium o gama alta, cualquier marca debe cumplir con prestaciones y beneficios exclusivos para el usuario, precio alto y no de fácil acceso). En los últimos años este segmento viene creciendo pese a las fluctuaciones de la coyuntura económica. Aprovechando este posicionamiento, BMW es la primera ...

  9. Educación para la sostenibilidad

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    Educadores por la sostenibilidad


    Full Text Available La importancia dada por los expertos en sostenibilidad al papel de la educación queda reflejada en el lanzamiento mismo de la Década de la Educación para el Desarrollo Sostenible o, mejor, para un futuro sostenible (2005-2014 a cuyo impulso y desarrollo esta destinado este artículo, así como la página web que la Organización de Estados Iberoamericanos ha habilitado dentro de su portal digital, para la celebración de la Década.


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    Ceres Germanna Braga Morais


    Full Text Available Este artigo apresenta um processo de reuso de requisitos, denominado Cognitio, o qual busca fornecer ganhos na produtividade e qualidade dos softwares gerados, de forma que os stakeholders se sintam motivados tanto para desenvolver software com reuso quanto para o reuso. Para a formação do repositório, organizamos as informações relacionadas aos requisitos através da linguagem Q7, e apresentamos através do framework NFR como o nosso processo pode ser aplicado.

  11. Oxitocina: nuevas perspectivas para una droga antigua


    Steven L. CLARK; Kathleen Rice SIMPSON; G. Eric KNOX; Thomas J. GARITE


    La oxitocina es el medicamento más comúnmente asociada con la prevención de complicaciones perinatales y recientemente fue incluida por el Instituto para la Administración Medicamentosa Segura (Institute for Safe Medication Practices - ISMP) en una pequeña lista de medicamentos “con alto grado de riesgos”, lo que puede “necesitar salvaguardas especiales para reducir el riesgo de error”. Las recomendaciones actuales para administrar este medicamento son vagas en relación a la indicación, tiemp...

  12. Conferencia educación para todos

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    Lucía Lemos


    Full Text Available América Latina tiene 42 millones de analfabetos. La crisis creada por la deuda externa produce fuertes restricciones presupuestarias en todos los sectores. En Tailandia (1990 se realizó la Conferencia Mundial sobre "Educación para Todos" se presentó la nueva visión de encontrar un camino para lograr una educación por todos y para todos.La autora, trata de sintetizar los documentos que circularon en la reunión.

  13. Modelo de requisitos para sistemas embebidos


    González Palacio, Liliana; Urrego Giraldo, Germán


    En este artículo se presenta un modelo de requisitos como apoyo para la construcción de sistemas embebidos. En la actualidad, las metodologías de Ingeniería de Requisitos propuestas para este dominio no establecen continuidad en su proceso de desarrollo, ya que poseen una fuerte orientación a la etapa de diseño y un énfasis más débil en la etapa de análisis. Además, dichas metodologías ofrecen pautas para tratar los requisitos luego de que han sido obtenidos, pero no proponen herramient...

  14. Actitud Positiva: la base para la competitividad

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    Marco Anderson Espinoza


    Full Text Available Una estrategia empresarial enfocado en el mejoramiento continuo de la productividad para la competitividad, depende significativamente del manejo inteligente de tres variables visibles:Calidad, Entrega oportuna y Costo. No obstante, estas tres variables no suelen sersuficientes. La estrategia debe ser complementada con el manejo adecuado de variables intangibles como la Motivación y las Condiciones de Trabajo, con la aplicación de Tecnología Ambientalmente Amigable, en un marco de Actitud Positiva.A final de cuentas, la Actitud Positiva es fundamental para el recurso humano de cualquier organización, a fin de construir una plataforma sólida y estable que sirva de base para soportar un proceso sostenible de mejoramiento de la productividad, para aumentar la competitividad como estrategia empresarial exitosa.

  15. Quitovac : Olla para hacer le tepache


    Rodriguez-Loubet , François


    Quitovac, Municipio General Plutarco Elías Calles, Sonora. Quitovac IV. Don Luciano unto a la Olla de Cachito. Olla para hacer el Tepache de Pitoya en la piesta del "Queso", siglo pasado y principios de Este.

  16. Competencias del profesorado universitario para la interculturalidad


    Shestakova, Nataliya; Domínguez Garrido, María Concepción; Cacheiro González, María Luz


    La presente investigación está dedicada a las competencias del profesorado universitario para la interculturalidad. Se trata de un estudio exploratorio con un enfoque mixto, cualitativo y cuantitativo, cuyo objetivo es conocer las competencias intercu

  17. Regulaciones para el transporte de sustancias infecciosas


    Casquero, José


    Para el propósito de transporte, se define como sustancia infecciosa, aquellas que son conocidas o razonablemente esperadas que contengan patógenos (bacterias, virus, rickettsias, parásitos, hongos, y priones)

  18. Using ParaPost Tenax fiberglass and ParaCore build-up material to restore severely damaged teeth. (United States)

    Caicedo, Ricardo; Castellon, Paulino


    This article describes a technique using ParaPost Tenax Fiber White, ParaPost Cement, and ParaPost ParaCore build-up material to restore a tooth with a significant loss of tooth structure. After successful root canal therapy, the posts were bonded in the canals and the core was built using ParaPost ParaCore build-up material. At that point, the tooth was prepared to receive a conventional porcelain-fused-to-metal crown.

  19. Páginas web para el aprendizaje

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    Isabel ÁLVAREZ


    Full Text Available Este artículo plantea la construcción de paginas web como vehículo para facilitar la integracion de las tecnologias de la informacion y la comunicacion en el aula para futuros maestros. El término Página Web Coherente enfatiza la utilización de páginas cuyo objetivo principal es promover el aprendizaje siguiendo un proceso colaborativo, una estructura integradora y un contenido educativo.

  20. Entrenamiento de fuerza para la salud


    Ortiz Cervera, Vicente


    Este artículo describe de manera breve y clara los efectos del entrenamiento de fuerza sobre la salud, al mismo tiempo da pautas para la realización y programación de los entrenamientos de fuerza para la salud en distintas edades. Se muestran las diferentes variables del entrenamiento de la fuerza junto con ejemplos de entrenamientos, basándose en las pautas marcadas en la revisión bibliográfica descrita.

  1. Un almuerzo para llevar saludable (Packing Smart)

    Centers for Disease Control (CDC) Podcasts


    En este podcast para niños, los chicos de Kidtastics hablan sobre almuerzos creativos para llevarse a la escuela, que ayuden a mantenerse con energía el resto del día.  Created: 8/22/2011 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 1/3/2012.

  2. Amendoins silvestres para uso ornamental.

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    Renato Ferraz de Arruda Veiga


    Full Text Available Algumas espécies silvestres de amendoim (Arachis spp. gênero Arachis L. (Fabaceae, vêm sendo utilizadas como forração em jardins no Brasil, porém todas com pouca variabilidade já que a distribuição do germoplasma é feita sempre pelos mesmos acessos4. Por outro lado, inúmeras coletas têm sido realizadas, particularmente pela Embrapa Recursos Genéticos e Biotecnologia (Cenargen, disponibilizando acessos até então inacessíveis à pesquisa científica. Em virtude dessa nova disponibilidade e igualmente de híbridos resultantes de pesquisas do Cenargen, organizou-se este trabalho. Foram objeto desta pesquisa cinco espécies: A. glabrata Benth., A. helodes Mart. ex Krapov.& Rigoni, A. pintoi‘Krapov.& W.C.Gregory, A. repens Handro e A. kempff-mercadoi Krapov.,W.C.Gregory & C.E.Simpson, e seis híbridos originados dos paternais: A. appressipila Krapov.&W.C.Gregory, A. paraguariensis Chodat & Hassl., A. pintoi, A. repens e A. vallsi Krapov.& W.C.Gregoryi. O experimento foi desenvolvido no período dos anos agrícolas de 1998 a 2000, na Fazenda Santa Elisa do Instituto Agronômico (IAC, em Campinas (SP, anotando-se o número de flores por planta, a velocidade de desenvolvimento, a capacidade de cobertura do solo, aspectos ornamentais como exuberância das flores e folíolos, coloração e, ainda, sanidade e vigor dos acessos. Os híbridos apresentaram um bom comportamento, porém com ciclo anual, ao passo que os acessos de Arachis kempffmercadoi, A.helodes, A. repens e A. glabrata mostraram-se mais recomendáveis para o uso em jardins por serem perenes. Todos os acessos ficam mais bonitos no verão em razão do período de floração e graças ao verde de sua massa foliar.


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    Maria José Caldeira do Amaral


    Full Text Available No Tratado do Amor Cortês - Tractatus de Amore - André Capelão deseja oferecer ao leitor a arte cortês de amar, a beleza do desejo erótico e a disciplina da paixão constitutiva dessa arte que é amar. O maior argumento dessa obra é efetivar o suspiro fundo que a dimensão amorosa infunde na alma do homem e da mulher aos quais foi concedida a virtude. Para esse autor, escriba da chancelaria real e talvez, não se sabe com certeza, um Ordo Sacratus, o amor é a raiz de toda cortesia, a fonte de todo bem. Nosso objetivo, então, é encontrar nessa suma amorosa construída nos enlaces da Literatura de Cavalaria Medieval, os desdobramentos essenciais dessa vida afetiva bela e virtuosa no enredo profundo do qual emerge o afeto, a fé e a contradição da experiência humana do sofrimento amoroso. Palavras Chave: Literatura Medieval. Amor Cortês, André Capelão, virtude, desejo. Abstract: With the treaty toward the love - Tractatus de Amore – André Capelão offers to the reader the courteous’ art for love, the erotic desire’s beauty and the  suffering discipline belong this love’s art  is. The best reason of this literary composition is to achieve the depth sigh that the loving dimension infuses into the lovers’s soul, the man and the woman wich this virtue was conceded. For this author, the royal chancery scribe and perhaps, no one knows for sure, a Sacratus Ordo, love is the root of all free, the source of all good. Our goal, then, is to find this sum loving built in interlacing of Medieval Knights literature, the essential developments of this beautiful and virtuous love life in the deep storyline which emerges affection, faith and the contradiction of the human experience of love suffering. Key words: Medieval Literature. Courteous Love. André Capelão. Virtue.

  4. Agricultura familiar para el desarrollo rural incluyente

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    Laksmi Reddiar Krishnamurthy


    Full Text Available Las comunidades indígenas Mayas de la península de Yucatán han practicado la antigua tradición de agricultura familiar, en particular los huertos caseros, para garantizar su seguridad alimentaria. Con el objetivo de mejorar la práctica tradicional considerando paradigmas de la ciencia moderna, por una parte, se colectaron datos para definir la complejidad estructural y diversidad funcional a partir de 20 huertos familiares en cinco comunidades: X - Maben, X - Pichil, X - Yatil, San José II y Melchor Ocampo; y por otra, se organizaron grupos de discusión para dilucidar la estrategia de gestión practicada por las comunidades nativas. Los resultados mostraron que los huertos son manejados principalmente por las mujeres. También mostraron que el propósito principal del crecimiento y mantenimiento de los huertos familiares es garantizar la producción de alimentos nutritivos durante todo el año. Y, por último que los huertos caseros también sirven para propósitos secundarios tales como la provisión de productos y servicios para la medicina tradicional. El estudio sugiere que se debe de promover e invertir en huertos caseros para mejorar las estrategias de desarrollo incluyente en ambientes socio-culturales y biofísicos similares.

  5. Estrategia para elevar la motivación laboral; factor imprescindible para mejorar nuestra productividad.


    Reina de los Ángeles Carballé Piñón


    Este trabajo "Estrategia para elevar la motivación laboral; factor imprescindible para mejorar nuestra productividad" resulta de la investigación realizada para tesis de maestría; se realizó el estudio de 2 entidades, nos permitió conocer las principales posiciones que sobre motivación existen, factores que la influencian, cómo incide en el desempeño laboral y que acciones diseñar para elevarla. Las 2 entidades seleccionadas, claves en el desempeño empresarial son un centro de interfase y un...

  6. Alimentos balanceados para perros en Costa Rica

    Directory of Open Access Journals (Sweden)

    Ruth Vargas


    Full Text Available Diagnóstico de la comercialización de alimentos balanceados para perros en Costa Rica. Para ampliar los reportes oficiales de la comercialización de alimentos para perros se creó una base de datos que incluyó cantidad, costo, empaque y formulación durante el período 1998 a agosto del 2000. De 1995 a 1998 y de 1996 a 1999 la producción nacional incrementó un 90,4% y la importación un 42,56% respectivamente, ocupando los alimentos nacionales un 72% del tonelaje y un 70% del valor en dólares americanos. No fue posible determinar cuál es el empaque más comercializado, pero si que los alimentos extrusados son los que ocupan el primer lugar y que los alimentos recomendados para cachorros y adultos son los que más se comercializan. La ausencia de datos en las declaraciones sugiere la necesidad de incrementar el control en las mismas en caso de requerirse un estudio de mercado, ya que contrariamente a esta situación el mayor número de garantías inscritas corresponden separadamente para las fases de cachorros y adultos. Merece también atención que las garantías indican mayores porcentajes de proteína cruda que los recomendados por la AAFCO y que al menos 36 fórmulas son recomendadas para estados sanitarios específicos (p.e. para perros con problemas de alergias, cálculos renales, pérdidas de pelo, etc. sin que oficialmente se encuentre registrada ninguna fórmula medicada

  7. Caracterización del proceso eriptótico desencadenado por concentraciones sublíticas de alfa hemolisina de E.coli


    Carrizo, Fernanda; Maté, Sabina; Bakás, Laura; Herlax, Vanesa Silvana


    En la Argentina cepas uropatogénicas de Escherichia coli causan del 75% al 90% de los episodios de infecciones urinarias, prevaleciendo en la infección urinaria neonatal, pediátrica, en la cistitis no complicada o recurrente de la mujer fértil, así como en la pielonefritis. La habilidad de las bacterias para invadir y colonizar tejidos está determinada por un conjunto de factores, entre los que se incluyen a la toxina alfa hemolisina (HlyA).

  8. Studies on Bis(Para Anisidine Acetylacetonato) Nickel (II) Complex ...

    African Journals Online (AJOL)

    Studies on Bis(Para Anisidine Acetylacetonato) Nickel (II) Complex. HN Aliyu, UL Bilyamin. Abstract. Schiff base was prepared from the reaction of para anisidine and acetylacetone. Bis(para anisidineacetylacetonato)nickel(II) complex was synthesized by the reaction of the prepared para anisidineacetylacetone ligand and ...

  9. Cross-elicitation responses to 2-methoxymethyl-para-phenylenediamine in para-phenylenediamine-allergic individuals

    NARCIS (Netherlands)

    Schuttelaar, M.-L.; Coenraads, P.-J.; Blömeke, B.; Goebel, C.


    The introduction of a methoxymethyl side chain into para-phenylenediamine (PPD) resulted in the development of a new hair dye molecule: 2-methoxymethyl-para-phenylenediamine (Me-PPD). Besides having excellent hair colouring properties, this PPD derivate has significantly lower skin-sensitizing


    Directory of Open Access Journals (Sweden)

    Gizelle Kaminski Corso


    Full Text Available Percebendo que o público-alvo das adaptações de textos clássicos não é tão somente a criança e o adolescente – leitores jovens, aos quais supostamente destinam-se as literaturas “infantil” e “infantojuvenil”, proponho neste texto uma nova classificação para as adaptações literárias, vendo-as não mais apenas como “adaptações para a literatura infantojuvenil”, mas como “literatura para jovens leitores”. Como tais textos são também lidos por adultos, por propósitos diversos, reconheço que o conceito proposto abrange um número maior de leitores. Para tanto, faço um breve percurso histórico-crítico acerca do aparecimento das adaptações no cenário literário brasileiro com a finalidade de corroborar e justificar a pertinência da classificação sugerida para as adaptações.

  11. Biocomercio: una alternativa para el desarrollo sostenible

    Directory of Open Access Journals (Sweden)

    Carlos Murillo R.


    Full Text Available El desarrollo sostenible en países ricos en biodiversidad dependerá de la capacidad de los gobiernos de implementar los arreglos institucionales necesarios para conciliar la preservación de los recursos naturales con el uso de los mismos para la producción de bienes y servicios que puedan potenciar el crecimiento económico y un mayor bienestar para las comunidades locales donde estos recursos se encuentren. Este es el objetivo de la Iniciativa de Biocomercio que ha venido impulsando la Conferencia de Naciones Unidas para el Comercio y el Desarrollo (UNCTAD en distintos países de Latinoamérica. En el tanto estos principios y los establecidos en el CDB se puedan viabilizar e inspiren los distintos Programas Nacionales de Biocomercio en los países de la región, parecería no haber dudas de que la Iniciativa abre nuevas puertas para el uso, aprovechamiento y desarrollo sostenible de los mismos.

  12. Modelo para el análisis de una aptitud cognitiva para el aprendizaje

    Directory of Open Access Journals (Sweden)

    Clara Cecilia Uribe Hernández


    Full Text Available La investigación en el campo de las aptitudes cognitivas para el aprendizaje requiere una forma de abordarlas y definir sus características y componentes. A su vez, esta definición debe conducir al investigador a la creación de pruebas de medición que ayuden al análisis de este tipo de aptitudes y su relación con otras variables del aprendizaje. Para dar respuesta a esas necesidades, el objetivo de este artículo es proponer la creación de un modelo para el análisis de una aptitud cognitiva para el aprendizaje, cuya estructura conste de cuatro elementos principales. Dos de ellos relacionados con los enfoques y consideraciones para emprender su estudio; los otros dos, con la definición de la aptitud, a través de sus características y sus componentes.

  13. Nuevo lenguaje para un nuevo medio

    Directory of Open Access Journals (Sweden)

    Inma Martín Herrera


    Full Text Available El concepto tradicional de comunicación unidereccional se ha roto para convertirse en comunicación pluridireccional que permitirá la retroalimentación informativa. Las nuevas formas de redactar, contar diseñar y presentar la información en Internet exige nuevos hábitos de lectura por parte de la audiencia. El lector deberá tomar conciencia de que está frente a un medio diferente con el que debe familiarizarse para hacer uso correcto del soporte digital, se informará adecuadamente para disfrutar de las ventajas del innovador medio, conocido como Periodismo de servicios o Nuevo Periodismo.

  14. Libertad religiosa, camino para la paz

    Directory of Open Access Journals (Sweden)

    Antonio Alonso


    Full Text Available La libertad religiosa es el núcleo del Mensaje para la XLIV Jornada Mundial de la Paz que ha dirigido Benedicto XVI. Cuestión, sin duda, extraordinariamente delicada, pues comporta graves implicaciones en materia de seguridad principalmente por dos motivos: primero, porque su violación supone una injusticia difícil de compaginar con el respeto a los Derechos Humanos; segundo, porque dicha libertad no puede ser esgrimida como pretexto para atropellar los derechos de los demás conciudadanos o incluso socavar la propia seguridad del Estado. El Santo Padre denuncia, a su vez, los estragos del relativismo y de los fanatismos, tanto religioso como anti-religioso, y propone el ejercicio del diálogo basado en la razón para superar los obstáculos en la convivencia interpuestos por estas amenazas a la paz y la seguridad.

  15. Una carrera para fortalecer las organizaciones

    Directory of Open Access Journals (Sweden)

    Flora Alcívar Rivera


    Full Text Available Los  recientes  cambios  en  la  estructura  económica mundial.  han dado como resultado modificaciones en el  terreno de  la ciencia.  la  tecnología.  la  cultura  y la educación.  comprometiendo  a  tus  Instituciones  de Educación  Superior a  fortalecer  y  a  acrualizar  los Programas de Estudio, buscando que sean relevantes y útiles  para  los Alumnos.  para  las  Empresas  y para  la Sociedad a la que se

  16. Rutina AUTOLISP para el despiece de columnas

    Directory of Open Access Journals (Sweden)

    Lorena Cocunubo Carreño


    Full Text Available El proyecto de creación de una herramienta Autolisp para el dibujo automático de los despieces de vigas sometidas a flexión y a cortante se desarrolla en un ambiente de programación informática LISP. Se inicia con la programación en el Visual Lisp de AutoCAD del algoritmo que permite tomar información de anchos de luz, sección transversal y momentos resistentes la viga para que automáticamente ejecute los comandos y el resultado final sea un despiece detallado de los hierros por flexión junto con los estribos por cortante separados adecuadamente. Los resultados están sujetos a criterios de diseños de la NSR-10 para así garantizar la seguridad del diseño sísmico.

  17. Estrategias de mercado para el frijol centroamericano

    Directory of Open Access Journals (Sweden)

    Lourdes Mart\\u00EDnez


    Full Text Available Estrategias de mercado para el frijol centroamericano. En los últimos años, el sub-sector de frijol en Centro América ha sido testigo de varios cambios dinámicos. Si no se encuentran medidas para incrementar la competitividad regional de este sub-sector, los países centroamericanos experimentarán impactos negativos en las áreas sociales y económicas de considerable magnitud, especialmente ahora que Centro América necesita ajustar su economía a los nuevos requerimientos de mercados mas abiertos, como el Tratado Centroamericano de Libre Comercio con USA (TLC. Vendedores de frijoles a nivel intermediario y de consumo final, así como técnicos de oficinas gubernamentales dedicadas al mercadeo de frijoles en Centro América fueron entrevistados para documentar los cambios experimentados, identificar los obstáculos que frenan la viabilidad del sub-sector e identificar las oportunidades de incremento de mercados en el futuro para los productores y vendedores de frijol. Los resultados muestran que para que continúen siendo competitivos, los países centroamericanos deben incrementar la productividad a través del apoyo a las investigaciones para el mejoramiento de variedades de frijol, especialmente aquellas que los consumidores prefieren por características específicas (e.g. color. También es imprescindible el fortalecimiento de los programas de distribución de variedades mejoradas a los productores; las mejoras en la transmisión de información de mercado a los productores; el fortalecimiento de los contactos entre productores, comercializadores a nivel mayorista y supermercados; y una política más específica de apertura de mercados de exportación, especialmente con los Estados Unidos.

  18. Oxitocina: nuevas perspectivas para una droga antigua

    Directory of Open Access Journals (Sweden)

    Steven L. CLARK


    Full Text Available La oxitocina es el medicamento más comúnmente asociada con la prevención de complicaciones perinatales y recientemente fue incluida por el Instituto para la Administración Medicamentosa Segura (Institute for Safe Medication Practices - ISMP en una pequeña lista de medicamentos “con alto grado de riesgos”, lo que puede “necesitar salvaguardas especiales para reducir el riesgo de error”. Las recomendaciones actuales para administrar este medicamento son vagas en relación a la indicación, tiempo de uso, dosis y el monitoreo de los efectos maternos y fetales. Una revisión de los datos clínicos y farmacológicos disponibles sugiere que las orientaciones específicas y basadas en evidencias para administrar oxitocina durante el parto puede derivarse de datos disponibles. Si implementadas, estas prácticas pueden reducir la probabilidad de daños al paciente. Esto sugiere el foco de las orientaciones para la administración electiva limitada de oxitocina, considerar estrategias que disminuyan la necesidad de usar oxitocina, confiar en terapéuticas de bajas dosis de oxitocina, la adhesión a definiciones semicuantitativas específicas sobre parto adecuado e inadecuado, y la aceptación de que, una vez que la actividad uterina adecuada sea alcanzada, es generalmente preferible esperar más tiempo que aumentar la infusión de oxitocina. El uso de protocolos conservadores y específicos para monitorear los efectos de la oxitocina en la madre y en el bebé tiende no sólo a aumentar los resultados, mas también a reducir los conflictos entre miembros del equipo obstétrico. Implementar estas orientaciones parece ser apropiada en una cultura cada vez más focalizada en la seguridad del paciente.

  19. The murine double-stranded RNA-dependent protein kinase PKR and the murine 2',5'-oligoadenylate synthetase-dependent RNase L are required for IFN-β-mediated resistance against herpes simplex virus type 1 in primary trigeminal ganglion culture

    International Nuclear Information System (INIS)

    Al-khatib, Khaldun; Williams, Bryan R.G.; Silverman, Robert H.; Halford, William; Carr, Daniel J.J.


    A study was undertaken to evaluate the efficacy of an adenoviral construct expressing the murine interferon-β (IFN-β) transgene (Ad:IFN-β) against herpes simplex virus type 1 (HSV-1) infection in a primary trigeminal ganglion (TG) cell culture. The transduction efficiency ranged from 0.2 to 11.0% depending on the multiplicity of infection (m.o.i.) of the adenoviral vector (0.5-50.0). Moreover, neurons were the main target of the adenoviral transduction. TG cultures transduced with Ad:IFN-β displayed up to a 19-fold reduction in viral titers compared with cells transduced with an Ad:Null or nontransduced TG culture controls. Transduction with Ad:IFN-β up-regulated two critical antiviral genes, double-stranded RNA-dependent protein kinase R (PKR) and 2',5'-oligoadenylate synthetase (OAS). The absence of PKR or RNase L (downstream effector molecule of OAS) attenuated Ad:IFN-β efficacy against HSV-1 replication, implicating a critical role for PKR and OAS/RNase systems in the establishment of IFN-induced resistance against HSV-1 in TG cells

  20. Desenvolvimento de sonda gama para cirurgia radioguiada


    José Oliveira da Silva, Iran


    O uso de técnicas de cirurgia radioguiada tem crescido e tem se mostrado muito eficiente para as cirurgias de câncer. O procedimento inicia-se antes da cirurgia com a administração ao paciente de um radiotraçador, geralmente emissor gama, que tem grande afinidade pelas células tumorais. Durante a cirurgia, uma sonda detectora de radiação gama é usada para identificar as regiões em que houve maior concentração do material radioativo e, portanto, os locais de células tumorais. ...