China
Africa
Explore chapters and articles related to this topic
Shy-Drager Syndrome and Multiple System Atrophy
Published in David Robertson, Italo Biaggioni, Disorders of the Autonomic Nervous System, 2019
Although Shy and Drager (1960) first described the condition subsequently named after them, Johnson et al. (1966) were the first authors to attribute the autonomic insufficiency to loss of preganglionic neurons in ILC of the spinal cord. Quantitative studies demonstrate a dramatic reduction in the number of ILC neurons (Low, Thomas and Dyck, 1978; Oppenheimer, 1980). Most importantly, the investigators compared cell counts between patients and normal controls. Of particular interest, however, is the study by Gray, Vincent and Hauw, (1988) who did not find a correlation between cell loss in the lateral horns and severity of autonomic failure. Comparable quantitative investigations of parasympathetic neurons are lacking, though cell loss in the dorsal vagal nuclei has been reported. Sacral parasympathetic outflow, i.e. Onuf’s nucleus, also appears to be affected by the degenerative process in MSA (Konno et al., 1986; Chalmers and Swash, 1987).
Faecal Incontinence
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
P. Ronan O’Connell, Thomas Dudding
Somatic motor pathways to the external sphincter originate from the Onuf nucleus in the S2–S4 anterior horn of the spinal cord. The somatic motor fibres travel in the cauda equina prior, dividing into dorsal and ventral rami that contribute to the sacral plexus. The sacral plexus is formed from the lumbosacral trunk (L4, L5) and the anterior primary rami from S1 through to S5. It supplies innervation to the levator ani and coccygeus muscles directly, and the external anal sphincter indirectly via the inferior rectal branch of the pudendal nerve (S2–S3) and the perineal branch of the pudendal nerve (S4). The pudendal nerve also provides sensory fibres to the anal canal below the level of the dentate line and perineum (see Figure 21.4).
Diagnosis and differential diagnosis of Parkinson’s disease
Published in Jeremy Playfer, John Hindle, Andrew Lees, Parkinson's Disease in the Older Patient, 2018
Bladder dysfunction is an important indicator of possible MSA.121 Atrophy of the brainstem leads to detrusor hyperreflexia, while loss of anterior horn cells in Onuf’s nucleus produces sphincter weakness. Cell loss in the interomediolateral columns impairs parasympathetic innervation of the bladder and causes atonia with retention and overflow incontinence. Detrusor instability may be an early feature with progression to failure of bladder emptying and high residual volume.121 In the elderly, other potential causes of urinary dysfunction, such as abnormal detrusor behaviour, concomitant cerebral and urological pathology including prostatic outflow obstruction in men, should be considered before attributing symptoms to MSA.
Efficacy of pelvic floor muscle exercise or therapy with or without duloxetine: a systematic review and network Meta-analysis
Published in The Aging Male, 2022
Jae Joon Park, Allison Kwon, Tae Il Noh, Yong Nam Gwon, Sung Ryul Shim, Jae Heon Kim
Treatment of PPUI starts with PFME and PFMT, and in patients’ refractory to such intervention, pharmacotherapy options are limited, warranting surgical treatment such as sling and artificial urethral sphincter [30]. Duloxetine is one of the limited drug therapy options available [31]. In patients undergoing PPUI, urine leakage occurs when the abdominal pressure induced by physical activity exceeds the urethral resistance due to contraction of the urethral sphincter [32]. The contraction of the urethral sphincter results from activation of the pudendal nerve induced by serotoninergic and noradrenergic neurotransmitters in the Onuf’s nucleus [11,33]. Accordingly, duloxetine, a selective serotonin (5-HT)-norepinephrine (NE) reuptake inhibitor, induces contraction of the urethral sphincter and alleviates PPUI symptoms [33,34].
Aberrant enteric neuromuscular system and dysbiosis in amyotrophic lateral sclerosis
Published in Gut Microbes, 2021
Yongguo Zhang, Destiny Ogbu, Shari Garrett, Yinglin Xia, Jun Sun
Sporadic (SALS) and familial (FALS) forms of ALS manifest similar pathological and clinical phenotypes, suggesting that different initiating causes lead to a mechanistically similar neurodegenerative pathway. Some clinical studies have indicated intestinal abnormalities in ALS patients.69–71 ALS patients have delayed colonic transit time and gastric emptying, and up to half of them have constipation during the disease course.71–73 The changes in the intermediolateral columns and the Onuf nucleus in ALS have been detected. Increased LPS is reported in SALS patients.5 ALS patients have elevated intestinal inflammation and dysbiosis.10,11 The ENS and smooth muscle automatism are unable to modulate the motor functions of the digestive tract, which provide an anatomical explanation for these clinical manifestations. The therapeutic methods to target microbiome and intestinal functions, e.g, FMT, prebiotics, and probiotics, will help both SALS and FALS patients.
Spinal cord involvement in Lewy body-related α-synucleinopathies
Published in The Journal of Spinal Cord Medicine, 2020
Raffaele Nardone, Yvonne Höller, Francesco Brigo, Viviana Versace, Luca Sebastianelli, Cristina Florea, Kerstin Schwenker, Stefan Golaszewski, Leopold Saltuari, Eugen Trinka
Sympathetic pathways which originate in the dorsolumbar spinal cord reach the penis via the lumbar splanchnic nerves or the paravertebral chain, while parasympathetic neurons, which are located in the sacral parasympathetic nucleus, reach the penis via the pelvic plexus. The Onuf’s nucleus which is located in the sacral cord also innervates the perineal striated muscles. Dorsolumbar sympathetic, sacral parasympathetic, and sacral pudendal neurons are coordinated by interneurons located in laminae VII and X to regulate the processes of erection and ejaculation in men. The supraspinal control is regulated by some brain areas, such as the preoptic area or paraventricular nucleus of the hypothalamus, which project directly to the spinal cord. Therefore, the spinal cord is the key structure upon which the peripheral and central inputs converge.84–86 Sexual dysfunction is common at the early stages of PD;71,87 moreover, it may also precede motor symptoms.88 Erectile dysfunction is an important and early symptom in men with MSA.89 Its earlier occurrence suggests a lack of a causal relationship to autonomic failure and hypotension.