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  • 1
    ISSN: 1432-2129
    Keywords: Schlüsselwörter Trigeminusneuralgie ; CSF ; Neurotransmitter ; Substanz P ; Somatostatin ; Key words Trigeminal neuralgia ; Neurotransmitters ; CSF ; Substance P ; Somatostatin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The etiology of trigeminal neuralgia is unknown, but both peripheral and central causes have been suggested. To investigate the role of central neurochemical mechanisms we measured epinephrine, norepinephrine and their breakdown product, vanilly mandelic acid (VMA), in the cerebrospinal fluid (CSF) of 16 patients (53.3 ± 8.3 years) suffering from trigeminal neuralgia. As markers for the dopaminergic system, we determined CSF levels of dopamine and its metabolite homovanillic acid (HVA). As a marker for the serotonergic system, we measured CSF levels of serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA). In addition, levels of the neuropeptides substance P and somatostatin were determined. The concentration of norepinephrine (P 〈 0.01), VMA (P 〈 0.05) and HVA (P 〈 0.05) were significantly decreased in patients with trigeminal neuralgia and correlated with the duration of the disease and depression scores. 5-HIAA was also significantly decreased (P 〈 0.05) compared to control patients. Whereas substance P was significantly elevated (P 〈 0.05), somatostatin was significantly decreased (P 〈 0.05). Various correlations between the classical neurotransmitters and the neuropeptides could be established. We hypothesize than the sum of complex neurochemical changes plays a role in the etiology of trigeminal neuralgia, which can be separated in local and more central proceedings. The increase in substance P, a major nociceptive neuromodulator, supports the concept of a local neurogenic inflammation, possibly located in the trigeminovascular system. Depending on the duration of the disease and depression, the loss of serotonergic, dopaminergic and noradrenergic innervation seems to reflect more central changes, possibly due to alterations in their antinociceptive descending pathways.
    Notes: Zusammenfassung Bei der Trigeminusneuralgie werden periphere und zentrale Entstehungsmechanismen diskutiert. Daher wurden bei 16 Patienten (53,3 ± 8,3 Jahre) mit einer idiopathischen Trigeminusneuralgie in der Zerebrospinalflüssigkeit (CSF) die Neuropeptide Substanz P und Somatostatin, die Neurotransmitter Noradrenalin und Adrenalin sowie die Metaboliten Homovanillinmandelsäure (HVA), Vanillinmandelsäure (VMA) und 5-Hydroxyindoleessigsäure (5-HIAA) bestimmt. Während die Substanz P in der CSF signifikant (p 〈 0,01) erhöht gefunden wurde, war das Somatostatin gegenüber den Kontrollpersonen signifikant erniedrigt (p 〈 0,05). Noradrenalin (p 〈 0,01), 5-HIAA (p 〈 0,01), HVA (p 〈 0,05) und VMA (p 〈 0,05) waren signifikant erniedrigt. Während die Erhöhung der Substanz P einen Hinweis auf eine lokal beschränkte neurogene Entzündung im trigemino-vaskulären System geben könnte, spricht die Reduktion monoaminerger Transmitter für eine zentral gestörte Schmerzmodulation. Diese scheint mit zunehmender Krankheitsdauer und begleitender Depression stärker zu werden. Die zahlreichen Korrelationen der Neuromediatoren untereinander, insbesondere auch zwischen den Neuropeptiden und den klassischen Neurotransmittern, sprechen für komplexe neurochemische Interaktionen im Rahmen der Schmerzentstehung.
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  • 2
    ISSN: 1433-8491
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 3
    ISSN: 0942-0940
    Keywords: Intracerebral haemorrhage ; intracranial pressure ; metanephrine ; normetanephrine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Autonomic nervous system dysfunction is a common complication of severe intracranial disease. The aim of this study was to reveal the autonomic changes in patients suffering from acute intracerebral haemorrhage (ICH). 25 patients with spontaneous ICH within 24 hours of onset of symptoms were included. All patients were treated with standardised medical management and the meta- and normetanephrines were detected by high performance liquid chromatography (HPLC) in 24-hour urine every day. The mean level of normetanephrine (709±579 μg/day) and metanephrine (244±161 mg/day) were significantly elevated in comparison with a control group, p⩽0,01. The norepinephrine elevation was of greater diagnostic and prognostic importance. Maximum urinary catecholamine metabolite levels occurred between day 3 to 10 after the bleeding. Normetanephrines correlated with the prognosis and the complications of ICH: intraventricular involvement resulted in significantly elevated normetanephrine levels (896±520 μg/day versus 311±78 μg/day) p⩽0,01. Patients with a great volume of haematoma developed severe autonomic dysregulation (normetanephrines 1114±493 μg/day), whereas patients with smaller haematoma did not (339±125 μg/day) p⩽0,0001; patients with bad outcome (1014±620 mg/day) had higher levels of normetanephrines than those with a good prognosis (322±110 μg/day) p⩽0,001. A close relationship to elevated intracranial pressure was established. This study demonstrated the feasibility of detecting autonomic nervous system dysfunction in neurological intensive care patients by means of examination of the metabolites of the catecholamines in the urine. The pattern of elevation in ICH and the relation to the clinical situation is presented. Norepinephrine offers the chance of simple and feasible monitoring of autonomic dysfunction.
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  • 4
    ISSN: 1468-2982
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: To investigate sympathetic nervous system and neuroendocrine changes in idiopathic trigeminal neuralgia, we determined the plasma level of the catecholamines norepinephrine and epinephrine, as well as cortisol and ACTH in 16 patients (55.38.3 years) with trigeminal neuralgia at four different times during the day (7.00, 13.00, 17.00 and 23.00). Morning and evening values of plasma norepinephrine as well as the daily mean value (dmv) were significantly higher (p〈0.01) in patients with trigeminal neuralgia than in an age- and gender-matched control group. Moreover, morning, afternoon and dmv epinephrine values were also significantly elevated. The dmv norepinephrine levels correlated with the intensity of the attacks (r=0.68, p〈0.01), the frequency of the attacks (r=0.75, p〈0.01) and the duration of the disease (r=0.78, p〈0.01). In addition to elevated catecholamines, trigeminal neuralgia patients also demonstrated significantly increased morning, evening and daily mean values of plasma cortisol. Thus, patients with trigeminal pain have an increased sympathetic nervous system activity for an extended period of time without a direct link to pain attacks, which suggests that the sympathetic nervous system itself is at least co-activated in trigeminal neuralgia and perhaps plays a role in the induction and maintenance of trigeminal pain. The neuroendocrine changes are similar to cluster headache and point to a central dysregulation of the hypothalamic-pituitary-adrenal axis, possibly due to the cyclic phenomena in idiopathic trigeminal neuralgia.
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  • 5
    ISSN: 1432-2129
    Keywords: Schlüsselwörter Migräne ; Spannungskopfschmerz ; Autonomes Nervensystem ; Key words Migraine ; Tension-type headache ; Autonomic nervous system
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Autonomic nervous system (ANS) dysfunction in migraine has been hyposthesized during the last years. However, the pathophysiological relevance of this dysfunction on the etiology and the maintenance of the headaches remains unclear. The aim of this study was to investigate connections between the ANS dysfunction and the clinical appearances of the pain and its processing in migraine and tension-type headache (TTH). Methods: Ten migraine-patients (31,4±10,6 years) and ten TTH-patients (49,3±14,6 years) underwent a cardiovascular reflex testing during headache-free intervals. A questionnaire was obtained to determine the patients’ clinical pain-symptoms. Results: The ANS function testings showed sympathetic hypofunction in both groups of patients (Fig. 1). In the migraine-group, there was a significant correlation between the pain-intensity and the extent of the autonomic dysfunction (r=0,82; Fig. 2). In the TTH-group, we found a correlation between the results of the orthostatic test and the v. Zerssen-depression-scale (r=0.69). Conclusions: These results suggest a sympathetic dysfunction in both headache-syndromes and suggest that the ANS plays an important role on the pathophysiology and the maintenance of the headaches.
    Notes: Zusammenfassung Störungen des autonomen Nervensystems (ANS) bei der Migräne werden seit langem postuliert. Unklar ist hingegen noch die pathophysiologische Bedeutung dieser Störungen bei der Entstehung und Aufrechterhaltung von Kopfschmerzen. Ziel dieser Studie war es, Zusammenhänge zwischen Regulationsstörungen des ANS und klinischen Phänomenen des Schmerzes und seiner Verarbeitung im Rahmen der Migräne und des Spannungskopfschmerzes zu untersuchen. Methode: Wir führten bei 10 Patienten mit Migräne (31,4±10,6 Jahre) und 10 Patienten mit Spannungskopfschmerz (49,3±14,6 Jahre) im schmerzfreien Intervall eine klinische Funktionstestung des ANS durch. Mit einem standardisierten Fragebogen wurden differenzierte klinische Daten zur Schmerzsymptomatik erhoben. Ergebnisse: Es ließ sich an beiden Kollektiven eine autonome Regulationsstörung im Sinn einer sympathischen Unterfunktion nachweisen. Des weiteren fand sich bei den Migränepatienten eine Korrelation zwischen der Schmerzintensität und dem Ausmaß der autonomen Regulationsstörungen. Bei den Spannungskopfschmerzpatienten zeigte sich eine Korrelation zwischen dem Testergebnis im Orthostasetest und der Depressivitätsskala nach von Zerssen. Schlußfolgerung: Zusammengefaßt weisen diese Ergebnisse auf eine sympathische Dysregulation bei beiden Kopfschmerzformen hin und legen darüber hinaus eine ätiopathogenetische Bedeutung des ANS bei deren Entstehung und Unterhaltung nahe.
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  • 6
    ISSN: 1435-1463
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 7
    ISSN: 1435-1463
    Keywords: Cerebrospinal fluid ; Parkinson's disease ; somatostatin-like immunoreactivity ; dementia ; monoamines
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary There is some evidence that Parkinson's disease (PD) seems to be a heterogenous and generalized brain disorder reflecting a degeneration of multiple neuronal networks, including somatostatinergic neurons. Somatostatin-like immunoreactivity (SLI) and its molecular forms, high molecular weight form (HMV-SST), somatostatin-14 (SST-14), somatostatin-25/28 (SST-25/28) and Des-ala-somatostatin (Des-ala-SST), as well as homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA) were estimated using HPLC and radioimmunoassay in the cerebrospinal fluid (CSF) of 35 aged parkinsonian patients with different stages of intellectual deterioration. The influence of L-dopa-treatment on these neurochemical parameters was evaluated. Without a correlation with dementia scores (p=0.11), SLI was significantly reduced in PD in comparison to the control group (p 〈 0.05). The reduction was related to the progression of the disease. Correlations between SLI, HVA and 5-HIAA indicate a heterogenous brain disorder in PD with alterations of several transmitter systems and functions. Complex qualitative and quantitative changes in the molecular pattern of SLI are compatible with a dysregulated synthesis and/or posttranslational processing. L-dopa-treatment was associated with a significant increase of HVA (p 〈 0.05) and HMV-SST (p 〈 0.05) and a slight, but insignificant increase of SLI (p=0.11).
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