Differences in the opioid system in selected brain regions of alcohol-preferring and alcohol-nonpreferring rats

BACKGROUND

Previous studies have suggested that alcohol-reinforcing effects are mediated by the endogenous opioid system, which, in turn, stimulates mesolimbic dopaminergic neurotransmission. In addition, evidence obtained in both humans and rats indicates that genetic factors may influence alcohol-drinking behavior. In the present study, we examined several components of the opioid system in selected brain regions of rats bred selectively for their innate alcohol preference (Sardinian preferring = sP) or alcohol aversion (Sardinian nonpreferring = sNP).

METHODS

To evaluate whether differences observed were consequent to alcohol intake, sP rats were divided into two subgroups, ethanol-naive sP (sP) and ethanol-experienced sP (sPexp). Opioid receptors were labeled, using [3H]naloxone (mu, delta, and kappa receptors), [D-Ala2,N-Me-Phe4,Gly,ol5]enkephalin ([3H]DAMGO; mu receptors), and [D-Ala2,D-Leu5]enkephalin ([3H]DADLE; delta receptors), by means of quantitative autoradiography. Enkephalin and dynorphin mRNA contents were measured by in situ hybridization by using 25- and 47-base oligonucleotide probes with sequences complementary to mRNA encoding rat enkephalin or dynorphin.

RESULTS

Our results revealed a significant reduction of opioid receptors in caudate-putamen nucleus and in the shell portion of the nucleus accumbens in sP compared with sNP rats. Alcohol intake partially reversed this reduction in the caudate-putamen nucleus. In addition, enkephalin mRNA expression was found to be decreased in the ventral part of caudate-putamen nucleus and increased in the cerebral cortex of sP rats compared with sNP rats; no significant differences were found in dynorphin mRNA expression in any of the brain areas examined.

CONCLUSIONS AND SIGNIFICANCE

Differences observed between the two lines of rats may implicate that genetic modifications in the opioid system are possibly responsible for the innate preference of sP rats toward alcohol intake. At the same time, it cannot be excluded that other functions might also be affected to some degree.

Gamma-hydroxybutyrate increases gastric emptying in rats

The influence of gamma-hydroxybutyrate (GHB; 10, 50 or 100 mg/kg orally) and of its receptor antagonist, NCS-382 (25, 100 or 200 mg/kg orally, and 100 or 200 mg/kg intraperitoneally), on gastric emptying was studied in rats by measuring the serum level of acetaminophen (20 mg/rat orally, 30 min after GHB or NCS-382) 15, 30, 45 and 60 min after acetaminophen administration, or the amount of acetaminophen still present in the stomach 30 min after its administration. The highest dose of GHB produced a significant increase in 15 and 30 min serum levels of acetaminophen, indicating an acceleration of gastric emptying. A similar result was obtained with the prokinetic drug cisapride, at the oral dose of 2 mg/kg. On the other hand, NCS-382 significantly and dose-dependently reduced the serum levels of acetaminophen at every time of blood sampling, indicating a delay of gastric emptying, an effect confirmed by the amount of acetaminophen still present in the stomach 30 min after administration. Moreover, NCS-382 antagonized the prokinetic effect of GHB. These results may suggest for GHB (and/or possibly for its metabolites) a role in rat stomach motility.

Voluntary control of human gait: conditioning of magnetically evoked motor responses in a precision stepping task

The aim of this study was to investigate visuomotor control during human gait. It was assumed that visual input should modulate transcranially evoked motor potentials (EMPs) during walking. The effect of transcranial magnetic stimulation (TMS) in a visually guided precision stepping task was compared with that during normal gait. EMPs were studied in tibialis anterior (TA), gastrocnemius (GM), and abductor digiti minimi (AD) muscles during treadmill walking. In both stepping tasks, a facilitation of EMPs was observed prior to activation of the respective leg muscle. EMP facilitation proved to be modulated throughout the stride cycle when normalising EMP with respect to the underlying electromyogram (EMG). Facilitation was strongest in TA prior to the swing phase. Significant differences of EMP facilitation between the visual and control tasks were present. In the visual task, maximal facilitation of TA EMPs prior to and during the swing phase was decreased compared to the control task. Conversely, there was increased facilitation of GM EMPs during swing phase of the visual task, prior to the heel strike and prior to the plantarflexion, which was the moment when the target was hit. Thus, the effect of visual input upon EMPs in TA and GM was differential and reciprocal according to the respective functional state. The results support the hypothesis of a conditioning effect of visual or, alternatively volitional, drive on EMPs during stepping.

Autoradiographic analysis of 5-HT2A binding sites in the brain of Sardinian alcohol-preferring and nonpreferring rats

The density of 5-HT2A binding sites in the brain of Sardinian alcohol-preferring (sP) and nonpreferring (sNP) rats was evaluated, using [3H]ketanserin for quantitative autoradiography. The highest [3H]ketanserin binding levels were found in the anterior olfactory nucleus, prefrontal cortex, medial prefrontal cortex, post-genual anterior cingulate cortex, insular cortex and claustrum. Statistically significant differences between sP and sNP rats were found in prefrontal cortex, medial prefrontal cortex and post-genual anterior cingulate cortex, where sP rats showed about 20% lower [3H]ketanserin binding levels. No significant difference was found in other areas, although some of them showed slightly lower [3H]ketanserin binding density in sP rats. The 5-HT2A receptor agonist, (+/-)-1-(2,5-dimethoxy-4-iodophenyl)-2-amino-propane hydrochloride (DOI), microinjected into the medial prefrontal cortex, induced a lower number of wet dog shakes in sP than in sNP rats. These results indicate a different density of 5-HT2A binding sites, and a different functional regulation of 5-HT2A receptor mechanisms in discrete brain areas of sP, in comparison to sNP rats. These findings, and those showing lower levels of 5-HT in the frontal cortex of sP rats, suggest that altered 5-HT function in fronto-cortical areas could be linked to the genetic predisposition to high voluntary ethanol intake in these rats.

Antidepressant-like effect of ethanol revealed in the forced swimming test in Sardinian alcohol-preferring rats

RATIONALE

A large body of evidence indicates high comorbidity between depression and alcohol abuse. The self-medication hypothesis proposes that depressed subjects may abuse ethanol because it reduces the symptoms of depression. The present study evaluated whether ethanol may exert an antidepressant-like action in genetically selected alcohol-preferring rats, either Sardinian alcohol-preferring (sP) or Marchigian Sardinian alcohol-preferring (msP) rats, and for comparison in Sardinian alcohol-non-preferring (sNP) rats.

METHODS

The forced swimming test (FST) was used to evaluate the antidepressant-like action of ethanol; in this test the effect of ethanol ingestion on the immobility time was determined.

RESULTS

Ethanol-naive sP rats exhibited a longer period of immobility in comparison to sNP rats. Both in ethanol-naive sP and msP rats, voluntary ethanol drinking reduced the immobility time. A similar effect was obtained when repeated (five or nine) intragastric administrations of 0.7 g/kg ethanol were given during the 24 h prior to the test in msP and in sP, but not in sNP rats. Desipramine, like ethanol, sharply reduced immobility at doses of 5 or 20 mg/kg, given 3 times in the 24 h before the test in msP rats. The reduced immobility induced by ethanol in msP rats was apparently not the consequence of a general motor activation, because 9 IG administrations of ethanol, 0.7 g/kg, failed to alter locomotor activity in the open field test. Moreover, blood alcohol levels and rectal temperature of msP, sP and sNP after IG ethanol administration were not statistically different.

CONCLUSIONS

The present results provide evidence for an antidepressant-like action of ethanol in sP and msP rats and suggest that this action may contribute to sustain their high ethanol drinking.

Salvia miltiorrhiza extract inhibits alcohol absorption, preference, and discrimination in sP rats

Experiment 1 of the present study investigated the ability of a standardized extract of Salvia miltiorrhiza in reducing voluntary ethanol intake in ethanol-preferring rats of the sP line. Ethanol intake occurred under the two-bottle free-choice regimen between 10% (v/v) ethanol and water in daily 4-h scheduled access periods; water was present 24 h/day. Intragastric administration of 200 mg/kg Salvia miltiorrhiza extract resulted in approximately 40% reduction in ethanol intake and preference throughout the 4-day treatment. This effect of Salvia miltiorrhiza extract was likely due to its ability of altering ethanol absorption from the gastrointestinal tract. Indeed, Experiments 2 and 3 of this study demonstrated that 200 mg/kg Salvia miltiorrhiza extract reduced blood ethanol levels (BELs) up to 60% in comparison to control rats, when ethanol was given IG, whereas it failed to modify BELs when ethanol was injected IP. The reducing effect of Salvia miltiorrhiza extract on ethanol absorption may have therefore resulted in an attenuated perception of the psychoactive effects of ethanol sought by ethanol-drinking rats. Consistently, the results of Experiment 4 of the present study demonstrated that a combination of 200 mg/kg Salvia miltiorrhiza extract IG and 1 or 2 g/kg ethanol IG resulted in a partial blockade of the discriminative stimulus effects of ethanol in sP rats trained to discriminate these doses of ethanol from water in a drug discrimination procedure. Collectively, the results are discussed as being suggestive that drugs curbing ethanol absorption from the gastrointestinal tract may constitute a novel strategy for controlling excessive alcohol consumption in human alcoholics.

Reduction of blood ethanol levels by the gamma-hydroxybutyric acid receptor antagonist, NCS-382

The present study demonstrates that the gamma-hydroxybutyric acid receptor antagonist, NCS-382, markedly reduces blood ethanol levels (BELs) in rats when ethanol is administered via the intragastric route, whereas it is completely ineffective when ethanol is injected IP. The reducing effect of NCS-382 on BELs is likely due to a lessened absorption of ethanol from the gastrointestinal tract.

Post-traumatic stress disorder and major depression among Italian Nazi concentration camp survivors: a controlled study 50 years later

BACKGROUND

The study aimed to assess the current and lifetime rates of post-traumatic stress disorder (PTSD) and major depression (MDD) among Nazi concentration camps survivors.

METHODS

We investigated 51 Italian political deportees and 47 Resistance Movement veterans who reported traumatic experiences during active service. The Structured Clinical Interview for DSM-IV was used to assess the presence of PTSD and MDD. The Dissociative Experiences Scale and the shorter version of the Hopkins Symptoms Checklist were also administered.

RESULTS

The lifetime rates of PTSD and MDD were 35.3% and 45.1% respectively among deportees and 4.3% and 6.4% among former partisans. The current rates for PTSD and MDD were 25.5% and 33.3% among deportees and 4.3% and 4.3% among former partisans. Dissociative symptoms were more severe among deportees than among Resistance movement veterans.

CONCLUSIONS

Concentration camp internment, even for political reasons, appears to have severe long-term psychiatric consequences.

Stimulation of locomotor activity by voluntarily consumed ethanol in Sardinian alcohol-preferring rats

Stimulation of motor activity induced by ethanol has been proposed to reflect the positive reinforcing properties of the drug. The present study was designed to assess whether voluntary ethanol intake would stimulate locomotor activity in Sardinian alcohol-preferring (sP) rats, selectively bred for high ethanol preference and consumption. Rats were habituated to a) consume either water alone (water-consuming rats) or ethanol (10%, v/v) as free choice together with water (ethanol-consuming rats) according to a 15-min limited access protocol for 10 consecutive days prior to the test, and b) explore an open field for 10 min immediately after the drinking session in a trial on 3 consecutive days before the test. On the test day, voluntary ethanol consumption in ethanol-consuming rats averaged 1.2 g/kg. Values for activity measures (time spent moving, number of square crossings and number of rearings) were significantly higher in ethanol- than in water-consuming rats at both 5- and 10-min intervals. These results suggest that the euphorigenic effects of ethanol, supposedly represented by the stimulation of locomotor activity, are part of the reinforcing properties of ethanol in sP rats.

Gamma-hydroxybutyric acid reducing effect on ethanol intake: evidence in favour of a substitution mechanism

Experiment 1 in the present study investigated the time course and dose range of gamma-hydroxybutyric acid (GHB) to reduce voluntary ethanol intake in selectively bred Sardinian ethanol-preferring (sP) rats. Ethanol (10%, v/v) and tap water were offered under the two-bottle free choice regimen with unlimited access. GHB (200, 300, and 400 mg/kg, i.p.) was administered 15 20 min prior to the start of the dark phase of the light-dark cycle. Ethanol and water intakes were recorded at different time intervals during the dark phase. GHB significantly reduced ethanol intake at doses of 300 and 400 mg/kg; statistical significance occurred only at the 15-min and 30-min observation times. The GHB dose of 300 mg/kg was devoid of any sedative effect, as demonstrated in Experiment 2 by the lack of any impairment of spontaneous locomotor activity. Finally, this dose of GHB was also found to exert a robust anxiolytic effect in sP rats tested on the elevated plus maze (Experiment 3). Collectively, the results of the present study demonstrate that a non-sedative and anxiolytic dose of GHB effectively reduced voluntary ethanol intake in sP rats. The rapid onset of the reducing effect of GHB on ethanol intake, as well as its anxiolytic effect, are discussed in terms of adding further support to the hypothesis that GHB may control alcohol craving and consumption in humans by substituting for ethanol's reinforcing effects.

Appetite suppression and weight loss after the cannabinoid antagonist SR 141716

The effect of the cannabinoid CB1 receptor antagonist, SR 141716, on food intake and body weight was assessed in adult, non-obese Wistar rats. The daily administration of SR 141716 (2.5 and 10 mg/kg; i.p.) reduced dose-dependently both food intake and body weight. Tolerance to the anorectic effect developed within 5 days; in contrast, body weight in SR 141716-treated rats remained markedly below that of vehicle-treated rats throughout the entire treatment period (14 days). The results suggest that brain cannabinoid receptors are involved in the regulation of appetite and body weight.

[Usefulness of stress echocardiography in the diagnosis of syndrome X]

Syndrome X is a clinical entity not yet well defined. The identification of patients with syndrome X is important as, in comparison with patients with obstructive coronary artery disease, their prognosis is quite favorable. The diagnosis is confirmed by coronary angiography, but non-invasive tools can give some useful information, too. We illustrate 5 cases of syndrome X in which the diagnosis, confirmed by coronary angiography, was suspected on the basis of stress echocardiography. We considered 5 female patients, aged 49-65 years, whose exercise electrocardiogram showed signs of reduced coronary reserve. In 3 patients thallium-201 myocardial scintigram was also performed, showing areas of reduced myocardial perfusion in all cases. We suggest the use of stress echocardiography, particularly with dipyridamole, whenever the clinical conditions contrast with the results of exercise ECG.

Involvement of GABA(A) and GABA(B) receptors in the mediation of discriminative stimulus effects of gamma-hydroxybutyric acid

The present study was designed to further investigate the pharmacological profile of the discriminative stimulus effects of gamma-hydroxybutyric acid (GHB). Drugs acting at the gamma-aminobutyric acid (GABA)B receptor (baclofen and CGP 35348), GABA(A)/benzodiazepine receptor complex (diazepam), N-methyl-D-aspartate (NMDA) receptor complex (dizocilpine), and cannabinoid receptor (WIN 55,212-2) were tested for substitution or blockade of the GHB interoceptive cue in rats trained to discriminate either 300 or 700 mg/kg of GHB i.g. from water in a T-maze, food-reinforced drug discrimination paradigm. Baclofen completely substituted for both training doses of GHB; however, its potency in substituting for GHB increased as the training dose of GHB was increased. CGP 35348 partially and completely blocked the cue elicited by 300 and 700 mg/kg of GHB, respectively. In contrast, diazepam partially substituted for 300 mg/kg of GHB, while failing to produce a GHB-appropriate response in the rat group trained to the higher GHB dose. Neither dizocilpine nor WIN 55,212-2 substituted for GHB. Collectively, these data suggest that: a) GHB produces a compound stimulus; and b) GABA(B)- and GABA(A)-mediated cues are prominent components of the mixed stimulus of GHB. However, the quality (i.e., the proportion of the component cues) of the stimulus varies as the training dose of GHB is increased; indeed, the contribution of the GABA(A)- and GABA(B)-mediated cues were smaller and greater, respectively, at 700 and 300 mg/kg of GHB training doses.

Stumbling reactions in man: influence of corticospinal input

The aim of this study was to evaluate the degree of contribution of supraspinal input to the generation of the compensatory leg muscle activation following stance perturbation. Therefore, evoked motor response (EMR) input-output relations of two different motor tasks were compared at 3 distinct periods: (1) the basic period of muscular activity during standing, i.e. when no additional cortical or spinal activity due to the different tasks is to be expected, (2) the pre-movement period with low background activity, when different spinal and cortical inputs to the motoneuronal pool can be assumed and (3) the period of plateau EMG activity of compensatory and voluntary motor task. Transcranial magnetic stimulation (TMS) just below the motor threshold was applied randomly at 19 different time-intervals before and during the onset of stance perturbation and for comparison during an equivalent voluntary foot-dorsiflexion task. Recordings of electromyographic (EMG) activity from the tibialis anterior (TA) and corresponding ankle-joint movements were made from both legs. Forward-directed displacements were induced by randomly-timed ramp impulses of constant acceleration upon a moveable platform. For comparison, leg muscle EMG was recorded during isometric foot dorsiflexion during stance while leaning back against a support. The stance perturbations were followed by a compensatory response (CR) in the TA with a mean onset time of 81 ms. During the basic period of muscular activity and the period of plateau EMG activity there was no significant difference of the input-output relation between stance perturbation and the voluntary motor task. However, in the voluntary task compared with the CR, there was significantly greater input-output relation (facilitation) of the EMR in the TA following TMS, which may be related to an increased cortical influence. In contrast to this result of the CR following stance perturbation, a facilitation of the EMR was described for hand muscles under corresponding conditions of automatic compensation for muscle stretch, suggesting a transcortical reflex loop. This difference in the results from upper and lower extremity muscles favors the assumption of a predominantly spinal generation of the TA-CR following stance perturbation.

Locomotor pattern in paraplegic patients: training effects and recovery of spinal cord function

Recent studies have shown that a locomotor pattern can be induced and utilized by paraplegic patients under conditions of body unloading using a moving treadmill. The present study investigated the behaviour of the locomotor pattern and also the relationship of its development to the spontaneous recovery of spinal cord function assessed by clinical and electrophysiological (tibial nerve somatosensory evoked potentials and motor evoked potentials) examinations. The earliest time that spinal locomotor activity could be induced was when signs of spinal shock had disappeared. This activity was distinct from spinal stretch reflex activity. In complete paraplegic patients the locomotor pattern improved spontaneously without training. This was coincident with both an increase of gastrocnemius electromyographic activity during the stance phase of gait and a decrease of body unloading. These effects reached a plateau after about 5 weeks. In complete and incomplete paraplegic patients a near linear increase of gastrocnemius electromyographic activity occurred during the stance phase of a step cycle with daily locomotor training over the whole training period of 12 weeks. This was also coincident with a significant decrease of body unloading. In contrast to this, neither clinical nor electrophysiological examination scores improved after the onset of training in both patient groups. Only in incomplete paraplegic patients was there recovery, albeit statistically insignificant, of spinal cord function according to the sensory and motor scores obtained in the neurological examination during the time period before onset of training. An improvement of locomotor function by training was also seen in patients with paraplegia due to a cauda lesion. Such training effects on muscles and tendons could be separated from those on the spinal locomotor centres. The findings of this study may be relevant for the future clinical treatment of paraplegic patients.

Serotonin is reduced in the frontal cortex of Sardinian ethanol-preferring rats

Ethanol-naive Sardinian alcohol-preferring (sP) and Sardinian alcohol-non-preferring (sNP) rats were tested to evaluate the levels of serotonin (5-HT) and 5-hydroxyindol-3-yl-acetic acid (5-HIAA) in the frontal cortex, hypothalamus, and nucleus accumbens, and the levels of dopamine (DA) and 3,4-dihydroxyphenylacetic acid (DOPAC) in the hypothalamus and nucleus accumbens. Compared with the sNP line, the sP rats had lower 5-HT and 5-HIAA concentrations in the frontal cortex, whereas no differences were found in the other brain areas tested, neither for neurotransmitters nor their metabolites. As the decreased 5-HT function is a feature shared by different alcohol-preferring strains, it could be linked to the genetic predisposition to voluntary ethanol consumption.

Tryptophan metabolism in male Sardinian alcohol-preferring (sP) and -non-preferring (sNP) rats

Parameters of tryptophan (Trp) and related metabolism were compared in male Sardinian alcohol-preferring (sP) and -non-preferring (sNP) rats. Liver Trp pyrrolase activity was 38-58% higher in sP than in sNP rats, and this was associated with a greater expression of the enzyme mRNA as measured by multiprobe oligonucleotide solution hybridization. Moderately (about 10-19%), but significantly, lower concentrations of free serum, total serum, and brain Trp were also observed in sP compared with sNP rats. Concentrations of whole brain 5-hydroxytryptamine (5-HT) and its major metabolite 5-hydroxyindol-3-yl-acetic acid (5-HIAA) were, however, 14-21% higher in sP rats. Serum corticosterone concentration was 18% higher in sP rats. We conclude that alcohol preference in Sardinian rats is associated with increased liver Trp pyrrolase activity and mRNA expression leading to a decrease in Trp availability to the brain. Although a simple serotonin deficiency could not be demonstrated in the whole brain, the possibility could not be ruled out that a deficiency may be present in discrete areas of the brain of the sP rat.

Gamma-hydroxybutyric acid intake in ethanol-preferring sP and -nonpreferring sNP rats

Gamma-hydroxybutyric acid (GHB) and ethanol share several pharmacological similarities, suggesting that GHB may exert ethanol-like effects in the central nervous system. The present study was designed to test whether selectively bred ethanol-preferring rats would, unlike ethanol-nonpreferring ones, self-administer GHB, consistent with their higher preference for ethanol. Male ethanol-naive Sardinian alcohol-preferring (sP) and Sardinian alcohol-nonpreferring (sNP) rats were used. In Experiment 1, GHB solution (1% (w/v) in water) was initially offered as the sole fluid available for 14 consecutive days and then presented under the two-bottle, free-choice regimen, one bottle containing water and the other the GHB solution, for an additional 14 consecutive days. During the free-choice phase, high preference for GHB and intake of pharmacologically relevant daily doses of GHB developed in both rat lines, presumably because the 14-day no-choice period would unmask the reinforcing properties of GHB and lead to acquisition of GHB preference also in the supposedly less susceptible sNP rats. In Experiment 2, the forced GHB drinking phase was reduced to 3 days. Under the subsequent free-choice regimen, daily GHB preference and intake were initially low in both sP and sNP rats; however, after approximately 10 days, GHB preference and intake in sP rats rose progressively and then stabilized to significantly higher levels than in sNP rats throughout the entire free-choice phase. It is likely that episodic binges of GHB intake occurring during the first 10 days resulted in experiencing the reinforcing properties of GHB by sP but not sNP rats. The results of the present study suggest that a) sP rats are genetically more sensitive to the reinforcing effects of both ethanol and GHB than sNP rats; and b) disclosure of the higher sensitivity of sP rats to the reinforcing effects of GHB is a function of the length of the induction procedure. The results are also discussed in terms of differences in GHB receptors contributing to the predisposition to ethanol preference and avoidance, respectively.

Preprotachykinin-A gene expression in the forebrain of Sardinian alcohol-preferring and -nonpreferring rats

Increasing evidence suggests that TKergic mechanisms might play a role in ethanol intake control. Preprotachykinin-A (PPT-A) mRNA brain levels were measured in Sardinian alcohol-preferring (sP) and Sardinian alcohol-nonpreferring (sNP) rats. PPT-A mRNAs were about 50% lower in sP than in sNP rats in the bed nucleus of the stria terminalis (BNST), whereas levels in the olfactory tubercle (Tu) were about 30% higher in sP than in sNP rats. Our findings suggest that altered PPT-A gene expression might contribute to the different ethanol preference and intake of sP opposite to sNP rats.

Locomotor training in paraplegic patients: a new approach to assess changes in leg muscle EMG patterns

This study describes an amplitude independent assessment of changes in leg muscle EMG patterns in both complete and incomplete paraplegic patients during the course of locomotor training. The approach expresses the change as an approximation of the patients' gait EMG pattern compared with that of healthy subjects. The variation ratio (VR), coefficient of variation (CV) and Pearson's correlation coefficient (R), are used as measures of the dissimilarity/similarity of a set of wave forms. These parameters were evaluated for their ability to assess changes in the EMG pattern of the patients with respect to that of healthy subjects. The VR showed the best correlation to our data and was therefore considered to represent the optimum variable in the assessment of changes in EMG patterns.

Locomotor capacity and recovery of spinal cord function in paraplegic patients: a clinical and electrophysiological evaluation

Recent studies have shown that a locomotor pattern can be induced and trained into paraplegic patients under conditions of body unloading using a moving treadmill. The present study investigated the behaviour of the locomotor pattern and also the relationship of its development to the spontaneous recovery of spinal cord function assessed by clinical and electrophysiological (tibial nerve somatosensory evoked potentials and motor evoked potentials) examinations. The earliest time that spinal locomotor activity could be induced was when signs of spinal shock had disappeared. This activity was distinct from spinal stretch reflex activity. In complete and incomplete paraplegic patients an increase of gastrocnemius electromyographic activity occurred during the stance phase of a step cycle with daily locomotor training over the whole training period of 12 weeks. This was coincident with a significant decrease in body unloading. In contrast to this, neither clinical nor electrophysiological examination scores improved after the onset of training in both patient groups. Only in incomplete paraplegic patients was there an insignificant increase in sensory and motor scores obtained in the neurological examination during the time period before onset of training. An improvement of locomotor function by training was also seen in patients with paraplegia due to a cauda lesion. Therefore, in patients with a spinal cord lesion training effects on muscles and tendons are present in addition to those on the spinal locomotor centres. The findings of this study may be relevant for future clinical treatment of paraplegic patients.