The effect of diaminopyridines on the activity recorded in the dorsal roots of isolated spinal cord

Treatment of stable chronic demyelinating polyneuropathy with 3,4-diaminopyridine

OBJECTIVE

To determine whether 3,4-diaminopyridine (3,4-DAP) would improve clinical or electrophysiologic function in patients with stable chronic demyelinating polyneuropathy.

DESIGN

We conducted a prospective, randomized, placebo-controlled, blinded, crossover study of 3,4-DAP in 34 patients with demyelinating polyneuropathy.

MATERIAL AND METHODS

Of the 17 men and 17 women, who were 21 to 80 years of age, 27 had hereditary motor and sensory neuropathy type I and 7 had acquired demyelinating polyneuropathy. Treatment consisted of stepped doses of 3,4-DAP (increasing to 20 mg four times daily) or placebo for 4 days. Pretreatment and posttreatment determination of the Neurologic Disability Score (NDS); isometric muscle strength testing; median, ulnar, and peroneal nerve conduction studies; and measurement of serum 3,4-DAP were performed. Quantitative computer-assisted sensory examinations were done in five patients.

RESULTS

The results for the final day of treatment with 3,4-DAP or placebo and the differences between pretreatment and posttreatment findings for total NDS, sensory NDS, isometric muscle strength testing, compound muscle action potential amplitude, sensory nerve action potential amplitude, motor and sensory conduction velocities, and vibration and cold detection thresholds did not vary significantly. A small improvement of 4 points in the motor NDS (P < 0.05) was found. Five patients with electrophysiologic conduction block had no significant reduction in the degree of block.

CONCLUSION

Because no improvement was noted in most measurements of neurologic function, despite use of high doses of drug, 3,4-DAP is unlikely to be beneficial in the treatment of stable chronic demyelinating polyneuropathy.

The isolated mammalian spinal cord

This review considers: spinal cord slices; isolated spinal cord sagitally or transversely hemisected; whole spinal cord; respiration control--[brain-stem spinal cord; brain-stem spinal cord with attached lungs]; nociception--[spinal cord with tail]; fictive locomotion--[spinal cord with one hind limb; spinal cord with two hind limbs]. Much of the functional circuitry of the CNS can be studied in the isolated spinal cord with the additional advantage that the isolated spinal cord can be perfused with known concentrations of ions, neurotransmitters, agonists, antagonists, and anaesthetics. These can be washed away, the circuitry allowed to recover and other drugs or different concentrations applied. Future preparations including the complete spinal cord, the two hind limbs, and a sagittal section of the complete brain will allow greater understanding of the multiple sensory and motor pathways and their interactions in the CNS.

The effect of bicuculline and baclofen on the dorsal root-ventral root reflex in the isolated spinal cord

1. In the lumbar spinal cord, 10(-6) M bicuculline reduces the inhibition of the dorsal root-ventral root (DR-VR) reflex produced by lateral stimulation of the spinal cord. The inhibition returns on washing in control artificial cerebrospinal fluid (ACSF). 2. Baclofen (10(-6) M) inhibits the monosynaptic DR-VR reflex which returns on washing in control ACSF. 3. This suggests an involvement of GABAA receptors in the lateral inhibition and GABAB receptors in the DR-VR reflex system. 4. The increased activity seen following bicuculline or tubocurarine probably resets the "set point" of neural activity to a lower level.

Tubocurarine and strychnine block Renshaw cell inhibition in the isolated mammalian spinal cord

1. Stimulating a lumbar dorsal root (A) of an isolated mammalian spinal cord preparation sets up a reflex (DR-VR) in the corresponding ventral root (A) of that segment. 2. If an adjacent motor root (B) is antidromically stimulated 100 msec before the dorsal root A is stimulated, it inhibits the ventral root A response. (i.e. Renshaw cell inhibition of A through antidromic stimulation of recurrent collateral of B). 3. Stimulation of the lateral side of the spinal cord 5 mm rostral to the DR-VR reflex sets up a powerful inhibition of the reflex. 4. The inhibition is abolished by tubocurarine, or by strychnine indicating that the lateral stimulation is activating a cholinergic and a glycinergic pathway. 5. Addition of tubocurarine increases the steady "spontaneous" activity in the motor roots. 6. Addition of tubocurarine and 10(-3) M magnesium produces long lasting rhythmic bursting activity in the motor roots that persists even after 45 min of washing. 7. The isolated mammalian spinal cord preparation in addition to having active sensory, motor, and interneurones, has active Renshaw cells that can be studied using this preparation free from any blood-brain barrier and so are easily permeated by tubocurarine, etc.