Oculomotor Synkinesis (Aberrant Reinnervation of the Third Cranial Nerve) Associated with Atypical Tolosa-Hunt Syndrome

Harris, Glenn; Breazzano, Mark P.; Shyu, Irene; Donahue, Sean P.; Lavin, Patrick

doi:10.1080/01658107.2019.1576738

Cited by 6 publications

(7 citation statements)

References 22 publications

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“…The functional outcome, judged by SFI, was equally poor in all rats, run–idle, idle-run, run–run, or idle–idle. Neither allograft nerve graft (present study), end-to-end nerve suture, or artificial nerve conduit have achieved correct myotopic reinnervation ( 2 , 3 , 7 , 31 – 34 ). Even cut and immediate suture of the thin (< 0.2 mm) buccal branch of the facial nerve in rats in close proximity to its target muscle causes severe misdirection of reinnervation ( 34 ).…”

Section: Discussionmentioning

confidence: 57%

“…Neither allograft nerve graft (present study), end-to-end nerve suture, or artificial nerve conduit have achieved correct myotopic reinnervation ( 2 , 3 , 7 , 31 – 34 ). Even cut and immediate suture of the thin (< 0.2 mm) buccal branch of the facial nerve in rats in close proximity to its target muscle causes severe misdirection of reinnervation ( 34 ). The greatest benefit of motor reinnervation is the restoration of muscle tonus and the reduction of muscle atrophy.…”

Section: Discussionmentioning

confidence: 57%

“…Although motoneurons preferentially reinnervate motor nerves ( 25 , 26 ), they do not reinnervate the motor endplates of the original muscle fibers. This misdirection of reinnervation in cranial and spinal nerves dramatically changes the myotopic organization of central motor nuclei ( 3 , 4 , 27 – 34 ). This results in an auto-paralytic syndrome ( 24 , 35 , 36 ) or other permanent functional deficiencies ( 3 , 4 , 35 , 37 , 38 ).…”

Section: Introductionmentioning

confidence: 99%

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Treadmill training of rats after sciatic nerve graft does not alter accuracy of muscle reinnervation

Barham

Andermahr²,

Majczyński

et al. 2023

Front. Neurol.

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Background and purposeAfter peripheral nerve lesions, surgical reconstruction facilitates axonal regeneration and motor reinnervation. However, functional recovery is impaired by aberrant reinnervation.Materials and methodsWe tested whether training therapy by treadmill exercise (9 × 250 m/week) before (run–idle), after (idle–run), or both before and after (run–run) sciatic nerve graft improves the accuracy of reinnervation in rats. Female Lewis rats (LEW/SsNHsd) were either trained for 12 weeks (run) or not trained (kept under control conditions, idle). The right sciatic nerves were then excised and reconstructed with 5 mm of a congenic allograft. One week later, training started in the run–run and idle–run groups for another 12 weeks. No further training was conducted in the run–idle and idle–idle groups. Reinnervation was measured using the following parameters: counting of retrogradely labeled motoneurons, walking track analysis, and compound muscle action potential (CMAP) recordings.ResultsIn intact rats, the common fibular (peroneal) and the soleus nerve received axons from 549 ± 83 motoneurons. In the run–idle group, 94% of these motoneurons had regenerated 13 weeks after the nerve graft. In the idle–run group, 81% of the normal number of motoneurons had regenerated into the denervated musculature and 87% in both run–run and idle–idle groups. Despite reinnervation, functional outcome was poor: walking tracks indicated no functional improvement of motion in any group. However, in the operated hindlimb of run–idle rats, the CMAP of the soleus muscle reached 11.9 mV (normal 16.3 mV), yet only 6.3–8.1 mV in the other groups.ConclusionTreadmill training neither altered the accuracy of reinnervation nor the functional recovery, and pre-operative training (run–idle) led to a higher motor unit activation after regeneration.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 57%

Section: Introductionmentioning

confidence: 99%

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Treadmill training of rats after sciatic nerve graft does not alter accuracy of muscle reinnervation

Barham

Andermahr²,

Majczyński

et al. 2023

Front. Neurol.

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“…Reversible aberrant regeneration was also reported following giant cell arteritis and ophthalmoplegic migraine. 34 Complete recovery was reported to be as high as 68.4% for ITCNP in previous series. 3 This occurred in 48.5% of our patients, which consisted of all patients with microvascular ischemia and undetermined causes as well as in one patient with trauma.…”

Section: Discussionmentioning

confidence: 83%

Isolated Third Cranial Nerve Palsy: Aetiology - Clinical Profile and Recovery at a Tertiary Neuro-ophthalmology Centre on the East Coast Peninsular of Malaysia

Nurul-Ain

Hitam

Shatriah

et al. 2022

J Health Sci Med Res

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Objective: This study aimed to study the aetiologies, clinical profile and recovery of isolated third cranial nerve palsy (ITCNP) patients, at a tertiary neuro-ophthalmology center on the East Coast Peninsular of Malaysia. Material and Methods: This was a retrospective study, involving 33 patients with newly diagnosed ITCNP, who were treated at the Hospital of the Universiti Sains, Malaysia; from January 2018 to December 2019, with a follow up period ranging from 18 to 24 months. The demographic data, clinical features and aetiologies of the patients were analysed. Results: Patients’ ages ranged from 14 to 79 years (mean: 48, 50 years of age). The main aetiology was microvascular ischemia (39.4%), followed by trauma (30.3%), aneurysm (15.2%), tumour (9.1%) and undetermined cause (6.1%). Neuroimaging was performed for those indicated cases; with either computed tomography (CT), CT angiography, digital subtraction angiography, magnetic resonance imaging (MRI) with contrast or MRI angiography. Two-thirds of the patients (66.7%) had periorbital pain, which included 30.8% of patients with microvascular ischemia and 60.6% had pupil involvement; which was also found in 23.1% of patients with microvascular ischemia. Complete external third nerve palsy occurred in 18.2% of patients, and aberrant regeneration was observed in 36.4% of patients. Complete recovery occurred in 48.5%, of all patients, having microvascular ischemia and undetermined causes. Conclusion: The aetiologies, clinical profile and recovery of ITCNP patients in our institution are comparable to those reported in other previous studies. Patients with microvascular ischemia may also demonstrate periorbital pain and anisocoria. Neuroimaging remains the gold standard and the best tool via which to exclude other sinister and lifethreatening aetiologies.

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“…This phenomenon occurs due to the motor axons missprout from the proximal nerve stump into inappropriate distal pathways (Langley and Hashimoto, 1917;Esslen, 1960). The misdirected reinnervation of muscles (Thomander, 1984;Aldskogius and Thomander, 1986;Sumner, 1990) may lead to autoparalytic syndrome (Montserrat and Benito, 1988), antagonistic inhibition (Angelov et al, 1999;Dohm et al, 2000;Valero-Cabré et al, 2001, 2004Valero-Cabré and Navarro, 2002;Hamilton et al, 2011), and synkinesis (Crumley, 1979;Montserrat and Benito, 1988;Yian et al, 2001;Harris et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Treatment With Nimodipine or FK506 After Facial Nerve Repair Neither Improves Accuracy of Reinnervation Nor Recovery of Mimetic Function in Rats

Barham

Streppel²,

Guntinas‐Lichius

et al. 2022

Front. Neurosci.

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PurposeNimodipine and FK506 (Tacrolimus) are drugs that have been reported to accelerate peripheral nerve regeneration. We therefore tested these substances aiming to improve the final functional outcome of motoric reinnervation after facial nerve injury.MethodsIn 18 female rats, the transected facial nerve was repaired by an artificial nerve conduit. The rats were then treated with either placebo, nimodipine, or FK506, for 56 days. Facial motoneurons were pre-operatively double-labeled by Fluoro-Gold and again 56 days post-operation by Fast-Blue to measure the cytological accuracy of reinnervation. The whisking motion of the vibrissae was analyzed to assess the quality of functional recovery.ResultsOn the non-operated side, 93–97% of those facial nerve motoneurons innervating the vibrissae were double-labeled. On the operated side, double-labeling only amounted to 38% (placebo), 40% (nimodipine), and 39% (FK506), indicating severe misdirection of reinnervation. Regardless of post-operative drug or placebo therapy, the whisking frequency reached 83–100% of the normal value (6.0 Hz), but whisking amplitude was reduced to 33–48% while whisking velocity reached 39–66% of the normal values. Compared to placebo, statistically neither nimodipine nor FK506 improved accuracy of reinnervation and function recovery.ConclusionDespite previous, positive data on the speed and quantity of axonal regeneration, nimodipine and FK506 do not improve the final functional outcome of motoric reinnervation in rats.

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Oculomotor Synkinesis (Aberrant Reinnervation of the Third Cranial Nerve) Associated with Atypical Tolosa-Hunt Syndrome

Cited by 6 publications

References 22 publications

Treadmill training of rats after sciatic nerve graft does not alter accuracy of muscle reinnervation

Treadmill training of rats after sciatic nerve graft does not alter accuracy of muscle reinnervation

Isolated Third Cranial Nerve Palsy: Aetiology - Clinical Profile and Recovery at a Tertiary Neuro-ophthalmology Centre on the East Coast Peninsular of Malaysia

Treatment With Nimodipine or FK506 After Facial Nerve Repair Neither Improves Accuracy of Reinnervation Nor Recovery of Mimetic Function in Rats

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