Proximal and distal spinal neurons innervating multiple synergist and antagonist motor pools

Motoneurons control muscle contractions, and their recruitment by premotor circuits is tuned to produce accurate motor behaviours. To understand how these circuits coordinate movement across and between joints, it is necessary to understand whether spinal neurons pre-synaptic to motor pools have divergent projections to more than one motoneuron population. Here, we used modified rabies virus tracing in mice to investigate premotor INs projecting to synergist flexor or extensor motoneurons, as well as those projecting to antagonist pairs of muscles controlling the ankle joint. We show that similar proportions of premotor neurons diverge to synergist and antagonist motor pools. Divergent premotor neurons were seen throughout the spinal cord, with decreasing numbers but increasing proportion with distance from the hindlimb enlargement. In the cervical cord, divergent long descending propriospinal neurons were found in contralateral lamina VIII, had large somata, were neither glycinergic, nor cholinergic, and projected to both lumbar and cervical motoneurons. We conclude that distributed spinal premotor neurons coordinate activity across multiple motor pools and that there are spinal neurons mediating co-contraction of antagonist muscles

Reducing Intrathecal Baclofen Related Infections: Service Evaluation and Best Practice Guidelines

Objectives: Intrathecal baclofen (ITB) pumps are an effective treatment for spasticity; however infection rates have been reported in 3–26% of patients in the literature. The multidisciplinary ITB service has been established at The National Hospital for Neurology and Neurosurgery, UCLH, Queen Square, London for over 20 years. Our study was designed to clarify the rate of infection in our ITB patient cohort and secondly, to formulate and implement best practice guidelines and to determine prospectively, whether they effectively reduced infection rates. / Methods: Clinical record review of all patients receiving ITB pre‐intervention; January 2013–May 2015, and following practice changes; June 2016–June 2018. / Results: Four of 118 patients receiving ITB during the first time period (3.4%, annual incidence rate of infection 1.4%) developed an ITB‐related infection (three following ITB pump replacement surgery, one after initial implant). Infections were associated with 4.2% of ITB‐related surgical procedures. Three of four pumps required explantation. Following change in practice (pre‐operative chlorhexidine skin wash and intraoperative vancomycin wash of the fibrous pocket of the replacement site), only one of 160 ITB patients developed infection (pump not explanted) in the second time period (0.6%, annual incidence rate 0.3%). The infection rate related to ITB surgical procedures was 1.1%. In cases of ITB pump replacement, the infection rate was reduced to 3.3% from 17.6%. / Conclusions: This study suggests that a straightforward change in clinical practice may lower infection rates in patients undergoing ITB therapy

Pediatric Gastrointestinal Endoscopy: European Society of Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) and European Society of Gastrointestinal Endoscopy (ESGE) Guidelines

ABSTRACT: This Guideline refers to infants, children and adolescents aged 0–18 years. The areas covered include: indications for diagnostic and therapeutic esophagogastroduodenoscopy and ileo-colonoscopy; endoscopy for foreign body ingestion; corrosive ingestion and stricture/stenosis endoscopic management; upper and lower gastrointestinal bleeding; endoscopic retrograde cholangio-pancreatography and endoscopic ultrasonography. Percutaneous endoscopic gastrostomy and endoscopy specific to inflammatory bowel disease (IBD) has been dealt with in other Guidelines [1–3] and are therefore not mentioned in this Guideline. Training and ongoing skill maintenance are to be dealt with in an imminent sister publication to this

Intense Synaptic Activity Enhances Temporal Resolution in Spinal Motoneurons

In neurons, spike timing is determined by integration of synaptic potentials in delicate concert with intrinsic properties. Although the integration time is functionally crucial, it remains elusive during network activity. While mechanisms of rapid processing are well documented in sensory systems, agility in motor systems has received little attention. Here we analyze how intense synaptic activity affects integration time in spinal motoneurons during functional motor activity and report a 10-fold decrease. As a result, action potentials can only be predicted from the membrane potential within 10 ms of their occurrence and detected for less than 10 ms after their occurrence. Being shorter than the average inter-spike interval, the AHP has little effect on integration time and spike timing, which instead is entirely determined by fluctuations in membrane potential caused by the barrage of inhibitory and excitatory synaptic activity. By shortening the effective integration time, this intense synaptic input may serve to facilitate the generation of rapid changes in movements

On the distribution of spinal premotor interneurons

The activity of flexor and extensor motor neurons is tightly regulated by a network of interneurons in the spinal cord. The introduction of rabies retrograde monosynaptic tracing has provided a powerful method to map interneurons directly connected to motor neurons so as to visualize premotor circuits. Previous strategies have used AAV for complementing rabies glycoprotein expression in motor neurons to obtain selectivity in transsynaptic transfer to identify premotor interneurons innervating specific motor neuron pools These studies revealed differences in the location of flexor and extensor premotor interneurons. Here, we report that by using a genetic approach to complement rabies glycoprotein expression in motor neurons, we did not observe any differences in the distribution of flexor and extensor premotor interneurons. In order to identify possible causes for these paradoxical findings, we discuss advantages and caveats of the experimental designs and suggest ways forward to resolve possible ambiguities. Furthermore, to obtain a complete picture of existing approaches and results we ask for contributions from the scientific community describing the use of additional mouse models, viral constructs, and complementation methods. The aim is to generate an open, comprehensive database to understand the specific organisation of premotor circuits