Autoantibodies to autonomic nervous tissues in diabetic neuropathy

115 might explain the emergence of the C-fiber-mediated spinal micturition reflex which is not prominent in normal animals but is evoked by low-threshold mechanical stimuli following spinal cord injury.

156 Autonomic Nerve Function During Inflammatory Bowel Diseases (IBD) A. ZinconO, G. Bogliun l, G. Cavaletti l, V. Crespi 1, L. Marzorati l, L. D'Angelo 2, L. Beretta 2, M.R. Panelli 2 and R. Rivolta 2

155 Autoantibodies to Autonomic Nervous Tissues in Diabetic Neuropathy M.M. ZanonO, M. Peakman 2, D. Vergani 2 and P.J. Watkins 1

~Clin. Neurologica e 2Div. di Medicina II, Ist. di Scienze Biomediche S. Gerardo, Monza, Italy

1Diabetic and 2Immunology Department, King's College Hospital, London, UK There is evidence that the immune system may play a role in the pathogenesis of autonomic neuropathy in Type 1 diabetes mellitus. We investigated the presence of autoantibodies to sympathetic and parasympathetic nervous structures in: 37 long-standing Type 1 diabetics (mean age 43.2 +_ 11.1 years, mean duration of diabetes 29.8 + 10.4 years) with abnormal autonomic function tests, of whom 30 had autonomic symptoms; 25 uncomplicated diabetic patients matched for age and duration of diabetes; 15 uncomplicated patients with diabetes of shorter duration (mean age 28.1 + 9, mean duration of diabetes 6.9 ± 3.9); 27 normal subjects. An indirect immunofluorescent complement-fixation technique was used, with monkey adrenal gland, rabbit cervical ganglia and vagus nerve as substrates. Thirty-three percent of the patients with symptomatic autonomic neuropathy were positive for at least one autoantibody (20% antisympathetic ganglia, 10% anti-vagus nerve and 13% antiadrenal medulla). The frequency of having one or more autoantibodies and the prevalence of anti-cervical ganglia antibodies were significantly higher in the neuropathic patients than in the diabetic controls with disease of similar duration and in the normal subjects (P<0.05), who were positive only for anti-adrenal medulla antibodies. Thirty-three percent of the uncomplicated patients with diabetes of shorter duration were also positive for at least one autoantibody (13% anti-ganglia, 13% anti-vagus nerve and 13% anti-adrenal medulla). Our data indicate that nervous tissue autoantibodies are associated with symptomatic autonomic neuropathy. Anti-sympathetic ganglia and anti-vagus nerve antibodies seem to be more disease-specific. Patients with diabetes of shorter duration who were positive for these autoantibodies may represent pre-neuropathic patients.

We evaluated 19 patients (9 males and 8 females; age range 17-68 years, mean 33), affected by IBD (ulcerative colitis (UC) and Crohn's disease (CD)) with respect to autonomic and somatic nerve functions. Nine patients were affected by RCU (1 first diagnosis, 8 relapses) and 10 were affected by CD (4 first diagnosis and 5 relapses). Autonomic nerve function was examined by three noninvasive tests: R-R interval variation (RR-IV) at rest and during deep-breathing and Sympathetic Skin Response (SSR). Autonomic nerve function was considered abnormal when at least one test was altered. Somatic nerve function was evaluated by clinical scales (Neurological Symptoms Score (NSS) and Neurological Disability Score (NDS) by Dyck and co-workers), by vibratory detection threshold and by neurophysiological tests (motor and sensory nerve conduction in upper and lower limbs, recorded bilaterally). Neurophysiological evaluation was considered pathological when two parameters in two different nerves were abnormal. In all 19 patients clinical scores and vilration threshold were normal. Seven patients (37%) presented neurophysiological evidence of autonomic neuropathy (mostly related to RRIV) and one of them with also sign of peripheral neuropathy. Three additional patients (16%) presented evidence of somatic neuropathy without abnormal autonomic function. Autonomic neuropathy was present in 4 patients affected by UC (all relapses) and in 3 patients with CD (2 at first diagnosis and 1 relapse). Autonomic disfunction was not related to the duration of the disease after first diagnosis. So far it is impossible to draw any clear conclusion about etio-pathological significance of those findings. Our study continues with a follow up of recruited patients and with evaluation of more new cases.

157 The Neuronal Organization of the 'Gastric' Area of the Dorsal Motor Nucleus of Vagus Nerve V.A. Bagaev and F.N. Makarov

I.P. Pavlov Institute of Physiology of Russian Academy of Sciences, St.-Petersburg, Russia The localization, morphological and-functional peculi-