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Evidence in humans
e462
Abstracts / Journal of the Neurological Sciences 357 (2015) e457–e512
In the field of pain research, Patrick Wall and Peter Nathan were among the first to conceptualize the idea that the Central Nervous System has many ways and strategies for modifying the incoming nociceptive information it receives. At present it is generally accepted that pain sensations are not merely inputs conveyed to the brain by a specialized chain of neurons, or of separated unidirectional ascending pathways which convey the information that inevitably produces the sensory experience of pain. Selection subserved by endogenous modulation networks is the main feature of sensory processing by which the brain is able to modify the features and efficacy of varied inputs arising from the outside world. Some of the particular features of pain perception result not only from the unique anatomofunctional organization of transduction mechanisms and bottom-up ascending pathways but also from the close interactions between bottom-up and top-down central regulation mechanisms. Such interactions create dynamic functional states that change under the influence of processes not necessarily related to pain, including environmental factors and biological rhythms. This may explain the crucial role of comorbidity mechanisms in persistent pain situations, dysfunctional pain and the large variability of pain perceptions and reactions in apparently identical experiments with highly trained subjects and on patients admitted to an emergency clinic. This talk outlines briefly the more relevant features of central regulation mechanisms of nociception, on the basis of animal studies that provide valuable translational models in our understanding of human endogenous pain modulatory systems.
doi:10.1016/j.jns.2015.09.163
1590 WFN15-1818 Pain MT 30.2 - Descending Control of Pain. From Brain to Dorsal Horn Evidence in humans D. Bouhassira. Pathophysiology and Clinical Pharmacology of Pain, Inserm U987, Boulogne-Billancourt, France The spinal transmission of pain signals is modulated by descending systems which can tonically or phasically, inhibit or facilitate the activity of dorsal horn nociceptive neurons. In humans, both the spinal nociceptive flexion (RIII) reflex and the concomitant painful sensation are inhibited in an intensity dependent manner by heterotopic painful stimuli. On the basis of this methodology, it has been demonstrated that, like in rats, Diffuse Noxious Inhibitory Controls (DNIC) are sustained in humans by an anatomical spinobulbo-spinal. Over the last twenty years, DNIC-like experimental paradigms, based on the classical "pain inhibits pain phenomenon", have been used in a large number of studies in humans for assessing descending pain modulation. More recently, the broader term Conditioned Pain Modulation (CPM) was coined because protocols used in numerous studies could not be directly compared to the initial DNIC paradigm. Studies in patients with chronic pain have shown that alterations of descending pain modulation could play a major role in the development and maintenance of pain in various clinical conditions, including fibromyalgia, irritable bowel syndrome, post-surgical pain or neuropathic pain. It has also been shown that alterations of pain modulation could be a predictor of the response to treatment. The main results of these studies will be summarized and discussed in this session.
doi:10.1016/j.jns.2015.09.164
1591 WFN15-1841 Stroke MT 3.1- Challenges in Stroke Care Around the World The global challenge of dementia – targeting the vascular contribution V. Hachinski. Clinical Neurological Sciences, Western University, London, Canada The global challenge of dementia: Targeting the Vascular contribution Vladimir Hachinski, MD, DSc, FRCPC Distinguished University Professor Department of CNS University of Western Ontario London, Canada Next year, globally, people 65 years of age or older will equal the number of children aged 5 years or younger. This poses a double challenge, prevent or delay dementia in the elderly and assure that children grow up with healthy habits and low risk for dementia and stroke. The risk factors for stroke and dementia are virtually the same. This represents an opportunity to prevent or delay both. A potential for modifying risk factors is exemplified by the fact that in the past 20 years stroke incidence has increased by 225% in low and middle income countries while it has declined by 42% in high income countries. The latter are also the countries showing trends in a decreasing incidence of dementia. In preventing and delaying stroke and dementia we need to coordinate, integrate and focus our efforts into a three stage approach: 1. Information 2. Motivation 3. Enablement The fact that stroke declined by almost one half in the high income countries, and more than doubled in middle and low income countries in two decades suggests that the big differences are not due to changes in the genetic makeup, but improvements in risk factor control. doi:10.1016/j.jns.2015.09.165
1592 WFN15-1937 Neuroimaging MT 9.1 - Demyelinating Diseases Radiologically isolated syndrome F. Fazekasa, N. De Stefanob, M. Filippic, F. Barkhof d, A. Rovirae. a Department of Neurology, Medical University of Graz, Graz, Austria; b Department of Neurological and Behavioural Sciences, University of Siena, Siena, Italy; cDivision of Neuroscience, Vita-Salute San Raffaele University, Milano, Italy; dDepartment of Radiology & Nuclear Medicine and Neurology, VU University Medical Center, Amsterdam, Netherlands; e Magnetic Resonance Unit Hospital Vall d`Hebron, Autonomous University of Barcelona, Barcelona, Spain MRI allows to advance the diagnosis of MS already at the time of a first clinical episode producing signs and symptoms suggestive of an inflammatory demyelinating disorder in that it serves to demonstrate dissemination in space and dissemination in time of lesions within the central nervous system (1). This comes from a high sensitivity of MRI for demyelinating lesions - at least in white matter- and lesion distribution characteristic for MS. A situation where MS typical MRI findings are detected incidentally, i.e. without suggestive or even any clinical symptoms has been termed radiologically isolated syndrome (RIS). In general the existence of such a situation does not come as a
Abstracts / Journal of the Neurological Sciences 357 (2015) e457–e512
In the field of pain research, Patrick Wall and Peter Nathan were among the first to conceptualize the idea that the Central Nervous System has many ways and strategies for modifying the incoming nociceptive information it receives. At present it is generally accepted that pain sensations are not merely inputs conveyed to the brain by a specialized chain of neurons, or of separated unidirectional ascending pathways which convey the information that inevitably produces the sensory experience of pain. Selection subserved by endogenous modulation networks is the main feature of sensory processing by which the brain is able to modify the features and efficacy of varied inputs arising from the outside world. Some of the particular features of pain perception result not only from the unique anatomofunctional organization of transduction mechanisms and bottom-up ascending pathways but also from the close interactions between bottom-up and top-down central regulation mechanisms. Such interactions create dynamic functional states that change under the influence of processes not necessarily related to pain, including environmental factors and biological rhythms. This may explain the crucial role of comorbidity mechanisms in persistent pain situations, dysfunctional pain and the large variability of pain perceptions and reactions in apparently identical experiments with highly trained subjects and on patients admitted to an emergency clinic. This talk outlines briefly the more relevant features of central regulation mechanisms of nociception, on the basis of animal studies that provide valuable translational models in our understanding of human endogenous pain modulatory systems.
doi:10.1016/j.jns.2015.09.163
1590 WFN15-1818 Pain MT 30.2 - Descending Control of Pain. From Brain to Dorsal Horn Evidence in humans D. Bouhassira. Pathophysiology and Clinical Pharmacology of Pain, Inserm U987, Boulogne-Billancourt, France The spinal transmission of pain signals is modulated by descending systems which can tonically or phasically, inhibit or facilitate the activity of dorsal horn nociceptive neurons. In humans, both the spinal nociceptive flexion (RIII) reflex and the concomitant painful sensation are inhibited in an intensity dependent manner by heterotopic painful stimuli. On the basis of this methodology, it has been demonstrated that, like in rats, Diffuse Noxious Inhibitory Controls (DNIC) are sustained in humans by an anatomical spinobulbo-spinal. Over the last twenty years, DNIC-like experimental paradigms, based on the classical "pain inhibits pain phenomenon", have been used in a large number of studies in humans for assessing descending pain modulation. More recently, the broader term Conditioned Pain Modulation (CPM) was coined because protocols used in numerous studies could not be directly compared to the initial DNIC paradigm. Studies in patients with chronic pain have shown that alterations of descending pain modulation could play a major role in the development and maintenance of pain in various clinical conditions, including fibromyalgia, irritable bowel syndrome, post-surgical pain or neuropathic pain. It has also been shown that alterations of pain modulation could be a predictor of the response to treatment. The main results of these studies will be summarized and discussed in this session.
doi:10.1016/j.jns.2015.09.164
1591 WFN15-1841 Stroke MT 3.1- Challenges in Stroke Care Around the World The global challenge of dementia – targeting the vascular contribution V. Hachinski. Clinical Neurological Sciences, Western University, London, Canada The global challenge of dementia: Targeting the Vascular contribution Vladimir Hachinski, MD, DSc, FRCPC Distinguished University Professor Department of CNS University of Western Ontario London, Canada Next year, globally, people 65 years of age or older will equal the number of children aged 5 years or younger. This poses a double challenge, prevent or delay dementia in the elderly and assure that children grow up with healthy habits and low risk for dementia and stroke. The risk factors for stroke and dementia are virtually the same. This represents an opportunity to prevent or delay both. A potential for modifying risk factors is exemplified by the fact that in the past 20 years stroke incidence has increased by 225% in low and middle income countries while it has declined by 42% in high income countries. The latter are also the countries showing trends in a decreasing incidence of dementia. In preventing and delaying stroke and dementia we need to coordinate, integrate and focus our efforts into a three stage approach: 1. Information 2. Motivation 3. Enablement The fact that stroke declined by almost one half in the high income countries, and more than doubled in middle and low income countries in two decades suggests that the big differences are not due to changes in the genetic makeup, but improvements in risk factor control. doi:10.1016/j.jns.2015.09.165
1592 WFN15-1937 Neuroimaging MT 9.1 - Demyelinating Diseases Radiologically isolated syndrome F. Fazekasa, N. De Stefanob, M. Filippic, F. Barkhof d, A. Rovirae. a Department of Neurology, Medical University of Graz, Graz, Austria; b Department of Neurological and Behavioural Sciences, University of Siena, Siena, Italy; cDivision of Neuroscience, Vita-Salute San Raffaele University, Milano, Italy; dDepartment of Radiology & Nuclear Medicine and Neurology, VU University Medical Center, Amsterdam, Netherlands; e Magnetic Resonance Unit Hospital Vall d`Hebron, Autonomous University of Barcelona, Barcelona, Spain MRI allows to advance the diagnosis of MS already at the time of a first clinical episode producing signs and symptoms suggestive of an inflammatory demyelinating disorder in that it serves to demonstrate dissemination in space and dissemination in time of lesions within the central nervous system (1). This comes from a high sensitivity of MRI for demyelinating lesions - at least in white matter- and lesion distribution characteristic for MS. A situation where MS typical MRI findings are detected incidentally, i.e. without suggestive or even any clinical symptoms has been termed radiologically isolated syndrome (RIS). In general the existence of such a situation does not come as a