Differences in Membrane Properties in Simulated Cases of Demyelinating Neuropathies: Internodal Focal Demyelinations with Conduction Block

The aim of this study is to investigate the membrane properties (potentials and axonal excitability indices) in the case of myelin wrap reduction (96%) in one, two and three consecutive internodes along the length of human motor nerve fibre. The internodally focally demyelinated cases (termed as IFD1, IFD2 and IFD3, respectively, with one, two and three demyelinated internodes are simulated using our previous double cable model of the fibre. The progressively greater increase of focal loss of myelin lamellae blocks the invasion of the intracellular potentials into the demyelinated zones. For all investigated cases, the radial decline of the extracellular potential amplitudes increases with the increase of the radial distance and demyelination, whereas the electrotonic potentials show a decrease in the slow part of the depolarizing and hyperpolarizing responses. The time constants are shorter and the rheobases higher for the IFD2 and IFD3 cases than for the normal case. In the recovery cycles, the same cases have less refractoriness, greater supernormality and less late subnormality than the normal case. The simulated membrane abnormalities can be observed in vivo in patients with demyelinating forms of Guillain-Barré syndrome. The study provides new information about the pathophysiology of acquired demyelinating neuropathies.     

Membrane property abnormalities in simulated cases of mild systematic and severe focal demyelinating neuropathies

The investigation of multiple nerve membrane properties by mathematical models has become a new tool to study peripheral neuropathies. In demyelinating neuropathies, the membrane properties such as potentials (intracellular, extracellular, electrotonic) and indices of axonal excitability (strength-duration time constants, rheobases and recovery cycles) can now be measured at the peripheral nerves. This study provides numerical simulations of the membrane properties of human motor nerve fibre in cases of internodal, paranodal and simultaneously of paranodal internodal demyelinations, each of them mild systematic or severe focal. The computations use our previous multi-layered model of the fibre. The results show that the abnormally greater increase of the hyperpolarizing electrotonus, shorter strength-duration time constants and greater axonal superexcitability in the recovery cycles are the characteristic features of the mildly systematically demyelinated cases. The small decrease of the polarizing electrotonic responses in the demyelinated zone in turn leads to a compensatory small increase of these responses outside the demyelinated zone of all severely focally demyelinated cases. The paper summarizes the insights gained from these modeling studies on the membrane property abnormalities underlying the variation in clinical symptoms of demyelination in Charcot-Marie-Tooth disease type 1A, chronic inflammatory demyelinating polyneuropathy, Guillain-Barré syndrome and multifocal motor neuropathy. The model used provides an objective study of the mechanisms of these diseases which up till now have not been sufficiently well understood, because quite different assumptions have been given in the literature for the interpretation of the membrane property abnormalities obtained in hereditary, chronic and acquired demyelinating neuropathies.     

Differences between the channels, currents and mechanisms of conduction slowing/block and accommodative processes in simulated cases of focal demyelinating neuropathies

To clarify the differences between the mechanisms of conduction slowing/block and accommodative processes in focal demyelinating neuropathies, this computational study presents the kinetics of the ionic, transaxonal and transmyelin currents defining the intracellular and electrotonic potentials in different segments of human motor nerve fibres. The computations use our previous double cable model of the fibres. The simulated fibres have focal demyelination of internodes, paranodes or both together. The intracellular potentials are defined mainly by the Na(+) current, as the contribution of the K(+) fast and K(+) slow currents to the total nodal ionic current is negligible. The paranodal demyelinations cause an increase in the transaxonal current and a decrease in the transmyelin current at the paranodal segments. However, there is an inverse relationship between the transaxonal and transmyelin currents at the same segments in the cases of internodal demyelination. The internodal ionic channels beneath the myelin sheath do not contribute to the intracellular potentials, but they show a high sensitivity to long-lasting pulses. The slow components of the electrotonic potentials depend on the activation of the channel types in the nodal or internodal axolemma, whereas the fast components of the potentials are determined mainly by the passive cable responses. However, the current kinetics changes (defining the investigated electrotonic changes) are relatively weak. The study summarizes the results from these modelling investigations on the mechanisms underlying the conduction slowing/block and accommodative processes in focal demyelinating neuropathies such as Guillain-Barré syndrome and multifocal motor neuropathy.     

Simulating focal demyelinating neuropathies: membrane property abnormalities

Membrane properties such as potentials (intracellular, extracellular, electrotonic) and axonal excitability indices (strength–duration and charge–duration curves, strength–duration time constants, rheobasic currents, recovery cycles) can now be measured in healthy subjects and patients with demyelinating neuropathies. They are regarded here in two cases of simultaneously reduced paranodal seal resistance and myelin lamellae in one to three consecutive internodes of human motor nerve fiber. The investigations are performed for 70 and 96% myelin reduction values. The first value is not sufficient to develop a conduction block, but the second leads to a block and the corresponding demyelinations are regarded as mild and severe. For both the mild and severe demyelinations, the paranodally internodally focally demyelinated cases (termed as PIFD1, PIFD2, and PIFD3, respectively, with one, two, and three demyelinated internodes) are simulated using our previous double-cable model of the fiber. The axon model consists of 30 nodes and 29 internodes. The membrane property abnormalities obtained can be observed in vivo in patients with demyelinating forms of Guillain-Barré syndrome (GBS) and multifocal motor neuropathy (MMN). The study confirms that focal demyelinations are specific indicators for acquired demyelinating neuropathies. Moreover, the following changes have been calculated in our previous papers: (1) uniform reduction of myelin thickness in all internodes (Stephanova et al. in Clin Neurophysiol 116: 1153–1158, 2005); (2) demyelination of all paranodal regions (Stephanova and Daskalova in Clin Neurophysiol 116: 1159–1166, 2005a); (3) simultaneous reduction of myelin thickness and paranodal demyelination in all internodes (Stephanova and Daskalova in Clin Neurophysiol 116: 2334–2341, 2005b); and (4) reduction of myelin thickness of up to three internodes (Stephanova et al., in J Biol Phys, 2006a,b, DOI: 10.1007/s10867-005-9001-9; DOI: 10.1007/s10867-006-9008-x). The mem- brane property abnormalities obtained in the homogenously demyelinated cases are quite different and abnormally greater than those in the case investigated here of simultaneous reduction in myelin thickness and paranodal demyelination of up to three internodes. Our previous and present results show that unless focal demyelination is severe enough to cause outright conduction block, changes are so slight as to be essentially indistinguishable from normal values. Consequently, the excitability-based approaches that have shown strong potential as diagnostic tools in systematically demyelinated conditions may not be useful in detecting mild focal demyelinations, independently of whether they are internodal, paranodal, or paranodal internodal.     

Action potentials and ionic currents through paranodally demyelinated human motor nerve fibres: computer simulations

 The relationship between the changes in the passive paranodal properties of the myelinated human motor nerve fibres and the conduction abnormalities obtained is examined on the basis of a double-cable model. Simulated systematic demyelination (all paranodal regions uniformly affected) and focal demyelination (paranodal regions at each end of a single internode affected) of the fibres are defined as a reduction of the paranodal seal resistance. By increasing the degree of demyelination, the kinetics of the action potentials and ionic currents in different segments of the fibres are explored. The altered paranodal seal resistance is found to be a factor impeding the invasion of the demyelinated regions by an action potential. We established that the conduction along the most severely demyelinated fibres (i.e. in the case of systematically demyelinated fibres) is more affected than along the focally demyelinated fibres. Received: 8 July 1996/Accepted in revised form: 13 December 1996     

Optical measurement of conduction in single demyelinated axons

Demyelination was initiated in Xenopus sciatic nerves by an intraneural injection of lysolecithin over a 2-3-mm region. During the next week macrophages and Schwann cells removed all remaining damaged myelin by phagocytosis. Proliferating Schwann cells then began to remyelinate the axons, with the first few lamellae appearing 13 d after surgery. Action potentials were recorded optically through the use of a potential-sensitive dye. Signals could be detected both at normal nodes of Ranvier and within demyelinated segments. Before remyelination, conduction through the lesion occurred in only a small fraction of the fibers. However, in these particular cases we could demonstrate continuous (nonsaltatory) conduction at very low velocities over long (greater than one internode) lengths of demyelinated axons. We have previously found through loose patch clamp experiments that the internodal axolemma contains voltage-dependent Na+ channels at a density approximately 4% of that at the nodes. These channels alone, however, are insufficient for successful conduction past the transition point between myelinated and demyelinated regions. Small improvements in the passive cable properties of the axon, adequate for propagation at this site, can be realized through the close apposition of macrophages and Schwann cells. As the initial lamellae of myelin appear, the probability of success at the transition zone increases rapidly, though the conduction velocity through the demyelinated segment is not appreciably changed. A detailed computational model is used to test the relative roles of the internodal Na+ channels and the new extracellular layer. The results suggest a possible mechanism that may contribute to the spontaneous recovery of function often seen in demyelinating disease.     

Membrane Characteristics of the Canine Papillary Muscle Fiber

Passive and active responses to intracellular and extracellular stimulation were studied in the canine papillary muscle. The electrotonic potential produced by extracellular polarization with the partition chamber method fitted the time course and the spatial decay expected from the cable theory (the time constant, 3.3 msec; the space constant, 1.2 mm). Contrariwise, spatial decay of the electrotonic potentials produced by intracellular polarization was very short and did not fit the decay curve expected for a simple cable, although only a small difference of time course in the electrotonic potentials produced by intracellular and extracellular polarizations was observed. A similar time course might result from the fact that when current flow results from intracellular polarization, the input resistance is less dependent on the membrane resistance. The foot of the propagated action potential rose exponentially with a time constant of 1.1 msec and a conduction velocity of 0.68 m/sec. The membrane capacity was calculated from the time constant of the foot potential and the conduction velocity to be 0.76 µF/cm². The responses of the papillary muscle membrane to intracellular stimulation differed from those to extracellular stimulation applied with the partition method in the following ways: higher threshold potential, shorter latency for the active response, linearity of the current-voltage relationship, and no reduction in the membrane resistance at the crest of the action potential during current flow.     

Different effects of blocked potassium channels on action potentials, accommodation, adaptation and anode break excitation in human motor and sensory myelinated nerve fibres: computer simulations

 Action potentials and electrotonic responses to 300-ms depolarizing and hyperpolarizing currents for human motor and sensory myelinated nerve fibres have been simulated on the basis of double cable models. The effects of blocked nodal or internodal potassium (fast or slow) channels on the fibre action potentials, early and late adaptations to 30-ms suprathreshold slowly increasing depolarizing stimuli have been examined. The effects of the same channels on accommodation after the termination of a prolonged (100 ms) hyperpolarizing current pulse have also been investigated. By removing the nodal fast potassium conductance the action potentials of the sensory fibres are considerably broader than those of the motor neurons. For both types of fibres, the blocked nodal slow potassium channels have a substantially smaller effect on the action potential repolarization. When the suprathreshold depolarizing current intensity is increased, the onset of the spike burst occurs sooner, which is common in the behaviour of the fibres. The most striking differences in the burst activity during early adaptation have been found between the fibres when the nodal fast potassium channels are blocked. The results obtained confirm the fact that the motor fibres adapt more quickly to sustained depolarizing current pulses than the sensory ones. The results also show that normal human motor and sensory fibres cannot be excited by a 100-ms hyperpolarizing current pulse, even at the threshold level. When removing the potassium channels in the nodal or internodal axolemma, the posthyperpolarization increase in excitability is small, which is common in the behaviour of the fibres. However, anode break excitation can be simulated in the fibres with simultaneous removal of the potassium channels under the myelin sheath, and this is more pronounced in the human sensory fibres than in motor fibres. This phenomenon can also be found when the internodal and some of the nodal (fast or slow) potassium channels are simultaneously blocked. Received: 8 November 1999 / Accepted in revised form: 29 February 2000     

Conduction along myelinated and demyelinated nerve fibres with a reorganized axonal membrane during the recovery cycle: model investigations

The changes in the excitability of the reorganized axonal membrane in myelinated and demyelinated nerve fibres as well as the causes conditioning such changes have been investigated by paired stimulation during the first 30 ms of the recovery cycle. The variations of the action potential parameters (amplitude and velocity) are traced also. The simulation of the conduction along the normal fiber is based on the Frankenhaeuser and Huxley (1964) and Goldman and Albus (1968) equations, while the demyelination is considered to be an elongation of the nodes of Ranvier. The axonal membrane reorganization is achieved by means of potassium channel blocking and increase of the sodium-channel permeability. It is shown that potassium channels block decreases membrane excitability for the myelinated and demyelinated fibres in the cases of initial and paired stimulation. With increasing sodium-channel permeability on the background of the blocked potassium channels, the membrane excitability is increased. For the fibres with a reorganized membrane, a supernormality of the membrane excitability is obtained, the latter remaining unrecovered during the 30 ms cycle under investigation. The supernormality of the excitability grows from the demyelinated fibre without reorganized membrane to the demyelinated fibre with reorganized one. For short interstimulus intervals, the second action potential propagates along the fibres with a reduced velocity and a decreased amplitude. No supernormality of the potential parameters (amplitude, velocity) is observed during the cycle up to 30 ms. The membrane properties of the myelinated and demyelinated fibres with blocked potassium channels recover in the interval from 15 to 20 ms depending on whether the sodium channels' increase of the permeability is added on the background of the blocked potassium channel or not. In the recovery cycle, the axonal membrane reorganization leads to an improvement of the conduction along most severely demyelinated fibres.     

Extracellular potential field of excited isolated frog muscle fibres immersed in a volume conductor

The extracellular potential field of isolated frog muscle fibres immersed in a volume conductor was studied at radial distances up to 3 mm during excitation. The shape of the field distant from both the point of the origin of the excitation and the end of the fibre as well as changes in the field when depolarization wave approached the fibre end were described. Different amplitude decrease rates in individual phases of the extracellular potential and the peak-to-peak amplitude at different temperatures were found. Extracellular potentials at long radial distances were recorded using an averaging technique. The shape of the extracellular potentials at long radial distances over the fibre and beyond its end were very similar to the shape of extraterritorial potentials of a single motor unit.     

A mouse model of inflammatory demyelinating neuropathy for the development of therapeutics: electrophysiological and morphological characterizations

To finalize a mouse model of inflammatory demyelinating neuropathy, we injected a solution containing a bovine pancreas protease, active at neutral pH, in the perineural space of the mouse left sciatic nerve (a nerve consisting of myelinated axons). The locomotive behaviour of animals was daily followed and, between 3 and 45 days after the injection, the sciatic nerves were removed from animals, studied using classical electrophysiological techniques and then, at least for some of them, examined using conventional microscopy. The right sciatic nerve, which did not receive a perineural injection, is a very good control, because it comes from the same animal as the left sciatic nerve which underwent the injection. The results obtained show that, under our experimental conditions, i) a demyelinisation of nerve fibres can be detected between 6 and 15 days after the injection of protease, resulting in a defective axonal conduction of action potentials, and ii) 45 days are sufficient to restore a normal axonal conduction. These results are interesting since they indicate that this mouse model can be used to test the ability of new pharmaceutical agents to counteract the defective nerve conduction of action potentials arising after an axonal demyelinisation, in the perspective of developing new useful molecules for the treatment of inflammatory demyelinating neuropathies.     

Changes in the muscle fibre extracellular action potentials in long-lasting (fatiguing) activity

The dependence of extracellular action potentials (ECAPs) of single frog muscle fibres on intracellular action potentials (ICAPs) was studied during long-lasting (fatiguing) activity. The conduction velocity, peak-to-peak amplitude and amplitudes of the separate phases of the first and second ICAP time derivatives decreased during long-lasting activity. The phases of the first and second ICAP space derivatives also decreased in amplitude and lengthened. ECAPs near the membrane were similar in shape and proportional in amplitude to (formula; see text) when recording at a distance from both the end of the fibre and the point of stimulation. At long radial distances, the amplitudes of the separate ECAP phases depended on the amplitude and length of the corresponding phases of (formula; see text). Thus the decrease in ECAP amplitude during long-lasting activity at long radial distances was less than at points close to the muscle fibre membrane. The consequences of these findings for the changes in electromyograms recorded by needle or superficial electrodes during long-lasting (fatiguing) activity are discussed.     

Mononeuropathies of the radial nerve: clinical and neurographic findings in 91 consecutive cases.

Retrospective features of 91 consecutive cases (68 men, 23 women; mean age 44.4 years) of radial mononeuropathy diagnosed over the last 8 years in two electromyography (EMG) services are reported to define the clinical and electrophysiological findings of radial neuropathies in relation to traumatic and non-traumatic causes and site of injury. The occurrence of radial neuropathy was 0.65 x 100 first electromyographic examinations. The most frequent site of damage was the main trunk at the spiral groove of the humerus (36%); the most frequent cause was nerve trauma (70%) due to fracture (36%). In neuropathies of the main trunk and posterior interosseous (PI) nerve, "complete nerve injury" was observed in 36% of cases, conduction motor block in 33% and motor conduction velocity slowing in 46%. At least one of these findings was present in 51%, whereas motor neurography was normal in 13% of cases. Sensory action potential (SAP) anomalies were observed in 51% of cases. In neuropathy of the superficial radial nerve, no SAP was detected in 30% of cases; in all others except one, SAP was reduced in amplitude. Non-traumatic neuropathies showed severer conduction block and less severe anomalies of SAP than traumatic neuropathies. No differences were found between men and women. EMG is essential for confirming the site of injury and neurographic study may be helpful for diagnosis, providing information about lesion type and severity.     

The effect of temperature on a simulated systematically paranodally demyelinated nerve fiber

The temperature dependence (from 10° to 50°C) of the intracellular action potentials' parameters as well as of the ionic currents' kinetics in normal and demyelinated nerve fiber is studied. The simulation of the conduction in the normal fiber is based on the Frankenhaeuser and Huxley (1964) and Goldman and Albus (1968) equations, while in the case of a demyelinated fiber according to the same equations modified by Stephanova (1988). The temperature coefficients (Q ₁₀) for the rate constants as well as for the sodium and potassium permeabilities are introduced. It is shown that increased temperature blocks conduction in the simulated demyelinated fiber at temperatures much lower than the blocking temperature for the normal fiber. When temperature is increased, the amplitude as well as the wavelength and the asymmetry of the potential decrease. The relationship between conduction velocity and temperature is non-linear. The velocity increases when the temperature approaches the blocking temperature, after which abruptly drops. At a given degree of demyelination with increasing temperatures, the ionic currents' flow and the membrane conduction respectively increase, but, at lower temperatures, when the degree of the demyelination is increased, the conduction is blocked.     

Neuropathy Associated with Hepatitis in Patients Maintained on Haemodialysis

During a study of peripheral nerve function in chronic renal failure, 11 patients who were being treated by chronic intermittent haemodialysis developed serum hepatitis. Before the infection there was a trend towards improvement in nerve conduction velocities. A pronounced deterioration in the conduction velocities in motor fibres of peripheral nerves occurred in association with hepatitis. In the months after recovery from the infection there was again a trend towards improvement in conduction velocities. We suggest that this reflects the occurrence of a peripheral neuropathy which is at least in part demyelinating. The neuropathy is related to the serum hepatitis, but its pathogenesis is indeterminate.     

Influence of the muscle fibre end geometry on the extracellular potentials

Intra- and extracellular action potentials of isolated frog muscle fibres were recorded at different distances to the end of the fibre. The first and second time derivatives of the intracellular action potentials were also recorded. The intracellular action potentials and their first and second time derivatives were almost the same regardless of the place of recording. With the decrease in the axial distance to the end the extracellular action potentials changed gradually in a complicated manner from a shape similar to the second time derivative into a shape similar to the first time derivative. Extracellular potentials, having two negative maxima, were recorded over the terminal taper part of the fibres.These alterations were simulated by a mathematical model. It was shown that the changes in the shape of the extracellular action potentials around the end of the fibres were mainly due to the existence of the fibre end though a better correspondence of the experimentally recorded and the calculated extracellular action potentials was obtained when the morphology of the fibre end was taken into consideration.     

Inflammatory demyelinating neuropathies: classification, evolution and prognosis

Inflammatory demyelinating neuropathies can be classified according to the topography of the nervous lesion. Acute and chronic polyradiculoneuritis are characterized by diffuse and multifocal, but predominantly proximal lesions, multifocal motor and sensory-motor neuropathies with persistent conduction blocks are restricted to some nerve trunks, while neuropathies due to monoclonal IgM with anti-MAG (Myelin Associated Glycoprotein) activity show distal and symmetric distribution. The clinical characteristics of inflammatory demyelinating neuropathies vary according to the type of neuropathy. Their course can be remittent or progressive but is especially marked by the risk of definitive axonal lesions, source of permanent neurological deficits. These neuropathies correspond to various mechanisms, which can be differentiated according to the antigenic target, the type of immunological disorder (with respect to cellular or humoral predominance), and the adapted therapeutic strategy. The inflammatory process is accompanied by energetic failure, leading to Na+/K+ pump impairment and intra-axonal Na+ accumulation. This failure results in Na+/Ca2+ exchanger activation, provoking neuronal Ca2+ influx, enzymatic proteolysis and axonal degeneration.     

Spectral and time domain characteristics of single muscle fibre action potentials during continuous activity extracted from model considerations

A model of the muscle fibre extracellular action potentials (ECAPs) calculation using experimentally recorded intracellular action potentials (ICAPs) has been applied to investigate the effect of repetitive stimulation on the electrical activity of isolated frog muscle fibres. The ECAPs were calculated both at small (0.01 mm) and at large (5 mm) radial distances to the fibre axis, and their relationship with the original ICAP parameters has been inferred. Fourier transformation of the calculated ECAPs in order to obtain the spectral characteristics and to trace out their behaviour during continuous fibre activity was performed. Stimulation frequency dependence on the ECAP time characteristics and on the shift of the maximum spectral density towards low frequencies at small and large radial distance were observed. The spectral density peak frequency is propagation velocity (PV)-dependent. The advantage of the presented method over the available experimental extracellular recording techniques from isolated muscle fibers is the possibility to show the effect of continuous muscle fibre activity on the parameters of the ECAPs and their spectral characteristics at large radial distance, which is not experimentally accessible. Our results are in agreement with those experimentally obtained. The results from the model prove the role of changes in PV of excitation along the muscle fibres (representing the last link in the complex organized motor system) in the development of fatigue. Received: 24 July 1997 / Accepted in revised form: 2 July 1998     

Functional Recovery of Regenerating Motor Axons is Delayed in Mice Heterozygously Deficient for the Myelin Protein P0 Gene

Mice with a heterozygous knock-out of the myelin protein P₀ gene (P₀+/?) develop a neuropathy similar to human Charcot–Marie–Tooth disease. They are indistinguishable from wild-types (WT) at birth and develop a slowly progressing demyelinating neuropathy. The aim of this study was to investigate whether the regeneration capacity of early symptomatic P₀+/? is impaired as compared to age matched WT. Right sciatic nerves were lesioned at the thigh in 7–8 months old mice. Tibial motor axons at ankle were investigated by conventional motor conduction studies and axon excitability studies using threshold tracking. To evaluate regeneration we monitored the recovery of motor function after crush, and then compared the fiber distribution by histology. The overall motor performance was investigated using Rotor-Rod. P₀+/? had reduced compound motor action potential amplitudes and thinner myelinated axons with only a borderline impairment in conduction and Rotor-Rod. Plantar muscle reinnervation occurred within 21 days in all mice. Shortly after reinnervation the conduction of P₀+/? regenerated axons was markedly slower than WT, however, this difference decayed with time. Nevertheless, after 1 month, regenerated P₀+/? axons had longer strength-duration time constant, larger threshold changes during hyperpolarizing electrotonus and longer relative refractory period. Their performance at Rotor-Rod remained also markedly impaired. In contrast, the number and diameter distribution of regenerating myelinated fibers became similar to regenerated WT. Our data suggest that in the presence of heterozygously P₀ deficient Schwann cells, regenerating motor axons retain their ability to reinnervate their targets and remyelinate, though their functional recovery is delayed.     

P-ANCA vasculitic neuropathy with 12-year latency between onset of neuropathy and systemic symptoms

Background  

The differential diagnosis of chronic progressive multifocal asymmetric neuropathies is challenging. Vasculitic neuropathies, multifocal forms of chronic inflammatory demyelinating polyneuropathy, multifocal motor neuropathies, and asymmetric lower motor neuron disorders are important considerations.