Publications by authors named "B A Kakulas"

187 Publications

Spinal cord injuries, human neuropathology and neurophysiology.

Acta Myol 2020 Dec 1;39(4):353-358. Epub 2020 Dec 1.

Perron Institute for Neurological and Translational Neuroscience, Perth, Western Australia, Australia.

A correlative approach to human spinal cord injuries (SCI) through the combination of neuropathology and neurophysiology provides a much better understanding of the condition than with either alone. Among the benefits so derived is the wide range of interventions applicable to the restorative neurology (RN) of SCI so that the neurological status of the SCI patient is thereby much improved. The neurophysiological and neuropathological elements underlying these advances are described.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.36185/2532-1900-039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7783432PMC
December 2020

The neuropathological foundations for the restorative neurology of spinal cord injury.

Clin Neurol Neurosurg 2015 Feb 29;129 Suppl 1:S1-7. Epub 2015 Jan 29.

Faculty of Medicine, Hasanuddin University, Indonesia.

An appreciation of the neuropathology of human spinal cord injury (SCI) is a basic requirement for all concerned with the medical treatment of patients with SCI as well as for the many neuroscientists devoted to finding a "cure". An understanding of the neuropathology of SCI is a necessary guide to those concerned at all levels of treatment, whether they are doctors or other health professionals. The underlying changes in the spinal cord are especially relevant to the restorative neurology (RN) of SCI. The new discipline of RN seeks to enhance the function of residual spinal cord elements which have survived the injury and so improve the patient's rehabilitative status. This is in contrast to the conventional approach in rehabilitation which works around the clinical neurological deficiencies. Following the injury a series of changes take place in the spinal cord and surrounding tissues which continue to evolve throughout the life of the patient. In flexion and extension injuries resulting from motor vehicle trauma, diving and sporting accidents the spinal cord is compressed and disrupted but usually with some continuity remaining in the white matter columns. The brunt of the injury is usually centrally placed where there is bleeding into the disrupted grey matter involving one two segments, usually cervical. The loss of central grey matter is nowhere near as important as is the tearing apart of the white matter tracts in determining the patient's clinical state. The central grey matter supplies one two overlapping segmental myotomes and sensory fields. In contrast loss of continuity in the long white matter tracts is catastrophic because all functions below the level of injury are affected, autonomic or voluntary either by paralysis or anaesthesia, usually both. It is important to determine the exact nature of the injury in every patient as a preliminary to treatment by RN. This assessment is both clinical and neurophysiological with special attention given to any part of the long white matter tracts which may have escaped the initial injury. It is these residual nerve fibres which provide the opportunity to improve the patient's neurological state by being re-activated, modulated and enhanced by stimulation or by other RN methods. The conversion of a clinically complete SCI patient to being incomplete and ambulant is a tremendous improvement in the patient's status. It is the purpose of this article to provide the reader with the essential neuropathology of SCI as a beginning point in planning treatment whether it is medical or ancillary, as well as to inform the neuroscientist about the condition being addressed in his or her research.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clineuro.2015.01.012DOI Listing
February 2015

Restorative neurology: past, present, and future.

Clin Neurol Neurosurg 2012 Jun 22;114(5):524-7. Epub 2012 Mar 22.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clineuro.2012.02.055DOI Listing
June 2012

Restorative neurology: consideration of the new anatomy and physiology of the injured nervous system.

Clin Neurol Neurosurg 2012 Jun 1;114(5):436-40. Epub 2012 Feb 1.

Spinal Cord Injury Research and Restorative Neurology, Crawford Research Institute, Shepherd Center, Department of Neurology, Emory University School of Medicine, Atlanta Veterans Administration Medical Center, Atlanta, GA 30309, USA.

The adult human nervous system is an incredibly complex set of thousands to tens of thousands of connections between a hundred billion neurons that develops via an intricate spatial-temporal process and is shaped by experience. In addition, any one anatomical arrangement of neural circuits is usually capable of multiple physiological states. Following neurological injury, a new anatomy, and consequently a new spectrum of physiology, emerges within this nervous system with its mix of both injured and uninjured parts. It is this new combination of neural components that determines the extent to which natural functional recovery can occur and the extent to which clinical interventions can further that recovery. Detecting the new anatomy and physiology of the injured human nervous system is difficult but not impossible and some methods can track over time changes in neural structure or, more often, functions that correlate with neurological improvement. The goal of restorative neurology is to make best use of this new anatomy and physiology to facilitate neurological recovery. While we are still learning about how neurorehabilitation interventions generate functional recovery, we can begin to test hypothesis regarding the underlying mechanisms of neural plasticity and attempt to augment those processes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clineuro.2012.01.010DOI Listing
June 2012

NG2 and phosphacan are present in the astroglial scar after human traumatic spinal cord injury.

BMC Neurol 2009 Jul 15;9:32. Epub 2009 Jul 15.

Department of Neurology, Aachen University Medical School, RWTH Aachen, Pauwelsstrasse 30, Germany.

Background: A major class of axon growth-repulsive molecules associated with CNS scar tissue is the family of chondroitin sulphate proteoglycans (CSPGs). Experimental spinal cord injury (SCI) has demonstrated rapid re-expression of CSPGs at and around the lesion site. The pharmacological digestion of CSPGs in such lesion models results in substantially enhanced axonal regeneration and a significant functional recovery. The potential therapeutic relevance of interfering with CSPG expression or function following experimental injuries seems clear, however, the spatio-temporal pattern of expression of individual members of the CSPG family following human spinal cord injury is only poorly defined. In the present correlative investigation, the expression pattern of CSPG family members NG2, neurocan, versican and phosphacan was studied in the human spinal cord.

Methods: An immunohistochemical investigation in post mortem samples of control and lesioned human spinal cords was performed. All patients with traumatic SCI had been clinically diagnosed as having "complete" injuries and presented lesions of the maceration type.

Results: In sections from control spinal cord, NG2 immunoreactivity was restricted to stellate-shaped cells corresponding to oligodendrocyte precursor cells. The distribution patterns of phosphacan, neurocan and versican in control human spinal cord parenchyma were similar, with a fine reticular pattern being observed in white matter (but also located in gray matter for phosphacan). Neurocan staining was also associated with blood vessel walls. Furthermore, phosphacan, neurocan and versican were present in the myelin sheaths of ventral and dorsal nerve roots axons. After human SCI, NG2 and phosphacan were both detected in the evolving astroglial scar. Neurocan and versican were detected exclusively in the lesion epicentre, being associated with infiltrating Schwann cells in the myelin sheaths of invading peripheral nerve fibres from lesioned dorsal roots.

Conclusion: NG2 and phosphacan were both present in the evolving astroglial scar and, therefore, might play an important role in the blockade of successful CNS regeneration. Neurocan and versican, however, were located at the lesion epicentre, associated with Schwann cell myelin on regenerating peripheral nerve fibres, a distribution that was unlikely to contribute to failed CNS axon regeneration. The present data points to the importance of such correlative investigations for demonstrating the clinical relevance of experimental data.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/1471-2377-9-32DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725028PMC
July 2009
-->