Van de Crommert H W A A, Steijvers P J M, Mulder Th, Duysens J
Sint Maartenskliniek-Research, Sint Maartenskliniek, Nijmegen, The Netherlands.
Exp Brain Res. 2003 Apr;149(4):405-12. doi: 10.1007/s00221-002-1366-4. Epub 2003 Mar 7.
In the cat it is known that the distribution and modulation of the so-called P2 responses are similar, irrespective of whether they are obtained with electrodes implanted in the different skin areas or in the various leg muscles. In man it is known that the specific stimulation of cutaneous afferents from different parts of the foot evokes P2 responses, the phase-dependent modulation pattern of which exhibits both location-specific and common features. Responses generally differ, but one striking feature is the occurrence of suppressive responses in the tibialis anterior (TA) of the ipsilateral (i) leg at the end of the swing phase independent of the nerve stimulated. The question arises of whether this aspecificity is limited to the foot. Can similar suppressive P2 responses in iTA be obtained when afferents outside the region of the foot are stimulated during walking? If so this would indicate that there is a very general suppression occurring of input to the TA motor neuron pool, for example through presynaptic inhibition of a corticospinal drive. To answer this type of question the motor responses following transcutaneous stimulation of the rectus femoris (RF) and the motor responses following stimulation of the femoral nerve branch innervating the skin area above the quadriceps were determined during human locomotion. Electromyographic (EMG) activity in iTA was recorded by means of surface electrodes. In all subjects (N=10), the first consistent responses following RF stimulation occurred at about 80 ms poststimulus. The amplitude of these responses showed a clear phase-dependent modulation pattern. Facilitatory responses occurred during the end stance and early swing phase and turned into suppressive responses at the end of the swing phase. To investigate whether cutaneous afferents overlying the RF determined some of the responses following transcutaneous RF stimulation, the experiments were repeated following local anesthesia of the skin under the stimulation electrodes. This did not affect the responses substantially, indicating that most of the RF stimulation results were related to activation of muscle afferents. A similar phase-dependent modulation pattern was found following stimulation of cutaneous afferents of the femoral nerve (Fn). However, this phase-dependent modulation pattern was less pronounced and less consistent over the subjects when compared to the one found following RF stimulation. Our first conclusion is that the results show that P2 reflexes can be elicited both by stimulation of cutaneous afferents in the foot and by proximal cutaneous nerve and muscle stimulation. Secondly, it can be concluded that the suppressive responses at the end of the swing phase are present for both RF stimulation and stimulation of cutaneous afferents of the foot. This result indicates that a wide variety of afferent inputs have a suppressive influence on the input drive to TA motor neurons just prior to heel strike.
已知在猫中,无论所谓的P2反应是通过植入不同皮肤区域还是不同腿部肌肉的电极获得,其分布和调制都是相似的。在人类中,已知来自足部不同部位的皮肤传入神经的特定刺激会引发P2反应,其相位依赖性调制模式呈现出位置特异性和共同特征。反应通常有所不同,但一个显著特征是,在摆动末期,同侧(i)腿的胫骨前肌(TA)会出现抑制反应,且与所刺激的神经无关。问题在于这种非特异性是否仅限于足部。在行走过程中刺激足部区域以外的传入神经时,能否在同侧胫骨前肌中获得类似的抑制性P2反应?如果是这样,这将表明存在一种非常普遍的对TA运动神经元池输入的抑制,例如通过对皮质脊髓驱动的突触前抑制。为了回答这类问题,在人类运动过程中,测定了股直肌(RF)经皮刺激后的运动反应以及刺激支配股四头肌上方皮肤区域的股神经分支后的运动反应。通过表面电极记录同侧胫骨前肌的肌电图(EMG)活动。在所有受试者(N = 10)中,RF刺激后最早出现的一致反应发生在刺激后约80毫秒。这些反应的幅度呈现出明显的相位依赖性调制模式。在终末站立期和早期摆动期出现易化反应,在摆动末期转变为抑制反应。为了研究覆盖股直肌的皮肤传入神经是否决定了经皮RF刺激后的一些反应,在刺激电极下方的皮肤局部麻醉后重复了实验。这对反应没有实质性影响,表明RF刺激的大多数结果与肌肉传入神经的激活有关。在刺激股神经(Fn)的皮肤传入神经后也发现了类似的相位依赖性调制模式。然而,与RF刺激后发现的模式相比,这种相位依赖性调制模式在受试者中不太明显且不太一致。我们的第一个结论是,结果表明P2反射既可以通过刺激足部的皮肤传入神经引发,也可以通过近端皮肤神经和肌肉刺激引发。其次,可以得出结论,在摆动末期的抑制反应在RF刺激和足部皮肤传入神经刺激中都存在。这一结果表明,在足跟撞击之前,多种传入输入对TA运动神经元的输入驱动具有抑制作用。