Bussel B, Roby-Brami A, Azouvi P, Biraben A, Yakovleff A, Held J P
Service de Rééducation Neurologique, Hôpital Raymond Poincaré, Garches, France.
Brain. 1988 Oct;111 ( Pt 5):1235-45. doi: 10.1093/brain/111.5.1235.
A patient with clinically complete cervical spinal cord transection developed rhythmic myoclonic movements of the trunk and lower limbs, demonstrating that, in man, such movements can be generated within the spinal cord itself when deprived of supraspinal control. Electromyographic (EMG) recordings used to define the features of the myoclonus, which had a frequency of 0.3-0.6 Hz, was bilaterally symmetric, and involved extensor muscles. The EMG bursts always appeared in phase in all muscles involved. Peripheral stimulation of flexor reflex afferents (FRA) could induce, slow or interrupt the rhythmic activity. When FRA stimulation induced a flexion reflex, it occurred between extensor EMG bursts and induced alternating flexion-extension activity which could be sustained for several cycles. Soleus and quadriceps monosynaptic reflexes were depressed during the silent period of the rhythmic activity. Several arguments, mainly the great sensitivity of the myoclonus to flexor reflex afferent stimulation, suggest that the myoclonus observed in this patient was due to partial release of a spinal stepping generator.
一名临床上颈髓完全横断的患者出现了躯干和下肢的节律性肌阵挛运动，这表明在人类中，当脊髓失去脊髓以上的控制时，这种运动可在脊髓自身内部产生。用于确定肌阵挛特征的肌电图（EMG）记录显示，其频率为0.3 - 0.6Hz，双侧对称，且涉及伸肌。所有受累肌肉的EMG爆发总是同步出现。对屈肌反射传入纤维（FRA）进行外周刺激可诱导、减慢或中断这种节律性活动。当FRA刺激诱发屈肌反射时，它出现在伸肌EMG爆发之间，并诱发可维持几个周期的交替屈伸活动。在节律性活动的静息期，比目鱼肌和股四头肌的单突触反射受到抑制。几个论据，主要是肌阵挛对屈肌反射传入刺激的高度敏感性，表明在该患者中观察到的肌阵挛是由于脊髓步发生器的部分释放所致。
