Spinal motoneuronal excitability in hyperkinesis: H-reflex recovery function and homosynaptic depression during wakefulness.

Variations in amplitude of the spinal monosynaptic H-reflex were examined during relaxed wakefulness in three unmedicated groups of subjects, hyperactive children (n=5), an age-matched group of control children (n=5), and a group of young adults (n=10), using techniques involving equal intensity percutaneous stimuli delivered in pairs or trains at varying rates. The paired-stimuli procedure generates a recovery function, the outstanding features of which are early depression, a peak of facilitation occurring between 100-300 msec, and complete recovery by 2-5 sec. Trains of stimuli delivered at rates greater than or equal to 1/sec effect a reduction in reflex amplitude which is termed homosynaptic depression. Both procedures revealed differences between hyperkinetic children and comparison groups. The paired-stimulus technique revealed a generalized reduction in excitability for hyperkinetic children for intervals extending up to 800 msec. In particular, hyperkinetic children were characterized by a significantly increased variability at the longer stimulus intervals. Hyperkinetic children also showed a more rapid reduction in reflex amplitude to initial stimuli in stimulus trains delivered at rates greater than or equal to 1/sec. Trains of stimuli at rates effecting facilitation in terms of the paired stimulus technique, i.e., 3,4 and 5/sec, revealed sustained amplitude enhancement for control subjects only. The recovery function data are consonant with spinal motoneuronal hypoexcitability in hyperkinetic children. Possible neruophysiological and neurochemical mechanisms underlying the reduced capability of hyperkinetic children to respond to rapidly delivered, repetitive stimuli are discussed.