Crone C, Nielsen J, Petersen N, Ballegaard M, Hultborn H
Department of Clinical Neurophysiology, Gentofte Amtssygehus, Copenhagen, Denmark.
Brain. 1994 Oct;117 ( Pt 5):1161-8. doi: 10.1093/brain/117.5.1161.
The soleus Hoffmann-reflex (H-reflex) was conditioned by a preceding stimulation of the common peroneal nerve in 74 healthy control subjects and 39 patients with spasticity in the lower extremities due to multiple sclerosis. At a conditioning-test interval of 1-3 ms a decrease of the size of the soleus H-reflex was seen in the healthy subjects. The decrease was most likely caused by disynaptic reciprocal Ia inhibition (Crone et al., 1987). In the spastic patients a similar short-latency inhibition was rarely seen. On the contrary, in several patients a facilitation was seen at a conditioning-test interval of 3-4 ms. A short-latency inhibition as pronounced as in healthy subjects was seen in four patients. These four patients did not differ from the other patients regarding the degree of spasticity or any other clinical parameter. However, they all used an external peroneal nerve stimulator daily as a walking aid. It is suggested that the lack of short-latency reciprocal inhibition reflects a deficient control of the interneurons which mediate this inhibitory spinal mechanism between antagonistic muscles in man. This might contribute to the pathophysiology of spasticity and it might be related to the frequent occurrence of co-contraction of functionally antagonistic muscles during gait in spastic patients. The existence of a pronounced reciprocal inhibition in patients receiving frequent stimulation of the peroneal nerve may suggest that regular activation of peripheral nerves is of importance for the maintenance of the activity in spinal pathways.
在74名健康对照者和39名因多发性硬化导致下肢痉挛的患者中，用先前刺激腓总神经的方法对比目鱼肌霍夫曼反射（H反射）进行条件刺激。在健康受试者中，当条件刺激-测试间隔为1 - 3毫秒时，可观察到比目鱼肌H反射的波幅减小。这种减小很可能是由双突触交互性Ia抑制引起的（克朗等，1987年）。在痉挛患者中，很少见到类似的短潜伏期抑制。相反，在一些患者中，在条件刺激-测试间隔为3 - 4毫秒时可观察到易化现象。在4名患者中观察到了与健康受试者一样明显的短潜伏期抑制。这4名患者在痉挛程度或任何其他临床参数方面与其他患者并无差异。然而，他们都每天使用外部腓总神经刺激器作为行走辅助工具。提示短潜伏期交互抑制的缺失反映了对中间神经元的控制不足，这些中间神经元介导了人类拮抗肌之间的这种脊髓抑制机制。这可能促成了痉挛的病理生理学过程，并且可能与痉挛患者在步态中功能拮抗肌频繁共同收缩的现象有关。在接受腓总神经频繁刺激的患者中存在明显的交互抑制，这可能表明外周神经的定期激活对于维持脊髓通路的活动很重要。
