Göbel H, Dworschak M
Klinik für Neurologie, Christian-Albrechts-Universität, Kiel.
Nervenarzt. 1996 Oct;67(10):846-59. doi: 10.1007/s001150050062.
The exteroceptive suppression period (ES) of the temporalis muscle activity is a trigemino-trigeminal brain stem reflex. It will be elicited most when stimulating trigeminal sensory afferents by painful stimuli and typically leads to a biphasic interruption of voluntary muscle activity. The first phase of decreased voluntary activity is called the early exteroceptive suppression period (ES1), the second, the late exteroceptive suppression period (ES2). Between these two suppression periods a phase of increased muscle activity, the so-called facilitation period (FP), can be seen. This phenomenon can be modulated by different stimulating parameters and usually, in healthy subjects, this normal pattern of the exteroceptive suppression can be elicited regularly. The reflex answer may occur at low non-painful stimulus intensities; typically, however, it appears to be most pronounced with high-intensity stimuli. Because of the obvious relationship between stimulus intensity, pain perception and reflex, the reflex is regarded as an antinociceptive reaction. The absence of an inhibition of motor activity can be visualized, for example, in hemimasticatory spasm or dystonic disorders. However, above all the ES nowadays attracts most attention as a tool to analyse different pain syndromes. One main advantage of this method in man is the ability to evaluate certain antinociceptive brain stem mechanisms functionally by means of a simple noninvasive technique. A large number of results have been obtained showing that chronic pain syndromes such as chronic tension-type headache and migraine cause changes within the normal ES recording pattern. Furthermore, some substances used in pain therapy, such as serotonin agonists or antagonists, acetylsalicylic acid or naloxone, may also alter the general appearance of the ES. This review will summarize different parameters that influence the ES reflex answer. Furthermore, the diagnostic value of changes in the ES for pathophysiological processes regarding pain perception and processing in certain pain syndromes will be discussed.
颞肌活动的外感受性抑制期（ES）是一种三叉神经-三叉神经脑干反射。当通过疼痛刺激激发三叉神经感觉传入时，该反射最易被诱发，通常会导致随意肌活动出现双相中断。随意活动减少的第一阶段称为早期外感受性抑制期（ES1），第二阶段称为晚期外感受性抑制期（ES2）。在这两个抑制期之间，可以看到肌肉活动增加的阶段，即所谓的易化期（FP）。这种现象可由不同的刺激参数调节，通常在健康受试者中，这种正常的外感受性抑制模式可以被定期诱发。反射反应可能在低强度非疼痛刺激时出现；然而，通常在高强度刺激时最为明显。由于刺激强度、疼痛感知和反射之间存在明显关系，该反射被视为一种抗伤害感受反应。例如，在偏侧咀嚼肌痉挛或肌张力障碍性疾病中，可以观察到运动活动抑制的缺失。然而，如今ES作为分析不同疼痛综合征的工具最受关注。该方法在人体中的一个主要优点是能够通过一种简单的非侵入性技术从功能上评估某些抗伤害感受性脑干机制。已经获得了大量结果，表明慢性紧张型头痛和偏头痛等慢性疼痛综合征会导致正常ES记录模式发生变化。此外，一些用于疼痛治疗的物质，如5-羟色胺激动剂或拮抗剂、乙酰水杨酸或纳洛酮，也可能改变ES的总体表现。本综述将总结影响ES反射反应的不同参数。此外，还将讨论ES变化在某些疼痛综合征中关于疼痛感知和处理的病理生理过程的诊断价值。
