Brain, Vol. 117, No. 6, 1449-1455, 1994
© 1994 Guarantors of Brain
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A quantitative assessment of presynaptic inhibition of la afferents in spastics
Differences in hemiplegics and paraplegics
1Department of Clinical Neurology and Neurophysiology, University of Freiburg Germany
2Department of Clinical Neurophysiology, Rééducation, Hôpital de la Salpétrière Paris, France
3Swiss Paraplegic Centre, University Hospital Balgrist Z
rich, Switzerland
Correspondence to:
Correspondence to: Professor E. Pierrot-Deseilligny, Rééducation, Hôpital de la Salpétrière, 47 Bd de I'H{circumflex}opital, 75651 Paris, Cedex 13, France
Soleus H-reflex facilitation evoked by a supramaximal conditioning stimulation to the femoral nerve was investigated in 28 healthy control subjects and 35 spastic patients of whom 17 were paraplegics with bilateral spinal cord lesion and 18 were hemiplegics with unilateral cerebral lesion. Heteronymous facilitation from quadriceps to soleus was measured 0.4 ms after onset, while the monosynaptic la excitation is still uncontaminated by any non-monosynaptic effect and can be used to assess ongoing presynaptic inhibition on la terminals to soleus motor neurons. In paraplegics, this heteronymous la facilitation was significantly larger than in control subjects (all individual results in these patients being above the mean observed in controls). This must reflect a decrease in presynaptic inhibition of la terminals in the paraplegics explored here. There was no correlation between this decreased presynaptic inhibition of la terminals and the degree of spasticity measured by Ashworth's scale. Surprisingly, the amount of heteronymous la facilitation in hemiplegics was the same as in normal subjects. This indicates that presynaptic inhibition of la terminals is unchanged in these patients and disagrees with the usual interpretation of reduced vibratory inhibition of the soleus H-reflex in hemiplegics. It is argued that this disagreement is due to the fact that vibratory inhibition of the reflex also depends on post-activation depression following repetitive synaptic transmission.
spasticity;; presynaptic inhibition;; hemiplegia;; paraplegia;; monosynaptic reflex
Received February 9, 1994. Revised April 21, 1994. Accepted June 10, 1994.
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