Nerve specific modulation of somatosensory inflow to cerebral cortex during submaximal sustained contraction in first dorsal interosseous muscle

Modulation of the early component (latency approximately 20-30 ms) of somatosensory evoked potentials (SEPs) and that of the middle and long latency cutaneous reflexes was examined in 13 healthy volunteers during fatiguing submaximal voluntary contraction (20% maximum) of the first dorsal interosseous muscle (FDI). The SEP was evoked by stimulating the ulnar nerve (U-SEP), a mixed nerve innervating the FDI muscle, the purely cutaneous nerves of the 2nd digit (D2-SEP) and the 5th digit (D5-SEP). The cutaneous reflex was recorded concurrently with D2-SEP. The size of D2- and D5-SEP significantly decreased during fatiguing contraction as compared to rest, and the decrease in both SEPs persisted throughout fatiguing contraction. In contrast, the significant decrease in the gating of U-SEP disappeared during the latter phase of fatiguing contraction. The ratio (reflex response/background EMG) of excitatory E2 (latency approximately 60-90 ms) and E3 (approximately 120-180 ms) responses following D2 stimulation significantly increased during the middle or latter phase of fatiguing contraction. In contrast, no significant changes in inhibitory I1 and I2 were seen. The release of the attenuation of U-SEP and a constant gating of the D2- and D5-SEP suggests that the brain selectively permits the muscular afferent inflow into the cortex during fatiguing contraction. An increase in the E2 and E3 reflex ratio of cutaneous reflexes during the later phase of fatiguing contraction most likely results from an increase in the excitability of the motor cortex.     

Gain and spatial characteristics of human lip-muscle reflexes

Mechanically evoked early and late excitatory reflexes (E1 and E2) and suppression responses (S) were studied in human lip muscle. Acceleration pulses were applied at 30-150 m/s2 independently to the upper and lower lips during lip rounding and lower-lip depression postures, and to both lips during a lip-press posture. E1 responses were prevalent during lip rounding and press gestures and S responses during lip depression. Reflex magnitudes were well correlated with stimulus acceleration for the 3 response components, with E1 responses showing the strongest association. The slopes of linear equations relating reflex and stimulus magnitudes, i.e. reflex gains, for E1 and E2 responses were highly variable across subjects. This variability was partially related to subject gender, females showing larger reflex gains. Two novel findings on the spatial aspects of lip-muscle reflexes are that: (1) S responses in lower-lip muscle are more prevalent to upper-lip versus lower-lip stimulation, and (2) E1 and E2 gains in lower-lip muscle are larger for stimulation of the lower lip compared to stimulation of the upper lip. Further testing suggested that this latter pattern differs with form of stimulation, with a laterally directed sliding stimulus on the upper lip producing predominant effects in both the upper- and lower-lip muscle, and an indenting stimulus producing the largest reflexes in muscle of the stimulated lip.     

Cutaneomuscular reflexes following stroke: a 2-year longitudinal study

Cutaneomuscular reflex responses (CMRs) have been studied in nine stroke patients (55-84 years) starting from the first 1-7 weeks after stroke and continuing at intervals of 6-8 weeks for up to 2 years. Multi-unit surface EMG signals were recorded from the stroke and non-stroke first dorsal interosseous (1DI) hand muscle while subjects gripped a dowel, and concomitant stimulation of the digital nerves of the index finger was delivered at 2.5 x threshold for perception. Motor function was measured using the Motor Assessment Scale (MAS) and patients were classified as having a good or a poor recovery according to their final functional outcome. None of the patients showed a change in the sizes of the E1, I1 and E2 reflex components over time. At initial testing, the size of the E1 component for all patients who showed good recovery fell within the 95% reference range (0-16.5% modulation of background EMG) found for normal age matched controls. In contrast, when first tested, 5/5 patients who showed no significant recovery over the 2-year period, had exaggerated spinal E1 components greater than 16.5%. We conclude that exaggerated E1 components could be predictive of a poor functional outcome at 2 years.     

Contralateral intramuscular acupuncture-like electrical stimulation differentially changes the short-latency responses to muscle stretch

Measurements were made from the human first dorsal interosseous and extensor digitorum communis muscles of the surface electromyographic activity reflexly produced by brief stretch of the muscle. For the first dorsal interosseous muscle, reflex EMG activity was also produced by electrical stimulation of the ulnar nerve at the wrist. The procedures were carried out before, during, and after 25 min of nonspecific, low-frequency electrical stimulation to the contralateral arm delivered through intramuscular electrodes. Control stimulation was delivered subcutaneously. The EMG recorded during a maintained contraction was rectified, filtered, and averaged. Two reflex components (M1 and M2) of the EMG response to muscle stretch or ulnar nerve stimulation were investigated. During nonspecific intramuscular stimulation to the contralateral arm, M1 responses of the extensor digitorum communis were depressed, initially by 37%. The effect began to fade during stimulation but extended beyond it. Reflex responses were elicited alternately by brief stretch of the first dorsal interosseus muscle and by electrical stimulation of the ulnar nerve in the same experiment. Nonspecific intramuscular stimulation to the contralateral arm depressed the M1 response to stretch, but had no effect on the M1 response to electrical stimulation. It is concluded that nonspecific intramuscular electrical stimulation reduces the amplitude of the M1 component of the response to brief stretch of contralateral muscle, either through depression of fusimotor activity or inhibition of oligosynaptic pathways that contribute to the early reflex response.     

Excitation of the motor cortex associated with the E2 phase of cutaneous reflexes in man

We investigated excitability changes of the motor cortex associated with the E2 phase of cutaneous reflexes in the first dorsal interosseous muscle using transcranial electrical and magnetic stimulation of the motor cortex in humans. EMG responses to combined cutaneous and weak magnetic cortical stimulation, which were elicited during the E2 phase of cutaneous reflexes, were larger than those by the same magnetic cortical stimulation alone. This facilitatory effect was reduced or even inhibitory effect was seen when the intensity of cortical stimulation was increased. Responses to weak electrical cortical stimulation were less affected by the combined cutaneous stimulation. The same facilitatory effect on responses to weak magnetic cortical stimulation was also observed in single motor unit recordings, too. Dissociation between facilitatory effects on the responses evoked by weak magnetic and weak electrical cortical stimulations suggests that the motor cortical excitability is increased in association with the E2 phase. The present results are consistent with the hypothesis that the E2 phase is a kind of transcortical reflex.     

Neural organization of the viscero-cardiac reflexes

The reflex responses evoked in the postganglionic nerves to the heart were tested in chloralose-anaesthetized cats. Electrical stimulation of the A delta afferent fibres from the left inferior cardiac nerve evoked spinal and supraspinal reflex responses with the onset latencies of 36 ms and 77 ms respectively. The most effective stimulus was a train of 3-4 electrical pulses with the intratrain frequency of 200-300 Hz. Electrical stimulation of the high threshold afferent fibres (C-fibres) from the left inferior cardiac nerve evoked the reflex response with the onset latency of 200 ms. The C-reflex was present in intact animals and disappeared after spinalization. The most effective stimulus to evoke this reflex was a train of electrical pulses delivered at a frequency of 1-2 Hz with an intratrain frequency of 20-30 Hz. The most prominent property of the C-reflex was its marked increase after prolonged repeated electrical stimulation. We conclude that: (1) viscero-cardiac sympathetic reflexes may be organized at the spinal and supraspinal level; (2) viscero-cardiac sympathetic reflexes evoked by stimulation of the A delta and C afferent fibres from the left inferior cardiac nerve have different central organization.     

Is the cutaneous silent period an opiate‐sensitive nociceptive reflex?

In humans, high-intensity electrical stimuli delivered to the fingers induce an inhibitory effect on C7-T1 motoneurons. This inhibitory reflex, called the cutaneous silent period (CSP) is considered a defense response specific for the human upper limbs. It is not clear whether the CSP-like other defense responses such as the corneal reflex and the R III reflex-is an opiate-sensitive nociceptive reflex. Because opiates suppress some, but not all, nociceptive reflexes, we studied the effect of the narcotic-analgesic drug fentanyl on the CSP and the R III reflex. The CSP was recorded from the first dorsal interosseous (FDI) muscle in seven normal subjects during voluntary contraction, before and 10 and 20 min after fentanyl injection. To assess possible fentanyl-induced changes, we also tested the effect of finger stimulation on motor evoked potentials (MEPs) elicited in the FDI muscle by transcranial magnetic stimulation before and after fentanyl injection. Fentanyl-induced changes were also studied on the R III reflex recorded from the biceps femoris muscle. Fentanyl, as expected, suppressed the R III reflex but failed to change the inhibitory effect of finger stimulation on FDI motoneurons. Finger stimulation reduced the size of MEPs in the FDI, and fentanyl injection left this inhibitory effect unchanged. The differential fentanyl-induced modulation of the CSP and R III reflex provides evidence that the CSP circuit is devoid of mu-opiate receptors and is therefore an opiate-insensitive nociceptive reflex, which may be useful in the assessment of central-acting, non-opioid drugs.     

Long latency response of the mentalis muscle following transcranial magnetic stimulation with a circular coil in normal subjects

Short latency response (SLR), middle latency response and long latency response (LLR) are elicited in facial muscles by transcranial magnetic stimulation. Although it has been said that the LLRs are elicited by the trigeminal nerve stimulation, a trigeminofacial reflex is recorded easily in normal subjects by the electrical stimulation in orbicularis oculi muscles as a blind reflex, but a trigeminal-facial reflex recorded in orbicularis oris, namely a snout reflex, is more difficult to record in normal subjects. The aim of this study is to demonstrate the LLR of lower facial muscles (mentalis muscle) by the transcranial magnetic stimulation, using a circular coil. The transcranial magnetic stimulations were performed over parieto-occipital scalp with frequencies of random and 0.3 Hz in 11 normal subjects and the responses in the mentalis muscle were recorded. The LLR of the mentalis muscle was recorded in all 11 subjects following SLRs. The latency, duration and LLR/SLR ratio were 37.4 msec, 20.3 msec and 9.1%, respectively. The waveform of the LLR varied trial to trial showing habituation with a stimulation of 0.3 Hz. At this time the LLR of the masseter muscle was not recorded following this transmagnetic stimulation. It was suggested that the LLR of the mentalis muscle is recorded by the transcranial magnetic stimulation of the trigeminal nerve with a circular coil. The ease and reliability of their recording make it possible to apply this LLR clinically as well as a blink reflex.     

Motor neurone excitability in back muscles assessed using mechanically evoked reflexes in spinal cord injured patients

Objective: The clinical and functional assessment of back muscles in human spinal cord injury (SCI) has received little attention. The aim of this study was to develop a method to assess the level of a thoracic spinal cord lesion based on the reflex activation of back muscles. Methods: In 11 control subjects and in 12 subjects with clinically complete thoracic SCI (T2–T12), either a spinous process or an erector spinae muscle was prodded to elicit short latency reflexes recorded electromyographically at the spinal level of stimulation. An electromagnetic servo, attached to a blunt probe, applied stimuli at a frequency of 1 Hz and amplitude of 3 mm. Two trials of 50 mechanical prods were conducted at each site. Results: Reflexes were evoked in control subjects in 82% of trials when the spinous process was prodded, and in 80% of trials when the muscle was prodded. In contrast, reflexes in SCI subjects could be elicited in 90–100% of trials two segments either above or below the lesion. Reflex responses in control subjects had a mean (SEM) latency of 5.72 (0.53) ms when the spinous process was prodded, and 5.42 (0.42) ms when the muscle was prodded. In the SCI subjects, responses had slightly (but insignificantly) longer latencies both above and below the lesion to either stimulus. The amplitude of reflex responses, expressed as a percentage of the background EMG, was on average 2–3 times larger at the three vertebral levels spanning the lesion in SCI subjects than at sites above or below the lesion or at any level in control subjects. Conclusion: We propose that the size of these mechanically evoked reflexes may be useful in determining the level of thoracic SCI. Furthermore, the reflexes might provide a valuable tool with which to monitor recovery after an intervention to repair or improve function of a damaged spinal cord.     

Location-specific and task-dependent modulation of cutaneous reflexes in intrinsic human hand muscles.

OBJECTIVE: The current study was designed to determine location-specificity in long latency cutaneous reflexes in intrinsic human hand muscles while performing a simple abduction and a manual task. METHODS: Subjects comprised of 13 neurologically intact healthy volunteers. Cutaneous reflexes following non-noxious electrical stimulation to the digits of the hand (digit 1, D1; digit 2, D2; and digit 5, D5) were elicited while the subjects performed isolated isometric contraction of the abductor pollicis brevis (APB), first dorsal interosseous (FDI) and abductor digiti minimi muscles (ADM). The cutaneous reflexes were also elicited while the subjects performed a pincer grip with D1 and D2 while slightly lifting the hand from the supporting surface by abduction of D5 (manual task). RESULTS: While performing isolated tonic voluntary contraction of the APB, FDI and ADM, the magnitude of E2 (peak latency approximately 60-90 ms) was larger when stimulation was delivered to the homotopic digit (e.g. APB response following D1 stimulation) than to the heterotopic nearby (e.g. APB response following D2 stimulation) or heterotopic distant digit (e.g. APB response following D5 stimulation). I2 ( approximately 90-120 ms) and E3 ( approximately 120-180 ms) were significantly larger following D5 stimulation than D1 or D2 stimulation in all muscles tested. The size of each component in the ADM following D1 and D2 stimulation did not increase even when the contraction level of the ADM increased. However, while performing the manual task, the E2 response in the ADM following both D1 and D2 stimulation was significantly increased as compared to that recorded during isolated D5 abduction. CONCLUSIONS: Long latency cutaneous reflexes following non-noxious electrical stimulation are organized in a highly location-specific as well as task-dependent manner. SIGNIFICANCE: Our findings provide further insight into the nature and functional significance of long latency cutaneous reflexes in human intrinsic hand muscles.     

Proprioceptive neuropathy affects normalization of the H-reflex by exercise after spinal cord injury

The H-reflex habituates at relatively low frequency (10 Hz) stimulation in the intact spinal cord, but loss of descending inhibition resulting from spinal cord transection reduces this habituation. There is a return towards a normal pattern of low-frequency habituation in the reflex activity with cycling exercise of the affected hind limbs. This implies that repetitive passive stretching of the muscles in spinalized animals and the accompanying stimulation of large (Group I and II) proprioceptive fibers has modulatory effects on spinal cord reflexes after injury. To test this hypothesis, we induced pyridoxine neurotoxicity that preferentially affects large dorsal root ganglia neurons in intact and spinalized rats. Pyridoxine or saline injections were given twice daily (IP) for 6 weeks and half of the spinalized animals were subjected to cycling exercise during that period. After 6 weeks, the tibial nerve was stimulated electrically and recordings of M and H waves were made from interosseous muscles of the hind paw. Results show that pyridoxine treatment completely eliminated the H-reflex in spinal intact animals. In contrast, transection paired with pyridoxine treatment resulted in a reduction of the frequency-dependent habituation of the H-reflex that was not affected by exercise. These results indicate that normal Group I and II afferent input is critical to achieve exercise-based reversal of hyper-reflexia of the H-reflex after spinal cord injury.     

Functions of a proprioceptive sense organ in freely moving insects: characteristics of reflexes elicited by stimulation of the locust metathoracic femoral chordotonal organ

(1) The metathoracic femoral chordotonal organ is an identified joint angle receptor of the locust hindleg. In order to assess and quantify the functions of this sense organ in the control of posture, mechanical stimuli were applied to the main ligament of the receptor in freely standing locusts. These stimuli produced an afferent discharge that mimicked a sudden small (10-15 degree) change in the angle of the femoro-tibial joint of the hindleg. The reflex effects that resulted from afferent stimulation were monitored myographically in the tibial extensor and flexor muscles. The angle of the femoro-tibial joint at the onset of sensory stimulation was also recorded by still photography. (2) As previously reported, stimulation of the chordotonal organ in freely standing animals produced resistance reflexes in tibial muscles that opposed the apparent joint movement. However, we also found that, at certain joint angles, a different mode of reflex response was elicited in which motoneurons to the tibial flexor muscle fired in response to apparent movements in any direction. (3) In this study, characteristics of resistance reflexes in the tibial extensor muscle were analyzed quantitatively, as that muscle is innervated by only one slow excitatory motoneuron. The gain of the resistance reflex (ratio of the firing frequency during afferent stimulation versus the rate of activity prior to the stimulus) was quite high in all preparations, and represent a greater than two-fold increase in motoneuron frequency (mean 2.11 +/- 0.54 S.D.). The reflex gain was also highest at the lowest initial rates of motoneuron activity (circa 5 Hz) and declined for higher firing frequencies (maximum 35 Hz).(ABSTRACT TRUNCATED AT 250 WORDS)     

Direct and reflex responses in perineal muscles on electrical stimulation.

Responses in the external anal and urethral sphincters as well as in the bulbocavernosus muscle have been evoked by supramaximal electrical stimulation of the penis (or clitoris), perineum and the peri-anal region and recorded electromyographically in 82 male subjects 5 to 73 years old and in nine female subjects 18 to 55 years old, who had no systemic diseases or demonstrable sacral nervous system lesion. On perineal stimulation (including the penis or clitoris) reflex responses with a typical latency of 33 ms and which exhibit no habituation were obtained in all muscles examined. Stimulation of the peri-anal region gave habituating reflex responses with a typical latency of 55 ms in all muscles examined. On perineal, and sometimes also peri-anal stimulation, stable short latency responses with typical latencies of 5 and 13 ms were recorded; both were considered to be direct responses. The different evoked muscle responses obtained by stimulation in the perineal and peri-anal region have to be distinguished when the bulbocavernosus and anal reflexes are recorded for evaluation of sacral nervous system lesions.     

Supraspinal regulation of spinal reflex discharge into cardiac sympathetic nerves

(1) In chloralose anaesthetized cats, reflex responses were recorded in inferior cardiac nerves following stimulation of intercostal nerves and hind limb afferent nerves. (2) In 80% of cats, a long latency reflex response alone was recorded, whereas, in the others, a short and long latency response was present to intercostal nerve stimulation. (3) In cats displaying only a long latency somatocardiac reflex response, damage to the ventral quadrant of the ipsilateral cervical spinal cord, through which runs a bulbospinal inhibitory pathway, resulted in the appearance of shorter latency reflexes to intercostal nerve stimulation. Lesions elsewhere in the cervical cord did not do this. (4) The characteristics of the early responses indicated that they were somatosympathetic reflexes and not dorsal root reflexes. (5) The early reflexes remained and the late reflex disappeared on subsequent complete transection of the spinal cord. The early reflexes were therefore spinal reflexes, and suppressed in the animal with cord intact. (6) Lesions at C4, which included a contralateral hemisection and a section of dorsal columns extending into the dorsal part of the lateral funiculus, abolished the inhibition of a sympathetic reflex that followed stimulation of some somatic afferent nerve fibres. These sections did not release the spinal reflex. Therefore, this reflex inhibition was not responsible for the suppression of the spinal somatosympathetic reflex. (7) The descending inhibitory influence on the segmental reflex pathway was not antagonized by strychnine, bicuculline or picrotoxin. (8) The possibility is discussed that the spinal reflex pathway into cardiac sympathetic nerves is tonically inhibited by a bulbospinal pathway originating from the classical depressor region of the ventromedial reticular formation.     

Abnormal cortical and brain stem plasticity in Gilles de la Tourette syndrome

We investigated primary motor cortex and brain stem plasticity in patients with Gilles de la Tourette syndrome. The study group comprised 12 patients with Gilles de la Tourette syndrome and 24 healthy subjects. Patients were clinically evaluated using the Yale Global Tic Severity Scale. We tested cortical plasticity by conditioning left primary motor cortex with intermittent or continuous theta‐burst stimulation in 2 separate sessions. Test stimulation consisted of 20 motor‐evoked potentials recorded from right first interosseous muscle before and after theta‐burst stimulation. We also tested brain stem plasticity by conditioning the right supraorbital nerve with facilitatory electric high‐frequency stimulation delivered at the same time as the late response of the blink reflex or inhibitory high‐frequency stimulation delivered before the late response on 2 separate sessions. Test stimulation consisted of 10 blink reflexes from the right orbicularis oculi muscle before and after high‐frequency stimulation. After intermittent theta‐burst stimulation, motor‐evoked potential amplitudes in healthy subjects increased significantly but remained unchanged in patients. Similarly, after continuous theta‐burst stimulation, motor‐evoked potential amplitudes decreased significantly in healthy subjects but did not in patients. After facilitatory high‐frequency stimulation, the blink reflex late response area in healthy subjects increased, whereas after inhibitory high‐frequency stimulation, it decreased. Conversely, in patients, both interventions left the blink reflex late response area unchanged. The lack of the expected inhibitory and facilitatory changes in motor‐evoked potential amplitudes and blink reflex late response area suggests that abnormal plasticity in the primary motor cortex and brain stem play a role in the pathophysiology of Gilles de la Tourette syndrome. © 2011 Movement Disorder Society     

Different responses to auditory and somaesthetic stimulation in patients with an excessive startle: a report of pediatric experience.

OBJECTIVES: Children with cerebral injury often exhibit brief muscle contraction to a variety of stimuli. However, it remains to be determined whether or not the pattern of the reaction is stereotypical irrespective of the site stimulated. To answer this question, we studied electromyographic (EMG) responses to three types of stimuli in children. METHODS: The EMG responses of cranial and limb muscles were recorded after acoustic or somaesthetic stimulation in 6 patients and 23 control subjects. RESULTS: Acoustic stimuli evoked patterned motor activity with a rostrocaudal progression. Nose-tapping stimuli elicited reflex EMG activity in the VIIth cranial muscles that was similar to the R1 component of the electrical blink reflex. Sternum-tap stimuli evoked motor activity in the sternocleidomastoid and arm muscles, and this reflex was probably mediated through the cervical cord (H-reflex). Moreover, late reflexes were evoked following these early reflexes in the patients. In particular, atypical forms of myoclonic jerks were evoked on sternum-tap stimuli. CONCLUSIONS: Many types of primitive reflexes were evoked following three types of stimuli. These reflexes included startle reflex, trigeminomotor reflex, H-reflex and atypical forms of myoclonus, and they were enhanced in the patient group. There are many startle-mimicking reflexes.     

Reinforcement of subliminal flexion reflexes by transcranial magnetic stimulation of motor cortex in subjects with spinal cord injury.

A 20 msec train (500 Hz; 0.1-0.2 msec duration) of percutaneous electrical stimulation (ES) applied to the plantar surface was used to condition muscle responses evoked in tibialis anterior (TA) by transcranial magnetic stimulation of the motor cortex in 8 subjects with traumatic spinal cord injury (SCI). The intensity of conditioning ES was adjusted to just subthreshold for evoking flexion reflexes in TA and was delivered at conditioning-test (C-T) intervals of 15-60 msec prior to cortical stimulation. Four subjects with clinically complete SCI revealed no muscle response to cortical stimulation or following combined subliminal percutaneous ES and cortical stimulation. Four subjects (3 clinically incomplete and 1 complete injury) demonstrated muscle responses with a latency of 70-80 msec time-locked to the percutaneous ES when the conditioning subliminal stimulation was delivered at C-T: 15-40 msec. These responses, resembling suprathreshold flexion reflexes, reflect the convergence of excitatory afferent and cortical inputs and provide evidence of preserved corticospinal innervation to the L4-5 segmental motoneuron or interneuron pools. In 3 of the subjects this preserved corticospinal influence was evident despite absence of motor evoked potentials (MEPs) following cortical stimulation. The effect of the combined electrical and cortical stimulation in yielding suprathreshold flexion reflexes, instead of the facilitated MEPs seen in control subjects, appears to be related to slowed central conduction, prolonged temporal dispersion of the motoneuron facilitation following cortical stimulation and segmental reflex changes associated with disrupted modulation of interneuronal pathways. The results show this conditioning paradigm to be useful in revealing preserved corticospinal innervation in some SCI subjects with absent MEPs.     

Modular organization of human leg withdrawal reflexes elicited by electrical stimulation of the foot sole.

Human withdrawal reflex receptive fields were determined for leg muscles by randomized, electrical stimulation at 16 different positions on the foot sole. Tibialis anterior, gastrocnemius medialis, peroneus longus, soleus, rectus femoris, and biceps femoris reflexes, and ankle joint angle changes were recorded from 14 subjects in sitting position. Tibialis anterior reflexes were evoked at the medial, distal foot and correlated well with ankle dorsal flexion. Gastrocnemius medialis reflexes were evoked on the heel and correlated with plantar flexion. Stimulation on the distal, medial sole resulted in inversion (correlated best with tibialis anterior activity), whereas stimulation of the distal, lateral sole evoked eversion. Biceps femoris reflexes were evoked on the entire sole followed by a small reflex in rectus femoris. A detailed withdrawal reflex organization, in which each lower leg muscle has its own receptive field, may explain the ankle joint responses. The thigh activity consisted primarily of flexor activation.     

Frequency limitation in the human baroreceptor reflex

In 10 unsedated normotensive subjects, low-level bilateral electrical stimulation of the carotid sinus nerves (0.35 ms, 1-2 V) was applied with frequencies of 20-200 Hz for therapeutic purposes. Both peak and steady-state reflex effects increased with the stimulus rate up to 80 Hz. After 1 min of stimulation, the largest fall of arterial pressure (21.0 +/- 5.8%, mean +/- S.D.) was produced by stimulus frequencies of 80-120 Hz. Right atrial pacing did not modify the results. After 1 min of stimulation at 200 Hz, the arterial pressure fall was reduced to 13.6 +/- 5.2% (P less than 0.001), whereas peak effects, reached after 15-40 s, were near maximal. The reduction of the depressor response emerged after about 10 s of stimulation and was complete after about 1 min. Peak RR-interval prolongation occurred within 10 s and showed no adaptation. Comparison of continuous stimulation and R-wave-triggered intermittent stimulation in 3 subjects suggested that the reflex effect was determined by the mean stimulus frequency. We conclude that frequency limitation in the baroreceptor reflex begins when the stimulus rate exceeds about 80 Hz. It leads to a frequency-dependent, gradual adaptation of the reflex effects when the stimulus rate exceeds 120 Hz. This conclusion is limited to the part of the reflex that is subserved by myelinated afferent fibers.     

Nociceptive trigeminocervical reflexes in healthy subjects

ObjectiveElectrical stimulation of the supraorbital trigeminal nerve branch induces trigeminocervical reflex responses (TCRs) in the neck muscles. The purpose of this study was to elicit more nociceptive TCR responses through preferential activation of the nociceptive afferents with a concentric surface electrode.MethodsWe recorded TCRs in 10 healthy subjects using both a standard (sTCR) and a nociceptive (nTCR) concentric surface electrode. We compared the baseline parameters, stimulus intensity/response, recovery, and habituation curves recorded for the two types of electrode, and assessed the effects of local anaesthesia.ResultsCompared with the sTCRs, nTCRs showed a significantly longer latency of the late reflex component, as well as lower pain and higher reflex thresholds. They also showed a different recovery cycle and stimulus intensity/response curve, but similar habituation rate. Local anaesthesia attenuated by 85% the late reflex response to stimulation by the concentric electrode, and by only 15% the response to standard electrode stimulation.ConclusionsThe differences observed stimulating with these two electrode types may be due to their different activation of the afferent fibres.SignificanceIf this study were extended to patients affected by primary headaches, TCR monitoring could emerge as a sensitive tool for detecting changes in nociceptive transmission at the level of trigeminocervical complex.