Reciprocal inhibition in hemiplegia: Correlation with clinical features and recovery
Reciprocal inhibition in hemiplegia: Correlation with clinical features and recovery
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DOI：
10.1017/s0317167100039135
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发表时间：
1996-02-01
影响因子：
3
通讯作者：
Lee, RG
中科院分区：
文献类型：
--
作者：
Okuma, Y;Lee, RG
背景资料：以前的报道已经描述了在偏瘫患者中相互Ia抑制的变化，但是Ia抑制的量和临床缺陷之间的相关性还没有很好地建立。研究方法：我们研究了16例中风后不同阶段的偏瘫患者和26例对照组的踝屈肌（胫骨前肌）和伸肌（比目鱼肌）之间的相互抑制。通过拮抗肌神经的条件刺激从比目鱼肌或胫骨前肌H反射的短潜伏期抑制确定双突触Ia抑制的量。结果如下：在功能恢复良好、轻度痉挛的患者中，腓神经传入比目鱼肌运动神经元的双突触Ia抑制增加，而在功能恢复差、伸肌痉挛更明显的患者中，这种抑制没有改变，有时甚至减弱。在获得连续记录的患者中，卒中后恢复期Ia抑制增加。Ia抑制胫骨前运动神经元往往是更大的恢复差患者明显痉挛比恢复良好的患者。晚期（D1）抑制，可能是由于突触前抑制，在患者中减少，尽管这种抑制的量和临床特征之间的一致相关性没有得到明确证明。结论：Ia抑制通路兴奋性的变化与偏瘫的某些临床特征相关。恢复过程中比目鱼肌运动神经元的Ia抑制增加可能是补偿下行运动命令丢失的机制。
Background: Previous reports have described changes in reciprocal Ia inhibition in hemiplegic patients, but correlations between the amount of Ia inhibition and the clinical deficits have not been well established. Methods: We studied reciprocal inhibition between ankle flexors (tibialis anterior) and extensors (soleus) in 16 hemiplegic patients at various stages following a stroke and in 26 control subjects. The amount of disynaptic Ia inhibition was determined from the short latency suppression of the soleus or tibialis anterior H-reflexes by conditioning stimulation of the antagonistic muscle nerves. Results: Disynaptic Ia inhibition from peroneal nerve afferents to soleus motoneurones was increased in patients who showed good recovery of function with mild spasticity, However, it was not changed, or even sometimes diminished, in patients who made a poor recovery and had more marked extensor spasticity. In patients where serial recordings were obtained there was an increase in Ia inhibition during the recovery period following stroke. Ia inhibition to the tibialis anterior motoneurones tended to be greater in the poor recovery patients with marked spasticity than in the good recovery patients. The late (D1) inhibition, presumably due to presynaptic inhibition, was decreased in the patients, although consistent correlations between the amount of this inhibition and the clinical features were not clearly demonstrated. Conclusions: Changes in excitability of Ia inhibitory pathways can be correlated with some of the clinical features seen in hemiplegia. Increased Ia inhibition of soleus motoneurones during recovery may be a mechanism to compensate for loss of descending motor commands.