Brainstem Reflexes Are Enhanced Following Severe Spinal Cord Injury and Reduced by Continuous Intrathecal Baclofen
Brainstem Reflexes Are Enhanced Following Severe Spinal Cord Injury and Reduced by Continuous Intrathecal Baclofen
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DOI：
10.1177/1545968309335979
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发表时间：
2009-11-01
影响因子：
4.2
通讯作者：
Vidal, Joan
中科院分区：
文献类型：
--
作者：
Kumru, Hatice;Kofler, Markus;Vidal, Joan
客观的。人类中枢神经系统的塑性变化可以发生在多个层面，包括脊髓损伤（SCI）中病变水平的喙部回路。 GABA 是大脑中最重要的抑制性神经递质。作者假设 SCI 患者可塑性的后果之一可能是脑干反射增强，并且他们研究了连续鞘内注射巴氯芬 (CITB) 对这种增强的影响。方法。作者研究了 9 名未使用巴氯芬的 SCI 患者和 8 名患有 CITB 的患者的眨眼反射 (BR)、下颌反射、咬肌静默期 (MSP) 和听觉惊恐反应 (ASR) 的早期同侧成分 R1 和晚期成分 R2。九名健康志愿者作为对照。结果。 CITB患者的BR R1波幅明显小于其他组。在未使用巴氯芬的 SCI 患者中，眼轮匝肌、胸锁乳突肌和肱二头肌中记录的 BR 和 ASR 的 R2 面积显着大于对照组，而 CITB 患者和对照组之间没有差异。与未服用巴氯芬的患者相比，患有 CITB 的患者的 MSP 幅度明显更大。结论。 SCI患者脑干反射的增强可能是由于SCI后脑干水平发生塑性变化。与未服用巴氯芬的患者相比，接受 CITB 的患者反应大小显着降低，这表明脑干反射的增强可能是由于 GABA 活性降低所致，并且 CITB 可以有效减少异常脑干过度兴奋。
Objective. Plastic changes in the human central nervous system can occur at multiple levels, including circuits rostral to the lesion level in spinal cord injury (SCI). GABA is the most important inhibitory neurotransmitter in the brain. The authors hypothesized that one of the consequences of plasticity in SCI patients could be enhancement of brainstem reflexes, and they investigated the effect of continuous intrathecal baclofen (CITB) on such enhancement. Methods. The authors studied the early ipsilateral component R1 and the late component R2 of the blink reflex (BR), jaw jerk, masseter silent period (MSP), and auditory startle response (ASR) in 9 SCI patients without baclofen and in 8 with CITB. Nine healthy volunteers served as controls. Results. The amplitude of R1 of BR was significantly smaller in patients with CITB than in the other groups. The area of R2 of BR and of the ASR recorded in the orbicularis oculi, sternocleidomastoid, and biceps brachii muscles were significantly larger in SCI patients without baclofen than in controls, whereas there was no difference between patients with CITB and controls. The MSP magnitude was significantly larger in patients with CITB as compared with those without baclofen. Conclusion. The enhancement of brainstem reflexes in SCI patients may be due to plastic changes at the brainstem level after SCI. The significant reduction in response size in patients with CITB in comparison with patients without baclofen suggests that the enhancement of brainstem reflexes may be due to decreased GABAergic activity and that CITB is effective ill reducing abnormal brainstem hyperexcitability.