Retosiban Prevents Stretch-Induced Human Myometrial Contractility and Delays Labor in Cynomolgus Monkeys

Context

Stretch of the myometrium promotes its contractility and is believed to contribute to the control of parturition at term and to the increased risk of preterm birth in multiple pregnancies.

Objective

To determine the effects of the putative oxytocin receptor (OTR) inverse agonist retosiban on (1) the contractility of human myometrial explants and (2) labor in nonhuman primates.

Design

Human myometrial biopsies were obtained at planned term cesarean, and explants were exposed to stretch in the presence and absence of a range of drugs, including retosiban. The in vivo effects of retosiban were determined in cynomolgus monkeys.

Results

Prolonged mechanical stretch promoted myometrial extracellular signal-regulated kinase (ERK)1/2 phosphorylation. Moreover, stretch-induced stimulation of myometrial contractility was prevented by ERK1/2 inhibitors. Retosiban (10 nM) prevented stretch-induced stimulation of myometrial contractility and phosphorylation of ERK1/2. Moreover, the inhibitory effect of retosiban on stretch-induced ERK1/2 phosphorylation was prevented by coincubation with a 100-fold excess of a peptide OTR antagonist, atosiban. Compared with vehicle-treated cynomolgus monkeys, treatment with oral retosiban (100 to 150 days of gestational age) reduced the risk of spontaneous delivery (hazard ratio = 0.07, 95% confidence interval 0.01 to 0.60, P = 0.015).

Conclusions

The OTR acts as a uterine mechanosensor, whereby stretch increases myometrial contractility through agonist-free activation of the OTR. Retosiban prevents this through inverse agonism of the OTR and, in vivo, reduced the likelihood of spontaneous labor in nonhuman primates. We hypothesize that retosiban may be an effective preventative treatment of preterm birth in high-risk multiple pregnancies, an area of unmet clinical need.

Guided intrathecal baclofen administration by using soleus stretch reflex in moderate-severe spastic multiple sclerosis patients with implanted pump

We tested the hypothesis that changes in soleus stretch reflex was correlated to changes in intrathecal baclofen dose in 12 multiple sclerosis patients with moderate-severe spasticity treated with intrathecal baclofen pump. Twice patients were evaluated clinically and biomechanically. The short-latency soleus stretch reflex was elicited by rotating the ankle joint 48 with a velocity from 3.1 to 1808/s. There was a strong correlation between changes in intrathecal baclofen dose and amplitude of the short-latency stretch reflex (r=- 0.88, PB < 0.001), which means that with an increase in baclofen dose there is a decrease in the amplitude. In contrast, no correlation exists between changes in intrathecal baclofen dose and clinical assessment of spasticity by using the Ashworth scale. The amplitude of the stretch reflex was very small (5 mV) compared with previous findings (> 50 μV), which indicates an effective antispastic effect of intrathecal baclofen. We suggest that clinical evaluation of spasticity using Ashworth scale is insensitive to detect minor changes in moderate-severe spasticity and consequently might not be very useful in evaluating spasticity in relation to ambulatory filling of baclofen pumps. The soleus stretch reflex might be useful in situations when there is doubt about the effect of intrathecally administered baclofen.

Tetanus toxin reduces local and descending regulation of the H-reflex

INTRODUCTION

Skeletal muscles that are under the influence of tetanus toxin show an exaggerated reflex response to stretch. We examined which changes in the stretch reflex may underlie the exaggerated response.

METHODS

H-reflexes were obtained from the tibialis anterior (TA) and flexor digitorum brevis (FDB) muscles in rats 7 days after intramuscular injection of tetanus toxin into the TA.

RESULTS

We found effects of the toxin on the threshold, amplitude, and duration of H-waves from the TA. The toxin inhibited rate-dependent depression in the FDB between the stimulation frequencies of 0.5–50 HZ and when a conditioning magnetic stimulus applied to the brain preceded a test electrical stimulus delivered to the plantar nerve.

CONCLUSIONS

Tetanus toxin increased the amplitude of the Hwave and reduced the normal depression of H-wave amplitude that is associated with closely timed stimuli, two phenomena that could contribute to hyperactivity of the stretch reflex.

[Clinical treatment of spasticity--spastic movement disorders]

Spasticity develops as a consequence of damage to the central nervous system (CNS). Clinically, spasticity is characterized by muscle hypertension and exaggerated reflexes and is associated with varying degrees of paresis. Together this results in the syndrome of spastic paresis. Patients suffer from impeded and retarded movement ability. Electrophysiological investigations of functional arm and leg movements (e.g. in walking) show a reduced activation of arm and leg muscles which can be explained by the loss of activating signals from motor brain centers and functional reflex systems. This effect predominates over the increased tendon-reflex activity. The reduced muscle activation caused by paresis is partially compensated by structural alterations of the muscle fibers (e.g. loss of sarcomeres). For this reason a functional improvement mostly cannot be achieved by antispastic medication which targets the deactivation of tendon-reflexes. However, they are useful in immobilized patients. In mobile patients functional improvement can be achieved by functional training which is accompanied by an adapted, i.e. reduced, spastic muscle tone.

[Effect of preconditioning of thermopaste application at Shenque (CV 8) on stretch reflex induced by procedure for prolapse and hemorrhoids in patients with hemorrhoids]

OBJECTIVE

To observe clinical effect, feasibility and security of preconditioning of thermopaste application at Shenque (CV 8) for relieving stretch reflex induced by procedure for prolapse and hemorrhoids (PPH).

METHODS

A total of 100 cases of mixed hemorrhoids (stage III and IV) patients were randomized into 1.0 h, 0.5 h, 0 h and control (no application) groups (n = 25 in each group) according to a random number table. Thermopaste was applied to Shenque (CV 8) 1.0 h and 0.5 h before PPH or conducted simultaneously with PPH. The mean arterial pressure, heart rate, blood oxygen saturation of patients before and after anastomose operation, and the incidence of adverse reactions within 24 hours after the procedure were monitored and recorded. The patient's pain degree was assessed by using visual analogue scale.

RESULTS

After the preconditioning, of the 25 patients in the 0.5 h group (0.5 h G), 14 experienced marked improvement (in the stretch reflex during PPH), 10 had an improvement, and 1 was invalid, respectively. The markedly effective rate and the total effective rate were 56% and 96%, respectively. The therapeutic effects for inhibiting stretch reflect being from the better to the poorer were 0.5 h G > 1.0 h G > 0 h G >NG. The heart rate and blood pressure from more stable to lesser stable were 0.5 h G> 1.0 h G > 0 h G > NG. The patients' pain reaction during operation and their adverse effects of nausea, vomiting, abdominal distention and abdominal pain, etc. occurred during operation also presented the same tendency in the 4 groups.

CONCLUSION

Thermopaste application to Shenque (CV 8) can effectively prevent and control visceral reflex in patients undergoing PPH, which effect is significantly better when conducted 0.5 hour before the operation.

Botulinum Neurotoxin A injections influence stretching of the gastrocnemius muscle-tendon unit in an animal model

Botulinum Neurotoxin A (BoNT-A) injections have been used for the treatment of muscle contractures and spasticity. This study assessed the influence of (BoNT-A) injections on passive biomechanical properties of the muscle-tendon unit. Mousegastrocnemius muscle (GC) was injected with BoNT-A (n = 18) or normal saline (n = 18) and passive, non-destructive, in vivo load relaxation experimentation was performed to examine how the muscle-tendon unit behaves after chemical denervation with BoNT-A. Injection of BoNT-A impaired passive muscle recovery (15% vs. 35% recovery to pre-stretching baseline, p < 0.05) and decreased GC stiffness (0.531 ± 0.061 N/mm vs. 0.780 ± 0.037 N/mm, p < 0.05) compared to saline controls. The successful use of BoNT-A injections as an adjunct to physical therapy may be in part attributed to the disruption of the stretch reflex; thereby modulating in vivo passive muscle properties. However, it is also possible that BoNT-A injection may alter the structure of skeletal muscle; thus modulating the in vivo passive biomechanical properties of the muscle-tendon unit.

Endogenous angiotensin II suppresses stretch-induced ANP secretion via AT1 receptor pathway

Angiotensin II (Ang II) is released by stretch of cardiac myocytes and has paracrine and autocrine effects on cardiac myocytes and fibroblasts. However, the direct effect of Ang II on the secretion of atrial natriuretic peptide (ANP) is unclear. The aim of the present study is to test whether Ang II affects stretch-induced ANP secretion. The isolated perfused beating atria were used from control and two-kidney one-clip hypertensive (2K1C) rats. The volume load was achieved by elevating the height of outflow catheter connected with isolated atria from 5cmH(2)O to 7.5cmH(2)O. Atrial stretch by volume load caused increases in atrial contractility by 60% and in ANP secretion by 100%. Ang II suppressed stretch-induced ANP secretion and tended to increase atrial contractility whereas losartan stimulated stretch-induced ANP secretion. Neither PD123319 nor A779 had direct effect on stretch-induced ANP secretion. The suppressive effect of Ang II on stretch-induced ANP secretion was blocked by the pretreatment of losartan but not by the pretreatment of PD123319 or A779. In hypertrophied atria from 2K1C rats, stretch-induced ANP concentration attenuated and atrial contractility augmented. The response of stretch-induced ANP secretion to Ang II and losartan augmented. The expression of AT1 receptor protein and mRNA increased but AT2 and Mas receptor mRNA did not change in 2K1C rat atria. Therefore, we suggest that Ang II generated endogenously by atrial stretch suppresses stretch-induced ANP secretion through the AT1 receptor and alteration of Ang II effect in 2K1C rat may be due to upregulation of AT1 receptor.

Wind-up of stretch reflexes as a measure of spasticity in chronic spinalized rats: The effects of passive exercise and modafinil

Spasticity is a common disorder following spinal cord injury that can impair function and quality of life. While a number of mechanisms are thought to play a role in spasticity, the role of motoneuron persistent inward currents (PICs) is emerging as pivotal. The presence of PICs can be evidenced by temporal summation or wind-up of reflex responses to brief afferent inputs. In this study, a combined neurophysiological and novel biomechanical approach was used to assess the effects of passive exercise and modafinil administration on hyper-reflexia and spasticity following complete T-10 transection in the rat. Animals were divided into 3 groups (n=8) and provided daily passive cycling exercise, oral modafinil, or no intervention. After 6weeks, animals were tested for wind-up of the stretch reflex (SR) during repeated dorsiflexion stretches of the ankle. H-reflexes were tested in a subset of animals. Both torque and gastrocnemius electromyography showed evidence of SR wind-up in the transection only group that was significantly different from both treatment groups (p<0.05). H-reflex frequency dependent depression was also restored to normal levels in both treatment groups. The results provide support for the use of passive cycling exercise and modafinil in the treatment of spasticity and provide insight into the possible contribution of PICs.

Desensitizing the posterior interosseous nerve alters wrist proprioceptive reflexes

PURPOSE

The presence of wrist proprioceptive reflexes after stimulation of the dorsal scapholunate interosseous ligament has previously been described. Because this ligament is primarily innervated by the posterior interosseous nerve (PIN) we hypothesized altered ligamento-muscular reflex patterns following desensitization of the PIN.

METHODS

Eight volunteers (3 women, 5 men; mean age, 26 y; range 21-28 y) participated in the study. In the first study on wrist proprioceptive reflexes (study 1), the scapholunate interosseous ligament was stimulated through a fine-wire electrode with 4 1-ms bipolar pulses at 200 Hz, 30 times consecutively, while EMG activity was recorded from the extensor carpi radialis brevis, extensor carpi ulnaris, flexor carpi radialis, and flexor carpi ulnaris, with the wrist in extension, flexion, radial deviation, and ulnar deviation. After completion of study 1, the PIN was anesthetized in the radial aspect of the fourth extensor compartment using 2-mL lidocaine (10 mg/mL) infiltration anesthesia. Ten minutes after desensitization, the experiment was repeated as in study 1. The average EMG results from the 30 consecutive stimulations were rectified and analyzed using Student's t-test. Statistically significant changes in EMG amplitude were plotted along time lines so that the results of study 1 and 2 could be compared.

RESULTS

Dramatic alterations in reflex patterns were observed in wrist flexion, radial deviation, and ulnar deviation following desensitization of the PIN, with an average of 72% reduction in excitatory reactions. In ulnar deviation, the inhibitory reactions of the extensor carpi ulnaris were entirely eliminated. In wrist extension, no differences in the reflex patterns were observed.

CONCLUSIONS

Wrist proprioception through the scapholunate ligament in flexion, radial deviation, and ulnar deviation depends on an intact PIN function. The unchanged reflex patterns in wrist extension suggest an alternate proprioceptive pathway for this position. Routine excision of the PIN during wrist surgical procedures should be avoided, as it alters the proprioceptive function of the wrist.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Blockade of acid sensing ion channels attenuates the exercise pressor reflex in cats

Although thin fibre muscle afferents possess acid sensing ion channels (ASICs), their contribution to the exercise pressor reflex is not known. This lack of information is partly attributable to the fact that there is no known selective in vivo antagonist for ASICs. Although amiloride has been shown to antagonize ASICs, it also has been shown to antagonize voltage-gated sodium channels, thereby impairing impulse conduction in sensory nerves. Our aim was to test the hypothesis that lactic acid accumulation in exercising muscle acted on ASICs located on thin fibre muscle afferents to evoke the metabolic component of the exercise pressor reflex. To test this hypothesis, we determined in decerebrate cats if amiloride attenuated the pressor and cardioaccelerator responses to static contraction, to tendon stretch and to arterial injections of lactic acid and capsaicin. We found a dose of amiloride (0.5 microg kg(-1); i.a.) that attenuated the pressor and cardioaccelerator responses to both contraction and lactic acid injection, but had no effect on the responses to stretch and capsaicin. A higher dose of amiloride (5 microg kg(-1), i.a.) not only blocked the pressor and cardioaccelerator responses to lactic acid and contraction, but also attenuated the responses to stretch and to capsaicin, manoeuvers in which ASICs probably play no significant role. In addition, we found that the low dose of amiloride (0.5 microg kg(-1)) had no effect on the responses of muscle spindles to tendon stretch and to succinylcholine, whereas the high dose (5 microg kg(-1)) attenuated the responses to both. Our data suggest the low dose of amiloride used in our experiments selectively blocked ASICs, whereas the high dose blocked ASICs and impulse conduction in muscle afferents. We conclude that ASICs play a role in the metabolic component of the exercise pressor reflex.

Thin-fiber mechanoreceptors reflexly increase renal sympathetic nerve activity during static contraction

The renal vasoconstriction induced by the sympathetic outflow during exercise serves to direct blood flow from the kidney toward the exercising muscles. The renal circulation seems to be particularly important in this regard, because it receives a substantial part of the cardiac output, which in resting humans has been estimated to be 20%. The role of group III mechanoreceptors in causing the reflex renal sympathetic response to static contraction remains an open question. To shed some light on this question, we recorded the renal sympathetic nerve responses to static contraction before and after injection of gadolinium into the arterial supply of the statically contracting triceps surae muscles of decerebrate unanesthetized and chloralose-anesthetized cats. Gadolinium has been shown to be a selective blocker of mechanogated channels in thin-fiber muscle afferents, which comprise the afferent arm of the exercise pressor reflex arc. In decerebrate ( n = 15) and chloralose-anesthetized ( n = 12) cats, we found that gadolinium (10 mM; 1 ml) significantly attenuated the renal sympathetic nerve and pressor responses to static contraction (60 s) after a latent period of 60 min; both responses recovered after a latent period of 120 min. We conclude that thin-fiber mechanoreceptors supplying contracting muscle are involved in some of the renal vasoconstriction evoked by the exercise pressor reflex.

Nociceptive flexion reflex and pain rating responses during endogenous opiate blockade with naltrexone in healthy young adults

The effect of opioid blockade on nociceptive flexion reflex (NFR) activity and subjective pain ratings was examined in 151 healthy young men and women. Using a within-subjects design, NFR threshold was assessed on 2 days after administration of either placebo or a 50mg dose of naltrexone. Electrocutaneous pain threshold and tolerance levels were measured after NFR threshold assessment on each day. Results indicated that administration of naltrexone was consistently associated with hypoalgesic responding. Specifically, participants exhibited lower levels of NFR activity and reported lower pain ratings for electrocutaneous stimulation delivered at pain threshold and tolerance levels following administration of naltrexone as compared to placebo. These findings indicate that opiate blockade using the current standard dose may elicit hypoalgesia. A potential moderating effect of dose of opiate-blockade medication and level of endogenous opioid activation should be carefully examined in future research.

Real-time measurement of serotonin release and motility in guinea pig ileum

Enterochromaffin (EC) cells are sensors that detect chemical or mechanical stimuli and respond with release of serotonin (5-HT). 5-HT activates local motor reflexes, but whether local motor reflexes also evoke 5-HT release is unknown. The aim of the present study was to establish the relationship between the release of 5-HT and the enteric neural circuits controlling the movements of the intestine. Recordings were made from full-thickness preparations of guinea pig ileum using electrochemical techniques with carbon fibre electrodes to measure local concentrations of 5-HT. The tension in the circular muscle (CM) and longitudinal muscle (LM) was recorded with force transducers. The release of 5-HT from the EC cells was detected selectively and the timing of the events quantified. Pressure-evoked peristalsis caused detectable 5-HT release only when the recording site was invaded by a ring of CM contraction. Spontaneous and stretch-evoked reflex contraction of the CM and LM occurred simultaneously with 5-HT release. Paralysis of the smooth muscle significantly reduced the stretch-evoked release. Muscarinic agonists evoked reflexes that were associated with increases in tension in CM and LM simultaneous with 5-HT release. Tetrodotoxin abolished the coordination between the CM contraction and 5-HT release but not the direct activation of the CM and EC cells by the agonists. In conclusion, the correlation between local motor reflexes and 5-HT release observed in the present study is caused primarily by the contraction of the smooth muscle and subsequent deformation of the mucosa. The EC cell is, thus, a site of convergence for mechanical forces that contribute to the release of 5-HT during motor reflexes.

Temporal facilitation of spastic stretch reflexes following human spinal cord injury

Recent evidence suggests that alterations in ionic conductances in spinal motoneurones, specifically the manifestation of persistent inward currents, may be partly responsible for the appearance of hyperexcitable reflexes following spinal cord injury (SCI). We hypothesized that such alterations would manifest as temporal facilitation of stretch reflexes in human SCI. Controlled, triangular wave, ankle joint rotations applied at variable velocities (30-120 deg s(-1)) and intervals between stretches (0.25-5.0 s) were performed on 14 SCI subjects with velocity-dependent, hyperexcitable plantarflexors. Repeated stretch elicited significant increases in plantarflexion torques and electromyographic (EMG) activity from the soleus (SOL) and medial gastrocnemius (MG). At higher velocities (> or = 90 deg s(-1)), reflex torques declined initially, but subsequently increased to levels exceeding the initial response, while mean EMG responses increased throughout the joint perturbations. At lower velocities (< or = 60 deg s(-1)), both joint torques and EMGs increased gradually. Throughout a range of angular velocities, reflex responses increased significantly only at intervals < or = 1 s between stretches and following at least four rotations. Ramp-and-hold perturbations used to elicit tonic stretch reflexes revealed significantly prolonged EMG responses following one or two triangular stretches, as compared to single ramp-and-hold excursions. Post hoc analyses revealed reduced reflex facilitation in subjects using baclofen to control spastic behaviours. Evidence of stretch reflex facilitation post-SCI may reflect changes in underlying neuronal properties and provide insight into the mechanisms underlying spastic reflexes.

[Dependence of electromyographic reaction indices of the muscles-antagonists and stiffness of the elbow joint on its extension velocity before and after the injection of neurotoxin]

Electromyographic (EMG) activity of the elbow joint muscles elicited by passive extension were recorded in anaesthetized cats before and after MPTP injection (7-10 mg/kg intramuscularly). It was shown that after injection of such dose of MPTP amplitude and duration of the stretch-related M2-3 --components of EMG increased and recovered on 9-10 day after the chemical injection. Perturbation of an external extensor loading applied to the forearm with different velocities elicited m. biceps brachii EMG reactions which amplitude in norm correlated with a muscle stretch velocity and duration correlated with applied force duration. The MPTP injection led to reversible changes of these stretch-reflex parameters. In norm elbow joint stiffness showed a linear dependence on external loading velocity. The MPTP injection resulted in joint stiffness decrease during the quick perturbation of loading. The stiffness recovery was a longer process comparing to the EMG recovery. It is concluded that the evoked stretch reflex parameter changes as a result of artificially produced dopamine deficiency are insufficient for the total stiffness increase and rigidity manifestation and that amplitude and duration increase of stretch responses may come earlier than parkinsonian rigidity manifestation. It is supposed the decisive importance of supraspinal influences on rigidity development in dopamine function deficiency conditions.

P2 antagonist PPADS attenuates responses of thin fiber afferents to static contraction and tendon stretch

Injection into the arterial supply of skeletal muscle of pyridoxal phosphate-6-azophenyl-2',4'-disulfonic acid (PPADS), a P2 receptor antagonist, has been shown previously to attenuate the reflex pressor responses to both static contraction and to tendon stretch. In decerebrated cats, we tested the hypothesis that PPADS attenuated the responses of groups III and IV muscle afferents to static contraction as well as to tendon stretch. We found that injection of PPADS (10 mg/kg) into the popliteal artery attenuated the responses of both group III (n = 16 cats) and group IV afferents (n = 14 cats) to static contraction. Specifically, static contraction before PPADS injection increased the discharge rate of the group III afferents from 0.1 +/- 0.05 to 1.6 +/- 0.5 impulses/s, whereas contraction after PPADS injection increased the discharge of the group III afferents from 0.2 +/- 0.1 to only 1.0 +/- 0.5 impulses/s (P < 0.05). Likewise, static contraction before PPADS injection increased the discharge rate of the group IV afferents from 0.3 +/- 0.1 to 1.0 +/- 0.3 impulses/s, whereas contraction after PPADS injection increased the discharge of the group IV afferents from 0.2 +/- 0.1 to only 0.3 +/- 0.1 impulses/s (P < 0.05). In addition, PPADS significantly attenuated the responses of group III afferents to tendon stretch but had no effect on the responses of group IV afferents. Our findings suggest that both groups III and IV afferents are responsible for evoking the purinergic component of the exercise pressor reflex, whereas only group III afferents are responsible for evoking the purinergic component of the muscle mechanoreflex that is evoked by tendon stretch.

Interest of peripheral anesthetic blocks as a diagnosis and prognosis tool in patients with spastic equinus foot: A clinical and electrophysiological study of the effects of block of nerve branches to the triceps surae muscle

OBJECTIVE

To evaluate clinically and electrophysiologically the effects of selective anesthetic blocks of motor nerve branches to the triceps surae muscle on lower limb stretch reflex in patients with spastic equinus foot.

METHODS

Eleven patients were assessed before and after selective anesthetic block of the superior soleus nerve or the gastrocnemius nerves, performed by lidocaine injection. The stretch reflex (SR) of the ankle with the knee flexed or extended and the Achilles tendon reflex (TR) were scored clinically. Additionally, the direct M response and the H reflex to tibial nerve stimulation were recorded on the three heads of the triceps surae muscle. The ratio of H reflex to M response of maximal amplitudes (H(max)/M(max)) was calculated.

RESULTS

The SR and TR mean scores were significantly reduced after soleus nerve block but not after gastrocnemius nerve block. Electrophysiologically, H(max) and H(max)/M(max) ratios were significantly reduced for the soleus muscle after soleus nerve block and for the lateral (but not medial) gastrocnemius muscle after gastrocnemius nerve block.

CONCLUSIONS

Soleus nerve block appeared more appropriate than gastrocnemius nerve block to relieve spasticity clinically. In addition, the decrease in H(max)/M(max) ratio suggested that lidocaine preferentially blocked proprioceptive Ia fibers rather than A-alpha motor fibers.

SIGNIFICANCE

Selective anesthetic blocks of nerve branches to the triceps surae muscle are useful in the assessment of lower limb spasticity and can benefit from H reflex investigation. H reflex recordings showed a preferential susceptibility of muscle spindle afferents to local anesthetics and supported the hypothesis of a prominent role of the soleus muscle in spastic ankle. The clinical and electrophysiological effects induced by anesthetic blocks may help to guide therapeutic interventions, such as neurotomy, neurolysis or botulinum toxin injection.

Botulinum toxin: mechanisms of action

This review describes therapeutically relevant mechanisms of action of botulinum toxin (BT). BT's molecular mode of action includes extracellular binding to glycoproteine structures on cholinergic nerve terminals and intracellular blockade of the acetylcholine secretion. BT affects the spinal stretch reflex by blockade of intrafusal muscle fibres with consecutive reduction of Ia/II afferent signals and muscle tone without affecting muscle strength (reflex inhibition). This mechanism allows for antidystonic effects not only caused by target muscle paresis. BT also blocks efferent autonomic fibres to smooth muscles and to exocrine glands. Direct central nervous system effects are not observed, since BT does not cross the blood-brain-barrier and since it is inactivated during its retrograde axonal transport. Indirect central nervous system effects include reflex inhibition, normalisation of reciprocal inhibition, intracortical inhibition and somatosensory evoked potentials. Reduction of formalin-induced pain suggests direct analgesic BT effects possibly mediated through blockade of substance P, glutamate and calcitonin gene related peptide.

Botulinum toxin: mechanisms of action

Botulinum toxin (BT) has been perceived as a lethal threat for many centuries. In the early 1980s, this perception completely changed when BT's therapeutic potential suddenly became apparent. We wish to give an overview over BT's mechanisms of action relevant for understanding its therapeutic use. BT's molecular mode of action includes extracellular binding to glycoprotein structures on cholinergic nerve terminals and intracellular blockade of the acetylcholine secretion. BT affects the spinal stretch reflex by blockade of intrafusal muscle fibres with consecutive reduction of Ia/II afferent signals and muscle tone without affecting muscle strength (reflex inhibition). This mechanism allows for antidystonic effects not only caused by target muscle paresis. BT also blocks efferent autonomic fibres to smooth muscles and to exocrine glands. Direct central nervous system effects are not observed, since BT does not cross the blood-brain barrier and since it is inactivated during its retrograde axonal transport. Indirect central nervous system effects include reflex inhibition, normalisation of reciprocal inhibition, intracortical inhibition and somatosensory evoked potentials. Reduction of formalin-induced pain suggests direct analgesic BT effects possibly mediated by blockade of substance P, glutamate and calcitonin gene-related peptide.

Effect of a single dose of levodopa on sexual response in men and women

From animal research, there is ample evidence for a facilitating effect of dopamine on sexual behavior. In humans, little experimental research has been conducted on the inter-relation between dopamine and sexual response, even less so in women than in men. We investigated the effect of levodopa (100 mg) on sexual response in men and women following a double-blind, placebo-controlled crossover design. Genital and subjective sexual responses were measured as well as somatic motor system activity by means of Achilles tendon (T) reflex modulation. Genital and subjective sexual arousal were not affected by levodopa. However, the drug increased T reflex magnitude in response to sexual stimulation in men, but not in women. These results support the view that dopamine is involved in the energetic aspects of appetitive sexual behavior in men. The observed gender difference in the effect of levodopa is discussed in the perspective of possible dopamine-steroid interaction.

[Evoked potentials of the somatic cortex, thalamus, and electromyographic reactions of the cat shoulder muscles elicited by elbow joint straightening in norm and after injection of neurotoxin]

EMG activity from the elbow joint muscles and evoked potentials (ep) from the somatic cortex (fields 4, 6) and thalamic nuclei (vl, vpl) elicited by passive extension were recorded in the unanesthetized cats before and after MPTP injection (total dose 10 mg/kg). It was shown, that after MPTP injection changes of the EMG response in cats are similar to that observed in parkinsonian patients: The increase of amplitude and duration of the stretch-related m2-3 -components of EMG, as well as excitation increase in thalamus and cortex was shown after MPTP. Perturbation of an external extensor loading applied to the forearm with different fixed force moments elicited m. biceps brachii EMG reactions which amplitude in norm correlated with a muscle stretch size. The MPTP injection influenced this dependence. Contrary to EMG responses n26-60 amplitude of the thalamic and cortical EP did not depend on the level of muscle stretch neither in norm nor after MPTP injection. Hence it supposed that an afferent excitation, which was responsible for this EP, did not take part in a generation of the m2-components of the stretch reflex. Late (n100) component's amplitude of the thalamic nuclei EP depended on the muscle stretch level. After MPTP injection this relation disappeared just as in the EMG responses. Since m2 components aroused in the spinal cord motor neurons earlier than n100 components in thalamus it is supposed that excitation of shoulder muscle receptors and spinal neurons, which provided with origin of m2 components consisting of EMG responses, were responsible for generation of the EP late components of thalamic nuclei VL and VPL.

Cyclosporin-A inhibits stretch-induced changes in myosin heavy chain expression in C2C12 skeletal muscle cells

Studies in vivo, have shown that passive stretch of skeletal muscle induces changes in contractile protein expression. In the present study the effects of passive stretch upon myosin heavy chain (MyHC) expression were examined in C2C12 cell myotubes. Passive stretch induced an upregulation of adult fast and slow MyHCs, which was prevented by cyclosporin A (CsA), an inhibitor of calcineurin. Calcineurin has been shown to act via the dephosphorylation of NFAT and MEF2 transcriptional factors. In this study no significant change in the phosphorylation state of these factors was observed. In contrast stretch induced an alteration in the levels of the myogenic regulatory factors (MRFs) MyoD, myogenin and myf5. The modulation in the level of these MRFs was also inhibited by CsA. These data indicate that changes in muscle phenotype in C2C12 can be modulated by passive stretch and some of these changes are calcineurin dependent.

Glutamate evoked neck and jaw muscle pain facilitate the human jaw stretch reflex

OBJECTIVE

Although pain and neuromuscular function are clearly linked in several clinical conditions manifested in the craniofacial and cervical regions, it is unclear if pain in these regions influences reflexly evoked activity in the jaw or neck muscles in humans. The aim of the present study was to test the effects of glutamate-evoked jaw or neck muscle pain on the jaw stretch reflex recorded in both jaw and neck muscles.

METHODS

Nineteen healthy men participated in the study. Electromyographic (EMG) recordings were made from the left masseter (MAL) and right masseter (MAR) muscles and the right sternocleidomastoid (SCM) and splenius (SP) muscles. Glutamate (1 M) or isotonic saline was injected into the MAR or right SP in random order and then the other solution was injected 1-3 weeks later. Pain intensity was scored on a 10 cm visual analogue scale. Stretch reflexes were evoked by standardized jaw stretches before, during and 15 min after the end of the experimental muscle pain. Twenty trials were averaged in each condition.

RESULTS

Pain evoked by MAR or SP glutamate injections was associated with a significant increase in the stretch reflex amplitude recorded in both MAR and SCM. The onset and offset times and duration of the stretch reflex did not change in any muscle during the various pain conditions. Injection of isotonic saline into the MAR or SP did not produce any significant change in the reflex parameters in any of the muscles.

CONCLUSIONS

The results indicate the close interplay between the craniofacial and cervical regions in the neuromuscular changes that may result from musculoskeletal pain in either region.

SIGNIFICANCE

The changes in neuromuscular activity documented in this study may be involved in the clinical occurrence of altered muscle activity in the orofacial and cervical regions as a result of deep tissue trauma and pain.

Change of stretch reflex threshold in spasticity: effect of botulinum toxin injections

Spasticity is a disorder of hypertonus associated with neurological diseases, characterized by a decrease in stretch reflex threshold. Stretch reflex threshold of wrist flexors has been recorded in subjects affected by forearm spasticity due to acute neurological lesions, occurred from one to sixty-one months before. In all the subjects a decreased stretch reflex threshold was recorded and a negative correlation between stretch reflex threshold and time of the disease resulted. In five subjects affected by mild spasticity the velocity stretch reflex threshold was tested one-three months after stroke and then six months later. In three cases a further decrease in stretch reflex threshold was recorded. Sixteen subjects affected by heavy forearm spasticity (quantified by Ashworth scale), were treated with Botulinum toxin injections to reduce spasticity. Fourteen of 16 subjects were responsive to the antispastic therapy: a decrease of at least 1 point in the Ashworth scale was detected after the treatment. In all the responsive cases an increase of stretch reflex threshold was recorded. The results confirm that the stretch reflex threshold is decreased in spastic muscles; it decreases progressively in time after the acute lesion. In addition, these results demonstrate that the decreased stretch reflex threshold can be reversed with Botulinum toxin injections. It is known that Botulinum toxin reduce the presynaptic release of Acetylcholine of neuromuscular synapses, but there are experimental evidences that it acts even on spindle's fibres, decreasing the sensitivity of intrafusal muscle fibres. This effect explains how Botulinum toxin increases the stretch reflex threshold in spastic muscles.

Serotonin enhances the resistance reflex of the locomotor network of the crayfish through multiple modulatory effects that act cooperatively

Serotonin (5HT) is an endogenous amine that modifies posture in crustacea. Here, we examined the mechanisms of action of 5HT on the resistance reflex in crayfish legs. This reflex, which counteracts movements imposed on a limb, is based on a negative feedback system formed by proprioceptors that sense joint angle movements and activate opposing motoneurons. We performed intracellular recordings from depressor motoneurons while repetitively stretching and releasing a leg joint proprioceptor in a resting in vitro preparation (i.e., a preparation that lacks spontaneous rhythmic activity). 5HT increased the amplitude of the depolarization during the release phase of the proprioceptor (corresponding to an upward movement of the leg) and the discharge frequency of the motoneurons. The 5HT-induced increase in the resistance reflex is caused, to a large extent, by polysynaptic pathways because it was very attenuated in the presence of high divalent cation solution. In addition to this activation of the polysynaptic pathways, 5HT also has postsynaptic effects that enhance the resistance reflex. 5HT causes a tonic depolarization, as well as an increase in the time constant and input resistance of motoneurons. We developed a simple mathematical model to describe the integrative properties of the motoneurons. The conclusion of this study is that the input frequency and the decay time constant of the EPSPs interact in such a way that small simultaneous changes in these parameters can cause a large effect on summation. Therefore, the conjunction of presynaptic and postsynaptic changes produces a strong cooperative effect on the resistance reflex response.

Botulinum toxin in post-stroke patients: stiffness modifications and clinical implications

OBJECTIVE

To objectively quantify stiffness and clinical changes in the upper limb of poststroke patients following botulinum toxin (BT) injection.

METHODS

Eighteen consecutive chronic post-stroke spastic patients were injected Botulinum toxin A in the forearm flexor spastic muscles. Spasticity was clinically evaluated with the Ashworth scale. Stiffness was measured with indices (passive stiffness index (ISI) and total stiffness index (TSI) obtained by mechanical wrist displacements induced by a torque motor,which could also provide the stretch reflex threshold speed (SRTS) from flexor muscles. Functional status was measured with the Barthel index and a specific hand ability scale, pain with a visual analogue scale (VAS). The ranges of voluntary wrist extension (EROM) and flexion (FROM) and wrist isometric extension and flexion (IE-IF) strength were also calculated.

RESULTS

IE and EROM significantly increased, being respectively p < 0.01 and p < 0.05; also SRTS was augmented (p < 0.001),while TSI showed lower values (p < 0.001); the Ashworth score decreased at least one point. Hand function for selected tasks improved in 50% of patients, the Barthel index only in 4 (22 %), forearm pain was completely relieved in 3 patients (17 %).

CONCLUSIONS

BT can be considered a valid therapeutic tool in all spastic patients, because of immediate advantages: reduction of muscle hypertonia, pain relief, improvement in selected motor performances.

An assessment of vascular pain using the flexor reflex in anesthetized rats

This study assessed the flexor reflex induced by intraarterial algogenic drugs in anesthetized rats. The experiments were performed on male Sprague Dawley rats weighing 290-350 g. The animals were anesthetized with urethane (1.3 g/kg i.p.) and an arterial cannula was inserted to the level of the bifurcation of the femoral artery. The magnitude of the flexor reflex was examined by recording the electromyograph from the posterior biceps femoris/semitendinous muscles. Results showed that the flexor reflex evoked by intra-arterial injection of capsaicin (0.05-0.5 microg) was dose-dependent. A similar reflex resulted from pinching the toe of the hindlimb. These responses were inhibited by morphine (5 mg/kg s.c.) and restored with naloxone (1.5 mg/kg s.c.). Intraarterial preinjection of procaine (2%, 200 microl) and capsazepine (20 microg), which is a selective vanilloid receptor antagonist, inhibited the capsaicin-evoked response, but not that of pinching. These results indicate that the flexor reflex is a useful tool for assessing vascular pain in anesthetized animals.

Capsaicin-induced joint inflammation is not blocked by local anesthesia

The purpose of this study was to evaluate the effect of local anesthetic blockade of afferent innervation on the development of capsaicin-induced edema in the rat temporomandibular joint (TMJ) region and on reflex jaw muscle activity. Under halothane anesthesia, 64 male Sprague-Dawley rats were prepared for monitoring of edema development by lateral movement of a needle overlying the left TMJ region and for acute recording of electromyographic activity in ipsilateral digastric and masseter muscles. A double-barrel catheter was inserted into the TMJ region for delivery of saline or 0.5% bupivacaine from 1 needle, followed with the injection of 1% capsaicin, 0.1% capsaicin, or vehicle control from the other needle 5 minutes later. Application of capsaicin into the saline pretreated TMJ region led to dose-dependent edema development and reflex jaw muscle activity; however, only 1% capsaicin solution resulted in significant tissue expansion and muscle activity when compared with the vehicle control. Pretreatment of the rat TMJ region with bupivacaine failed to inhibit capsaicin-induced edema development, although successful blockade of nerve conduction was confirmed with the absence of reflex jaw muscle activity. Capsaicin-induced edema of the rat TMJ region developed independent of axonal conduction, suggesting neurogenic inflammation may arise regardless of functional nerve conduction.

Reduction of clinical temporomandibular joint pain is associated with a reduction of the jaw-stretch reflex

AIMS

To examine the jaw-stretch reflex after injection of local anesthetic (LA) into painful temporomandibular joints (TMJs), since the functional role of jaw-stretch reflexes in patients with painful temporomandibular disorders is still not well understood.

METHODS

Thirteen female patients with a clinical diagnosis of disc displacement without reduction and TMJ pain participated in this open study. Reflex responses were evoked by fast stretches at 15% of the maximal voluntary contraction level before and after injection of 1 mL carbocaine into the painful TMJ. Electromyographic (EMG) activity was recorded from the left and right masseter and temporalis muscles, and the mean level of prestimulus EMG activity and peak-to-peak amplitude of the stretch reflex were measured. Visual analog scale ratings of TMJ pain and TMJ pressure pain thresholds (PPTs) were also obtained. Eleven healthy women were examined with the same protocol (except for PPT determinations) before and after injection of LA into the TMJ.

RESULTS

In patients, injection of LA reduced the TMJ pain during jaw movements and maximum clenching (P < .021) and increased the PPTs in the painful TMJ (P < .01). The prestimulus EMG activity in the masseter on the painful side (feedback muscle) was unaffected by the injection of LA (P > .262). There were no significant side-to-side asymmetries of latency or amplitude measures of the stretch reflex in the patient group. Both the peak-to-peak amplitude and the normalized peak-to-peak amplitude of the stretch reflex were reduced in the masseter and temporalis muscles on the painful side and in the masseter on the nonpainful side after LA injections (P < .048). There were no effects of LA injections into the TMJ in the healthy group on any EMG or stretch parameters.

CONCLUSION

These results do not support the notion of asymmetries in the jaw-stretch reflex in patients with TMJ pain, but they do suggest that the reflex sensitivity can be influenced by nociceptive activity from the TMJ area.

Peripheral neuropathy and cancer

Peripheral neuropathy has a major impact on quality of life and may limit the amount of treatment patients can receive. Neurotoxic agents are used increasingly in oncologic practice, yet clinicians are often unaware of the protean manifestations of neuropathy and find its management troubling. Recent knowledge about the mechanisms of neuropathic disease and new treatments may help to minimize the impact of neuropathy on this vulnerable patient population.

Mechanical Measurements of the Effects of Intrathecal Baclofen Dosage Adjustments in Cerebral Palsy

OBJECTIVE

The purpose of this pilot study was to determine the feasibility of using mechanical measures of stretch reflexes to monitor spasticity after intrathecal baclofen dosage changes.

DESIGN

Mechanical measures were made in studying six participants with cerebral palsy who were undergoing treatment for spasticity using intrathecal baclofen therapy. Mechanical measurements of stretch reflexes were made before and after pump implant in four of the six participants and after dosage changes in all participants, for a period of up to 2 yrs. The measurements comprised electromyograms and resistive torque responses to movement of the ankle, imposed with an isokinetic dynamometer. For each test session, random movements were applied to the ankle at each of four to seven speeds, repeated three or five times.

RESULTS

Stretch reflex excitability decreased in three of four participants after initiation of intrathecal baclofen therapy and decreased with increasing dosages in three of the six participants. Broken catheters coincided with heightened mechanical measures in two cases.

CONCLUSION

Mechanical measures of stretch reflexes change after intrathecal baclofen dosage adjustments, reflecting the clinical course of intrathecal baclofen therapy.

Effect of muscle relaxants on experimental jaw-muscle pain and jaw-stretch reflexes: a double-blind and placebo-controlled trial

A randomised, double-blind, placebo-controlled three-way cross-over study was performed to investigate the effect of two muscle relaxants (tolperisone hydrochloride and pridinol mesilate) on experimental jaw-muscle pain and jaw-stretch reflexes. Fifteen healthy men participated in three randomised sessions separated by at least 1 week. In each session 300 mg tolperisone, 8 mg pridinol mesilate or placebo was administered orally as a single dose. One hour after drug administration 0.3 ml hypertonic saline (5.8%) was injected into the right masseter to produce muscle pain. Subjects continuously rated their perceived pain intensity on an electronic 10-cm visual analogue scale (VAS). The pressure pain threshold (PPT) was measured and short-latency reflex responses were evoked in the pre-contracted (15% maximal voluntary contraction) masseter and temporalis muscles by a standardised stretch device (1 mm displacement, 10 ms ramp time) before (baseline), 1 h after medication (post-drug), during ongoing experimental muscle pain (pain-post-drug), and 15 min after pain had vanished (post-pain). Analysis of variance demonstrated significantly lower VAS peak pain scores (5.9 +/- 0.4 cm) after administration of tolperisone hydrochloride compared with pridinol mesilate (6.8 +/- 0.4 cm) and placebo (6.6 +/- 0.4 cm) (P=0.020). Administration of pridinol mesilate was associated with a significant decrease in PPTs compared with tolperisone hydrochloride and placebo (P=0.002) after medication, but not after experimental jaw-muscle pain. The normalised peak-to-peak amplitude of the stretch reflexes were not significantly influenced by the test medication (P=0.762), but were in all sessions significantly facilitated during ongoing experimental jaw-muscle pain (P=0.034). In conclusion, tolperisone hydrochloride provides a small, albeit significant reduction in the perceived intensity of experimental jaw-muscle pain whereas the present dose had no effect on the short-latency jaw-stretch reflex.

Relative contributions of neural mechanisms versus muscle mechanics in promoting finger extension deficits following stroke

The origins of impaired finger and hand function were examined in 10 stroke survivors with chronic spastic hemiparesis, with the intent of assessing whether mechanical restraint or altered neurophysiological control mechanisms are responsible for the well-known impairment of finger extension. Simultaneous extension of all four metacarpophalangeal (MCP) joints of the impaired hand was either externally imposed using a rotary actuator or attempted voluntarily by the subject. Trials were conducted both before and after administration of a local anesthetic, blocking the median and ulnar nerves at the elbow. The anesthetic was administered to reduce the activity of the muscles flexing the MCP joints, in order to distinguish mechanical from neuronal resistance to imposed MCP rotation. We found that the nerve blockade resulted in a reduction in velocity-dependent torque (P = 0.01), thereby indicating significant joint impedance due to spasticity. Blockade also produced a posture-dependent reduction in static torque in declaratively relaxed subjects (P = 0.04), suggesting some tonic flexor activity for specific hand postures. No change in either extensor isometric (P = 0.33) or isokinetic (0.53) torque was apparent, but 3 of the 10 subjects did exhibit substantial (>10 degrees ) improvement in voluntary MCP extension following the blockade. This improvement seemed largely due to a decrease in inappropriate flexor activity during the movement, rather than an increase in extensor activity. We argue that persistent and inappropriate flexor activation plays a role in limiting voluntary finger extension, and that this activation is potentially a reflection of altered supraspinal control of key spinal pathways. In all cases, this inappropriate activation was compounded by weakness, apparent in both the extensor and flexor muscles.

Effects of TMJ anesthesia and jaw gape on jaw-stretch reflexes in humans

OBJECTIVE

To study the roles of afferent sensory inputs in the temporomandibular joint (TMJ) and of muscle length in the modulation of the jaw-stretch reflex in humans.

METHODS

Reflexes were evoked in both the masseter and temporalis muscles under standardized conditions in 11 young women. The study was performed in two sessions; experimental conditions were jaw gape and injection of local anesthetics. For jaw gape, 4, 14, and 24 mm were used in random order. One milliliter TMJ injections (carbocaine, 10 mg/ml, versus isotonic saline, 0.9%) were given in a randomized, double blind manner. When a participant received carbocaine during the first session, isotonic saline was injected during the second one. A total of 480 reflexes were evoked in every participant.

RESULTS

No significant differences were found between carbocaine and isotonic saline. ANOVA and post hoc paired t tests did show, however, a significant effect of jaw gape for the left masseter and anterior temporalis muscles, with the 14 mm gape having the highest amplitude.

CONCLUSIONS

Blocking the afferent sensory input (including the mechanoreceptors) from the TMJ seems to have no influence on the sensitivity of the human jaw-stretch reflex. Instead, muscle spindles are the most likely receptors to be responsible for the reflex modulation that was observed in the present study.

Chemical ablation of sensory afferents in the walking system of the cat abolishes the capacity for functional recovery after peripheral nerve lesions

Weakening the ankle extensor muscles of cats by denervation of the synergists of the medial gastrocnemius (MG) muscle results in transient increase in yield at the ankle during early stance. Recovery of ankle function occurs over a period of 1-2 weeks, is use-dependent, and is associated with increases in the strength of reflexes from MG group I muscle afferents and an increase in the magnitude of bursts in the MG muscles during stance. These observations have led to the hypothesis that feedback from large muscle afferents is necessary for functional recovery. In this investigation we have tested this hypothesis by examining functional recovery in animals treated with pyridoxine, a drug known to destroy large muscle afferents. In four adult animals we confirmed that pyridoxine abolished the group I-mediated tendon-tap reflex in the ankle extensor muscle, and subsequently found that group I afferents from MG were either destroyed or non-conducting. Immediately after pyridoxine treatment the animals showed severe locomotor dysfunction but all recovered significantly over a period of 1 or 2 months and showed only minor kinematics deficits at the time of the muscle denervations. In all four pyridoxine-treated animals, weakening of the ankle extensors by denervation of the synergists of the MG muscle resulted in a large increase in yield at the ankle that persisted almost unchanged for a month after the operation. The magnitude of burst activity in the MG muscle during early stance of the pyridoxine-treated animals either did not increase or increased only slightly after the denervation of synergists. These observations are consistent with the hypothesis that feedback from group I afferents is necessary for functional recovery in untreated animals.

Endogenous opioids support the spinal inhibitory action of an alpha 2-adrenoceptor agonist in the decerebrated, spinalised rabbit

The present study examined the possible contribution of endogenous opioids to inhibition of spinal reflexes by an alpha(2)-adrenoceptor agonist. In rabbits decerebrated and spinalised under halothane/nitrous oxide anaesthesia, the selective alpha(2)-adrenoceptor agonist dexmedetomidine (3-30 microg intrathecal) induced significant decreases in short- and long-latency reflex responses evoked in medial gastrocnemius (MG) motoneurones by stimulation of the sural nerve. After recovery from dexmedetomidine, the mu-opioid receptor antagonist beta-funaltrexamine (beta-FNA; 100 microg intrathecal) significantly enhanced short-latency but not long-latency MG reflex responses. After beta-FNA, inhibition of all reflexes by dexmedetomidine was significantly weaker than in the control state, whereas the cardiovascular actions of dexmedetomidine were unaffected. These data confirm that activation of spinal alpha(2)-adrenoceptors depresses MG reflexes evoked by all groups of sural nerve afferent fibres, and shows that endogenous opioid tone supports the inhibitory action of alpha(2) agonists, possibly by a synergistic interaction in the spinal cord.

Involvement of N-methyl-D-aspartate receptors for the Ptychodiscus brevis toxin-induced depression of monosynaptic and polysynaptic reflexes in neonatal rat spinal cord in vitro

The effects of Ptychodiscus brevis toxin (PbTx) on the Ia-alpha motoneuron synaptic transmission in neonatal rat spinal cord in vitro was examined. The stimulation of a dorsal root evoked monosynaptic (MSR) and polysynaptic reflex (PSR) potentials in the segmental ventral root in Mg2+-free medium. Superfusion with PbTx (2.8-84 microM) depressed the MSR and the PSR in a concentration-dependent manner. At 2.8 microM of PbTx, the depression of MSR and PSR was 24+/-8.3% and 37+/-9.7%, respectively. The maximal depression was seen at 84 microM of the toxin (78% for MSR and 96% for PSR). The concentration of toxin required to produce 50% depression was 28.3+/-6.4 microM for MSR and 5.5+/-1.1 microM for PSR. The PbTx (28 microM) did not alter the magnitude of the dorsal root or the ventral root potentials. Addition of MgSO4 (1.3 mM) or DL-2-amino-5-phosphonovaleric acid (APV; 10 microM) to the physiological solution abolished the PSR totally and decreased the MSR by about 30%. In both the conditions, the PbTx-induced depression of the MSR was attenuated significantly. The PbTx-induced depression was blocked completely in the presence of APV+6-cyano-7-nitroquinoxaline-2,3-dione (0.1 microM). NMDA (1 microM) by itself did not alter the magnitude of MSR or PSR but enhanced the PbTx-induced depression (28 microM) of PSR significantly. 7-Chlorokynurenic acid (3 microM; glycine(B) antagonist) did not block the PbTx-induced depression of MSR. D-serine (glycine(B) agonist) did not reverse the PbTx-induced depression of reflexes although it reversed the 7-chlorokynurenic acid-induced depression of PSR. The results indicate that the PbTx depressed the spinal reflexes without altering the magnitude of dorsal root or ventral root activity. The depression of the PSR involved NMDA receptors while that of the MSR involved NMDA and non-NMDA receptors. The PbTx actions did not involve the glycine(B) site of the NMDA receptor.

The effect of glutamate-evoked masseter muscle pain on the human jaw-stretch reflex differs in men and women

AIMS

To compare jaw-stretch reflex responses in male and female subjects and to determine whether injection of glutamate into the masseter muscle facilitates these responses in both sexes.

METHODS

Jaw-stretch reflex responses were evoked with a muscle stretcher, and pain intensity was scored by 11 men and 13 women before and after the injection of glutamate (1.0 mol/L, 0.2 ml) into the masseter muscle. The subjects rated glutamate-evoked pain intensity on a visual analog scale.

RESULTS

Baseline jaw-stretch reflex responses were larger and glutamate injections into the masseter muscle were significantly more painful in women than in men, however, glutamate significantly facilitated jaw-stretch reflex responses in men but not in women.

CONCLUSION

These results suggest that there is a significant sex-related difference in human jaw-stretch reflex responses and their modulation by painful stimuli. Since one possible function of facilitated jaw-stretch reflex responses during jaw muscle pain may be to reduce jaw mobility and thus protect against further exacerbation of an existing injury, the finding of a sex-related difference in modulation of jaw-stretch reflex responses may prove to be important in clarifying why the prevalence of temporomandibular disorders is greater in women than in men.

5-HT4 receptor enhances the propulsive power of the peristaltic reflex in the rat distal colon

The present study was designed to investigate the nature of the 5-HT4 receptors affecting the peristaltic reflex in the isolated rat distal colon. A single peristaltic reflex was evoked by infusing Tyrode solution into the lumen of the isolated segment using our modified Trendelenburg's method under an isovolumic condition. A 5-HT4 receptor agonist, mosapride (10 nM), did not affect the threshold pressure and the propagation distance of the reflex contraction, but significantly increased the developed pressure (maximum pressure - threshold pressure) from 19.1 +/- 11.8 cm H2O in the control to 26.8 +/- 13.0 cm H2O (n = 8, P<0.05) without affecting the resting muscle tone in the distal colon. The present result suggests that stimulation of 5-HT4 receptor enhances the propulsive power to move the luminal contents in the rat distal colon.

ATP and 5-HT are the principal neurotransmitters in the descending excitatory reflex pathway of the guinea-pig ileum

Neurotransmission underlying descending excitatory reflexes evoked by distension was studied in opened segments of guinea-pig ileum and compared with peristalsis in intact segments. The opened segments were distended by inflating a balloon against the serosa at the oral end and changes in muscle length recorded from the anal end. Distension elicited contractions in both circular (CM) and longitudinal (LM) muscle layers. Granisetron, a 5-HT(3) receptor antagonist (10 nmol L-1 to 1 micromol L-1) reduced CM contractions (24% control), without affecting the LM. The P2 receptor antagonist, pyridoxal phosphate-6-azopheyl-2',4'-disulphonic acid (PPADS; 10 micromol L-1), reduced CM contractions to 31% and LM contractions to 39%. Hexamethonium (500 micromol L-1) enhanced LM contractions, but had no effect on CM contractions. Granisetron (1 micromol L-1) had no significant effect on the threshold for peristaltic contractions in a modified Trendelenburg preparation, but decreased the decay time of these contractions by 37%. PPADS (10 micromol L-1) had no significant effect in this preparation. Thus, the descending excitatory pathways to CM and LM can be distinguished pharmacologically; the former depend on 5-HT(3) and P2 ATP receptors, the latter are independent of 5-HT(3) receptors. Nicotinic receptors may have little part in either pathway. These properties differ from conventional peristaltic reflexes, which are effectively abolished by nicotinic blockade.

Effects on the fusimotor-muscle spindle system induced by intramuscular injections of hypertonic saline

Intramuscular injection of hypertonic saline (HS) is a procedure widely adopted to experimentally induce deep muscle pain in humans. This study was undertaken to test whether intramuscular injections of HS (5%) influence the activity of primary and secondary muscle spindle afferents (MSAs) from homonymous as well as heteronymous muscles. The experiments were performed on six cats anaesthetised with alpha-chloralose. Usually responses of two to nine MSAs from gastrocnemius medialis (GM) and/or gastrocnemius lateralis (GL) muscles were recorded simultaneously, while HS was injected either into the receptor-bearing muscle (homonymous responses) or into a close (GM/GL) or remote synergistic muscle (posterior biceps, PB, heteronymous responses). The mean rate of discharge and the depth of modulation of the MSA responses to sinusoidal stretching of the receptor-bearing muscle were calculated. Out of the 42 afferents tested (7 from GM and 35 from GL), 38 (90%) exhibited statistically significant responses to injections of HS into homonymous and/or heteronymous muscles. With injections into the homonymous muscle, the average maximal increase in mean rate of discharge was 74% and the average decrease in depth of modulation was --18%. The mean duration of the effects was 2.1 min. The corresponding values for heteronymous injections into a close synergist were 87%, -17% and 2.1 min (GM or GL), and for injections into PB 52%, -11%, and 1.8 min. The majority of the responses (72%) were compatible with reflex action on static fusimotor neurones, whereas 20% of the responses could be attributed to mixed static and dynamic fusimotor action. The remaining 8% of the responses were attributed to inhibition of fusimotor activity. There were no statistically significant differences between the responses following injections into homonymous or heteronymous muscles. Injections of Tyrode's solution did not induce any significant alterations in MSA responses, implying that they were not induced by direct and/or injury effects of the injections. HS-related changes in MSA activity were completely abolished after the nerves to corresponding muscles were cut, confirming the reflex nature of the effects. Thus, intramuscular injections of HS induce reflex changes in MSA activity from both homonymous and heteronymous muscles, most likely via fusimotor reflexes. Predominantly static fusimotor neurones were activated. The possible role of the fusimotor-muscle spindle system in altered motor control during experimentally induced muscle pain is discussed.

Influence of methodological parameters on human jaw-stretch reflexes

The influence of methodological parameters and experimental conditions on the human jaw-stretch reflex was studied in healthy subjects in order to develop a reliable tool for investigation of the excitability of motoneuron pool. Short-latency excitatory reflex responses were evoked by a custom-made stretch device with the subjects biting on a jaw-bar with their front teeth. The displacement and ramp time of the stretches were accurately controlled and automatically triggered by a computer. The reflex responses were measured in the surface electromyogram (EMG) of the masseter and anterior temporalis muscles with online monitoring of the clenching level. The peak-to-peak amplitude of the jaw-stretch reflex was shown to be proportional to the level of EMG activity during isometric contractions, to increase proportionally with increasing stretch displacement at a given ramp time, and to decrease proportionally with increasing ramp time at a given stretch displacement. There were no significant differences in the reflex amplitude between repeated recordings within one session or between different sessions. Local anesthetic around the lower incisors as well as the upper incisors had no significant influence on the reflex amplitude. However, different biting positions on the bars of the stretch device significantly influenced the amplitude of the stretch reflex.

Physiologic and clinical monitoring of spastic hypertonia

Spasticity has been defined as "a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex, as one component of the upper motor neuron syndrome." Increased motor neuron excitability and enhanced stretch-evoked synaptic excitation of motor neurons are potential neurophysiologic mechanisms to explain this phenomenon. The relative contribution of these two distinct mechanisms likely varies depending on the location of the lesion in the central nervous system. The patient history is an important component of the clinical evaluation focusing on potential nociceptive inputs that can worsen spasticity (e.g., urinary tract infections, skin breakdown). Assessment of the impact of the spasticity on function (positive and negative), position, care of the patient, and pain should be pursued. Clinical examination of spasticity is performed using methods to evoke and quantify spastic reflex responses to muscle stretch stimuli and to observe the patient performing functional tasks to note the impact of spasticity on their performance. Treatment is based on the negative impact of the spasticity on the patient, severity of the problems, and whether the hypertonicity is focal or diffuse in distribution (see article by Elovic elsewhere in this issue). First-line treatments include elimination of nociceptive stimuli, range of motion, seating and positioning, and other physical modalities. If additional intervention is necessary, oral medications are implemented for widespread spasticity, whereas focal problems are treated with prolonged stretching and splinting or casting to maintain muscle stretch and optimal positioning. In more severe cases, invasive procedures may be needed to supplement other treatments. Neurolytic procedures are pursued for focal tone problems. For generalized hypertonicity, intrathecal pump administration of medications or surgical interruption of reflex pathways has been helpful. Ultimately, the clinician must systematically approach the evaluation and treatment of spasticity. As decisions regarding moving from less to more invasive treatments are discussed, the potential risks and side effects of treatment options must be weighed versus the potential benefits that the patient might receive to maintain a rational approach to the management of spasticity.

Intrathecal clonidine for controlling spastic hypertonia

Intrathecal clonidine is a powerful antispastic drug. Its mechanism of action is more selective than baclofen. The acute effects are reviewed. An assessment of side effects of clonidine during chronic infusion is needed.