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PubMed1973

Intermittent hypothermia. Independence of central and reflex thermoregulatory mechanisms.

Three patients who had suffered episodes of spontaneous hypothermia are described. Circulatory control was normal for their age but there was evidence of a persistent defect of thermoregulatory mechanisms. In all patients vascular thermoregulatory reflexes dependent upon peripheral receptors were active and in two patients reflex shivering could be obtained. There appeared, however, to be a failure of central thermoregulation as the vascular reflexes were active at abnormally low central temperatures and a fall in central temperature did not initiate shivering. It is concluded that in patients who have suffered spontaneous hypothermia there may be a persistent defect of central mechanisms subserving vasomotion and shivering, although thermoregulatory reflexes dependent upon peripheral receptors can be active. The reflex pathways for thermoregulation in man therefore have a separate integrity, physiologically independent of the central thermoregulatory mechanisms.

Aged↗
PubMed1991

Upbeat nystagmus: clinicopathological and pathophysiological considerations.

We describe an electro-oculographic study of upbeat nystagmus in 4 patients, with neuropathological correlation in one. All patients had lesions in the pontine tegmentum. The electro-oculographic data may be explained by imbalanced vertical vestibular or smooth pursuit eye movement control. The nystagmus stopped or reversed direction during convergence or in supine head positions. We propose that changes in the intensity or direction of upbeat nystagmus that are induced by convergence or changes in head position, are caused by vertical imbalance in the otolithic-ocular reflex, when superimposed on an imbalanced vestibulo-ocular reflex (VOR). Imbalance of the otolithic-ocular reflex and the vertical VOR are caused by damage in the pontomedullary tegmentum.

Adult↗
PubMed1983

Prostaglandin-mediated inhibition of noradrenaline release. VII. Effect of indomethacin on some cardiovascular reflexes in man.

The effect of indomethacin, a prostaglandin (PG) synthesis inhibitor, on some cardiovascular reflexes was studied in healthy subjects. Heart rate (HR) and respiratory sinus arrhythmia (RSA) in the basal state and during carotid stimulation (neck suction), Valsalva ratio, and changes in heart rate and blood pressure (BP) during an orthostatic test were measured before and one hour after administration of indomethacin (1.5 mg/kg). The efficacy of the PG synthesis inhibitor was monitored by analysis of platelet aggregation induced by arachidonic acid. Following indomethacin no change was observed in basal HR. Carotid stimulation depressed the HR and this effect was of the same amplitude before and after indomethacin. The amplitude of RSA was not affected by indomethacin, either in the basal state or during carotid stimulation. The Valsalva ratio and the changes in HR and BP during the orthostatic test were similar before and after the drug. Circulating levels of noradrenaline were unaffected by indomethacin. These data demonstrate that inhibition of PG bioformation in man does not affect major cardiovascular reflexes. Consequently they disfavour the hypothesis that endogenously formed PG would be involved in the normal activity of the afferent, central or efferent pathways for cardiovascular regulation.

Adult↗
PubMed1987

Human orthostatic reflexes after taking temazepam at night.

1. Cardiovascular orthostatic reflexes have been studied at night in 12 healthy male subjects who were given two soft gelatin capsules each containing 0 or 10 mg temazepam at 21.30 h. 2. The changes in heart rate, blood pressure and forearm blood flow on consecutive 5 min exposures to lower body negative pressure (suction) at 30, 40 and 50 mm Hg were measured before and then 1.5 and 9.5 h after giving doses of 10 or 20 mg temazepam in a placebo-controlled double-blind cross-over study. 3. Pre-suction resting values were not affected by temazepam, but 1.5 h after giving the capsules there were significant differences in the responses to suction between the placebo and 20 mg temazepam experiments: the tachycardia after 20 mg temazepam was about one-third greater and the forearm vasoconstriction was about 50% less. The effect of the 10 mg dose was equivocal. No residual effects were detected the next morning. 4. These alterations in orthostatic reflexes soon after the administration of temazepam at night did not impair the maintenance of arterial blood pressure in these healthy subjects.

Adolescent↗
PubMed1987

A computer-controlled system to perturb the ankle joint of freely standing cats trained to maintain a given force.

A computer-based system was developed to (1) train freely standing cats to match various target forces with the left hindlimb, (2) perturb the left ankle joint when the cat was maintaining a desired force and (3) compare reflex responses before and after decerebration. Cats quickly learned to stand unaided on 4 pedestals. During a training session, a range of target force windows was presented to the cat. A successful trial consisted of maintaining the force applied on the left rear pedestal within the target window for a preset time period. To assist the cat, a light was turned on whenever the force was within the target window. A food pellet reward was delivered by the computer after each successful trial. To test reflex responses, the position of the left hindlimb could be briefly perturbed by activating a servo-controlled printed motor configured to rotate the pedestal about the axis of the ankle joint. Perturbations that either flexed or extended the ankle joint were presented pseudo-randomly by the computer. This approach has been used to quantify the magnitude of muscle afferent volleys and the reflex EMG in ankle extensor muscles of normal and decerebrated cats, in response to similar mechanical perturbations. It has also been used to study dynamic features in the electroneurogram recorded from a cutaneous nerve by implanted nerve cuff electrodes, and the correlations among the electroneurogram, the vertical contact force applied on the pedestal and the force recorded from muscle tendons by implanted transducers. This approach may have general applications in the study of postural control, including the study of the discharge patterns of individual motor, sensory or spinal cord neurons in freely standing cats.

Animals↗
PubMed1991

Influence of neuropathy on the microvascular response to local heating in the human diabetic foot.

1. The diabetic neuropathic foot exhibits excess arteriovenous anastomotic shunt flow due to a reduced sympathetic vasoconstrictor tone. Local axon reflexes (mediating postural vasoconstriction, for example) are preserved even in severe diabetic neuropathy. This excess shunt flow and its local neurogenic control may be important in the development of complications of the neuropathic limb. 2. The response of arteriovenous anastomoses to local heating was assessed in 13 diabetic patients with neuropathy (12 insulin-dependent), 10 diabetic control patients (seven insulin-dependent) and 10 normal control subjects. The aim was to study the local reflex control of arteriovenous flow when central sympathetic tone had been largely removed. 3. The change in skin blood flow on local heating to 44 degrees C was measured by using a laser Doppler flowmeter in standard environmental conditions with the foot at heart level. Two sites were assessed: (i) the plantar surface of the great toe (a site in which skin blood flow is dominated by arteriovenous shunt flow) and (ii) the dorsum of the foot (a site without anastomotic flow). 4. It was found that when heat was applied to the plantar surface of the great toe in the diabetic patients with neuropathy a paradoxical decrease in flow through arteriovenous anastomoses occurred, flow declining to 65% (P less than 0.05) of its resting value. This could be compared with an increase in flow over the same time period of 262% and 228% (P less than 0.01) in diabetic control patients and normal subjects, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Vestibulo-ocular reflexes in peripheral labyrinthine lesions: III. Bilateral dysfunction.

Measurements were made of the lesion-induced changes in vestibulo-ocular reflexes (VOR) to rotatory stimuli in a group of patients with bilateral peripheral labyrinthine lesions. All the patients had caloric responses that were below the confidence levels used for normal responses in our laboratory. Responses to rotatory stimuli were greatly decreased or absent at low frequencies of stimulation, but present to a much greater degree at the higher frequencies. Phase measurements showed an increase in relationship to the velocity of the stimulus; there was a corresponding shortening of the time constant as obtained from impulse response measurements. A parametric study indicated that the changes in the responses can be described by a decrease in the sensitivity coefficient and in the basic time constant of a simplified pendulum model equation of vestibular function. A theoretical analysis of the data using a new model for the organization of the vestibular pathways indicated that the preservation of the high-frequency responses was the result of adaptive changes brought about in the central vestibular pathways and/or changes in the receptor-neuron transduction characteristics. Thus, despite the almost complete absence of any caloric response, the vestibular system reflexes remained adequate to maintain gaze during normal head movements.

Adult↗
PubMed1987

Correlation of the severity of autonomic dysfunction to cardiovascular reflexes and to plasma noradrenaline levels in Parkinson's disease.

The present study analyses the relation of both the diminished cardiovascular reflexes and the diminished plasma noradrenaline (NA) response to standing to the severity of the autonomic nervous system (ANS) dysfunction in patients with Parkinson's disease (PD). 47 patients with PD were investigated. A clear correlation was established between the duration and the severity of PD (by the Webster rating scale) and the degree of autonomic dysfunction (ANS disability scale). Similarly, a significant negative correlation was found between the diminished cardiovascular reflexes and the clinical severity of the ANS disturbance. Furthermore, a slight correlation was shown between the clinical severity of ANS dysfunction and plasma NA concentrations in response to a standing-up stimulus.

Aged↗
PubMed1977

Interactions between unloading reflex and voluntary muscle activity under different instructions.

Changes in the instantaneous firing frequency of a separate motor unit (MU) in the unloading reflex and voluntary movement according to instruction, triggered by external mechanical disturbance in the position of the arm, were studied. The activity of m. biceps brachii and m. pronator teres was recorded using surface bipolar electrodes with small area and small interelectrode distance. The correct position of the electrode with respect to the MU was controlled vectorelectromyographically. The probabilities of the appearance of an impulse in successive 10 ms intervals before and after the unloading were determined. The effect of the voluntary movement performed by the subject according to instruction on the reflex response is demonstrated, as well as the opposite effect, i.e. of the type of the external disturbing action on the voluntary movement. Certain problems related to the transcortical reflex response are discussed. It is assumed that some maxima in the summated electromyogram (EMG) which correspond in time to transcortical reflex influences are not due to a higher excitability of the alpha-motoneurones, but they are obtained by grouping of the impulses of many activated tonic MUs whose activity is recorded by recording the summated EMG.

Action Potentials↗
PubMed1995

[Severe bradycardia and hypotension during epidural anesthesia in a patient undergoing hemorrhoidectomy].

Severe bradycardia and hypotension developed suddenly in two patients undergoing hemorrhoidectomy under lumbar epidural anesthesia in the jackknife position, about 5 to 10 min after epidural administration of buprenorphine. Severe vago-vagal reflex was supposed to have been induced with buprenorphine in a situation where venous return was decreased by epidural anesthesia and the jackknife position.

Anesthesia, Epidural↗
PubMed2006

Location specificity of plantar cutaneous reflexes involving lower limb muscles in humans.

It is known that cutaneous reflexes in human hand muscles show strong location-specificity dependent on the digit stimulated. We hypothesized that in lower leg muscles the cutaneous reflex following tactile sensation of the plantar surface of the foot is also organized in a location-specific manner. The purpose of the present study was to test this hypothesis. Middle latency reflexes (approximately 70-110 ms, MLR) following non-noxious electrical stimulation to different locations on the plantar foot were recorded from 16 neurologically intact volunteers (15 males, 1 female). Electrical stimulation was given to the fore-medial (f-M), fore-lateral (f-L) and heel (HL) regions of the plantar surface of the right foot while the subjects performed isometric dorsiflexion (tibialis anterior, TA), plantarflexion (soleus, Sol and medial gastrocnemius, MG), eversion (peroneus longus, PL) and knee extension (vastus lateralis, VL) while sitting and standing. In the Sol and MG, an excitatory response was observed following HL stimulation, which was switched to an inhibitory response following f-M or f-L stimulation (P < 0.001). A reciprocal pattern in contrast to Sol was observed in the TA. In the PL, MLR exhibited significant excitation following both f-L and HL stimulation, which, however, was switched to an inhibitory response following f-M stimulation (P < 0.001). Moderate inhibition of the MLR was seen in the VL for all stimulated positions. Systematic stimulation along the lateral side of the plantar foot demonstrated that the reflex reversal occurred around the middle of the plantar foot in the Sol and TA. In all muscles tested, the slope of the regression line between the magnitude of the MLR and background electromyographic activity significantly decreased during standing compared with sitting except for the PL following f-L simulation. These results suggest that reflex effects from cutaneous nerves in the plantar foot onto the motoneurons innervating the lower leg muscles are organized in a highly topographic manner in humans. The organization of these reflexes may play an important role in the alteration of limb loading and/or ground contact in response to tactile sensation of the plantar foot while sitting and standing.

Adult↗
PubMed1977

The neurological examination in dementia.

The thesis of this chapter is that the neurological phenomena discussed and numerous others omitted or not yet recognized relate primarily to a release of primitive activity when diffuse brain damage erodes cerebral inhibition mechanisms. Anatomical correlations are always difficult when there are multiple lesions, and those that have been made have not completely explained these phenomena. A phylogenetic explanation is not completely adequate either but certainly does not bar further investigations. Indeed such a concept points out the necessity to continue to search for other fetal or developmental responses in dementia, to assess the interrelationships between these reflexes, and to quantify the stimulus as well as the response. The prognostic value of these reflexes is not emphasized, because it is not known. In the evaluation of dementia, one of the last obvious frontiers of neurological science, both specific observations and general principles await discovery.

Aged↗
PubMed2004

Otolith and canal reflexes in human standing.

We used galvanic vestibular stimulation (GVS) to identify human balance reflexes of the semicircular canals and otolith organs. The experiment used a model of vestibular signals arising from GVS modulation of the net signal from vestibular afferents. With the head upright, the model predicts that the GVS-evoked canal signal indicates lateral head rotation while the otolith signal indicates lateral tilt or acceleration. Both signify body sway transverse to the head. With the head bent forward, the model predicts that the canal signal indicates body spin about a vertical axis but the otolith signal still signifies lateral body motion. Thus, we compared electromyograms (EMG) in the leg muscles and body sway evoked by GVS when subjects stood with the head upright or bent forward. With the head upright, GVS evoked a large sway in the direction of the anodal electrode. This response was abolished with the head bent forward leaving only small, oppositely directed, transient responses at the start and end of the stimulus. With the head upright, GVS evoked short-latency (60-70 ms), followed by medium-latency (120 ms) EMG responses, of opposite polarity. Bending the head forward abolished the medium-latency but preserved the short-latency response. This is compatible with GVS evoking separate otolithic and canal reflexes, indicating that balance is controlled by independent canal and otolith reflexes, probably through different pathways. We propose that the short-latency reflex and small transient sway are driven by the otolith organs and the medium-latency response and the large sway are driven by the semicircular canals.

Adult↗
PubMed1981

Gait apraxia in communicating hydrocephalus.

Apraxia of gait in patients with communicating hydrocephalus appears in the context of a generalised motor disorder that includes defective righting reflexes, generalised increased tone to passive movements, grasp reflexes, difficulty with serial movements of the hands and defective smooth pursuit eye movements. The inability to walk does not appear to be due to a motor disorder but to release of proprioceptive supporting reactions. This mechanism is triggered by proprioceptive stimuli.

Apraxias↗
PubMed1998

Bilateral deficit in plantar flexion: relation to knee joint position, muscle activation, and reflex excitability.

Six male subjects made maximal isometric plantar flexions unilaterally (UL) and bilaterally (BL), with the knee joint angle positioned at 90 degrees and 0 degrees (full extension) and the ankle joint kept at 90 degrees. Plantar flexion torque and electromyogram (EMG) of the lateral gastrocnemius (LG) and the soleus (Sol) muscles were recorded. There was a deficit in torque in BL compared to UL (P<0.05), and the deficit was greater when the knee was extended than when bent to 90 degrees (13.9% vs 6.6%). The integrated EMG (iEMG) of UL and BL did not differ when the knee was at 90 degrees. On the other hand, when the knee was extended iEMG of LG was smaller for BL than for UL, suggesting that the larger bilateral deficit when the knee was extended was due to a reduced activity of the LG motor units. In addition, the H-reflex recorded from Sol when the contralateral leg was performing a maximal unilateral plantarflexion was reduced. This would indicate that the force deficit was associated with a reduction of motoneuron excitability.

Adult↗
PubMed1993

Autonomic reflexes in patients with cardioinhibitory carotid sinus syncope.

Autonomic reflexes were investigated in patients with the cardioinhibitory carotid sinus syndrome. Heart rate, blood pressure and forearm blood flow responses were recorded during prolonged head-up tilt, the Valsalva manoeuvre, lower body negative pressure and sequential respiratory cycles in ten patients and nine age-matched controls. The mean maximum R-R interval prolongation during carotid sinus massage was 4.4 s. Three patients had syncope during prolonged head-up tilt. Heart rate and blood pressure responses were similar for patients and controls who completed tilt. Responses to lower body negative pressure and Valsalva manoeuvre were similar for both groups. Respiratory sinus arrhythmia was significantly less marked in patients, 7 bpm (0 to 20 bpm) versus 15 bpm (6 to 35 bpm; p = 0.05). Therefore, neck massage and deep breathing produce abnormal cardiac vagal responses, whereas other reflexes, including response to lower body negative pressure and the Valsalva manoeuvre are within the normal range in cardioinhibitory carotid sinus syndrome.

Aged↗
PubMedDate not supplied

Effects of trichloroethylene on the human vestibulo-oculomotor system.

Ten healthy volunteers were subjected to a vestibulo-oculomotor test battery before, during and 1 hour after trichloroethylene exposure. The concentration of trichloroethylene in inspiratory air was 32-78 ppm (176-429 mg/m3). The concentration of trichloroethylene in venous blood was followed throughout the experiment. The mean pulmonary uptake was estimated. Each test person was also subjected to a control experiment, breathing air free of trichloroethylene. A decreased ability to visually suppress the vestibulo-oculomotor reflex during sinusoidal stimulation was noticed during trichloroethylene exposure. One hour after exposure the test subjects showed a decreased maximum velocity of the voluntary saccade and a decreased ability to follow a sinusoidally moving target.

Adult↗
PubMed1998

Three-dimensional organization of otolith-ocular reflexes in rhesus monkeys. III. Responses To translation.

The three-dimensional (3-D) properties of the translational vestibulo-ocular reflexes (translational VORs) during lateral and fore-aft oscillations in complete darkness were studied in rhesus monkeys at frequencies between 0.16 and 25 Hz. In addition, constant velocity off-vertical axis rotations extended the frequency range to 0.02 Hz. During lateral motion, horizontal responses were in phase with linear velocity in the frequency range of 2-10 Hz. At both lower and higher frequencies, phase lags were introduced. Torsional response phase changed more than 180 degrees in the tested frequency range such that torsional eye movements, which could be regarded as compensatory to "an apparent roll tilt" at the lowest frequencies, became anticompensatory at all frequencies above approximately 1 Hz. These results suggest two functionally different frequency bandwidths for the translational VORs. In the low-frequency spectrum (<<0.5 Hz), horizontal responses compensatory to translation are small and high-pass-filtered whereas torsional response sensitivity is relatively frequency independent. At higher frequencies however, both horizontal and torsional response sensitivity and phase exhibit a similar frequency dependence, suggesting a common role during head translation. During up-down motion, vertical responses were in phase with translational velocity at 3-5 Hz but phase leads progressively increased for lower frequencies (>90 degrees at frequencies <0.2 Hz). No consistent dependence on static head orientation was observed for the vertical response components during up-down motion and the horizontal and torsional response components during lateral translation. The frequency response characteristics of the translational VORs were fitted by "periphery/brain stem" functions that related the linear acceleration input, transduced by primary otolith afferents, to the velocity signals providing the input to the velocity-to-position neural integrator and the oculomotor plant. The lowest-order, best-fit periphery/brain stem model that approximated the frequency dependence of the data consisted of a second order transfer function with two alternating poles (at 0.4 and 7.2 Hz) and zeros (at 0.035 and 3.4 Hz). In addition to clearly differentiator dynamics at low frequencies (less than approximately 0.5 Hz), there was no frequency bandwidth where the periphery/brain stem function could be approximated by an integrator, as previously suggested. In this scheme, the oculomotor plant dynamics are assumed to perform the necessary high-frequency integration as required by the reflex. The detailed frequency dependence of the data could only be precisely described by higher order functions with nonminimum phase characteristics that preclude simple filtering of afferent inputs and might be suggestive of distributed spatiotemporal processing of otolith signals in the translational VORs.

Animals↗