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PubMed1993

The recto-levator reflex: the description of a new reflex and its clinical application. Preliminary report.

This communication embodies the description of a technique of recording a new reflex which I call "recto-levator reflex". The study was performed on 32 normal volunteers. The technique comprises the introduction of a balloon connected with a catheter into the rectum. A concentric needle electrode was introduced into the levator ani. The rectal balloon was distended and the levator myoelectric activity was recorded. In 12 patients, the procedure was repeated after levator infiltration with xylocaine or saline. When the rectal balloon was inflated with air, the levator muscle contracted. Levator contraction increased with increasing rectal distension. Anesthetized muscle did not respond, while saline-infiltrated muscle responded to rectal distension. Latency of the reflex was calculated. The recto-levator reflex seems to play an important role at defecation. On rectal distension with stools, levator contraction opens the rectal neck. Changes in the latency or amplitude of the reflex would indicate a defect in the reflex pathway. The reflex may thus prove of diagnostic significance in defecation disorders.

Adult↗
PubMed2001

The blink reflex and the corneal reflex are followed by cortical activity resembling the nociceptive potentials induced by trigeminal laser stimulation in man.

Laser stimulation of the supraorbital regions evokes brain potentials (LEPs) related to trigeminal nociception. The aim of this study was to record the R2 component of the blink reflex and the corneal reflex in 20 normal subjects, comparing the scalp activity following these reflexes with the nociceptive potentials evoked by CO2 laser stimulation of supraorbital regions. Cortical and muscular reflexes evoked by stimulation of the first trigeminal branch were recorded simultaneously. The R2 component of the blink reflex and the corneal reflex were followed by two cortical peaks, which resembled morphologically N-P waves of LEPs. The two peaks demonstrated a difference in latency of approximately 40 ms, which is consistent with activation time of nociception. This finding suggests that these reflexes are induced by activation of small pain-related fibers.

Adult↗
PubMed1970

Reflex inhibition of monosynaptic reflexes by stimulation of type J pulmonary endings.

1. Monosynaptic reflexes, evoked from flexor and extensor hind limb muscle nerves in cats anaesthetized with pentobarbitone sodium, were depressed for several seconds after right intra-atrial injection of phenyl diguanide. Injection of the drug close to the aortic valves did not produce the same effect on the reflex. There was no obvious depression of polysynaptic reflexes on intra-atrial injection of phenyl diguanide.2. This depression of the monosynaptic reflex was present even after the administration of atropine, which lessened the hypotension due to phenyl diguanide. The blood gas tensions were also measured after the administration of phenyl diguanide, and were not altered to a degree where one would expect the depression to be secondary to a change in arterial gas tensions. The depression was also present in paralysed and artificially ventilated cats.3. The afferent pathway causing this depression of the monosynaptic reflex runs in the vagus nerve, as shown by experiments done before and after vagotomy. Intercollicular decerebration also abolished this inhibition of the monosynaptic reflex.4. Prior intravenous injection of strychnine (0.1 mg/kg) abolished the effect of intra-atrial administration of phenyl diguanide.5. It was concluded that stimulation of type J pulmonary endings causes a reflex inhibition of monosynaptic reflexes lasting for several seconds via regions of the brain cephalad to the intercollicular level.

Animals↗
PubMed1981

Dependence of the Achilles tendon reflex on the excitability of spinal reflex pathways.

Muscle afferent activity from the triceps surae was recorded during experimentally induced alterations in amplitude of the Achilles tendon jerk. No changes in the neural afferent response to tendon percussion or in the background level of neural activity occurred when the reflex response was altered by discomfort, distraction, changes in attention, or changes in the rate of tendon percussion. Reinforcement of the Achilles tendon jerk by forceful contraction of the forearm muscles did not alter the relationship between intensity of the tendon tap and amplitude of the evoked neural afferent volley. Nevertheless, such maneuvers lowered the reflex threshold and raised reflex sensitivity so that a smaller afferent volley was required to produce a tendon jerk, and an increase in the afferent volley produced a disproportionately greater increase in reflex electromyographic activity than would have occurred at rest. Reinforcement maneuvers potentiated the H-reflex but did not alter the electrically induced afferent volley or the background level of neural activity. It is concluded that these changes in reflex responsiveness occurred through intrinsic spinal mechanisms independent of the fusimotor system.

Achilles Tendon↗
PubMed2003

Proprioceptive reflexes in patients with reflex sympathetic dystrophy.

Reflex sympathetic dystrophy (RSD) is a syndrome that frequently follows an injury and is characterized by sensory, autonomic and motor features of the affected extremities. One of the more common motor features of RSD is tonic dystonia, which is caused by impairment of inhibitory interneuronal spinal circuits. In this study the circuits that modulate the gain of proprioceptive reflexes of the shoulder musculature are quantitatively assessed in 19 RSD patients, 9 of whom presented with dystonia. The proprioceptive reflexes are quantified by applying two types of force disturbances: (1) disturbances with a fixed low frequency and a variable bandwidth and (2) disturbances with a small bandwidth around a prescribed centre frequency. Compared to controls, patients have lower reflex gains for velocity feedback in response to the disturbances around a prescribed centre frequency. Additionally, patients with dystonia lack the ability to generate negative reflex gains for position feedback, for these same disturbances. Proprioceptive reflexes to the disturbances with a fixed low frequency and variable bandwidth present no difference between patients and controls. Although dystonia in the RSD patients was limited to the distal musculature, the results suggest involvement of interneuronal circuits that mediate postsynaptic inhibition of the motoneurons of the proximal musculature.

Adult↗
PubMed1995

Efferent projections of the olivary pretectal nucleus in the albino rat subserving the pupillary light reflex and related reflexes. A light microscopic tracing study.

The olivary pretectal nucleus is a primary visual centre sensitive to luminance changes. It is involved in the pupillary light reflex, the consensual pupillary light reflex and related reflexes, such as the lid closure reflex whereby pupillary constriction takes place. Since the olivary pretectal nucleus is a small nucleus, previous studies using degeneration, horseradish peroxidase and radioactive amino acid tracing were limited regarding to the exclusiveness of the projections from the olivary pretectal nucleus. In the present study the position of the olivary pretectal nucleus in the rat was first localized by physiological recording of the neurons upon luminance stimulation. Subsequently, an anterograde tracer Phaseolus vulgaris leucoagglutinin was injected iontophoretically. This allows a much more precise localization of the olivary pretectal nucleus projections. Ascending and descending pathways originating from the olivary pretectal nucleus were observed. Ascending fibres project bilaterally to the intergeniculate leaflet, the ventral part of the lateral geniculate nucleus and ipsilaterally to the anterior pretectal nucleus. In addition, contralateral projections were observed to the zona incerta and the fields of Forel. Descending fibres project bilaterally to the periaqueductal gray, the nucleus of Darkschewitsch, the interstitial nucleus of Cajal, the Edinger-Westphal nucleus and the intermediate gray layer of the superior colliculus. Also a contralateral projection to the oculomotor nucleus and an ipsilateral projection to the pontine nucleus and the nucleus of the optic tract were found. Furthermore, the contralateral olivary pretectal nucleus received a small projection. Retrograde tracing experiments using two fluorescent dyes revealed that the fibres projecting to the contralateral olivary pretectal nucleus and to the contralateral interstitial nucleus of Cajal are collaterals. The projection from the olivary pretectal nucleus to the facial nucleus which has been described to receive an input in cats could not be confirmed for the rat. The fact that the Edinger-Westphal nucleus, the interstitial nucleus of Cajal and the superior colliculus receive an input from the olivary pretectal nucleus suggests that this primary visual centre is not only involved in the pupillary light reflex, but also in controlling eye and head position and saccadic eye movements. Although visual acuity largely depends on receptive field sizes of retinal ganglion cells and their central connections, the stronger sympathetic influence during the pupillary light reflex in animals with frontally placed eyes compared to animals with laterally placed eyes may also contribute to the higher visual acuity in animals with frontally placed eyes.

Afferent Pathways↗
PubMed1980

Incontinence of urine due to instability of micturition reflexes: Part I. Detrusor reflex instability.

Micturition reflex instability may result from malfunction of the detrusor reflex or instability of the pudendal nucleus which innervates the pelvic floor muscles and external sphincter. Detrusor instability is the result of sacral micturition reflex center (SMRC) hyperexcitability. This may be caused by underinhibition or overfacilitation of the SMRC, and there are both central and peripheral causes of each. Detrusor hypertrophy may invoke chronic overactivity of the detrusodetrusor facilitative reflex causing SMRC overfacilitation. Similarly, distal urethral stricture and/or chronic urethritis causing chronic overactivity of the urethrodetrusor facilitative reflex is a common cause of SMRC overfacilitation. Pathologic relaxation and weakness of the striated muscles of the pelvic floor and perineum resulting in underactivity of the perineodetrusor inhibitory reflex, is a common cause of SMRC underinhibition. In adult women these factors often coexist. Each may predispose to stress-induced detrusor instability and are often seen in association with, or are confused with, true stress incontinence. The distinguishing characteristics of detrusor hypertonicity and detrusor hyperreflexia are reviewed, and the various mechanisms of pseudostress incontinence and of urgency incontinence are discussed in detail.

Adult↗
PubMedDate not supplied

[Effect of polysynaptic flexion reflex on monosynaptic reflexes of calf muscles prior to and following intramuscular injection of ethylbenzatropine in drug-induced muscle rigidity].

In patients with drug-induced parkinsonism and in healthy subjects the effect of stimulation of low-threshold skin fibres of sural nerve producing the polysynaptic flexion reflex of the short head of the biceps femoris muscle on the monosynaptic H reflex of calf muscles was studied before and after administration of ethylbenzatropine. In healthy subjects stimulation of low-threshold skin nerve was followed by facilitation of H reflex in the time of 70 to 200 msec. from the conditioning stimulation to the test stimulation. After one single intramuscular dose of ethylbenzatropine this late facilitating effect disappeared. In patients with drug-induced parkinsonism stimulation of afferent fibres of flexion reflex failed to cause late facilitation of H reflex and one dose of ethylbenzatropine brought no changes. During systematic administration of the drug an evident tendency for facilitation of H reflex was observed, similarly as in healthy subjects. The results obtained in healthy subjects and in patients with drug-induced parkinsonism are explained as evidence of inhibitory action of noradrenaline in certain chains of spinal interneurons, since noradrenaline release in the spinal cord is determined by the striatal equilibrium between the cholinergic and dopaminergic systems. The corrective action of ethylbenzatropine would depend on its central action on certain spinal chains of interneurons determining transmission of impulses from dermal afferent nerves to alpha motoneurons.

H-Reflex↗
PubMed1975

Acoustic reflex and reflex decay. Occurrence in patients with cochlear and eighth nerve lesions.

Acoustic reflex and reflex decay tests were administered to 50 normal ears, 50 ears with hearing loss due to noise trauma, 50 ears that had Meniere disease, and 28 ears that had involvement of the eighth nerve. In one normal ear, ten noise trauma ears, 11 Meniere disease ears, and 24 eighth nerve lesion ears to reflexes or reflex decay that were suggestive or retrocochlear lesions were observed. Acoustic reflex and reflex decay results are also compared to tone decay results for these patients.

Acoustic Stimulation↗
PubMed1991

Straining puborectalis reflex: description and significance of a "new" reflex.

The present communication studies the technique and clinical significance of a new reflex, termed straining puborectalis reflex. Nineteen healthy volunteers with an average age of 38.2 years were studied, including ten males and nine females. The intravesical pressure, representative of intra-abdominal pressure, was measured by means of a balloon-tipped catheter introduced into the urinary bladder and connected to a pressure transducer. The electromyographic (EMG) activity of the puborectalis muscle was recorded using a concentric needle electrode inserted into the muscle. The EMG response of the puborectalis muscle to straining at different pressures was recorded. The response to two types of straining--sudden momentary and slow, sustained--was observed. The procedure was repeated in ten subjects after puborectalis infiltration with xylocaine or saline. Sudden straining evoked puborectalis contraction, whereas slow, sustained straining did not. Puborectalis contraction increased with the increase in straining intensity. These results were reproducible. The anesthetized puborectalis did not respond to straining, whereas the saline-infiltrated muscle did. The latency of the reflex was studied. Besides its role as a voluntary continent sphincter, the puborectalis seems to have a role also in the involuntary continence of the pelvic organs through the straining-puborectalis reflex. The muscle contracts on sudden straining, sealing the rectal and vesical necks and thereby preventing fecal or urinary leak. However, it is only on sudden straining that the puborectalis contracts. Slow, sustained straining as occurs during defecation and micturition does not evoke the reflex action. The straining puborectalis reflex is informative and may be incorporated as an investigative tool in patients with fecal and urinary control disorders.

Adult↗
PubMed1993

Non-reflex and reflex mediated ankle joint stiffness in multiple sclerosis patients with spasticity.

In this study, we have measured the passive, the intrinsic, and the reflex-mediated mechanical response to stretch of the ankle extensors and flexors in 13 spastic multiple sclerosis patients and 10 healthy control subjects. In the ankle flexors, the patients had no reflex-mediated stiffness. The passive stiffness was increased by 138% (95% confidence interval: 26-91%) and the intrinsic stiffness by 79% (41-158%) when compared with the healthy subjects. In the ankle extensors, the reflex-mediated stiffness and the intrinsic stiffness of the patients were equal to the reflex-mediated and the intrinsic stiffness in healthy subjects. The passive stiffness was increased by 152% (41-352%). We conclude that spastic muscles in multiple sclerosis patients have an increased non-reflex stiffness (passive plus intrinsic stiffness), and that the reflex-mediated stiffness in the extensors during a sustained voluntary contraction does not differ significantly from healthy subjects.

Adult↗
PubMed1988

Stabilizing gaze reflexes in the pigeon (Columba livia). I. Horizontal and vertical optokinetic eye (OKN) and head (OCR) reflexes.

A quantitative study of horizontal and vertical optokinetic nystagmus (OKN) and optocollic reflex (OCR) has been performed in the pigeon using the search-coil technique. The reflexes were analysed in response to either velocity steps or sinusoidal stimulation. Results show that: 1. In response to a velocity step stimulation, the slow phase velocity of both OKN and OCR increases gradually to reach a steady state level. When the stimulation stops in the dark, After Responses (OKAN-I, OKAR-I) occur. Time constants of the OKN charge (or OCR charge) and of the After Responses are lower for vertical than for horizontal responses. 2. In the free-head condition, both the head and the eye display a synchronized nystagmus which add their effects. However, the head reflex (OCR) accounts for about 80-90% of the entire linear gaze response (head + eye), except for the vertical steady state responses which are wholly accomplished by the head (OCR). 3. Both closed-loop and open-loop gains of steady state responses are higher for horizontal than for vertical reflexes. Vertical OCR, horizontal OKN and vertical OKN show properties of binocular integration, the response gain being higher for binocular than for monocular stimulations. By contrast, the horizontal OCR shows little binocular integration but displays a higher response gain for monocular stimulation, compared to horizontal OKN. 4. The horizontal OKN elicited by both monocular and binocular stimulation is asymmetrical, the gain being higher when the eye is driven by a temporo-nasal stimulation. In contrast, both vertical OKN and vertical OCR are practically symmetrical. 5. While both the gain of horizontal OKN and its linear range (up to 20 degrees/s) are improved when the head is free (gaze gain close to 1 up to 40 degrees/s), the vertical OKN and the vertical OCR have similar gain profiles and similar domains of linearity (up to 10 degrees/s). 6. In response to increasing the frequency of a sinusoidal stimulation at constant peak velocity, all the reflexes display a drop in gain and a strong increase of phase lag. The phase increase is greater for horizontal than for vertical reflexes. On the other hand, both gain and phase are higher for OCR than for OKN, both in the horizontal plane as well as in the vertical plane. 7. For sinusoidal stimulations, when the peak velocity (PV) is increased at a constant frequency (0.03 Hz), nonlinearities appear (drop in gain, phase increase) both for OKN and OCR.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1985

Sensitivity of pulmonary chemo reflexes and lung inflation reflexes to repetitive stimulation and to inhibition with lidocaine and morphine.

To study reflex responses caused by stimulation of pulmonary C-fibers and lung inflation, we used a preparation in which the left pulmonary artery and veins were ligated and cannulated and the right and left bronchi were cannulated separately in open-chest dogs. These experiments were performed to establish whether the reflex responses to injections of 150 micrograms of capsaicin through the left pulmonary circulation and inflations of this left lung to 30 cm H2O would be diminished if repeated frequently. Furthermore, the sensitivities of the reflex responses evoked by these capsaicin injections and by left lung inflations (LLI) to blockade with lidocaine or with morphine were studied. Both repeated injections of capsaicin into the left pulmonary circulation and repeated inflations of the left lung for up to 100 min produced a persistent triad of reflex responses: bradycardia, hypotension, and cessation of diaphragmatic contractions. Lidocaine injections (50 mg) into the pulmonary artery of the vascularly isolated lung abolished all reflex responses to subsequent injections of capsaicin, but only attenuated the triad of responses to subsequent left lung inflations by half. Morphine sulfate (60 mg) administered to the pulmonary vascular bed of the isolated lung reduced, but did not eliminate, the triad of reflex responses to subsequent capsaicin injections and lung inflations. The influences of morphine upon capsaicin and lung inflation responses were not abolished by naloxone.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2003

Role of positive urethrovesical feedback in vesical evacuation. The concept of a second micturition reflex: the urethrovesical reflex.

Upon feeling the urge to urinate, the urinary bladder contracts, the urethral sphincters relax and urine flows through the urethra. These actions are mediated by the micturition reflex. We investigated the hypothesis that vesical contraction is maintained by positive feedback through continuous flow of urine through the urethra, and that the cessation of urine flow aborts detrusor contraction. Normal saline was infused into the urinary bladders of 17 healthy volunteers (age 35.2 years+/-4.2(SD); ten women and seven men) at a rate of 100 ml/min. On urge, which occurred at a mean volume of 408.6 ml+/-28.7 of saline, the subject micturated while the vesical and urethral pressures during voiding were being recorded; residual urine was measured. The test was repeated after anesthetizing the urethra with xylocaine gel or, on another occasion, after applying a bland gel. On micturition, the urine was evacuated as a continuous stream without straining; no residual fluid was collected. After urethral anesthetization, the fluid came out of the urethra in multiple intermittent spurts and only with excessive straining. There was a large amount of residual fluid (184.6 ml+/-28.4). The results of bland gel application showed no significant difference ( P>0.05) from those without gel. Detrusor contraction during micturition is suggested to be maintained by positive urethrovesical feedback elicited by the continued passage of urine through the urethra. This feedback seems to be effected through the urethrovesical reflex, which produces vesical contraction on stimulation of the urethral stretch receptors. Abortion of this reflex by urethral anesthetization resulted in failure of detrusor contraction and excessive straining was needed to achieve bladder evacuation in multiple spurts. The urethrovesical reflex is thus assumed to constitute a second micturition reflex responsible for the continuation of detrusor contraction and urination. The role of this reflex in the pathogenesis of micturition disorders needs to be studied.

Adult↗
PubMed1985

The flexor reflex--influence of stimulus parameters on the reflex response.

The flexor reflex evoked in the tibialis anterior muscle by stimulation of the medial plantar nerve was investigated in 54 normal subjects. Three main reflex components were identified (excitation--inhibition-- excitation), the early excitation being composed of two subcomponents. Occasionally, a fourth (excitatory) reflex component was seen breaking through EMG inhibition. The individual reflex components were differentially susceptible to facilitatory influences which suggested transmission via a central multichannel system. Methodological experiments showed that the amplitudes and to some degree also the latencies of the individual reflex components were modified by both the parameters of the stimulus as well as by the degree of pre-innervation. However, the patterning of the reflex response was basically independent from methodological permutations.

Adult↗
PubMed1991

The cause of increased pupillary light reflex latencies in diabetic patients: the relationship between pupillary light reflex and visual evoked potential latencies.

In 42 diabetic patients the relationship between the latency of the pupillary light reflex and the pattern reversal visual evoked potential (P100) was examined. Fifty-five percent of diabetic patients had pupillary light reflex latencies above the normal range. In 19% the visual evoked potentials were prolonged when compared to the normal range. Latencies of pupillary light reflexes and VEPs showed no correlation. There was a minimal correlation between the presence of retinopathy and prolongation of both the pupillary light reflex and the visual evoked response latency (kappa coefficients respectively: 0.31, P less than 0.01 and 0.36, P less than 0.02). The presence of an increased pupillary light reflex latency was positively correlated with a reduced respiratory sinus arrhythmia (kappa coefficient: 0.58, P less than 0.0001). Increased VEP latencies showed no correlation with signs of cardiovascular autonomic neuropathy. We conclude that the afferent optic pathway can be affected in diabetic patients. However, prolongation of pupillary light reflex latency in diabetic patients is primarily due to an efferent pupillary defect and represents parasympathetic dysfunction.

Adult↗
PubMed1985

Blink reflex in patients with hemispheric cerebrovascular accident (CVA). Blink reflex in CVA.

A blink reflex consists of an early unilateral component, R1, and a late bilateral component, R2. During an acute phase of hemispheric cerebrovascular accident, R1 and R2 were abnormal in 30 and 50 of 66 patients, respectively. Paired stimuli usually corrected R1 but not R2, which was profoundly suppressed. The discrepancy between polysynaptic R2 and oligosynaptic R1 indicates a greater disfacilitation at the level of interneurons than at the motoneuron, which serves as the final common path. Abnormality of R2 occurred bilaterally with stimulation on the affected side of face and contralaterally after stimulation on the normal side in 31 patients. This finding suggests a diffuse loss of internuncial excitability, contralateral to the hemispheric lesion. Changes of R2 implicated the brainstem pathways forming the afferent and efferent arc of the reflex in 7 and 8 patients, respectively. The remaining 4 comatose patients had no R2 irrespective of stimulus sites. Clinical localization of the hemispheric lesion showed no consistent correlation with the type of blink reflex abnormalities. The CT scans revealed widely scattered changes in 29 patients with abnormal blink reflex but with a tendency to overlap in the inferior Rolandic area. This contrasted with conspicuous sparing of the inferior post-central region in 10 patients with normal blink reflex. These findings suggest the presence of crossed facilitation to this reflex from wide areas of the cortex but most prominently from the sensory representation of the face.

Acute Disease↗
PubMed1990

Levator-urethral reflex. A new reflex with clinical significance.

A preliminary study of a new reflex which I called "levator-urethral reflex" is presented. Twenty-three volunteers were studied. Two concentric needle electrodes were introduced: one in the levator ani muscle (stimulating electrode) and the other in the external urethral sphincter (recording electrode). Levator stimulation evoked external sphincter contraction in all the subjects. The anesthetized sphincter did not respond while the saline-infiltrated one responded. The mean latency of the reflex was 168 ms. The levator-urethral reflex regulates the relation between micturition and continence. Reflex external urethral sphincter contraction keeps micturition under control despite the involuntary opening of the vesical neck as a result of levator contraction. Measurement of the latency of the reflex could be an objective and accurate means of investigating micturition disorders.

Adolescent↗