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PubMed2002

Rectoanal reflex parameters in incontinence and constipation.

PURPOSE: The transient relaxation of the internal anal sphincter in response to rectal distention is believed to play an important role in the continence mechanism. Most anorectal physiology laboratories merely report the rectoanal inhibitory reflex as being either present or absent. This study aimed to assess the parameters of the rectoanal inhibitory reflex in incontinent and constipated patients and healthy control subjects, in an attempt to analyze differences in internal anal sphincter function in these groups. We analyzed each response of the internal anal sphincter to rectal distention with progressively increasing volumes of air at a single site (proximal anal canal). METHODS: Fifty-five constipated and 99 incontinent patients and healthy control subjects underwent manometry. Various parameters of the rectoanal inhibitory reflex were analyzed, and percentage sphincter relaxation was calculated at each volume at which rectoanal inhibitory reflex occurred. RESULTS: There was no difference in the volume of rectal distention required to elicit sensation (P = 0.626) or the rectoanal inhibitory reflex (P = 0.371) in the three groups. There was a significant correlation between the volume required to elicit the rectoanal inhibitory reflex and that at which sensation was first felt only in the incontinent (P = 0.0001) group. Significantly greater sphincter relaxation was seen at each volume (P = 0.001) in the incontinent as compared with the constipated patients. With progressive rectoanal inhibitory reflex, consistently progressive increases in internal anal sphincter relaxation were found only in the incontinent group. This consistent relationship was not seen in the constipated patients or in healthy control subjects. CONCLUSIONS: Assessment of various parameters of the rectoanal inhibitory reflex yielded important information regarding the continence mechanism. Altered responses of the internal anal sphincter in anorectal disorders plays a role in the associated physiologic impairment. This may have significant clinical implications with regard to sphincter-saving resections.

Adolescent↗
PubMed2003

Recovery of the rectoanal inhibitory reflex after restorative proctocolectomy: does it correlate with nocturnal continence?

PURPOSE: The rectoanal inhibitory reflex has an important role in fecal sampling and discrimination of rectal contents. The aim of this study was to determine the significance of rectoanal inhibitory reflex after restorative proctocolectomy with ileal pouch-anal anastomosis for mucosal ulcerative colitis. METHODS: The medical records of 345 patients who underwent ileal pouch-anal anastomosis from September 1988 to May 1999 were retrospectively reviewed. One hundred patients who underwent double-stapled ileal pouch-anal anastomosis and had anorectal physiology testing within 3 months before surgery as well as after ileostomy closure (mean, 23.1; range, 3-77 months) were analyzed. Anorectal physiology testing included detecting the presence of the rectoanal inhibitory reflex, sensory threshold volume, and rectal or pouch capacity and compliance. Parameters to determine incontinence included daytime and nocturnal bowel movement frequency, nocturnal spotting, status of continence for solid or liquid stool, gas, use of pads, and lifestyle alteration were surveyed in 62 of the 100 patients at a mean of 3.9 (range, 1-9.1) years to determine the incontinence score. RESULTS: Whereas the rectoanal inhibitory reflex was noted in 96 (96 percent) patients before surgery, it was found in only 53 (53 percent) after ileostomy closure (P < 0.0001). Incontinence status data was available in only 62 of the 100 patients (32 RAIR-positive; 30 RAIR-negative). There were no significant differences between the rectoanal inhibitory reflex-positive and the rectoanal inhibitory reflex-negative groups relative to the interval between surgery and manometry (22 vs 25 months), postoperative threshold sensation volume (32 vs 31 ml), postoperative compliance (19 vs 12 cm H(2)O/ml), postoperative capacity (85 66 ml), daytime/nighttime stool frequency (6.2/2 vs 5.5/1.5), or postoperative incontinence score (3.9 vs 1.8). However, there were significant differences relative to the incidence of nocturnal soiling (12/30 (40 percent) 23/32 (72 percent), P = 0.0012) favoring the presence of the rectoanal inhibitory reflex. CONCLUSION: Preservation of the rectoanal inhibitory reflex correlated with a decrease in the incidence of nocturnal soiling after double-stapled ileoanal reservoir construction.

Adolescent↗
PubMed1992

Cardiopulmonary receptor and arterial baroreceptor reflexes after acute myocardial infarction.

The baroreceptor-heart rate reflex in human is impaired 2 days after a myocardial infarction but it improves 10 days after the acute coronary event. This study investigated whether (1) the baroreceptor-heart rate reflex improvement takes the reflex back to normal, and (2) the cardiopulmonary reflex is affected by myocardial infarction. In subjects studied 8 to 11 days after a transmural anterior or inferior myocardial infarction the baroreceptor-heart rate reflex sensitivity (slope of the linear regression between negative neck chamber pressures and lengthenings in RR interval) was similar to that seen in control subjects (-6.2 +/- 0.8 vs -6.0 +/- 0.6 ms/mm Hg, mean +/- SEM) and did not change when reassessed 10 days later. In contrast, the cardiopulmonary reflex sensitivity (changes in forearm vascular resistance induced by changing central venous pressure through nonhypotensive lower body suction and leg raising) was markedly less in subjects studied 8 to 11 days after myocardial infarction than in control subjects; the reduction amounted to 58.1 +/- 8% (p less than 0.01). The cardiopulmonary reflex sensitivity greatly improved when reassessed 28 to 45 days later. Thus, the baroreflex is normal about 10 days after myocardial infarction. This condition markedly impairs the cardiopulmonary reflex, but the impairment is also transient.

Blood Pressure↗
PubMed1985

Neural organization of the viscero-cardiac reflexes.

The reflex responses evoked in the postganglionic nerves to the heart were tested in chloralose-anaesthetized cats. Electrical stimulation of the A delta afferent fibres from the left inferior cardiac nerve evoked spinal and supraspinal reflex responses with the onset latencies of 36 ms and 77 ms respectively. The most effective stimulus was a train of 3-4 electrical pulses with the intratrain frequency of 200-300 Hz. Electrical stimulation of the high threshold afferent fibres (C-fibres) from the left inferior cardiac nerve evoked the reflex response with the onset latency of 200 ms. The C-reflex was present in intact animals and disappeared after spinalization. The most effective stimulus to evoke this reflex was a train of electrical pulses delivered at a frequency of 1-2 Hz with an intratrain frequency of 20-30 Hz. The most prominent property of the C-reflex was its marked increase after prolonged repeated electrical stimulation. We conclude that: (1) viscero-cardiac sympathetic reflexes may be organized at the spinal and supraspinal level; (2) viscero-cardiac sympathetic reflexes evoked by stimulation of the A delta and C afferent fibres from the left inferior cardiac nerve have different central organization.

Animals↗
PubMed1985

Effects of a distant noxious stimulation on A and C fibre-evoked flexion reflexes and neuronal activity in the dorsal horn of the rat.

In the halothane-anaesthetized rat, the responses of 49 neurons in the lumbo-sacral cord and the reflex discharge in the common peroneal nerve following electrical stimulation of the sural nerve were recorded in order to study possible relations between neuronal events and reflex nerve discharges. A distant noxious stimulus (to activate Diffuse Noxious Inhibitory Controls (DNIC) of Le Bars et al.) was used as a conditioning stimulus. Only the responses of neurons receiving an input from both A and C fibres were studied. The neurons were classified as class 1 (low threshold mechanoreceptive input only, n = 2), class 2 (nonnoxious and noxious inputs, n = 34) or class 3 (responding to noxious stimuli only, n = 13). During conditioning stimulation the C fibre evoked discharge was inhibited in 32 out of 34 class 2 neurons. The A fibre-evoked discharge was simultaneously inhibited in 29 of these neurons. The main effect of the distant noxious stimulation on the C fibre evoked neuronal discharge was to decrease the discharge by a constant number of spikes, independent of the level of evoked activity. Only one class 3 neuron was inhibited during conditioning stimulation and none of the class 1 cells were influenced by DNIC. During conditioning stimulation the late and prolonged C fibre evoked reflex nerve discharge (latency 160-200 ms, duration up to several hundred ms) was strongly depressed. Concomitantly, a short-lasting reflex nerve discharge appeared over the interval 115-160 ms. This released reflex nerve discharge (RR) had a constant latency. There was no simultaneous change of the A beta evoked reflex nerve discharge. After the end of the distant noxious stimulation the late C fibre evoked reflex nerve discharge (latency 160-200 ms) recovered. Concomitantly, the RR disappeared. The possibility that the class 2 neurons and the class 3 neurons are intercalated in different reflex pathways is discussed.

Animals↗
PubMed1988

Reflex effects evoked by stimulation of hypoglossal afferent fibers.

In pentobarbitone-anesthetized cats, electrical stimulation of the central ends of the main trunks of transected hypoglossal nerves evoked vascular (pressor or depressor) reactions, mydriasis, slow and deep breathing, and reflex activation of laryngeal and facial muscles. Stimulation of the central end of the transected ramus descendens hypoglossi also provoked reflex contraction of cricothyroideus. These reflexes may be elicited also after intracranial section of hypoglossal nerve roots, but not after intracranial section of ipsilateral vagal roots. The above reflexes were abolished by acute section of the ipsilateral hypoglossonodosal branch, but they may be reproduced by electrical stimulation of the central end of this anastomotic branch between hypoglossal nerve and nodose ganglion. Stimulation of the central end of one transected hypoglossus evoked reflex efferent discharges in contralateral hypoglossus and contraction of contralateral tongue muscles. Stimulation of the central end of one transected hypoglossal end-branch inhibited efferent discharges in another end-branch. The crossed hypoglossohypoglossal reflex and the ipsilateral reflex inhibition were abolished by section of the hypoglossonodosal branch or vagal roots at the stimulated side. We conclude that reflexes evoked by stimulation of peripheral hypoglossal nerve in cats are mediated by afferent fibers directed to the nodose ganglion and entering the brain stem via vagal roots.

Afferent Pathways↗
PubMed1992

Movement features and H-reflex modulation. II. Passive rotation, movement velocity and single leg movement.

Modulation of soleus H-reflex magnitudes during pedalling, and their approximation when seated with appropriate joint positions and contractile activity was demonstrated in the previous paper. The present study investigated the modulation of H-reflexes during (A) pedalling movement in the absence of contractile activity, (B) different movement velocities and (C) movement of a single limb. Using a customized tandem cycle ergometer, seated subjects with trunk supported relaxed their leg muscles and allowed their legs to be rotated. Their feet were supported on the pedals with the ankle braced. Reflexes were collected at four phases in the movement cycle (with some at 13 phases) and with speeds of 5-60 revolutions per min (cycle times from 12 to 1 s). The results showed that (i) reflex magnitude substantially decreased with limb rotation (P less than 0.05). The degree of inhibition was dependent on the phase position. (ii) Increasing speed of passive rotation increased the inhibition at all positions, but was most pronounced near the fullest flexion of hip and knee. When subjects actively pedalled, the relationship between speed and inhibition remained. (iii) When the contralateral leg was moved and the target leg was stationary, crossed projection of reflex inhibition was clear. (iv) The reflex gain measured during active pedalling of one leg was similar to that observed during two legged pedalling. Again, a crossed effect from the contralateral leg could be observed. We conclude that the net influence of discharge from movement-elicited afference is inhibitory on this reflex path and that the reflex modulation during pedalling arises from overlaid sources.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Prolonged inhibition of the flexor reflex by probing the cervix uteri in the cat.

In decerebrate or spinal cats, sustained mechanical stimulation of the cervix uteri inhibited the flexor reflex elicited by electrical stimulation of the foot pad during the probing period (160 s). After probing, 3-15 min were required for reflex recovery. No additional inhibition was produced if probing was repeated before recovery, but instead the reflex was facilitated. When probing was applied 5-10 min after reflex recovery the reflex was again abolished. The recovery, however, occurred earlier and was followed by facilitation. Probing the cervix with single mechanical pulses inhibited transiently (140-200 ms) the short latency reflex components, but the components with longer latencies are unaffected or facilitated. Distension of the vaginal wall with a balloon also inhibited the flexor reflex, but a transient, mild facilitation appeared several seconds after the distension. In general, whenever the inhibition decreases, the facilitation predominates. Our findings suggest that cervical probing or vaginal distension triggers both a long-lasting inhibition and a concomitant facilitation in different intraspinal flexor reflex pathways.

Afferent Pathways↗
PubMed1994

Stimulation of the hypothalamus initiates the urethrogenital reflex in male rats.

The urethrogenital (UG) reflex is a spinal sexual reflex which is tonically inhibited in the intact male rat by neurons in the nucleus paragigantocellularis (nPGi). The medial preoptic area of the hypothalamus (MPOA) is involved in the activation of male sexual behavior. The present study examines the effect of hypothalamic stimulation on the UG reflex in the intact male rat. Areas of the hypothalamus were stimulated bilaterally with either electrical stimulation or D,L-homocysteic acid (DLH) and the presence of the UG reflex examined. Stimulation of discrete aras of the hypothalamus evoked the UG reflex. The UG reflex could be initiated in the absence of genital stimulation. Microinjections of DLH into the MPOA also initiate the UG reflex. These data suggest that stimulation of neurons in the MPOA overcome the inhibition by the nPGi and facilitate spinal genital reflexes leading to ejaculation.

Animals↗
PubMed1995

The effects of vision and task complexity on Hoffmann reflex gain.

Previous research demonstrates modulation of the Hoffmann reflex amplitude and gain during changes in environmental conditions. H-reflex gain (defined in this study as the ratio of H-reflex amplitude to average soleus background EMG) is considered a functional measure of reflex modulation. In this study the effects of manipulating visual input and surface stability were to investigated in 17 subjects under four experimental conditions: (1) vision-stable surface, (2) no vision-stable surface, (3) vision-unstable surface, and (4) no vision-unstable surface. In each condition, subjects performed fifteen trials of a single leg stance for 7 s. The H-reflex was electrically elicited at the end of each trial by delivering a 1 ms square wave stimulation to the tibial nerve in the popliteal online for each trial (sampling rate = 2 kHz). An analysis of variance revealed significant decreases in H-reflex gain for the visual (F1.16 = 4.71, P < 0.05) and, surface conditions (F1.16 = 7.67, P < 0.05), however there was no interaction (F1.16 = 0.48, P < 0.05), between these variables. These results suggest that supraspinal mechanisms, possibly presynaptic inhibition, modulate H-reflex gain across environmental conditions. We conclude that visual and possibly cutaneous inputs were responsible for driving presynaptic inhibition and thus decreasing H-reflex gain.

Analysis of Variance↗
PubMed1996

Microinjection of NMDA antagonist into the NTS of conscious rats blocks the Bezold-Jarisch reflex.

The purpose of the present study was to evaluate whether or not cardiovagal excitatory and sympatho-inhibitory pathways of the Bezold-Jarisch reflex at the NTS level were mediated by NMDA receptors. The Bezold-Jarisch reflex was activated by intravenous (i.v.) injection of serotonin in conscious rats before and after microinjection of phosphonovaleric acid (AP-5) a selective NMDA antagonist, into the NTS. The Bezold-Jarisch reflex was also activated before and after methyl-atropine (i.v.) in order to evaluate if the changes in mean arterial pressure were dependent on the bradycardic response. The data showed that AP-5 into the NTS produced a dose-dependent reduction in both bradycardic and hypotensive responses to activation of the Bezold-Jarisch reflex. Methyl-atropine also blocked the bradycardic and hypotensive responses to Bezold-Jarisch reflex activation. The data show that in conscious rats the cardiovagal component of the Bezold-Jarisch reflex plays a major role in the cardiovascular changes produced by the activation of this reflex and suggest that the neurotransmission of the cardiovagal component of the Bezold-Jarisch reflex is mediated by NMDA receptors.

2-Amino-5-phosphonovalerate↗
PubMed1983

Stretch reflex modulation during a cyclic elbow movement.

Small torque pulses were delivered to the forearm in order to test the stretch reflex of the brachialis and triceps arm muscles in 11 normal subjects performing a cyclic movement about the elbow in the horizontal plane. The flexion-extension movement was paced by a metronome and performed under various loading conditions. Reflexes for each muscle were tested either in each 50 msec segment of the 2 sec cycle period, or in a smaller number of selected phases. A late reflex, appearing at a latency of about 60 msec (measured from the onset of the torque increment), was modulated extensively during the movement cycle. The amplitude of the late reflex increased markedly at the onset of a muscle contraction. In many of the subjects reflex responsiveness began to increase as early as 200 msec prior to the onset of voluntary muscle activity. Peak reflex responses were elicited by stimuli delivered 100-150 msec prior to the peak rate of increase of dynamic load (composed of inertial, viscous and elastic forces). The increase in responsiveness was followed by a drop which was generally coincident in time with the peak rate of increase of the load opposing muscle contraction. The modulation of the late reflex is appropriately timed for reflex-generated tension to help counteract dynamic loads, intrinsic to the movement.

Adult↗
PubMed1988

Operant conditioning of primate spinal reflexes: effect on cortical SEPs.

Previous studies have demonstrated operant conditioning of the primate spinal stretch reflex (SSR) and of its electrical analog, the H-reflex. We studied the evoked potential recorded over primary somatosensory cortex (SEP) which accompanies the H-reflex to determine whether the initial cortical response changes in the course of conditioned H-reflex change. When H-reflex amplitude changed, SEP amplitude also changed, but only half as much as the H-reflex. The results indicate that, while operant conditioning of the H-reflex has its largest effect on the spinal pathway of the reflex, it also has some effect on supraspinal pathways of the initial cortical response.

Animals↗
PubMed1990

Vibration insensitivity of a short latency reflex linking the lower leg and the active knee extensor muscles in humans.

The study indirectly investigated the afferent source of a human lower limb reflex that spans two joints and may link limb muscular activity during movement. Low threshold (motor nerve threshold (MT) to 1.6 MT) single, 1 msec, pulses were delivered to the common peroneal nerve at caput fibula. Heteronymous excitatory responses were observed in the elctromyogram of the knee extensor muscle vastus medialis (VM), when the latter was prior contracted. The briefest latency for the VM reflex was 24.2 msec. The distal belly and tendon of the tibialis anterior muscle were vibrated for 20 min at a frequency of 105 Hz, amplitude 1-2 mm, to inhibit the reflex potential evoked by group Ia afferent fibres from that muscle. This significantly reduced the amplitude of the group Ia mediated Hoffmann (H) reflex in TA. Such vibration did not depress the amplitude of the heteronymous reflex to VM, when initially the latter was at peak amplitude or at its mid-range for amplitude. Reflex latency, threshold, and stimulation current for peak expression suggested that group II fibres were unlikely to be the major initiators of the reflex. The results support the view that this human reflex is primarily Ib mediated.

Action Potentials↗
PubMed1990

Movement modulation of a short latency reflex linking the lower leg and the knee extensor muscles in humans.

Movement modulation of a heteronymous short latency spinal reflex was investigated with transcutaneous, low threshold, stimuli to the common peroneal nerve, during leg pedalling in humans. Electromyographic (EMG) electrodes on the skin over the quadriceps muscles revealed an excitatory response at a minimum latency of 22.8 msec. Samples were obtained at 5 phases in the cycle of pedal crank rotation, and for stimulus intensities to evoke both maximal, and submaximal, reflexes in quadriceps. Over the pedal cycle, the peak-to-peak magnitude of the reflex, in the 3 quadriceps muscles studied, was deeply modulated, including an areflexive phase. The reflex magnitude was linearly dependent on the ongoing EMG activity in quadriceps. It could be fully re-initiated if contractions were produced out of phase in pedalling. The slopes of the regression lines of reflex magnitude (as % maximum reflex) on contraction level (% maximum voluntary contraction) when pedalling (1.05 (r = 0.86, P less than 0.01], and with isometric contractions in the same subjects seated (1.03 (r = 0.69, P less than 0.01], were very similar, with similar thresholds. This contrasts with the inhibition of soleus H reflexes during human gait. The present heteronymous reflex, acting between limb segments, is modulated coincident with ongoing contraction level in the target muscle.

Adult↗
PubMed1991

The ubiquity of contraction enhanced H reflexes: normative data and use in the diagnosis of radiculopathies.

Surface recorded contraction enhanced H reflexes to single stimuli were obtained from muscles supplied by the C5, 6, 7, 8, L3, 4, 5, S1 and 2 nerve roots. For each of 12 such muscles, these reflexes were recorded from 25 control subjects as well as standard unenhanced H reflexes from the gastrocnemius muscles. Amplitude and latency criteria for normality were determined. Thirty-two patients with typical histories and physical findings of radiculopathy secondary to degenerative disease of the spine (C6 nerve root - 9 patients, C7 - 10, C8 - 4, L4 - 4, L5 - 4, S1 - 1) were studied with these H reflexes and the needle electrode. Thirty patients had H reflex abnormalities appropriate to the signs and symptoms. Eighteen had absent H reflexes and 16 had abnormalities to amplitude criteria. None were abnormal by latency criteria. Twelve patients had abnormal needle examinations and all also had abnormal H reflexes. These results indicate that contraction enhanced H reflexes are ubiquitous, readily obtainable and sensitive to the presence of clinically clear-cut radiculopathies.

Adolescent↗
PubMed1995

N-methyl-D-aspartate and alpha 2-adrenergic mechanisms are involved in the depressant action of flupirtine on spinal reflexes in rats.

In urethane-chloralose anesthetised rats the muscle relaxant activity of flupirtine was investigated on the monosynaptic Hoffmann reflex recorded from plantar foot muscles and on the polysynaptic flexor reflex recorded from tibialis muscle. Intraperitoneal (i.p.; 2.5-25 mumol/kg) and intrathecal (i.t.; 33-330 nmol) administration of flupirtine depressed the polysynaptic flexor reflex in anesthetised rats in a dose-dependent manner without affecting the monosynaptic Hoffmann reflex. Flupirtine produced a similar pattern on spinal reflexes as NMDA receptor antagonists, such as (-)-2-amino-7-phosphonoheptanoic acid (500 nmol i.t.) and memantine (125 mumol/kg i.p.), the benzodiazepines diazepam (18 mumol/kg i.p.) and midazolam (80 nmol i.t.), and the alpha 2-adrenoceptor agonist tizanidine (2 mumol/kg). In contrast, the GABAA receptor agonist muscimol (21 mumol/kg i.p.; 20 nmol i.t.) and the GABAB receptor agonist baclofen (47 mumol/kg i.p.; 2 nmol i.t.) reduced the magnitude of both the flexor and the Hoffmann reflex, whereas the non-NMDA receptor antagonist 6,7-dinitroquinoxaline-2,3-dione (DNQX; 10 nmol i.t.) depressed the Hoffmann reflex without affecting the flexor reflex. The effect of i.t. injection of flupirtine was prevented by coadministration of the mixed alpha 1/alpha 2-adrenoceptor antagonist yohimbine (10 nmol) and the excitatory amino acid N-methyl-D-aspartate (NMDA; 0.1 nmol), but neither by coadministration of the alpha 1-adrenoceptor antagonist prazosine (10 nmol), the GABAA receptor antagonist bicuculline (1 nmol), the GABAB receptor antagonist phaclofen (100 nmol), the non-NMDA receptor agonist alpha-amino-3-hydroxy-5-tertbutyl-4-isoxazolepropionic acid (ATPA; 0.1 pmol) nor by pre-treatment with the benzodiazepine receptor antagonist flumazenil (16 mumol/kg).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic alpha-2 Receptor Agonists↗
PubMed1996

Effects of NK433, a new centrally acting muscle relaxant, on masticatory muscle reflexes in rats.

The effects of (-)-(R)-2-methyl-3-(1-pyrrolidinyl)-4'- trifluoromethylpropiophenone monohydrochloride (NK433), a novel centrally acting muscle relaxant, on masticatory muscle reflexes were investigated in rats. NK433 inhibited the monosynaptic tonic vibration reflex of the masseter muscle and the polysynaptic tonic periodontal masseteric reflex. These reflexes are increased by gamma-motor activity. NK433 had a weak inhibitory effect on the polysynaptic jaw opening reflex evoked by electrical stimulation of the tooth pulp, which is little related with gamma-motor activity. Eperisone-HCl depressed the three types of masticatory muscle reflexes. When intravenously administered, eperisone-HCl was equipotent to NK433, but the effect of eperisone-HCl was shorter-lasting than that of NK433. The effect of intragastrically administered NK433 on the periodontal masseteric reflex was about three times stronger than that of eperisone-HCl. These results suggest that NK433 inhibits masticatory muscle reflexes controlled by the gamma-motor system and thus may ameliorate the temporomandibular joint syndrome in man.

Animals↗