[MUSCLE TONUS. PHYSIOLOGICAL AND PHYSIOPATHOLOGICAL ASPECTS. I. THE PHYSIOLOGIST IN RELATION TO MUSCLE TONUS].
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The integrated electromyographic study allows to determine action of the variation amplitudes of tonic activity of the masseter muscles, the anterior temporalis muscles and the trapezius muscles induced by angular cephalic displacements of 10 degrees in the three space planes, in sitting position (P.A) and upright position (P.D.). The direction of the variations can be simultaneously positive or negative according to the vertical reference position (P.R.) in the different muscles studied. The masseter muscles showed the largest variations of the P.A. to the P.D. Twenty per cent of the subjects can be classified in a hypertonic category.
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The regulation of muscle tonus takes place at least at six levels of the central nervous system: the spinal cord, vestibular nuclei, the cerebellum, the reticular formation, extrapyramidal system and the motor cortex. A multiple complexity of the connections of these systems in the regulation of muscle tonus is presented, so that therapy can be usefully applied in states of muscle tonus disorders.
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OBJECTIVE: To elucidate the character and distribution of the abnormal muscle tonus in the body axis in progressive supranuclear palsy. Although neck hypertonus has been well described in progressive supranuclear palsy, little is known about the involvement of the truncal muscles. METHODS: Muscle tonus of the neck and trunk was separately investigated in 13 patients with progressive supranuclear palsy by clinical examination and surface EMG during passive rotation. Muscle hypertonus was graded according to a four point scale, and subjected to statistical analysis. The results were compared with those from 13 age matched patients with Parkinson's disease and six healthy volunteers. RESULTS: In all but one patient with progressive supranuclear palsy, there was a distinct difference in muscle tonus between the neck and trunk. A tonic shortening reaction characteristic of dystonia and an increased tonic stretch reflex (rigidity) were present in the neck muscles of patients with progressive supranuclear palsy, whereas only normal to moderately increased tonus was noted in the truncal muscles (neck v trunk, shortening reaction p=0.0001; stretch reflex p=0.0241). Follow up studies disclosed an increase in axial muscle tonus with predilection for the neck in three of four patients. In the 13 patients with Parkinson's disease, however, no significant difference was found in muscle rigidity between the neck and trunk. CONCLUSION: Mild changes in truncal muscle tonus with prominent neck dystonia and rigidity are characteristic of progressive supranuclear palsy. It is suggested that separate clinical evaluation of muscle tonus in the neck and trunk may be helpful for distinguishing progressive supranuclear palsy from Parkinson's disease.
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In 19 patients with multiple sclerosis and 1 with subacute sclerosing panencephalitis the mean increase in muscle tonus was found to be 3.1 (range 1--4 according to Burke-Ashwort). In 10 controls with multiple sclerosis the mean spasticity was 2.4. Dantrium was given in doses up to 800 mg for 14--16 days and it caused a greater reduction of spasticity than placebo (p less than 0.05). In 12 patients (60%) varying degrees of muscle tonus reduction was observed. In 11 patients the efect of Dantrium was compared with that of other drugs (Clonazepam, Tetradiazepam, Carisoprodol and Lyoresal). In 6 cases Dantrium was a more effective drug than other muscle relaxants and in 5 cases no difference was observed or other drugs were superior to Dantrium.
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Systemically administered 3-nitropropionic acid (3- NPA), irreversible inhibitor of succinate dehydrogenase, produced characteristic bilateral lesions in the striatum (STR) in the rat. Inside the lesion, neutrophils invaded and strong immunoreaction for IgG as well as complement factor C3b/C4b receptor (C3b/C4br) were observed. The core of the lesion lost the immunoreaction for glial fibrillary acidic protein (GFAP) while the marginal area had abundant GFAP-labeled astrocytes around the vessels. Intoxicated rats often became somnolent and were awkward in cooperative movement on a pole climbing test, but they had a quite good memory retention in a passive avoidance learning. Muscle tonus in some of the intoxicated rats became hypotonic with low voltage electromyogram (EMG) activity, especially in lower limbs. In summary, 3-NPA intoxicated rats had selective bilateral lesions in the STR and exhibited disturbances in a cooperative movement owing to the impairment in muscle tonus, thus it would be a useful animal model to deduce the central pathogenesis of Huntington's disease.
Muscular spasm is a frequent symptom which is difficult to record precisely. On the basis of literature on the subject and of own studies, we undertook to describe various methods of examination which could be used to demonstrate such changes. Up to now, palpation is still the most important and most exact method for the experienced examiner. In this way local as well as extended muscular spasms can be made evident. The disadvantage however is the lack of objective proof. The easy-to-use Tissue-Compliance-Meter of Fischer, which measures the consistency of soft tissue, documents the intraindividual difference rather than the interindividual difference. This is due to the individually variable thickness of the subcutaneous fatty tissue. However, on the whole there is a good correlation to the findings of palpation. The pendulous-test and badismography allow especially the conclusion with regard to unilateral changes of tonus in the gluteal and upper leg muscles. This method also very well suits the intraindividual comparison, but less so the interindividual one. The continuous electromyogram is able to show the enhanced activity in spasmotic muscles also during sleep. The evaluation of enhanced muscle activity remains uncertain when using plain electromyogram. Recording of muscle tissue oxygen pressure is of little use to evaluate muscle spasm. Nonetheless, it provides interesting insights into pathogenetic questions. Thermography, measuring the blood circulation at the skin surface, is especially suited for perceiving intraindividual differences in case of muscle spasm. Nuclear magnetic resonance spectroscopy allows for noninvasive pH measurements in the muscle and therewith renders certain data concerning the degree of tension of this tissue. It is not yet suited for routine examination. The value of positron emission tomography for registering muscle spasm remains uncertain. Hopefully, this method, which documents the muscle energy metabolism, will enable us to more clearly evaluate muscle spasm than previous methods have done. Light and electron microscopic studies have provided contradictory results concerning histological changes in muscle biopsy in case of muscle spasm.
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