This study aimed to investigate changes in the H-reflex recruitment curve in compressive radiculopathy, specifically assessing differences between symptomatic and asymptomatic limbs in patients with unilateral S1 radiculopathy through derived parameters. A total of 24 volunteers (15 male and 9 female, aged between 22 and 60 years) with confirmed nerve root compression in the L5/S1 segment participated. Nerve root compression was verified through clinical MRI examination and attributed to disc protrusion, spinal canal stenosis, or isthmic spondylolisthesis of L5/S1. Analysis revealed no difference in M-wave threshold intensity between symptomatic and non-symptomatic limbs. However, the H-reflex exhibited a trend toward increased threshold intensity in the symptomatic limb. Notably, a significant decrease in the slope of the H-reflex was observed on the symptomatic side, and the maximal H-reflex amplitude proved to be markedly different between the two limbs. The Hmax/Mmax ratio demonstrated a significant decrease in the symptomatic limb, indicating reduced effectiveness of signal translation. In conclusion, our findings emphasize the importance of H-reflex parameters in evaluating altered recruitment curves, offering valuable insights for neurological examinations. The observed differences in maximal values of M-wave, H-reflex, and their ratio in affected and unaffected limbs can enhance the diagnostic process for lumbosacral unilateral radiculopathy and contribute to a standardized approach in clinical assessments.

• MeSH
• Adult MeSH
• Electromyography MeSH
• H-Reflex * physiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Radiculopathy * physiopathology   diagnosis   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

H-reflex je nejčastěji zmiňovaným reflexem v elektrofyziologické literatuře. Není již (jako dříve) považován za striktně monosynaptický reflex, protože bylo prokázáno, že se skládá z kratší monosynaptické a delší oligosynaptické složky. Je rutinně využíván v EMG laboratořích pro řadu předností (poměrně snadná a rychlá výbavnost), ale je třeba respektovat i všechny limitace, které vyšetřování tohoto reflexu provázejí. Jde zejména o správnou techniku vybavování reflexu (tj. správné umístění elektrod – stimulačních i snímacích) a též o kritické zhodnocení latence a amplitudy, které jsou ovlivněny mnoha faktory (zejména fenomény presynaptické inhibice a postaktivační deprese). Nejedná se o přesný elektrofyziologický korelát reflexu šlachy Achillovy, neboť při stimulaci neurologickým kladívkem jsou drážděny i jiné struktury než selektivně dostředivá Ia vlákna. Při správné interpretaci výsledků je H-reflex velmi užitečný nástroj v diagnostice zvláště senzomotorických polyneuropatií, proximálně lokalizovaných lézí charakteru plexopatie, radikulopatie S1 či postižení n. ischiadicus. V poslední době se hodnocení H-reflexu prosazuje i ve sportovní medicíně a při studiu lokomoce u pacientů s inkompletní míšní lézí. Modulace H-reflexu byva tež využivana k monitoraci stupně svaloveho hypertonu při studiu spasticity.

H-reflex is the most extensively studied reflex in the electrophysiological literature. It is no longer considered to be strictly monosynaptic since it has been shown to contain a shorter monosynaptic and longer oligosynaptic component. It is widely used in EMG laboratories. The relative ease with which the H-reflex can be elicited makes it an attractive clinical tool. However, we must take into account the limitations to H-reflex examination in neurophysiology. This concerns the choice of appropriate methods used to elicit the H-reflex (correct location of stimulating and recording electrodes) and correct evaluation of amplitude and latency, which are influenced by many factors (including the phenomenon presynaptic of inhibition and post-activating depression). The H-reflex is not exclusively monosynaptic, it consists of monosynaptic and oligosynaptic pathways. This reflex is not an equivalent of tendon jerk reflex because it bypasses muscle spindle mechanisms. With correct interpretation, the H-reflex is a useful tool for diagnosing sensorimotor polyneuropathy, plexopathy, radiculopathy S1 and static nerve lesions. It has been used in sports medicine research to evaluate musculoskeletal injuries and can be used as a tool to assess the neurophysiologic mechanism underlying the recovery of walking after spinal cord injuries. H-reflex modulation is also used to monitor the degree of hypertonia in the study of spasticity.

• Keywords
• postaktivační deprese, presynaptická inhibice,
• MeSH
• Lower Extremity MeSH
• Electromyography utilization   MeSH
• H-Reflex * physiology   MeSH
• Humans MeSH
• Polyneuropathies diagnostic imaging   MeSH
• Radiculopathy diagnostic imaging   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

V éře neustálého prohlubování a zdokonalování zobrazovacích metod v diagnostice míšních lézí (například magnetická rezonance, PET/CT, apod.) se neurofyziologické metody zdají být stále méně a méně významné. Jejich přínos však zůstává při stanovení diagnózy, určení prognózy, průkazu subklinické dysfunkce nebo jasném potvrzení klinické poruchy, která není na morfologických metodách patrná. Morfologické metody spolehlivě určí anatomické poměry v páteřním kanále včetně struktur, které se nacházejí v blízkosti míchy a kořenů. K finální diagnostice je stále nutná vzájemná korelace morfologických a funkčních metod, doplněná podrobnou anamnézou a objektivním klinickým nálezem. Elektrofyziologické metody lze použít k přesnějšímu určení dysfunkce na úrovni míšního segmentu, míšního reflexního oblouku, motoneuronu či jednotlivé míšní dráhy. V práci je podán stručný přehled neurofyziologických metod, které se v současné době v diagnostice míšních dysfunkcí používají (somatosenzorické a motorické evokované potenicály, reflexní děje včetně periody útlumu).

Neurophysiological methods are less and less significant contributing to diagnosis of spinal cord lesions in the period of continuoustechnical improvement of imaging methods such as magnetic resonance, PET/CT, etc. However, their benefit remains in diagnosis,prognosis, evidence of subclinical dysfunction, or clear evidence of a spinal cord lesion that is not apparent on morphologicalmethods. These morphological methods (magnetic resonance imaging, CT, x-ray) reliably determine anatomical proportions inthe spinal canal, including structures that are located near the spinal cord and spinal roots. A correlation between morphologicaland functional methods is required, based on a detailed history and objective clinical finding. Electrophysiological methods canbe used to determine dysfunction at the level of the spinal segment, spinal reflex arc, motoneuron or spinal pathways. In thisstudy we present an overview of neurophysiological methods used in the diagnosis of spinal dysfunctions (somatosensory andmotor evoked potentials, H reflex and F wave, cutaneous silent period).

• Keywords
• kožní perioda útlumu,
• MeSH
• Electrophysiology MeSH
• Evoked Potentials * physiology   MeSH
• H-Reflex physiology   MeSH
• Muscle, Skeletal innervation   MeSH
• Humans MeSH
• Evoked Potentials, Motor physiology   MeSH
• Spinal Cord Diseases * diagnosis   MeSH
• Neural Conduction physiology   MeSH
• Neurologic Examination MeSH
• Spinal Cord Injuries diagnosis   MeSH
• Reflex * physiology   MeSH
• Evoked Potentials, Somatosensory physiology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

Projekt je zaměřen na studium patofyziologických mechanismů hluboké mozkové stimulace vnitřního pallida (DBS GPi) u dystonických syndromů. Pomocí funkčně zobrazovacích (resting-state fMRI) a elektrofyziologických metod (single-pulse a párová TMS, EMG) budou hledány anatomicko-funkční vztahy na kortikální, subkortikální a spinální úrovni, které neuromodulační léčba může ovlivnit. Součástí je analýza longitudinálních neuroplastických změn indukovaných neurostimulací. Očekáváme, že dojde k funkčním změnám motorického systému na všech úrovních CNS, a že některý ze sledovaných parametrů bude korelovat s mírou klinického postižení. Lze předpokládat, že zjištěné výsledky přispějí k pochopení účinků DBS a ke stanovení prediktivních faktorů úspěšnosti léčby. Zjištěné výsledky pomohou ke zkvalitnění výběru dystonických pacientů k neuromodulační léčbě a tím k optimalizaci vynaložených nákladů na DBS.; The project is aimed at the study of the pathophysiological mechanisms of deep brain stimulation of the globus pallidus interna (GPi DBS) in dystonic patients. Using functional imaging (resting-state fMRI) and electrophysiological testing (single-pulse and paired TMS, EMG), anatomical-functional processes affected by neurostimulation will be analyzed at the cortical, subcortical and spinal levels. The search will include analysis of DBS-induced long-term neuroplastic changes. We believe that functional changes in the motor system will be found in all levels of the central nervous system and that some of the analyzed parameters will correlate with the degree of dystonic involvement. The results are expected to improve our understanding of DBS mechanisms and identify predictive factors of positive therapeutic outcomes. The results should improve the selection of dystonic patients for neuromodulation treatment and thus optimize the financial means expended on DBS.

• MeSH
• Dystonia physiopathology   therapy   MeSH
• Globus Pallidus MeSH
• H-Reflex MeSH
• Deep Brain Stimulation MeSH
• Magnetic Resonance Imaging MeSH
• Cerebral Cortex physiopathology   MeSH
• Brain Stem MeSH
• Neurotransmitter Agents therapeutic use   MeSH
• Transcranial Magnetic Stimulation MeSH
• Reflex, Startle MeSH

• Conspectus
• Patologie. Klinická medicína
• NML Fields
• neurologie
• fyziologie
• patologie
• NML Publication type
• závěrečné zprávy o řešení grantu IGA MZ ČR

BACKGROUND: Deep brain stimulation (DBS) of the globus pallidus interna is an effective tool for the treatment of dystonia with possible distant effects reaching beyond the basal ganglia network. AIM: We analyzed the cortical silent period (CoSP) to test inhibitory circuits at the cortical level, and the cutaneous silent period (CuSP) and the H-reflex to test inhibitory circuits at the spinal level. METHODS: The upper limb muscles of 16 patients (9F, aged 54±(SD)16years) with generalized (N=9) and cervical (N=7) dystonia treated with DBS bilaterally were examined by the CoSP, CuSP and H-reflex in two states with random order: (i) in DBS ON and (ii) in DBS OFF condition two hours later, and compared with healthy controls. RESULTS: While the CuSP and H-Reflex did not differ between groups and remained unaffected by DBS, the CoSP was influenced significantly in dystonia. The CoSP onset latency was shortened (p<0.05 corrected) and the CoSP duration prolonged (p<0.01 corrected) in ON versus OFF condition. This effect was especially larger in generalized or phasic type of dystonia. Compared to healthy controls, the CoSP latency and duration became shorter in patients during the OFF condition only. CONCLUSION: The pallidal DBS did not affect the spinal inhibitory circuitry in dystonia. However, the abnormally low cortical inhibition was normalized after DBS possibly offering more efficient suppression of aberrant dystonic movements.

• MeSH
• Adult MeSH
• Dystonia therapy   MeSH
• Globus Pallidus physiology   MeSH
• H-Reflex physiology   MeSH
• Deep Brain Stimulation methods   MeSH
• Middle Aged MeSH
• Humans MeSH
• Spinal Cord physiopathology   MeSH
• Young Adult MeSH
• Evoked Potentials, Motor physiology   MeSH
• Cerebral Cortex physiopathology   MeSH
• Neural Inhibition physiology   MeSH
• Aged MeSH
• Cortical Spreading Depression physiology   MeSH
• Severity of Illness Index MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Cíl: Cílem studie bylo zhodnotit přínos elektrofyziologického vyšetření v diferenciální diagnostice lumbální spinální stenózy (LS) a diabetické polyneuropatie (DPN). Soubor a metodika: Elektrofyziologické vyšetření bylo provedeno u 68 pacientů s klinicky symptomatickou LS, u 28 pacientů s DPN a 32 zdravých dobrovolníků. Výsledky: Vyšetřené elektrofyziologické parametry z horních končetin (latence F vlny n. ulnaris a amplituda senzitivního neurogramu n. radialis), všechny hodnocené latence z dolních končetin (F vlny n. tibialis, H reflexu m. soleus, spinální latence MEP) a amplituda senzitivního neurogramu n. suralis signifikantně odlišovaly pacienty s LS a DPN. ROC analýza nicméně prokázala pouze dva elektrofyziologické parametry jako efektivní nezávislé faktory pro odlišení pacientů s LS a DPN: latenci ulnarisové F vlny (optimální diskriminační hodnota je 24,2 ms, senzitivita 82,7 % a specificita 63,9 %) a amplitudu senzitivního neurogramu n. radialis (optimální diskriminační hodnota je 10,5 ?V, senzitivita 75,5 % a specificita 58,2 %). Vícerozměrná diskriminační analýza poskytla kanonické skóre s nejsilnější prediktivní hodnotou. Závěry: Elektrofyziologické vyšetření z horních končetin je užitečné v diferenciální diagnostice LS a DPN, nicméně nejlepší diskriminační efekt vykazuje kanonické skóre, které zahrnuje několik elektrofyziologických parametrů. Klíčová slova: lumbální spinální stenóza – diabetická polyneuropatie – elektrofyziologické vyšetření – elektromyografie Autoři deklarují, že v souvislosti s předmětem studie nemají žádné komerční zájmy. Redakční rada potvrzuje, že rukopis práce splnil ICMJE kritéria pro publikace zasílané do biomedicínských časopisů.

Aim: To evaluate validity of electrophysiological examination in the differential diagnostics of lumbar spinal stenosis (LS) and diabetic polyneuropathy (DPN). Methods: Electrophysiological parameters were examined in 68 patients with clinically symptomatic LS, in 28 patients with DPN, and in a group of 32 healthy volunteers. Results: Electrophysiological parameters evaluated from the upper extremities (F-wave latency of the ulnar nerve and radial SNAP amplitude), all the latencies measured in the lower extremities (tibial F-wave, soleus H-reflex and spinal latency of MEP), and the sural SNAP amplitude contributed significantly to distinguishing the LS from DPN patients. ROC analysis, however, disclosed only two electrophysiological parameters as effective in independent discrimination between the LS and DPN patient groups: ulnar F-wave latency (cut-off point at 24.2 ms, sensitivity 82.7% and specificity 63.9%); and radial SNAP amplitude (cut-off point at 10.5 ?V, sensitivity 75.5%, specificity 58.2%). Multivariate discrimination provided a canonical score with the most powerful predictive value of all. Conclusions: Electrophysiological examination evaluated from the upper extremities proved very useful in the differential diagnostics of LS and DPN, but the most powerful predictive value was obtained by using a canonical score involving several electrophysiological parameters.

• Keywords
• lumbální spinální stenóza, elektrofyziologické vyšetření, latence F vlny,
• MeSH
• Reflex, Abnormal physiology   MeSH
• Lumbar Vertebrae MeSH
• Diabetic Neuropathies * diagnosis   MeSH
• Diagnosis, Differential MeSH
• Discriminant Analysis MeSH
• Lower Extremity MeSH
• Adult MeSH
• Electrodiagnosis * methods   statistics & numerical data   MeSH
• H-Reflex MeSH
• Upper Extremity MeSH
• Muscle, Skeletal physiopathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Evoked Potentials, Motor MeSH
• Motor Neurons physiology   MeSH
• Multivariate Analysis MeSH
• Statistics, Nonparametric MeSH
• Neural Conduction physiology   MeSH
• Radial Nerve physiology   MeSH
• Tibial Nerve physiology   MeSH
• Ulnar Nerve physiology   MeSH
• Predictive Value of Tests MeSH
• Reaction Time physiology   MeSH
• ROC Curve MeSH
• Aged MeSH
• Spinal Stenosis * diagnosis   MeSH
• Case-Control Studies MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH

The Monograph of professors M.G.Dudin and D.Yu.Pinchuk “Idiopathic scoliosis. Neurophysiology and neurochemistry “continues the series of books (already published /issued/ “Idiopathic scoliosis: Diagnosis, pathogenesis”/2009/ and “Central nervous system and idiopathic scoliosis”/2011/), devoted to the study of one of the most difficult and problematic spine injuries in children and teenagers – idiopathic scoliosis (AIS). This work is the result of many years of research of the brain and spinal cord structures role, and neuromuscular apparatus in the etiology and pathogenesis of three-plane spinal column /vertebra column/ deformation. In addition to a wide range of expert’s opinions presented in the world literature, the authors present their own data, a significant part /quantity/ of which is published for the first time. This refers to the chronobiological aspects of neuro-hormonal regulation and the role of neuropeptides in the development of muscle’s imbalance, issues of the spine shaping and clinical neurophysiological characteristics of child’s “scoliosis risk groups”/children referring to “scoliosis risk groups”/.

• MeSH
• Child MeSH
• Electromyography MeSH
• Pineal Gland physiology   MeSH
• H-Reflex MeSH
• Humans MeSH
• Melatonin MeSH
• Adolescent MeSH
• Neuromuscular Diseases physiopathology   MeSH
• Neuropeptides MeSH
• Spine growth & development   MeSH
• Scoliosis * diagnosis   etiology   MeSH
• Severity of Illness Index MeSH
• Thalamus physiology   MeSH
• Back Muscles anatomy & histology   physiology   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH

OBJECTIVE: The cutaneous silent period (SP) is a spinal inhibitory reflex, which suppresses activity in spinal motor nuclei. Transcranial magnetic stimulation (TMS) elicits a cortical SP, which represents GABA(B) receptor-mediated inhibition of cortical excitability. Baclofen as a strong GABA(B) agonist effectively reduces muscle hypertonia, however, it is not known whether intrathecal baclofen (ITB) may modulate spinal inhibitory circuits. METHODS: We evaluated clinical and neurophysiological effects of ITB in ten patients with severe spasticity due to spinal cord injury (n = 9) and chronic progressive multiple sclerosis (n = 1). Neurophysiological assessment included H reflex and cutaneous and cortical SPs, before and 15, 30, 60, 90, 120, and 180 min after ITB bolus administration. RESULTS: ITB suppressed soleus H reflex as early as 15 min after lumbar bolus injection; MAS scores declined after 1 h. Cortical SP end latency and duration increased progressively with a significant maximum 3h following ITB bolus, whereas cutaneous SP latency and duration did not change significantly. CONCLUSION: The present findings suggest that baclofen does not affect the cutaneous SP, but prolongs the cortical SP. SIGNIFICANCE: The spinal inhibitory circuitry of the cutaneous SP is not modulated by GABA(B) receptor-mediated activity, in contrast to the cortical inhibitory circuitry of the cortical SP, which is subject to powerful GABA(B) control.

• MeSH
• GABA-B Receptor Agonists administration & dosage   pharmacology   MeSH
• Baclofen administration & dosage   pharmacology   MeSH
• Time Factors MeSH
• Adult MeSH
• H-Reflex drug effects   physiology   MeSH
• Muscle, Skeletal innervation   MeSH
• Middle Aged MeSH
• Humans MeSH
• Spinal Nerves drug effects   physiopathology   MeSH
• Cerebral Cortex drug effects   physiopathology   MeSH
• Spinal Injuries complications   MeSH
• Reaction Time drug effects   physiology   MeSH
• Reflex drug effects   physiology   MeSH
• Multiple Sclerosis complications   MeSH
• Injections, Spinal MeSH
• Muscle Spasticity etiology   physiopathology   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Clinical Trial MeSH
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study MeSH

PURPOSE: The natural course of lumbar spinal stenosis (LSS) fluctuates and is not necessarily progressive. The aim of this study was to explore the predictors of clinical outcome in patients with LSS that might eventually help to optimise the therapeutic choices. METHODS: A group of 56 patients (27 men, 29 women, median age 55; range 31-72 years) with clinically symptomatic mild-to-moderate LSS were re-examined after a median period of 88 months and their clinical outcomes classified as satisfactory (34 patients, 60.7 % with stable or improved clinical status) or unsatisfactory (22 patients, 39.3 % for whom clinical status deteriorated). A wide range of demographical, clinical, imaging and electrophysiological entry parameters were evaluated as possible predictors of clinical outcome. RESULTS: Unlike the demographical, clinical and imaging variables, certain electrophysiological parameters were significantly associated with unsatisfactory outcomes. There was a significantly higher prevalence of pluriradicular involvement detected by EMG in patients with unsatisfactory outcome than those with satisfactory outcome (68.2 vs. 32.3 %; p = 0.035). Patients with unsatisfactory outcome had more frequent bilateral abnormalities of the soleus H-reflex (50.0 vs. 14.7 %; p = 0.015) and lower mean H-reflex amplitude. Multivariate logistic regression proposed two variables as mutually independent predictors of unsatisfactory outcome: EMG signs of pluriradicular involvement (OR = 3.72) and averaged soleus H-reflex amplitude ≤ 2.8 mV (OR = 2.87). CONCLUSIONS: Satisfactory outcomes were disclosed in about 61 % of the patients with mild-to-moderate LSS in a 7-year follow-up. Electrophysiological abnormalities, namely the presence of pluriradicular involvement and abnormalities of the soleus H-reflex, were predictive of deterioration of clinical status in these patients.

• MeSH
• Lumbar Vertebrae MeSH
• Adult MeSH
• Electromyography MeSH
• H-Reflex physiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Odds Ratio MeSH
• Disease Progression MeSH
• ROC Curve MeSH
• Aged MeSH
• Spinal Stenosis complications   physiopathology   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Increased excitability of the spinal motor system has been observed after loud and unexpected acoustic stimuli (AS) preceding H-reflexes. The paradigm has been proposed as an electrophysiological marker of reticulospinal tract activity in humans. The brainstem reticular formation also maintains dense anatomical interconnections with the cortical motor system. When a startling AS is delivered, prior to transcranial magnetic stimulation (TMS), the AS produces a suppression of motor evoked potential (MEP) amplitude in hand and arm muscles of healthy subjects. Here we analyzed the conditioning effect of a startling AS on MEP amplitude evoked by TMS to the primary motor leg area. Ten healthy volunteers participated in two experiments that used a conditioning-test paradigm. In the first experiment, a startling AS preceded a suprathreshold transcranial test stimulus. The interstimulus interval (ISI) varied between 20 to 160 ms. When given alone, the test stimulus evoked a MEP amplitude of approximately 0.5 mV in the slightly preinervated soleus muscle (SOL). In the second experiment, the startling AS was used to condition the size of the H-reflex in SOL muscle. Mean MEP amplitude was calculated for each ISI. The conditioning AS suppressed MEP amplitude at ISIs of 30-80 ms. By contrast, H-reflex amplitude was augmented at ISIs of 100-200 ms. In conclusions, acoustic stimulation exerts opposite and ISI-specific effects on the amplitude of MEPs and H-reflex in the SOL muscle, indicating different mechanism of auditory-to-motor interactions at cortical and spinal level of motor system.

• MeSH
• Acoustic Stimulation methods   utilization   MeSH
• Lower Extremity MeSH
• Adult MeSH
• Electromyography methods   instrumentation   utilization   MeSH
• Human Experimentation MeSH
• Financing, Organized MeSH
• H-Reflex physiology   MeSH
• Muscle, Skeletal MeSH
• Humans MeSH
• Motor Cortex physiology   MeSH
• Motor Neurons physiology   MeSH
• Evoked Potentials, Auditory MeSH
• Statistics as Topic MeSH
• Transcranial Magnetic Stimulation methods   utilization   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH