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PubMedDate not supplied

Carbamazepine, clonazepam and focal reflex proprioceptive seizures.

We studied a 34-year-old man with focal tonic-clonic seizures sometimes elicited by some active postures of the right hand and evolving at times to secondary generalization. Treatment with carbamazepine (CBZ) in combination with parenteral diazepam induced both a dramatic increase of focal reflex proprioceptive seizures and choreoathetoid dyskinesias in the affected hand. CBZ was withdrawn and clonazepam (CZP) given 2 mg daily, with complete relief of seizures and choreoathetoid dyskinesias. CZP had a suppressive effect on seizures for over 15 years, without development of tolerance.

Adult↗
PubMed1970

The proprioceptive reflex control of the intercostal muscles during their voluntary activation.

1. A quantitative study has been made of the reflex effects of sudden changes in mechanical load on contracting human intercostal muscles during willed breathing movements involving the chest wall. Averaging techniques were applied to recordings of electromyogram (EMG) and lung volume, and to other parameters of breathing.2. Load changes were effected for brief periods (10-150 msec) at any predetermined lung volume by sudden connexion of the airway to a pressure source variable between +/- 80 cm H(2)O so that respiratory movement could be either assisted or opposed. In some experiments airway resistance was suddenly reduced by porting from a high to a low resistance external airway.3. Contracting inspiratory and expiratory intercostal muscles showed a ;silent period' with unloading which is attributed to the sudden withdrawal from intercostal motoneurones of monosynaptic excitation of muscle spindle origin.4. For both inspiratory and expiratory intercostal muscles the typical immediate effect of an increase in load was an inhibitory response (IR) with a latency of about 22 msec followed by an excitatory response (ER) with a latency of 50-60 msec.5. It was established using brief duration stimuli (< 40 msec) that the IR depended on mechanical events associated with the onset of stimulation, whereas stimuli greater than 40 msec in duration were required to evoke the ER.6. For constant expiratory flow rate and a constant load, the ER of expiratory intercostal muscles increased as lung volume decreased within the limits set by maximal activation of the motoneurone pool as residual volume was approached.7. The ER to a constant load increased directly with the expiratory flow rate at which the load applied, also within limits set by maximal activation of the motoneurone pool.8. For a given load, the ER during phonation was greater than that occurring at a similar expiratory flow rate without phonation when the resistance of the phonating larynx was mimicked by an external airway resistance.9. It is argued that the IR is due to autogenetic inhibition arising from tendon organs and that the ER is due to autogenetic excitation arising from intercostal muscle spindles.10. The initial dominance of inhibition in this dual proprioceptive reflex control was not predicted by the servo theory. It is proposed that the reflex pathways subserving autogenetic inhibition are under a centrifugal control which determines in relation to previous experience (learning) the conditions under which autogenetic facilitation is allowed.

Airway Resistance↗
PubMed1983

The afferent volleys responsible for spinal proprioceptive reflexes in man.

1. To define the neural volleys responsible for the Achilles tendon jerk and the H reflex, muscle afferent activity was recorded using micro-electrodes inserted percutaneously into appropriate fascicles of the tibial nerve in the popliteal fossa.2. The response of soleus muscle afferents to tendon percussion consisted of a dispersed volley, starting 3.5-7.0 ms after percussion, increasing to a peak over 6.5-11.0 ms, and lasting 25-30 ms, depending on the strength of percussion. Electrical stimuli to the sciatic nerve at a level adequate to evoke an H reflex but subthreshold for the M wave produced a more synchronized volley, the fastest fibres of which had conduction velocities of 62-67 m/s, and the slowest 36-45 m/s.3. The wave of acceleration produced by percussion subthreshold for the ankle jerk spread along the skin at over 150 m/s. Midway between the bellies of the gastrocnemii it consisted of a damped oscillation with four to five separate phases and maximum amplitude approximately one-twentieth of that recorded on the Achilles tendon.4. With ten primary spindle endings, tendon percussion subthreshold for the ankle jerk elicited two to five spike discharges per tap, the shortest interspike intervals being 4-7 ms. Tendon percussion elicited single discharges from two Golgi tendon organs, and altered the discharge pattern of a single secondary spindle ending. The degree of dispersion of the multi-unit muscle afferent volley can be explained by the pattern of discharge of primary spindle endings.5. Percussion on the Achilles tendon evoked crisp afferent volleys in recordings from nerve fascicles innervating flexor hallucis longus, tibialis posterior, the intrinsic muscles of the foot and the skin of the foot. Electrical stimuli delivered to the tibial nerve in the popliteal fossa at a level sufficient for the H reflex of soleus produced either a volley in muscle afferents from the intrinsic muscles of the foot or a volley in cutaneous afferents from the foot.6. For comparable stimuli in the two positions, the H reflex was inhibited but the Achilles tendon jerk enhanced when the ankle was dorsiflexed from 105 degrees to 90 degrees .7. The duration of the rise times of the excitatory post-synaptic potentials (e.p.s.p.s) produced in soleus motoneurones by electrical stimulation, and by tendon percussion subthreshold for the H reflex and the ankle jerk respectively, was estimated from post-stimulus time histograms of the discharge of voluntarily activated single motor units in soleus. The mean e.p.s.p. rise times were 1.9 ms for electrical stimulation and 6.6 ms for tendon percussion. There was evidence that the duration of the electrically evoked e.p.s.p. was curtailed by an inhibitory post-synaptic potential (i.p.s.p.) of only slightly longer latency than the e.p.s.p.8. The mechanically induced and electrically induced afferent volleys are not homogeneous volleys in group I a afferents from triceps surae. The afferent volleys differ in so many respects that it is probably invalid to compare the H reflex and tendon jerk as a measure of fusimotor activity. It is suggested that neither reflex can be considered a purely monosynaptic reflex.

Achilles Tendon↗
PubMed1990

[Proprioceptive reflexes and the regulation of movement].

Apart from the direct influences of muscle spindle sensory endings on skeletomotor neurones a great deal of their reflex drive is provided indirectly via the gamma-loop. Fusimotor neurones modulate their discharge rate in parallel with that of the skeletomotor neurones during the rising phase, as well as during the maintained reflex tension in m.triceps surae of decerebrated cat, when small tension oscillations are present in the muscle. However, under other conditions of spinal reflex activities either skeletomotor or fusimotor neurones could be activated independently by impulses from muscle receptors. On the ground of the presented results, it can be supposed that fusimotor firing, together with the afferent firing from muscle spindles, does not provide the main stimulus for the reflex activity of skeletomotor neurones but serves as an indicator of the deviations from the expected or planned movement representing, in this way, its model.

Animals↗
PubMed1997

Influence of respiratory afferents upon the proprioceptive reflex of skeletal muscles in healthy humans.

Relationships between respiratory afferents and the motor drive to skeletal muscles are well documented in animals, but human data are scarce. Tonic vibratory response (TVR) elicited by mechanical tendon vibrations were explored in an arm (extensor digitorum, ED) and a leg (vastus lateralis, VL) muscle, in healthy subjects. Tendon vibrations were delivered during unloaded breathing and after 10 breathing cycles while the subject breathed through an inspiratory or expiratory resistive load in order to activate respiratory afferents. Inspiratory loaded breathing significantly enhanced TVR in ED and VL muscles whereas the effects of expiratory loading depended on the vibrated muscle (increased TVR in ED; decreased TVR in VL). These results suggest that inspiratory muscle afferents activated during inspiratory loading facilitate the gamma motor drive to arm and leg muscles whereas the activation of pulmonary vagal afferents during expiratory loading can exert a facilitating or suppressive influence on the gamma motor drive, depending on the limb muscle group.

Adult↗