The sacral cord conduction time of the soleus H-reflex was investigated in 30 normal adult subjec... more The sacral cord conduction time of the soleus H-reflex was investigated in 30 normal adult subjects using three different methods. (1) The posterior tibial nerve was stimulated at the popliteal fossa by graded electric shocks, and the recordings were made from different lumbar epidural intervertebral levels. The afferent action potentials from the dorsal roots and the reflexively evoked efferent action potentials from the ventral roots were recorded. The time interval between the negative peaks of the ventral and dorsal root potentials was used to calculate the approximate sacral cord reflex delay time, which was found to be 1.3 ms. on average. (2) The sacral cord reflex delay time was found to be about 2.0 ms using the conduction time of the afferent, that of the efferent limbs and total reflex time of the soleus H-response. (3) By stimulating the lumbosacral roots at the epidural levels and using the difference between the soleus H and M response latencies, the sacral cord reflex delay was determined to be approximately 2.4 ms. These findings indicated that the soleus H-reflex is exclusively monosynaptic. It is proposed that in humans the synaptic transmission at the sacral cord is approximately 0.4 ms.
To the Editor: We thank Dr. Finsterer and colleagues for repeating our work and for giving us the... more To the Editor: We thank Dr. Finsterer and colleagues for repeating our work and for giving us the opportunity to present further data on more of our patients (Table 1). According to us and also to Gilchrist et al. (l) , turn-amplitude (T/A) ratio analysis has a lower diagnostic sensitivity than conventional electromyography (EMG). In our juvenile myoclonic epilepsy (JME) cases, we first made at least four needle EMG recordings and then used the T/A analysis (2). The results of our conventional EMG evaluations, including some additional cases that we examined after our previous report, showed that of 3 1 cases, 11 had subclinical involvement of anterior horn cells (Fig. 1). In 7 of these 1 1 cases, T/A values were in excess of normal limits for the muscle investigated. The reason for this is that the T/A ratio fails to reflect neurogenic changes unless they are pronounced ( 1 ) (StHlberg, personal communication). This may explain four of the differences between our findings and those of Finsterer et al., (3) who investigated the biceps muscle without using a
Different variables of oropharyngeal swallowing change in response to bolus volume and consistenc... more Different variables of oropharyngeal swallowing change in response to bolus volume and consistency as determined by manometric/videofluoroscopic studies. But the subject is debatable especially from the physiologic point of view. No electrophysiologic studies are available on human subjects. The effects of bolus volume and viscosity on different variables of oropharyngeal swallowing were investigated using electrophysiologic methods. Mechanical upward and downward laryngeal movements and submental electromyographic (SM-EMG) activity of the laryngeal elevator muscles were recorded during dry and 3-, 10-, and 20-ml water swallowing in 14 normal subjects. Cricopharyngeus (CP) muscle was investigated during 3- and 10-ml water swallowing in 10 normal subjects. Semisolid and liquid swallowing were compared in eight normal subjects. The total duration of SM-EMG, time necessary for larynx elevation, CP-EMG pause related with upper esophageal sphincter opening and swallowing variability (jit...
The few electrophysiologic studies of the cremasteric muscle (CM) have mainly been restricted to ... more The few electrophysiologic studies of the cremasteric muscle (CM) have mainly been restricted to the cremaster reflex with no reference to central and peripheral nerve conduction to the muscle, probably for technical reasons.Twenty-six normal adult male volunteers were studied by transcranial magnetic cortical stimulation (TMS) and stimulation of thoracolumbar roots. The genitofemoral nerve (GFN) was stimulated electrically at the anterior superior iliac spine and a needle electrode was inserted into the CM for conduction studies. The motor latency to the CM from the cortical TMS ranged from 20 to 33 ms among the subjects (25.8 +/- 2.9 ms, mean +/- SD). Magnetic stimulation of the lumbar roots produced a motor response of the CM within 9.6 +/- 1.9 ms (range, 6-15). The central motor conduction time to the CM was 16.5 +/- 2.8 ms (range, 10-21). Stimulation of the GFN produced a compound muscle action potential with a mean value of 6.4 +/- 1.8 (range, 4-10) ms in 23 of the 26 cases. Thus, central motor nerve fibers to the CM motor neurons exist, and there may be a representation area for the CM in the cerebral cortex. The GFN motor conduction time to the CM may have clinical utility, such as in the evaluation of the groin pain due to surgical procedures in the lower abdomen.
Groin pain in the lower abdomen but including the ilioinguinal region is frequent after inguinal ... more Groin pain in the lower abdomen but including the ilioinguinal region is frequent after inguinal hernia operations, but the integrity of the nerves in this region, including the genitofemoral nerve (GFN), has not been investigated. We studied GFN motor conduction time to the cremasteric muscle (CM), the CM electromyogram (EMG), and the CM reflex in 30 patients with unilateral inguinal hernia who underwent herniorrhaphy and in 26 similar patients who had no surgical intervention. Among the 30 patients undergoing herniorrhaphy, 14 (47%) showed motor involvement of the GFN, whereas 6 of the 26 (23%) patients not treated surgically had involvement of the GFN. These findings indicate that subclinical motor involvement of the GFN can be demonstrated by electrophysiological methods and is common after inguinal herniorrhaphy. Based on patient complaints, the herniated mass may also be responsible for motor involvement of the GFN in some patients before surgery.
ABSTRACT Motor conduction velocity is expected to be normal or nearly normal in amyotrophic later... more ABSTRACT Motor conduction velocity is expected to be normal or nearly normal in amyotrophic lateral sclerosis (ALS). Some studies have suggested that pathology may be present in the proximal axons. Indeed, some investigators have shown a decrease in the proximal conduction velocity in ALS by using motor conduction velocity measurements and H-reflex and F-response recordings, but they could not delineate the precise region of the conduction pathology. In this study, unlike the ones carried out previously, the most proximal segment has been studied in 11 patients with ALS, 13 normal controls, and 5 patients with sequel of poliomyelitis (SPM) by recording sensory and motor spinal root potentials. While no conduction pathology, H-reflex, or F-response abnormalities were found in ALS patients compared to normal subjects, it was shown that conduction velocity decreased in the proximal segment of the lower motor neuron of the ventral root. Despite motor neuron pathology in SPM, there was no proximal motor conduction slowing compared with that in normal subjects.
Juvenile myoclonic epilepsy (JME) is not an uncommon seizure disorder, occurring in 5-10% of epil... more Juvenile myoclonic epilepsy (JME) is not an uncommon seizure disorder, occurring in 5-10% of epileptic patients. A subclinical anterior horn cell involvement has been suggested in some JME patients by concentric needle electromyography (EMG) and turn/amplitude analysis. In this study, 22 JME patients and 17 normal control subjects have been studied with macro EMG, which is a sensitive method to assess the size of motor units. Most JME patients (19 of 22) had a pathologically increased number of individual large macro motor unit action potentials (MUAPs) compared to control subjects. For both biceps brachii and tibialis anterior muscles, means of median macro MUAP amplitudes were significantly greater than those of normal controls, whereas the fiber density values were only slightly increased. This suggested another kind of anterior horn cell involvement in JME than seen in motor neuron diseases.
The sacral cord conduction time of the soleus H-reflex was investigated in 30 normal adult subjec... more The sacral cord conduction time of the soleus H-reflex was investigated in 30 normal adult subjects using three different methods. (1) The posterior tibial nerve was stimulated at the popliteal fossa by graded electric shocks, and the recordings were made from different lumbar epidural intervertebral levels. The afferent action potentials from the dorsal roots and the reflexively evoked efferent action potentials from the ventral roots were recorded. The time interval between the negative peaks of the ventral and dorsal root potentials was used to calculate the approximate sacral cord reflex delay time, which was found to be 1.3 ms. on average. (2) The sacral cord reflex delay time was found to be about 2.0 ms using the conduction time of the afferent, that of the efferent limbs and total reflex time of the soleus H-response. (3) By stimulating the lumbosacral roots at the epidural levels and using the difference between the soleus H and M response latencies, the sacral cord reflex delay was determined to be approximately 2.4 ms. These findings indicated that the soleus H-reflex is exclusively monosynaptic. It is proposed that in humans the synaptic transmission at the sacral cord is approximately 0.4 ms.
To the Editor: We thank Dr. Finsterer and colleagues for repeating our work and for giving us the... more To the Editor: We thank Dr. Finsterer and colleagues for repeating our work and for giving us the opportunity to present further data on more of our patients (Table 1). According to us and also to Gilchrist et al. (l) , turn-amplitude (T/A) ratio analysis has a lower diagnostic sensitivity than conventional electromyography (EMG). In our juvenile myoclonic epilepsy (JME) cases, we first made at least four needle EMG recordings and then used the T/A analysis (2). The results of our conventional EMG evaluations, including some additional cases that we examined after our previous report, showed that of 3 1 cases, 11 had subclinical involvement of anterior horn cells (Fig. 1). In 7 of these 1 1 cases, T/A values were in excess of normal limits for the muscle investigated. The reason for this is that the T/A ratio fails to reflect neurogenic changes unless they are pronounced ( 1 ) (StHlberg, personal communication). This may explain four of the differences between our findings and those of Finsterer et al., (3) who investigated the biceps muscle without using a
Different variables of oropharyngeal swallowing change in response to bolus volume and consistenc... more Different variables of oropharyngeal swallowing change in response to bolus volume and consistency as determined by manometric/videofluoroscopic studies. But the subject is debatable especially from the physiologic point of view. No electrophysiologic studies are available on human subjects. The effects of bolus volume and viscosity on different variables of oropharyngeal swallowing were investigated using electrophysiologic methods. Mechanical upward and downward laryngeal movements and submental electromyographic (SM-EMG) activity of the laryngeal elevator muscles were recorded during dry and 3-, 10-, and 20-ml water swallowing in 14 normal subjects. Cricopharyngeus (CP) muscle was investigated during 3- and 10-ml water swallowing in 10 normal subjects. Semisolid and liquid swallowing were compared in eight normal subjects. The total duration of SM-EMG, time necessary for larynx elevation, CP-EMG pause related with upper esophageal sphincter opening and swallowing variability (jit...
The few electrophysiologic studies of the cremasteric muscle (CM) have mainly been restricted to ... more The few electrophysiologic studies of the cremasteric muscle (CM) have mainly been restricted to the cremaster reflex with no reference to central and peripheral nerve conduction to the muscle, probably for technical reasons.Twenty-six normal adult male volunteers were studied by transcranial magnetic cortical stimulation (TMS) and stimulation of thoracolumbar roots. The genitofemoral nerve (GFN) was stimulated electrically at the anterior superior iliac spine and a needle electrode was inserted into the CM for conduction studies. The motor latency to the CM from the cortical TMS ranged from 20 to 33 ms among the subjects (25.8 +/- 2.9 ms, mean +/- SD). Magnetic stimulation of the lumbar roots produced a motor response of the CM within 9.6 +/- 1.9 ms (range, 6-15). The central motor conduction time to the CM was 16.5 +/- 2.8 ms (range, 10-21). Stimulation of the GFN produced a compound muscle action potential with a mean value of 6.4 +/- 1.8 (range, 4-10) ms in 23 of the 26 cases. Thus, central motor nerve fibers to the CM motor neurons exist, and there may be a representation area for the CM in the cerebral cortex. The GFN motor conduction time to the CM may have clinical utility, such as in the evaluation of the groin pain due to surgical procedures in the lower abdomen.
Groin pain in the lower abdomen but including the ilioinguinal region is frequent after inguinal ... more Groin pain in the lower abdomen but including the ilioinguinal region is frequent after inguinal hernia operations, but the integrity of the nerves in this region, including the genitofemoral nerve (GFN), has not been investigated. We studied GFN motor conduction time to the cremasteric muscle (CM), the CM electromyogram (EMG), and the CM reflex in 30 patients with unilateral inguinal hernia who underwent herniorrhaphy and in 26 similar patients who had no surgical intervention. Among the 30 patients undergoing herniorrhaphy, 14 (47%) showed motor involvement of the GFN, whereas 6 of the 26 (23%) patients not treated surgically had involvement of the GFN. These findings indicate that subclinical motor involvement of the GFN can be demonstrated by electrophysiological methods and is common after inguinal herniorrhaphy. Based on patient complaints, the herniated mass may also be responsible for motor involvement of the GFN in some patients before surgery.
ABSTRACT Motor conduction velocity is expected to be normal or nearly normal in amyotrophic later... more ABSTRACT Motor conduction velocity is expected to be normal or nearly normal in amyotrophic lateral sclerosis (ALS). Some studies have suggested that pathology may be present in the proximal axons. Indeed, some investigators have shown a decrease in the proximal conduction velocity in ALS by using motor conduction velocity measurements and H-reflex and F-response recordings, but they could not delineate the precise region of the conduction pathology. In this study, unlike the ones carried out previously, the most proximal segment has been studied in 11 patients with ALS, 13 normal controls, and 5 patients with sequel of poliomyelitis (SPM) by recording sensory and motor spinal root potentials. While no conduction pathology, H-reflex, or F-response abnormalities were found in ALS patients compared to normal subjects, it was shown that conduction velocity decreased in the proximal segment of the lower motor neuron of the ventral root. Despite motor neuron pathology in SPM, there was no proximal motor conduction slowing compared with that in normal subjects.
Juvenile myoclonic epilepsy (JME) is not an uncommon seizure disorder, occurring in 5-10% of epil... more Juvenile myoclonic epilepsy (JME) is not an uncommon seizure disorder, occurring in 5-10% of epileptic patients. A subclinical anterior horn cell involvement has been suggested in some JME patients by concentric needle electromyography (EMG) and turn/amplitude analysis. In this study, 22 JME patients and 17 normal control subjects have been studied with macro EMG, which is a sensitive method to assess the size of motor units. Most JME patients (19 of 22) had a pathologically increased number of individual large macro motor unit action potentials (MUAPs) compared to control subjects. For both biceps brachii and tibialis anterior muscles, means of median macro MUAP amplitudes were significantly greater than those of normal controls, whereas the fiber density values were only slightly increased. This suggested another kind of anterior horn cell involvement in JME than seen in motor neuron diseases.
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