Quantitative analysis of blink reflexes in patients with hemiplegic disordersAnalyse quantitative des réflexes de clignement chez des hémiplégiques

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Abstract

Electrically evoked blink reflexes were investigated in 18 patients with hemiplegia and in 15 control subjects, using common electromyographic techniques. The EMG activities of the early and late components were quantitatively assessed by means of electronic averaging and integration. In addition, the latencies of the single components were determined. Regarding the EMG activity of the late components two major types of BR alteration could be distinguished. In type I stimulation of the clinically affected side evoked significantly decreased late components on both the affected and the unaffected sides. This pattern points to a lowered excitability of the brain stem trigeminal systems and may be associated with predominantly sensory disorders. In type II the decrease of the late components was confined to the affected side independent of the side of stimulation. This pattern may indicate a lowered excitability of the brain stem facial systems and/or of the lateral bulbar reticular formation and may be correlated with predominantly motor deficits. Both types are presumably due to a loss of facilitatory influences associated with the hemispheral lesion. Although the early component was frequently decreased on the affected side there was no consistent pattern and no relation to the alterations of the late components. The latencies of both responses, predominantly of the late ones were frequently prolonged, in particular following stimulation of the affected side. Comparison of the seemingly normal components in the patients with the corresponding control values pointed to a generally lowered blink reflex excitability in hemiplegic patients.

Résumé

Chez 18 hémiplégiques et 15 sujets témoins on a étudié les réflexes de clignement (BR) évoqués par stimulation électrique, en utilisant des techniques électromyographiques courantes. Les activités EMG des composantes précoces et tardives ont été exprimées quantitativement par moyennage électronique et intégration. De plus on a déterminé les latences des composantes individuelles. En ce qui concerne l'activité EMG des composantes tardives, on a pu distinguer 2 types principaux d'altérations du BR. Dans le type I, la stimulation du côte cliniquement atteint a évoqué des composantes tardives significativement diminuées, du côté sain comme du côté atteint. Ce résultat traduit une baisse de l'excitabilité du systéme trigéminal du tronc cérébral et peut être associé á des troubles essentiellement sensoriels. Dans le type II, la baisse des composantes tardives fut limitée au côté atteint, indépendamment du côté de la stimulation. Cette réponse pourrait indiquer une diminution d'excitabilité du systéme facial du tronc cérébral et/ou de la formation réticulée bulbaire et être corrélée avec des déficits á prédominance motrice. Les 2 types sont probablement dus á un manque d'influences facilitatrices associé à la lésion hémiplégique. Bien que la composante précoce ait été fréquemment diminuée du côté atteint, il n'est pas apparu de symptômes constants, ni de relation avec les altérations des composantes tardives. Les latences des deux réponses, surtout celles de la plus tardive, étaient souvent augmentées, en particulier pour la stimulation du côté atteint. La comparaison des composantes apparemment normales des malades avec les valeurs correspondantes des témoins a révélé une diminution générale de l'excitabilité du BR chez les hémiplégiques.

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    Supported by Deutsche Forschungsgemeinschaft (De 227/2-1).

    2

    Supported by Deutscher Akademischer Austauschdienst.

    3

    Present address: Institute of Physiology, Bulgarian Academy of Sciences, Acad. G. Bontchev St. B 1. I, Sofia 1113, Bulgaria.

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