Effect of spinal cord injury and of intrathecal baclofen on brainstem reflexes

被引:25
作者
Kumru, Hatice
Kofler, Markus [1 ]
机构
[1] Hochzirl Hosp, Dept Neurol, A-6170 Zirl, Austria
关键词
Blink reflex; Blink reflex recovery; Intrathecal baclofen; Prepulse inhibition; Spasticity; Spinal cord lesion; auditory startle reaction; MASSETER INHIBITORY REFLEX; ACOUSTIC STARTLE REFLEX; ORBICULARIS OCULI REFLEX; CEREBROSPINAL-FLUID; BLINK REFLEX; PREPULSE INHIBITION; PARKINSONS-DISEASE; GABAERGIC NEURONS; MOTOR CORTEX; CORTICAL REORGANIZATION;
D O I
10.1016/j.clinph.2011.06.036
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Reorganization of neural circuits within the central nervous system following injury appears to be a means of compensatory mechanism for loss of function. Reorganization following spinal cord injury is known to evoke changes at the cortical and spinal cord levels. Recent studies, however, provide evidence of enhanced brainstem reflexes and alterations in excitatory and inhibitory interneuronal brainstem circuits, suggesting that reorganization following spinal cord injury occurs also at the brainstem level. Reversal of these changes by continuous intrathecal baclofen infusion to normal levels or beyond indicates strong GABAergic involvement. Rapid changes in the blink reflex and its prepulse inhibition following intrathecal baclofen bolus application that parallel clinical changes in muscle hypertonia suggest a muscle tone regulating effect of baclofen at the brainstem level. Enhanced brainstem reflexes in spinal cord injury patients may be the consequence of decreased GABA-mediated inhibition and/or strengthening of facilitatory connections due to either direct or indirect plastic changes occurring at the brainstem level. Modulation of brainstem reflexes by baclofen may foster the understanding of pathophysiological mechanisms underlying diseases with increased brainstem activity. Rehabilitation after central nervous system injury will always be a challenge, but understanding the mechanisms of reorganization of undamaged neural pathways may help to develop better strategies for enhancing neuronal plasticity and for implementing neuronal reorganization into carefully planned therapy. (C) 2011 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:45 / 53
页数:9
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