[Pathophysiology of spasticity].

Spasticity is characterized by abnormal increase in phasic and velocity-dependent response to muscle stretching, such as exaggerated tendon jerks and clonus. Clasp-knife phenomenon is often observed in the affected muscles. Spasticity is caused by either an excess input to the spinal cord or a disordered descending control of the spinal motor system including the myotatic reflex arc. The increased input due to hyperactivity of γ motor neurons has not been demonstrated in human subjects. The hyperactivity of excitatory interneurons and decreased function of the inhibitory system interneurons in the spinal cord as well as the uncoupling of the inhibitory system from the central system are believed to be involved in spasticity; however, the underlying pathology may differ based on the lesion site and the time elapsed since loss of reciprocal inhibition.

[1]  M. V. von Arbin,et al.  Spasticity After Stroke: Its Occurrence and Association With Motor Impairments and Activity Limitations , 2003, Stroke.

[2]  E. Sachs.  THE SUBPIAL RESECTION OF THE CORTEX IN THE TREATMENT OF JACKSONIAN EPILEPSY (HORSLEY OPERATION) WITH OBSERVATIONS ON AREAS 4 AND 6 , 1935 .

[3]  F. Walshe.  THE DISORDERS OF MOTOR FUNCTION FOLLOWING AN ABLATION OF PART OF THE “LEG AREA” OF THE CORTEX IN MAN , 1935 .

[4]  J. Iles,et al.  Inhibition of monosynaptic reflexes in the human lower limb. , 1987, The Journal of physiology.

[5]  J. Nielsen,et al.  Methodological implications of the post activation depression of the soleus H-reflex in man , 2004, Experimental Brain Research.

[6]  K. Hagbarth,et al.  Muscle spindle responses to stretch in normal and spastic subjects. , 2018, Scandinavian journal of rehabilitation medicine.

[7]  D. Oppenheimer,et al.  THE CERVICAL CORD IN MULTIPLE SCLEROSIS , 1978, Neuropathology and applied neurobiology.

[8]  J. Gracies,et al.  Pathophysiology of spastic paresis. II: Emergence of muscle overactivity , 2005, Muscle & nerve.

[9]  I. Engberg,et al.  DIFFERENTIAL SUPRASPINAL CONTROL OF INHIBITORY AND EXCITATORY ACTIONS FROM THE FRA TO ASCENDING SPINAL PATHWAYS. , 1965, Acta physiologica Scandinavica.

[10]  K. Koketsu,et al.  Cholinergic and inhibitory synapses in a pathway from motor‐axon collaterals to motoneurones , 1954, The Journal of physiology.

[11]  V R Edgerton,et al.  Adaptations of human skeletal muscle fibers to spaceflight. , 1995, Journal of gravitational physiology : a journal of the International Society for Gravitational Physiology.

[12]  S. Chokroverty,et al.  Pure motor hemiplegia due to pyramidal infarction. , 1975, Archives of Neurology.

[13]  A. Thilmann,et al.  Biomechanical changes at the ankle joint after stroke. , 1991, Journal of neurology, neurosurgery, and psychiatry.

[14]  B. W. Peterson,et al.  Patterns of projection and branching of reticulospinal neurons , 1975, Experimental Brain Research.

[15]  T. Szilágyi,et al.  Effect of weightlessness on myofibrillar proteins of rat skeletal muscles with different functions in experiment of biosatellite "Cosmos-1129". , 1983, Acta physiologica Hungarica.

[16]  S. Andreassen,et al.  Non–reflex and reflex mediated ankle joint stiffness in multiple sclerosis patients with spasticity , 1993, Muscle & nerve.

[17]  H. Freund.  Abnormalities of Motor Behavior After Cortical Lesions in Humans , 2011 .

[18]  A. Thilmann,et al.  The mechanism of spastic muscle hypertonus. Variation in reflex gain over the time course of spasticity. , 1991, Brain : a journal of neurology.

[19]  R. Kearney,et al.  Intrinsic and reflex stiffness in normal and spastic, spinal cord injured subjects , 2001, Experimental Brain Research.

[20]  V. Dietz,et al.  Amplitude modulation of the human quadriceps tendon jerk reflex during gait , 2004, Experimental Brain Research.

[21]  Robert M. Brownstone,et al.  Hyperexcitable dendrites in motoneurons and their neuromodulatory control during motor behavior , 2003, Trends in Neurosciences.

[22]  Verhaart Wj.  Corticofugal degeneration following thermocoagulation of areas 4, 6 and 4-s in Macaca mulatta. , 1940 .

[23]  R K Powers,et al.  Input-output functions of mammalian motoneurons. , 2001, Reviews of physiology, biochemistry and pharmacology.

[24]  Hans Hultborn,et al.  Key mechanisms for setting the input-output gain across the motoneuron pool. , 2004, Progress in brain research.

[25]  P. Bucy.  STUDIES ON THE HUMAN NEUROMUSCULAR MECHANISM: II. EFFECT OF VENTROMEDIAL CHORDOTOMY ON MUSCULAR SPASTICITY IN MAN , 1938 .

[26]  E. Pierrot‐Deseilligny.  Electrophysiological assessment of the spinal mechanisms underlying spasticity. , 1990, Electroencephalography and clinical neurophysiology. Supplement.

[27]  C. Crone,et al.  The spinal pathophysiology of spasticity – from a basic science point of view , 2007, Acta physiologica.

[28]  G. Bergmark.  CEREBRAL MONOPLEGIA, WITH SPECIAL REFERENCE TO SENSATION AND TO SPASTIC PHENOMENA. , 1910 .

[29]  S C Gandevia,et al.  Muscle spindle activity in the affected upper limb after a unilateral stroke. , 1999, Brain : a journal of neurology.

[30]  T. Sinkjaer,et al.  Spastic movement disorder: impaired reflex function and altered muscle mechanics , 2007, The Lancet Neurology.

[31]  S. S. Tower.  PYRAMIDAL LESION IN THE MONKEY , 1940 .

[32]  A. Pénicaud,et al.  Presynaptic inhibition and homosynaptic depression: a comparison between lower and upper limbs in normal human subjects and patients with hemiplegia. , 2000, Brain : a journal of neurology.

[33]  B. Bussel,et al.  Effect of intrathecal clonidine on group I and group II oligosynaptic excitation in paraplegics , 2003, Experimental Brain Research.

[34]  J. Leestma,et al.  Pure motor hemiplegia, medullary pyramid lesion, and olivary hypertrophy. , 1976, Journal of neurology, neurosurgery, and psychiatry.

[35]  J. Feldman,et al.  Synaptic control of motoneuronal excitability. , 2000, Physiological reviews.

[36]  S. W. Ranson,et al.  NATURE OF PARESIS FOLLOWING LATERAL CORTICO-SPINAL SECTION IN MONKEYS , 1943 .

[37]  D. Burke,et al.  Are spinal "presynaptic" inhibitory mechanisms suppressed in spasticity? , 1972, Journal of the neurological sciences.

[38]  P. Bucy,et al.  Destruction of the pyramidal tract in the monkey. The effects of bilateral section of the cerebral peduncles. , 1966, Journal of neurosurgery.

[39]  A. Travis,et al.  Neurological deficiencies after ablation of the precentral motor area in Macaca mulatta. , 1955, Brain : a journal of neurology.

[40]  I. Engberg,et al.  Reticulospinal inhibition of transmission in reflex pathways , 1968, The Journal of physiology.

[41]  V. Dietz,et al.  Motor unit involvement in spastic paresis: Relationship between leg muscle activation and histochemistry , 1986, Journal of the Neurological Sciences.

[42]  M. Faist,et al.  Modulation, probably presynaptic in origin, of monosynaptic Ia excitation during human gait , 1996, Experimental Brain Research.

[43]  P. Delwaide,et al.  Short-latency autogenic inhibition (IB inhibition) in human spasticity. , 1988, Journal of neurology, neurosurgery, and psychiatry.

[44]  D Burke,et al.  Spasticity as an adaptation to pyramidal tract injury. , 1988, Advances in neurology.

[45]  O. Hyndman.  PHYSIOLOGY OF THE SPINAL CORD: I. ROLE OF THE ANTERIOR COLUMN IN HYPERREFLEXIA , 1941 .

[46]  J. Lance.  Disordered muscle tone and movement. , 1981, Clinical and experimental neurology.

[47]  R. Herndon,et al.  Bilateral infarction of the pyramidal tracts in man , 1962, Neurology.

[48]  C. Woolsey,et al.  The Pyramidal Tract , 1957, Neurology.

[49]  V. Dietz,et al.  Tension development and muscle activation in the leg during gait in spastic hemiparesis: independence of muscle hypertonia and exaggerated stretch reflexes. , 1984, Journal of neurology, neurosurgery, and psychiatry.

[50]  B. Bussel,et al.  Evidence for recurrent inhibition by motoneurons in human subjects , 1975, Brain Research.

[51]  Jaynie F. Yang,et al.  Role of motoneurons in the generation of muscle spasms after spinal cord injury. , 2004, Brain : a journal of neurology.

[52]  B. Olausson,et al.  Antispastic effects of l-dopa , 1996, Experimental Brain Research.

[53]  D Burke,et al.  Spasticity, decerebrate rigidity and the clasp-knife phenomenon: an experimental study in the cat. , 1972, Brain : a journal of neurology.

[54]  M. E. Goldberger,et al.  The extrapyramidal systems of the spinal cord. II. Results of combined pyramidal and extrapyramidal lesions in the macaque , 1969, The Journal of comparative neurology.

[55]  S. Meunier,et al.  Pattern of monosynaptic heteronymous Ia connections in the human lower limb , 2004, Experimental Brain Research.

[56]  O. Foerster,et al.  THE MOTOR CORTEX IN MAN IN THE LIGHT OF HUGHLINGS JACKSON'S DOCTRINES , 1936 .

[57]  P. Ashby,et al.  Segmental reflex pathways in spinal shock and spinal spasticity in man , 1974, Journal of neurology, neurosurgery, and psychiatry.

[58]  M. Faist,et al.  Amplitude modulation of the quadriceps H-reflex in the human during the early stance phase of gait , 2004, Experimental Brain Research.

[59]  V. Marchand-Pauvert,et al.  The pattern of excitation of human lower limb motoneurones by probable group II muscle afferents , 1999, The Journal of physiology.

[60]  E. Jankowska.  Interneuronal relay in spinal pathways from proprioceptors , 1992, Progress in Neurobiology.

[61]  K H Mauritz,et al.  Chronic transformation of muscle in spasticity: a peripheral contribution to increased tone. , 1985, Journal of neurology, neurosurgery, and psychiatry.

[62]  E. Pierrot-Deseilligny,et al.  Recurrent inhibition of alpha-motoneurons in patients with upper motor neuron lesions. , 1982, Brain : a journal of neurology.

[63]  M. Siu,et al.  Plateau potentials in sacrocaudal motoneurons of chronic spinal rats, recorded in vitro. , 2001, Journal of neurophysiology.

[64]  P. Brown.  Pathophysiology of spasticity. , 1994, Journal of neurology, neurosurgery, and psychiatry.

[65]  D. Lindsley,et al.  Role of brain stem facilitatory systems in maintenance of spasticity. , 1949, Journal of neurophysiology.

[66]  V. Dietz.  Human neuronal control of automatic functional movements: interaction between central programs and afferent input. , 1992, Physiological reviews.

[67]  P. Bucy.  Is there a pyramidal tract. , 1957, Brain : a journal of neurology.

[68]  P. Delwaide,et al.  Tizanidine and electrophysiologic analysis of spinal control mechanisms in humans with spasticity , 1994, Neurology.

[69]  T. J. Putnam.  RESULTS OF TREATMENT OF ATHETOSIS BY SECTION OF EXTRAPYRAMIDAL TRACTS IN THE SPINAL CORD , 1938 .

[70]  J. Eccles,et al.  Presynaptic inhibition of the spinal monosynaptic reflex pathway , 1962, The Journal of physiology.

[71]  P. Delwaide,et al.  Pathopsychological aspects of spasticity in man. , 1987 .

[72]  W. Chambers,et al.  An experimental study of cerebellar dyskinesia in the rhesus monkey. , 1967, Brain : a journal of neurology.

[73]  H. Magoun,et al.  An inhibitory mechanism in the bulbar reticular formation. , 1946, Journal of neurophysiology.

[74]  P. Bucy,et al.  DESTRUCTION OF THE "PYRAMIDAL TRACT" IN MAN. , 1964, Journal of neurosurgery.

[75]  V. Horsley.  The Linacre Lecture ON THE FUNCTION OF THE SO-CALLED MOTOR AREA OF THE BRAIN , 1909, British medical journal.

[76]  A. Lundberg.  Multisensory control of spinal reflex pathways. , 1979, Progress in brain research.

[77]  J Quintern,et al.  Electrophysiological studies of gait in spasticity and rigidity. Evidence that altered mechanical properties of muscle contribute to hypertonia. , 1981, Brain : a journal of neurology.

[78]  Jean-Michel Gracies,et al.  Pathophysiology of spastic paresis. I: Paresis and soft tissue changes , 2005, Muscle & nerve.

[79]  R. Angel,et al.  THE H REFLEX IN NORMAL, SPASTIC, AND RIGID SUBJECTS. , 1963, Archives of neurology.

[80]  P. Ashby,et al.  Neurophysiological Changes Following Spinal Cord Lesions in Man , 1975, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[81]  W. McCulloch,et al.  A cortico-bulbo-reticular pathway from area 4-s. , 1946, Journal of neurophysiology.

[82]  W. Fries,et al.  Motor recovery following capsular stroke. Role of descending pathways from multiple motor areas. , 1993, Brain : a journal of neurology.

[83]  E. Liddell,et al.  REFLEX RELEASE OF FLEXOR MUSCLES BY SPINAL SECTION , 1932 .

[84]  K. Castleman,et al.  Morphometric analysis of rat muscle fibers following space flight and hypogravity. , 1980, The Physiologist.

[85]  S. Gilman,et al.  Effects of medullary pyramidotomy in the monkey. II. Abnormalities of spindle afferent responses. , 1971, Brain : a journal of neurology.

[86]  M. Gorassini,et al.  Persistent inward currents in motoneuron dendrites: Implications for motor output , 2005, Muscle & nerve.

[87]  R. Schmidt,et al.  Presynaptic inhibition in the vertebrate spinal cord revisited , 1999, Experimental Brain Research.

[88]  E. Pierrot-Deseilligny,et al.  Non‐monosynaptic transmission of the cortical command for voluntary movement in man. , 1994, The Journal of physiology.

[89]  M. Faist,et al.  Impaired modulation of quadriceps tendon jerk reflex during spastic gait: differences between spinal and cerebral lesions. , 1999, Brain : a journal of neurology.

[90]  J. Nielsen,et al.  Central control of reciprocal inhibition during fictive dorsiflexion in man , 2004, Experimental Brain Research.

[91]  P. Wagley.  A study of spasticity and paralysis. , 1945, Bulletin of the Johns Hopkins Hospital.

[92]  O. Hyndman.  PHYSIOLOGY OF THE SPINAL CORD: II. THE INFLUENCE OF CHORDOTOMY ON EXISTING MOTOR DISTURBANCES , 1943 .

[93]  J. Eccles,et al.  Distribution of recurrent inhibition among motoneurones , 1961, The Journal of physiology.

[94]  H. Fang,et al.  Spastic hemiplegia in man , 1961, Neurology.

[95]  C. Crone,et al.  Reciprocal inhibition and corticospinal transmission in the arm and leg in patients with autosomal dominant pure spastic paraparesis (ADPSP). , 2004, Brain : a journal of neurology.

[96]  R. Katz,et al.  Recurrent inhibition in humans , 1999, Progress in Neurobiology.

[97]  D. Desplanches,et al.  Structural and functional responses to prolonged hindlimb suspension in rat muscle. , 1987, Journal of applied physiology.

[98]  N. Petersen,et al.  Disynaptic reciprocal inhibition of ankle extensors in spastic patients. , 1994, Brain : a journal of neurology.

[99]  E Godaux,et al.  Mechanism of the vibration paradox: excitatory and inhibitory effects of tendon vibration on single soleus muscle motor units in man , 1978, The Journal of physiology.

[100]  J. Noth,et al.  Trends in the pathophysiology and pharmacotherapy of spasticity , 1991, Journal of Neurology.

[101]  J. Nielsen,et al.  Changes in transmission across synapses of Ia afferents in spastic patients. , 1995, Brain : a journal of neurology.

[102]  M. Gorassini,et al.  Role of persistent sodium and calcium currents in motoneuron firing and spasticity in chronic spinal rats. , 2004, Journal of neurophysiology.

[103]  A. M. Lassek.  THE HUMAN PYRAMIDAL TRACT: X. THE BABINSKI SIGN AND DESTRUCTION OF THE PYRAMIDAL TRACT , 1944 .

[104]  L. Edström.  Selective atrophy of red muscle fibres in the quadriceps in long-standing knee-joint dysfunction. Injuries to the anterior cruciate ligament. , 1970, Journal of the neurological sciences.

[105]  P Ashby,et al.  Pyramidal and extrapyramidal control of tonic mechanisms in the cat. , 1972, Brain : a journal of neurology.

[106]  M. Gorassini,et al.  Evidence for plateau potentials in tail motoneurons of awake chronic spinal rats with spasticity. , 2001, Journal of neurophysiology.

[107]  J. Nielsen,et al.  Appearance of reciprocal facilitation of ankle extensors from ankle flexors in patients with stroke or spinal cord injury. , 2003, Brain : a journal of neurology.

[108]  M. Illert,et al.  On the mechanism of the post-activation depression of the H-reflex in human subjects , 1996, Experimental Brain Research.

[109]  P. Marque,et al.  Facilitation of transmission in heteronymous group II pathways in spastic hemiplegic patients , 2001, Journal of neurology, neurosurgery, and psychiatry.

[110]  R. Shields,et al.  Muscle and bone plasticity after spinal cord injury: review of adaptations to disuse and to electrical muscle stimulation. , 2008, Journal of rehabilitation research and development.

[111]  A. Travis,et al.  Neurological deficiencies following supplementary motor area lesions in Macaca mulatta. , 1955, Brain : a journal of neurology.

[112]  G. McCouch,et al.  Sprouting as a cause of spasticity. , 1958, Journal of neurophysiology.

[113]  S. Meunier,et al.  Pattern of heteronymous recurrent inhibition in the human lower limb , 2004, Experimental Brain Research.

[114]  P. E. Crago,et al.  Mechanisms of the clasp-knife reflex studied in an animal model , 1979, Experimental Brain Research.

[115]  James W. Lance,et al.  The control of muscle tone, reflexes, and movement , 1980, Neurology.

[116]  H. B. Curry,et al.  PURE MOTOR HEMIPLEGIA OF VASCULAR ORIGIN. , 1965, Archives of neurology.

[117]  P. Marque,et al.  Evidence for excitation of the human lower limb motoneurones by group II muscle afferents , 1996, Experimental Brain Research.

[118]  Darcy Fehlings,et al.  Reliability of the Tardieu Scale for assessing spasticity in children with cerebral palsy. , 2010, Archives of physical medicine and rehabilitation.

[119]  T. J. Putnam.  TREATMENT OF UNILATERAL PARALYSIS AGITANS BY SECTION OF THE LATERAL PYRAMIDAL TRACT , 1941 .