A new approach to estimation of the number of central synapse(s) included in the H-reflex

BACKGROUND: Among the main clinical applications of the H-reflex are the evaluation of the S1 nerve root conductivity such as radiculopathy and measurement of the excitability of the spinal motoneurons in neurological conditions. An attempt has been made to reduce the pathway over which H-reflex can be obtained in a hope to localize a lesion to the S1 nerve root, so the S1 central loop has been suggested. The main goal of this study is the estimation of the H-reflex number of synapse(s) for better understanding of the physiology of this practical reflex. METHODS: Forty healthy adult volunteers (22 males, 18 females) with the mean age of (37.7 ± 10.2) years participated in this study. They were positioned comfortably in the prone position, with their feet off the edge of the plinth. Recording electrodes were positioned at the mid point of a line connecting the mid popliteal crease to the proximal flare of the medial malleolus. Stimulation was applied at the tibial nerve in the popliteal fossa and H, F and M waves were recorded. Without any change in the location of the recording electrodes, a monopolar needle was inserted as cathode at a point 1 cm medial to the posterior superior iliac spine, perpendicular to the frontal plane. The anode electrode was placed over the anterior superior iliac spine, and then M and H waves of the central loop were recorded. After processing the data, sacral cord conduction delay was determined by this formula: * Sacral cord conduction delay = central loop of H-reflex – (delays of the proximal motor and sensory fibers in the central loop). RESULTS: The central loop of H-reflex was (6.77 ± 0.28) msec and the sacral cord conduction delay was (1.09 ± 0.06) msec. CONCLUSION: The sacral cord conduction time was estimated to be about 1.09 msec in this study and because at least 1 msec is required to transmit the signal across the synapse between the sensory ending and the motor cell, so this estimated time was sufficient for only one central synapse in this reflex

Effects of age and leg length upon central loop of the Gastrocnemius-soleus H-reflex latency

BACKGROUND: central loop of the gastrocnemius-soleus H-reflex latency (T(c)) that looks promising in the diagnosis of S1 radiculopathy; has been investigated in a few studies and only two of them have focused on the constitutional factors affecting it. Although leg length has been shown to contribute to the T(c), the role of age is controversial. More confusing, none of the previously performed studies have used strict criteria to rule out subclinical neuropathy, so the results could be misleading. This study has been performed to determine the influence of leg length and age on T(c )among a carefully selected group of healthy volunteers. METHODS: after screening forty six volunteers by taking history, physical examination and a brief electrophysiologic study; forty of them were selected to enroll into the study. T(c )was obtained in all the study subjects and leg length and age were recorded for correlational analyses. RESULTS: this group was consisted of 26 males (65%) and 14 females (35%) with the age range of 19–65 years (Mean ± SD: 37 ± 10.7) and leg length range of 29.5–43 centimeters (36.4 ± 3.4). Mean ± SD for T(c )was 6.78 ± 0.3. We found a significant correlation between T(c )and leg length (p value= 0.003, r = 0.49 and confidence interval 95% = 0.59–0.88), no significant correlation was found between age and T(c )(p value= 0.48, r = 0.11), also we obtained the regression equation as: T(c )= 0.04L + 5.28 CONCLUSIONS: in contrast to leg length, age was not correlated with T(c). Future studies are required to delineate other contributing factors to T(c)