Spasticity, spastic dystonia, and static stretch reflex in hypertonic muscles of patients with multiple sclerosis
Luca Puce, Antonio Currà, Lucio Marinelli, Laura Mori, Elisabetta Capello, Rachele Di Giovanni, Matteo Bodrero, Claudio Solaro, Filippo Cotellessa, Francesco Fattapposta, Carlo Trompetto
Abstract
OBJECTIVE: To investigate prevalence of EMG patterns underlying hypertonia in multiple sclerosis (MS) and whether these patterns indicate different levels of spinal excitability. METHODS: We investigated the EMG activity recorded from 108 hypertonic muscles of 59 consecutive MS patients. To investigate spastic dystonia (SD), we looked for the presence of EMG activity in muscles in a resting position. To investigate dynamic stretch reflex (DSR) and static stretch reflex (SSR), we looked for the presence of EMG activity in response to a manually performed passive stretch of the muscle. RESULTS: DSR was evoked in 104 muscles. In 51 muscles, DSR was the sole EMG activity. This pattern corresponds to the classical notion of spasticity, and was predominant in extensors. In contrast, SSR was detected in 48 muscles - predominantly in flexors. SD was observed in 28 muscles, showing even distribution in flexor and extensor muscles. Only in the flexors, SSR was associated with a larger DSR compared to spasticity. CONCLUSIONS: These findings likely depend on the central effects of both flexor and extensor spindle afferents on the homonymous spinal motor neurons. SIGNIFICANCE: Improving our capacity to assess spinal excitability in MS patients.