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. 2003 Jul;74(7):913–917. doi: 10.1136/jnnp.74.7.913

Long term course of the H reflex after selective tibial neurotomy

T Roujeau 1, J Lefaucheur 1, V Slavov 1, R Gherardi 1, P Decq 1
PMCID: PMC1738540  PMID: 12810779

Abstract

Objectives: This study was conducted to evaluate the long term clinical and electrophysiological outcome by recording the H reflex in a consecutive series of six patients treated by selective tibial neurotomy for spastic equinus foot.

Method: The amplitudes of Hmax reflexes, Mmax responses, and Hmax:Mmax ratio were recorded in six patients with chronic lower limb spasticity, before and after surgery, at day 1 and 8 months and 24 months after selective tibial neurotomy. The passive range of movement, the stretch reflex score according to the Tardieu scale, the osteoarticular and tendon repercussions, and the quality of motor control of dorsiflexion were evaluated preoperatively and postoperatively.

Results: At the end of the study, all patients presented a reduction of equines. Gait and Tardieu's score of spasticity had improved in all patients. Active dorsiflexion of the ankle was unchanged in four patients, but two improved by 5° to 12°. In five cases, fascicular resection of the superior nerve to soleus was, alone, sufficient to reduce spastic equinus foot, without recurrence, for a mean follow up of 28 months. Two patients were reoperated on, one for remaining spasticity related to an underestimated spasticity of the gastrocnemius muscles, and the other for painful claw toes. Hmax, Mmax, and Hmax:Mmax ratios were significantly lower the day after surgery. The reduction of Hmax and Hmax/Mmax ratio remained stable over time and was still statistically significant two years after the operation. However, the value of Mmax eight months postoperatively was no longer significantly different from the preoperative value.

Conclusion: This study shows the long term efficacy of the selective tibial neurotomy as treatment of spastic equinus foot. Neurotomy confined to fibres supplying the soleus muscle is sufficient in most cases and acts by decreasing sensory afferents without significant long term motor denervation.

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Selected References

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  1. ANGEL R. W., HOFMANN W. W. THE H REFLEX IN NORMAL, SPASTIC, AND RIGID SUBJECTS. Arch Neurol. 1963 Jun;9:591–596. doi: 10.1001/archneur.1963.00460060021002. [DOI] [PubMed] [Google Scholar]
  2. Allison S. C., Abraham L. D. Correlation of quantitative measures with the modified Ashworth scale in the assessment of plantar flexor spasticity in patients with traumatic brain injury. J Neurol. 1995 Oct;242(10):699–706. doi: 10.1007/BF00866923. [DOI] [PubMed] [Google Scholar]
  3. Banks R. W., Barker D. Specificities of afferents reinnervating cat muscle spindles after nerve section. J Physiol. 1989 Jan;408:345–372. doi: 10.1113/jphysiol.1989.sp017463. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Berard C., Sindou M., Berard J., Carrier H. Selective neurotomy of the tibial nerve in the spastic hemiplegic child: an explanation of the recurrence. J Pediatr Orthop B. 1998 Jan;7(1):66–70. doi: 10.1097/01202412-199801000-00012. [DOI] [PubMed] [Google Scholar]
  5. Berger W., Horstmann G., Dietz V. Tension development and muscle activation in the leg during gait in spastic hemiparesis: independence of muscle hypertonia and exaggerated stretch reflexes. J Neurol Neurosurg Psychiatry. 1984 Sep;47(9):1029–1033. doi: 10.1136/jnnp.47.9.1029. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Brown M. C., Butler R. G. Regeneration of afferent and efferent fibres to muscle spindles after nerve injury in adults cats. J Physiol. 1976 Sep;260(2):253–266. doi: 10.1113/jphysiol.1976.sp011514. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Collins W. F., 3rd, Mendell L. M., Munson J. B. On the specificity of sensory reinnervation of cat skeletal muscle. J Physiol. 1986 Jun;375:587–609. doi: 10.1113/jphysiol.1986.sp016135. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Decq P., Cuny E., Filipetti P., Fève A., Kéravel Y. Les neurotomies périphériques dans le traitement de la spasticité. Indications, technique et résultats aux membres inférieurs. Neurochirurgie. 1998 Sep;44(3):175–182. [PubMed] [Google Scholar]
  9. Decq P., Cuny E., Filipetti P., Kéravel Y. Role of soleus muscle in spastic equinus foot. Lancet. 1998 Jul 11;352(9122):118–118. doi: 10.1016/s0140-6736(98)85025-3. [DOI] [PubMed] [Google Scholar]
  10. Decq P., Filipetti P., Cubillos A., Slavov V., Lefaucheur J. P., Nguyen J. P. Soleus neurotomy for treatment of the spastic equinus foot. Groupe d'Evaluation et de Traitement de la Spasticité et de la Dystonie. Neurosurgery. 2000 Nov;47(5):1154–1161. doi: 10.1097/00006123-200011000-00027. [DOI] [PubMed] [Google Scholar]
  11. Delwaide P. J., Cordonnier M., Gadea-Ciria M. Excitability relationships between lower limb myotatic arcs in spasticity. J Neurol Neurosurg Psychiatry. 1978 Jul;41(7):636–641. doi: 10.1136/jnnp.41.7.636. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Dietz V., Quintern J., Berger W. Electrophysiological studies of gait in spasticity and rigidity. Evidence that altered mechanical properties of muscle contribute to hypertonia. Brain. 1981 Sep;104(3):431–449. doi: 10.1093/brain/104.3.431. [DOI] [PubMed] [Google Scholar]
  13. Einsiedel L. J., Luff A. R. Activity and motor unit size in partially denervated rat medial gastrocnemius. J Appl Physiol (1985) 1994 Jun;76(6):2663–2671. doi: 10.1152/jappl.1994.76.6.2663. [DOI] [PubMed] [Google Scholar]
  14. Einsiedel L. J., Luff A. R. Effect of partial denervation on motor units in the ageing rat medial gastrocnemius. J Neurol Sci. 1992 Oct;112(1-2):178–184. doi: 10.1016/0022-510x(92)90148-e. [DOI] [PubMed] [Google Scholar]
  15. Einsiedel L., Luff A. R., Proske U. Sprouting of fusimotor neurones after partial denervation of the cat soleus muscle. Exp Brain Res. 1992;90(2):369–374. doi: 10.1007/BF00227250. [DOI] [PubMed] [Google Scholar]
  16. Fève A., Decq P., Filipetti P., Verroust J., Harf A., N'Guyen J. P., Keravel Y. Physiological effects of selective tibial neurotomy on lower limb spasticity. J Neurol Neurosurg Psychiatry. 1997 Nov;63(5):575–578. doi: 10.1136/jnnp.63.5.575. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Gordon T., Yang J. F., Ayer K., Stein R. B., Tyreman N. Recovery potential of muscle after partial denervation: a comparison between rats and humans. Brain Res Bull. 1993;30(3-4):477–482. doi: 10.1016/0361-9230(93)90281-f. [DOI] [PubMed] [Google Scholar]
  18. Hufschmidt A., Mauritz K. H. Chronic transformation of muscle in spasticity: a peripheral contribution to increased tone. J Neurol Neurosurg Psychiatry. 1985 Jul;48(7):676–685. doi: 10.1136/jnnp.48.7.676. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Lance J. W., Burke D. J., Neilson P. D., Milder D. G. A physiological approach to motor disorders. Electroencephalogr Clin Neurophysiol Suppl. 1978;(34):501–505. [PubMed] [Google Scholar]
  20. Lance J. W. Disordered muscle tone and movement. Clin Exp Neurol. 1981;18:27–35. [PubMed] [Google Scholar]
  21. Lance J. W. The control of muscle tone, reflexes, and movement: Robert Wartenberg Lecture. Neurology. 1980 Dec;30(12):1303–1313. doi: 10.1212/wnl.30.12.1303. [DOI] [PubMed] [Google Scholar]
  22. Levin M. F., Hui-Chan C. Are H and stretch reflexes in hemiparesis reproducible and correlated with spasticity? J Neurol. 1993 Feb;240(2):63–71. doi: 10.1007/BF00858718. [DOI] [PubMed] [Google Scholar]
  23. Matthews W. B. The clinical implications of the H reflex and of other electrically induced reflexes. Mod Trends Neurol. 1970;5(0):241–253. [PubMed] [Google Scholar]
  24. Nielsen J. F., Sinkjaer T. A comparison of clinical and laboratory measures of spasticity. Mult Scler. 1996 Apr;1(5):296–301. doi: 10.1177/135245859600100506. [DOI] [PubMed] [Google Scholar]
  25. Park D. M., Shon S. K., Kim Y. J. Direct muscle neurotization in rat soleus muscle. J Reconstr Microsurg. 2000 Jul;16(5):379–383. doi: 10.1055/s-2000-7349. [DOI] [PubMed] [Google Scholar]
  26. Pierrot-Deseilligny E., Mazevet D. The monosynaptic reflex: a tool to investigate motor control in humans. Interest and limits. Neurophysiol Clin. 2000 Apr;30(2):67–80. doi: 10.1016/s0987-7053(00)00062-9. [DOI] [PubMed] [Google Scholar]
  27. Rafuse V. F., Gordon T., Orozco R. Proportional enlargement of motor units after partial denervation of cat triceps surae muscles. J Neurophysiol. 1992 Oct;68(4):1261–1276. doi: 10.1152/jn.1992.68.4.1261. [DOI] [PubMed] [Google Scholar]
  28. Sehgal N., McGuire J. R. Beyond Ashworth. Electrophysiologic quantification of spasticity. Phys Med Rehabil Clin N Am. 1998 Nov;9(4):949-79, ix. [PubMed] [Google Scholar]

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