H波と臨床神経診断(<特集>脳と神経の研究V)

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By means of the evoked electromyogram, we studied variation of H wave in the normal and in patients who were suffering from spasticity or rigidity, and influence of Jendrassik's reflex reinforcement to H wave. The H wave was elucited by stimulation of the tibial nerve at the popliteal fossa and recorded from the soleus muscle with surface electrodes as stimulating and recording electrodes. I) Hitherto we believed that the frequency distribution of amplitude of H wave (H) was in accordance with normal distribution and we applied arithmetic mean, standard deviation and coefficient of variation to clinical analysis. As a result of more precise analysis of frequency distribution of H in above stated three cases, the said factors are still practically applicable, however, it became apparent that they held not always true. 1. The principle of frequency distribution of H passes for in three cases, i.g. the normal, the spasticity and the rigidity. 2. The frequency distribution of the greatest H without M is the reprensentative of frequency distribution at any magnitude of H. 3. It proved that a hundred or more H were sufficient to get a frequency distribution of H and it belongs to binominal distribution. Its factors are arithmetic mean, mode, median, quartile distance, relative quartile distance from the point of mode relative distance from the point of median, standard deviation, coefficient of variation, skewness and binominal probability. It can be divided into two parts: one is an area of accumulation, the other is an area of scatter. The distribution is pathognomonic in the normal, the spastic and the rigid respectively. 4. The form of frequency distribution can be modified by medicine. The medicine which works facilitatory to the central nervous system modifies the curve in distal part origin. The medicine which works inhibitory to H wave modifies it in proximal part from origin. From these points it is considered that pathophysiological differences between the normal and the spastic or the rigid lie in the fault of mechanism which controls the frequency distribution of H and we propose that analysis of the frequency distribution of H can be applicable in clinical neurology. II) Often a clear response can be obtained while the subject tightly clasps his hands together and pulls or grips tightly. This is the method used to produce reflex reinforcement of tendon jerks termed Jendrassik's maneuver. It has been suggested that this mechanism is attributable to the avertion of the subject's attention from his leg to his hand which calls forth overflowing of impulses. But some authors asserted that it was due to an increased fusimotor discharge to motoneurons via gamma-loop. Our opinions are as follows. 1. Jendrassik's reflex reinforcement method enlarged amplitude of H wave as well as the tendon jerk. 2. When the tibial nerve was topically anesthetized with 0.5〜l% procaine at distal part from the site of stimulation, H wave showed very low voltage although the effect of the Jendrassik's maneuver on H wave still recognizable in spite of gamma-fibre blockade. So we can say that the fusimotor activation via gamma-loop does not plag a principal role and there must be some other tract directly responsible for invigorating motoneurons. 3. By means of electrical stimulation of the radical nerve and analysis of its influence to H wave, it proved that there was a facilitatory tract through which impulses from upper limb ascend to the motoneuron. In cases with spinal tumor which were conceived to have lesion in this presumptive tract, the Jendrassik's effort were not found. 4. By means of combination the strainmeter with signals of electric lamp light for starting of Jendrassik's maneuver, we found out that variation of H wave commenced 200 to 400 msec earlier than starting or ending of Jendrassik's maneuver. From these points of view we inferred that concentration of attention to hand rather than avertion of attention from leg had to be more important factor to the reinforcement. Furthermore with this method many discrepancies concerning the mechanism of Jendrassik's reflex reinforcement will be resolved.
千葉大学の論文

H波と臨床神経診断(<特集>脳と神経の研究V)

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