REFLEXES THE CODES OF NEUROLOGY

reflexesneurologytaskindumankapak21432

ELECTROPHYSIOLOGICAL REFLEXES IN NEUROLOGY AND THEIR APPLICATIONS

Aslıhan Baran

Yüksek İhtisas University, Faculty of Medicine, Department of Neurology, Ankara, Türkiye

Baran A. Electrophysiological Reflexes in Neurology and Their Applications. In: Duman T, editor. Reflexes The Codes of Neurology. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.255-268.

ABSTRACT

Electrophysiological reflexes are a fundamental component of neurology, providing critical information on the structural and functional integrity of the nervous system at multiple levels. They are essential for assessing peripheral and central nervous system pathways and are widely utilized in clinical and research contexts. Due to the inherent limitations of direct experimentation in humans, reflex studies serve as a valuable indirect method for exploring the organization and connectivity of sensorimotor circuits. Although indirect, changes in reflex excitability following various conditioning stimuli offer important insights into the neural mechanisms underlying such modulation. In clinical practice, electrophysiological reflexes play a significant role in diagnosing a wide range of neurological disorders and are increasingly used to monitor treatment response and guide management strategies.

Keywords: Reflex; Electrophysiology; Nervous system; Neuronal plasticity; Nervous system diseases.

Referanslar

  1. Hoffmann P. Beitrag zur Kenntnis der menschlichen Reflexe mit besonderer Berücksichtigung der elektrischen Erscheinungen. Arch Anat Physiol. 1910;1:223-46. [Crossref]  [PubMed]
  2. Kimura J. Electrodiagnosis in diseases of nerve and muscle: principles and practice. 4th ed. Oxford: Oxford University Press; 2013. p.209. [Crossref]  [PubMed]
  3. Knikou M. The H-reflex as a probe: pathways and pitfalls. J Neurosci Methods. 2008;171(1):1-12. [Crossref]  [PubMed]
  4. Magladery JW, Porter WE, Park AM, Teasdall RD. Electrophysiological studies of nerve and reflex activity in normal man. IV. The two-neurone reflex and identification of certain action potentials from spinal roots and cord. Bull Johns Hopkins Hosp. 1951;88(6):499-519. [Crossref]  [PubMed]
  5. Burke D, Gandevia SC, McKeon B. The afferent volleys responsible for spinal proprioceptive reflexes in man. J Physiol. 1983;339:535-52. [Crossref]  [PubMed]
  6. Pierrot-Deseilligny E, Mazevet D. The monosynaptic reflex: a tool to investigate motor control in humans. Interest and limits. Neurophysiol Clin. 2000;30(2):67-80. [Crossref]  [PubMed]
  7. Hermens HJ, Freriks B, Disselhorst-Klug C, Rau G. Development of recommendations for SEMG sensors and sensor placement procedures. J Electromyogr Kinesiol. 2000;10(5):361-74. [Crossref]  [PubMed]
  8. Zehr EP. Considerations for use of the Hoffmann reflex in exercise studies. Eur J Appl Physiol. 2002;86(5):455-68. [Crossref]  [PubMed]
  9. Chen YS, Zhou S. Soleus H-reflex and its relation to static postural control. Gait Posture. 2011;33(2):169-78. [Crossref]  [PubMed]
  10. Palmieri RM, Ingersoll CD, Hoffman MA. The Hoffmann Reflex: methodologic considerations and applications for use in sports medicine and athletic training research. J Athl Train. 2004;39(3):268-77. [Crossref]  [PubMed]
  11. Misiaszek JE. The H-reflex as a tool in neurophysiology: its limitations and uses in understanding nervous system function. Muscle Nerve. 2003;28(2):144-60. [Crossref]  [PubMed]
  12. McIlroy WE, Collins DF, Brooke JD. Movement features and H reflex modulation. II. Passive rotation, movement velocity and single leg movement. Brain Res. 1992;582(1):85-93. [Crossref]  [PubMed]
  13. Cheng J, Brooke JD, Misiaszek JE, Staines WR. The relationship between the kinematics of passive movement, the stretch of extensor muscles of the leg and the change induced in the gain of the soleus H reflex in humans. Brain Res. 1995;672(1-2):89-96.
  14. Hiraoka K. Phase-dependent modulation of the soleus H-reflex during rhythmical arm swing in humans. Electromyogr Clin Neurophysiol. 2001;41(1):43-7. [Crossref]  [PubMed]
  15. Paquet N, Hui-Chan CWY. Human soleus H-reflex excitability is decreased by dynamic head-and-body tilts. J Vestib Res. 1999;9(5):379-83. [Crossref]  [PubMed]
  16. Bonnet M, Decety J, Jeannerod M, Requin J. Mental simulation of an action modulates the excitability of spinal reflex pathways in man. Brain Res Cogn Brain Res. 1997;5:221-8. [Crossref]  [PubMed]
  17. Magladery JW, McDougal DB Jr. Electrophysiological studies of nerve and reflex activity in normal man. I. Iden tification of certain reflexes in the electromyogram and the conduction velocity of peripheral nerve fibres. Bull Johns Hopkins Hosp. 1950;86:265-90. [Crossref]  [PubMed]
  18. Crone C, Nielsen J. Methodological implications of the post-activation depression of the soleus H-reflex in man. Exp Brain Res. 1989;78(1):28-32. [Crossref]  [PubMed]
  19. Sádek P, Hru?ková H, Ostrý S, Otahal J. Neurophysiological assessment of H reflex alterations in compressive radiculopathy. Physiol Res. 2024;73(3):427?33. [Crossref]  [PubMed]
  20. Zheng C, Zhu Y, Lv F, Ma X, Xia X, Wang L, et al. Abnormal flexor carpi radialis H-reflex as a specific indicator of C7 as compared with C6 radiculopathy. J Clin Neurophysiol. 2014;31(6):529-34. [Crossref]  [PubMed]
  21. Petrik J, Amendola A, Rampersand R, Mabey S, Hayes KC. The effects of an isolated ankle effusion on H-reflex amplitude, viscoelasticity, and postural control of the ankle. Presented at 22nd Annual Meeting of the American Orthopedic Society of Sports Medicine; Rosemont, IL; 1996:271. [Crossref]  [PubMed]
  22. Wolpaw JR. Spinal cord plasticity in acquisition and maintenance of motor skills. Acta Physiol (Oxf). 2007;189:155-69. [Crossref]  [PubMed]
  23. Nielsen J, Crone C, Hultborn H. H-reflexes are smaller in dancers from The Royal Danish Ballet than in well-trained athletes. Eur J Appl Physiol Occup Physiol. 1993;66:116-21. [Crossref]  [PubMed]
  24. Aagaard P, Simonsen EB, Andersen JL, Magnusson P, Dyhre-Poulsen P. Neural adaptation to resistance training: Changes in evoked V-wave and H-reflex responses. J Appl Physiol. 2002;92(6):2309-18. [Crossref]  [PubMed]
  25. Zhang J, Wang M, Wei B, Shi J, Yu T. Research progress in the study of startle reflex to disease states. Neuropsychiatr Dis Treat. 2022;18:427-35. [Crossref]  [PubMed]
  26. Valls-Solé J. Assessment of excitability in brainstem circuits mediating the blink reflex and the startle reaction. Clin Neurophysiol. 2012;123(1):13-20. [Crossref]  [PubMed]
  27. Nardone R, Höller Y, Brigo F, et al. Functional brain reorganization after spinal cord injury: Systematic review of animal and human studies. Brain Res. 2013;1504:58-73. [Crossref]  [PubMed]
  28. Rothwell JC. The startle reflex, voluntary movement, and the reticulospinal tract. In: Cruccu G, Hallett M, eds. Brainstem Function and Dysfunction. Vol. 58. (Supplements to Clinical Neurophysiology). 1st ed. Amsterdam: Elsevier; 2006. p. 223-231. [Crossref]
  29. Valls-Solé J, Valldeoriola F, Molinuevo JL, Cossu G, Nobbe F. Prepulse modulation of the startle reaction and the blink reflex in normal human subjects. Exp Brain Res. 1999;129(1):49-56. [Crossref]
  30. 30. Thompson PD, Colebatch JG, Brown P, Rothwell JC, Day BL, Obeso JA, et al. Voluntary stimulus-sensitive jerks and jumps mimicking myoclonus or pathological startle syndromes. Mov Disord. 1992;7(3):257-62. [Crossref]
  31. Nickerson RS. Intersensory facilitation of reaction time: Energy summation or preparation enhancement? Psychol Rev. 1973;80:489-509. [Crossref]  [PubMed]
  32. Ison JR, Sanes JN, Foss JA, Pinckney LA. Facilitation and inhibition of the human startle blink reflexes by stimulus anticipation. Behav Neurosci. 1990;104(3):418-429. [Crossref]  [PubMed]
  33. Alvarez-Blanco S, Leon L, Valls-Solé J. The startle reaction to somatosensory inputs: Different response pattern to stimuli of upper and lower limbs. Exp Brain Res. 2009;195(3):285-92. [Crossref]  [PubMed]
  34. Khasani S, Becker K, Meinck HM. Hyperekplexia and stiff-man syndrome: Abnormal brainstem reflexes suggest a physiological relationship. J Neurol Neurosurg Psychiatry. 2004;75(9):1265-9. [Crossref]  [PubMed]
  35. Ebishima K, Takahashi H, Stickley A, Nakahachi T, Sumiyoshi T, Kamio Y. Relationship of the acoustic startle response and its modulation to adaptive and maladaptive behaviors in typically developing children and those with autism spectrum disorders: A pilot study. Front Hum Neurosci. 2019;13:Article 5. [Crossref]  [PubMed]
  36. Lyons G, Arthur-Kelly M, Eidels A, Mavratzakis A. Deep assessment: A novel framework for improving the care of people with very advanced Alzheimer’s disease. Biomed Res Int. 2015;2015:Article 749451. [Crossref]  [PubMed]
  37. Cuthbert BN, Bradley MM, Lang PJ. Probing picture perception: Activation and emotion. Psychophysiology. 1996;33(2):103-11. [Crossref]  [PubMed]
  38. Mavratzakis A, Molloy E, Walla P. Modulation of the startle reflex during brief and sustained exposure to emotional pictures. Psychol. 2013;4(4):389-95. [Crossref]
  39. Skljarevski V, Ramadan NM. The nociceptive flexion reflex in humans ? Review article. Pain. 2002;96(3):3-8. [Crossref]  [PubMed]
  40. Lance JW, McLeod JG. A physiological approach to clinical neurology. 3rd ed. Edinburgh: Butterworth-Heinemann; 1981. p. 73-100.
  41. Dhondt E, Van Oosterwijck S, Coppieters I, Danneels L, Van Oosterwijck J. Effects of conditioned pain modulation on the nociceptive flexion reflex in healthy people: A systematic review. Clin J Pain. 2019;35(9):794-807. [Crossref]  [PubMed]
  42. Sandrini G, Arrigo A, Bono G, Nappi G. The nociceptive flexion reflex as a tool for exploring pain control systems in headache and other pain syndromes. Cephalalgia. 1993;13(1):21-7. [Crossref]  [PubMed]
  43. Willer JC. Comparative study of perceived pain and nociceptive flexion reflex in man. Pain. 1977;3(1):69-80. [Crossref]  [PubMed]
  44. Sandrini G, Alfonsi E, Bono G, Facchinetti F, Montalbetti L, Nappi G. Circadian variations of human flexion reflex. Pain. 1986;25(3):403-10. [Crossref]  [PubMed]
  45. Sandrini G, Serrao M, Rossi P, Romaniello A, Cruccu G, Willer JC. The lower limb flexion reflex in humans. Prog Neurobiol. 2005;77(5):353-95. [Crossref]  [PubMed]
  46. Garcia-Larrea L, Sindou M, Mauguiere F. Nociceptive flexion reflexes during analgesic neurostimulation in man. Pain. 1989;39(2):145-56. [Crossref]  [PubMed]
  47. Andersen OK, Gracely RH, Arendt-Nielsen L. Facilitation of the human nociceptive reflex by stimulation of alpha-beta-fibers in a secondary hyperalgesic area sustained by nociceptive input from the primary hyperalgesic area. Acta Physiol Scand. 1995;155(1):87-97. [Crossref]  [PubMed]
  48. Deuschl G, Lücking CH. Physiology and clinical applications of hand muscle reflexes. Electroencephalogr Clin Neurophysiol. 1990;41(2):84-101. [Crossref]  [PubMed]
  49. Rothwell J, Antal A, Burke D, Carlsen A, Georgiev D, Jahanshahi M, et al. Central nervous system physiology. Clin Neurophysiol. 2021;132(12):3043-83. [Crossref]  [PubMed]
  50. Dhar D, Kamble N, Pal PK. Long-latency reflexes in clinical neurology: A systematic review. Can J Neurol Sci. 2023;50(5):751-63. [Crossref]  [PubMed]
  51. Jenner JR, Stephens JA. Cutaneous reflex responses and their central nervous pathways studied in man. J Physiol. 1982;333(1):405-19. [Crossref]  [PubMed]
  52. Miget G, Hentzen C, Turmel N, Chesnel C, Le Breton F, Sheikh Ismael S, et al. Assessment of sacral spinal excitability using stimulus-response curves of the bulbocavernosus reflex. Clin Neurophysiol. 2021;132(8):2123-9. [Crossref]  [PubMed]
  53. Shibasaki H. Myoclonus. Curr Opin Neurol. 1995;8(4):331-4. [Crossref]  [PubMed]
  54. Noth J, Podoll K, Friedemann HH. Long-loop reflexes in small hand muscles studied in normal subjects and in patients with Huntington’s disease. Brain. 1985;108(1):65-80. [Crossref]  [PubMed]
  55. Fuhr P, Zeffiro T, Hallett M. Cutaneous reflexes in Parkinson’s disease. Muscle Nerve. 1992;15(7):733-9. [Crossref]  [PubMed]
  56. Deuschl G, Strahl K, Schenck E, Lücking CH. The diagnostic significance of long-latency reflexes in multiple sclerosis. Electroencephalogr Clin Neurophysiol. 1988;70(1):56-61. [Crossref]  [PubMed]
  57. Alfonsi E, Bono G, Mertel J, Sandrini G, Bollani E, Moglia A. Electrically elicited short and long-latency responses of intrinsic hand muscles in hereditary ataxias: Effects of isometric and ballistic isotonic voluntary contractions. Electromyogr Clin Neurophysiol. 1992;32(7):435-42. [Crossref]
  58. Elie B, Guiheneuc P. Sympathetic skin response: Normal results in different experimental conditions. Electroencephalogr Clin Neurophysiol. 1990;76(3):258-67. [Crossref]  [PubMed]
  59. Vodusek DB, Amarenco G, Podnar S. Clinical neurophysiological tests. In: Abrams P, Cardozo L, Khoury S, Wein A, eds. Incontinence. 4th ed. Plymouth, UK: Health Publication Ltd; 2009. p. 523-40. [Crossref]  [PubMed]
  60. Nair KP, Taly AB, Rao S, Murali T. Afferent pathways of sympathetic skin response in spinal cord: A clinical and electrophysiological study. J Neurol Sci. 2001;187(1?2):77-80. [Crossref]  [PubMed]
  61. Claus D, Schondorf R. Sympathetic skin response. In: Deuschl G, Eisen A, editors. Recommendations for the Practice of Clinical Neurophysiology: Guidelines of the International Federation of Clinical Neurophysiology. EEG Suppl. 1999;52:277-82.
  62. Kucera P, Goldenberg Z, Kurca E. Sympathetic skin response: Review of the method and its clinical use. Bratisl Lek Listy. 2004;105(3):108-16. [Crossref]  [PubMed]
  63. Gutrecht JA. Sympathetic skin response. J Clin Neurophysiol. 1994;11(5):519-24. [Crossref]  [PubMed]
  64. Vetrugno R, Liguori R, Cortelli P, Montagna P. Sympathetic skin response: Basic mechanisms and clinical applications. Clin Auton Res. 2003;13(5):256-70. [Crossref]  [PubMed]
  65. Yokota T, Matsunaga T, Okiyama R, Hirose K, Tanabe H, Furukawa T, et al. Sympathetic skin response in patients with multiple sclerosis compared with patients with spinal cord transection and normal controls. Brain. 1991;114(4):1381?94. [Crossref]  [PubMed]
  66. Kugelberg E. Facial reflexes. Brain. 1952;75(3):385-96. [Crossref]  [PubMed]
  67. Boelhouwer AJW, Brunia CHM. Blink reflexes and the state of arousal. J Neurol Neurosurg Psychiatry. 1977;40(1):58-63. [Crossref]  [PubMed]
  68. Cruccu G, Deuschl G. The clinical use of brainstem reflexes and hand-muscle reflexes. Clin Neurophysiol. 2000;111(3):371-87. [Crossref]  [PubMed]
  69. Ongerboer de Visser BW, Cruccu G. Neurophysiologic ex amination of the trigeminal, facial, hypoglossal, and spinal accessory nerves in cranial neuropathies and brain stem disorders. In: Brown WF, Bolton CF, editors. Clinical Electromyography. Boston: Butterworth-Heinemann; 1993. p. 61-92.
  70. Esteban A. A neurophysiological approach to brainstem reflexes: Blink reflex. Neurophysiol Clin. 1999;29(1):7-38. [Crossref]  [PubMed]
  71. Daube J, Burke D, Hallett M, Cruccu G, Ongerboer de Visser BW. Human reflexes and late responses: Report of an IFCN committee. Electroencephalogr Clin Neurophysiol. 1994;90(5):393-403. [Crossref]  [PubMed]
  72. Evinger CA. A brain stem reflex in the blink of an eye. Physiology. 1995;10(5):196-202. [Crossref]  [PubMed]
  73. Kimura I. Disorder of interneurons in parkinsonism: The orbicularis oculi reflex to paired stimuli. Brain. 1973;96(1):87-96. [Crossref]  [PubMed]
  74. Basso MA, Evinger C. An explanation for reflex blink hyperexcitability in Parkinson’s disease. II. Nucleus raphe magnus. J Neurosci. 1996;16(23):7318-30. [Crossref]  [PubMed]
  75. Valls-Solé J. Neurophysiological assessment of trigeminal nerve reflexes in disorders of the central and peripheral nervous system. Clin Neurophysiol. 2005;116(10):2255-65. [Crossref]  [PubMed]
  76. Aramideh M, Ongerboer de Visser BW. Brainstem reflexes: Electrodiagnostic techniques, physiology, normative data, and clinical applications. Muscle Nerve. 2002;26(1):14-30. [Crossref]  [PubMed]
  77. Bologna M, Agostino R, Gregori B, Belvisi D, Manfredi M, Berardelli A. Metaplasticity of the human trigeminal blink reflex. Eur J Neurosci. 2010;32(10):1707-14. [Crossref]  [PubMed]
  78. Ongerboer de Visser BW, Goor C. Jaw reflexes and masseteric electromyograms in mesencephalic and pontine lesions: An electrophysiologic study. J Neurol Neurosurg Psychiatry. 1976;39(1):90-2. [Crossref]  [PubMed]
  79. Cruccu G, Ongerboer de Visser BW. The jaw reflexes. The International Federation of Clinical Neurophysiology. Electroencephalogr Clin Neurophysiol Suppl. 1999;52:243-247. [Crossref]
  80. Accornero N, Berardelli A, Bini G, Cruccu G, Manfredi M. Corneal reflex elicited by electrical stimulation of the human cornea. Neurology. 1980;30(8):782-5. [Crossref]  [PubMed]
  81. Cruccu G, Inghilleri M, Fraioli B, Guidetti B, Manfredi M. Neurophysiologic assessment of trigeminal function after surgery for trigeminal neuralgia. Neurology. 1987;37(4):631-8. [Crossref]  [PubMed]
  82. Cruccu G, Agostino R, Fornarelli M, Inghilleri M, Manfredi M. Recovery cycle of the masseter inhibitory reflex in man. Neurosci Lett. 1984;49(1-3):63-8. [Crossref]  [PubMed]
  83. Ongerboer de Visser BW, Cruccu G, Manfredi M, Koelman JHTM. Effects of brainstem lesions on the masseter inhibitory reflex: Functional mechanisms of reflex pathways. Brain. 1990;113(3):781-94. [Crossref]  [PubMed]