Abnormal corticospinal tract modulation of the soleus H reflex in patients with pure spastic paraparesis

Central motor conduction time (CMCT) is usually abnormally prolonged in leg muscles of patients with pure hereditary spastic paraparesis (PHSP). One consequence of such abnormality should be an abnormal timing in the modulation of segmental reflexes, which might be more relevant for the pathophysiology of spasticity-related gait disturbances than just the CMCT delay. We examined the effects of transcranial magnetic stimulation (TMS) on the soleus H reflex in 13 control subjects and 11 PHSP patients using a conditioning (TMS) and test (H reflex) paradigm. Interstimulus interval (ISI) was 0-100 ms in steps of 10 ms. The amplitude of the H reflex at each interval was expressed as percentage of the control H reflex and the conditioned curves were compared between control subjects and patients. In control subjects, TMS-induced facilitation of the H reflex with two well-defined phases: early (ISIs 10 and 20 ms) and late (ISIs 70-90 ms). In patients, the early phase of facilitation was significantly reduced, while there was facilitation at 40 ms that was not present in control subjects. However, neither the characteristics of the MEP nor the differential modulation of the H reflex correlated significantly with clinical measures of motor dysfunction. Our results indicate an abnormal effect of TMS on the H reflex in PHSP patients. This suggests that the excitability of interneurons and soleus motoneurons is not modified in tune with the arrival of descending inputs. Desynchronization of the descending volley may contribute to both the lack of early facilitation and the presence of abnormal facilitatory phases.