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1 Department of Neurology and Clinical Neurophysiology, University Hospital Freiburg, Freiburg, Germany
2 Department of Neuropediatrics and Muscular Disorders, Children's University Hospital, University Hospital Freiburg, Germany
* To whom correspondence should be addressed. E-mail: faist{at}nz11.ukl.uni-freiburg.de.
In healthy adults soleus H-reflexes are rhythmically modulated and generally depressed during gait compared to rest. From ages 6 to 13 years, there is a progressive increase in the tonic inhibition of H-reflexes during walking, especially during the stance phase of the step cycle. In adults, rhythmic modulation and tonic depression are severely disturbed after bilateral spinal lesions, but remain partly preserved after unilateral cerebral lesions. Children with diplegic cerebral palsy (CP) suffer from a bilateral supraspinal lesion of the corticospinal tract that occurs before the maturation of the CNS is complete. If supraspinal structures are involved in the tonic, but not rhythmic, age-dependent reflex depression, it could be hypothesized that the tonic reflex depression with age is disturbed in CP, whereas the rhythmic part of the modulation remains unaffected. To test this hypothesis, soleus H-reflexes were assessed during gait in 16 CP children aged 5-11 and 15-16, and compared to 25 age-matched healthy children walking at similar velocities. While the rhythmic part of the modulation pattern was present in CP, there was no significant tonic reflex depression with age, thus reflecting a lack of maturation of the corticospinal tract. It is argued the rhythmic part of the modulation may be generated on a spinal or brainstem level and is, therefore, not affected by the bilateral supraspinal lesion, while the tonic depression that occurs with maturation of the CNS is under supraspinal control. In conclusion, the supraspinal structures affected in CP are therefore likely involved in this age-dependent tonic depression.
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