title: Trigemino-cervical-spinal reflexes in humans.
abstract: BACKGROUND
  Electrical stimulation of the supraorbital nerve (SON) induces late reflex responses in the neck muscles; these responses are hypothesised to be polysynaptic reflexes participating in a defensive withdrawal retraction of the head from facial nociceptive stimuli. Such responses may extend to the proximal muscle of the arms.
  
  
  OBJECTIVE
  (1) to investigate reflexes in the upper limb muscles (trigemino-spinal responses, TSR) and their relationship with trigemino-cervical responses (TCR); and (2) to identify the nociceptive component of such reflexes and their functional significance.
  
  
  METHODS
  Reflex responses were registered from the semispinalis capitis and biceps brachii muscles after electrical stimulation of the SON in 12 healthy subjects. The sensory (ST), painful (PT) and reflex thresholds, the latency and area of the responses, the effect of heterotopic painful stimulation (HTP), the recovery cycle as well as the effect of the expected and unexpected stimuli were measured.
  
  
  RESULTS
  Stable reproducible TCR and TSR responses were identified at 2.5+/-0.4 x ST, which corresponded exactly to the PT in all the subjects. The TCR and TSR areas were markedly reduced after HTP. The recovery cycle of the TSR area was faster than that of the TCR. Repeated rhythmic stimulation failed to induce progressive reflex suppression.
  
  
  CONCLUSIONS
  These results confirm the nociceptive nature of the TCR and indicate that the biceps brachii response (TSR) has the same nocifensive significance as the posterior neck muscle responses. TCR and TSR are mediated different polysynaptic pathways The presence of trigemino-cervical-spinal responses in our study clearly indicates that there is a reflex interaction between nociceptive trigeminal afferents and both upper and lower cervical spinal cord motoneurons.
authors.affiliation: Dipartimento di Neurologia e Otorinolaringoiatria, Università di Roma La Sapienza, Viale dell'Università 30, 00185 Rome, Italy. jackmarian@mclink.it
authors.forename: Mariano
authors.initials: M
authors.lastname: Serrao
authors.forename: Paolo
authors.initials: P
authors.lastname: Rossi
authors.forename: Leoluca
authors.initials: L
authors.lastname: Parisi
authors.forename: Armando
authors.initials: A
authors.lastname: Perrotta
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Bartolo
authors.forename: Patrizio
authors.initials: P
authors.lastname: Cardinali
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Amabile
authors.forename: Francesco
authors.initials: F
authors.lastname: Pierelli
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000502:physiology; D004558:Electric Stimulation / Q000379:methods; D004576:Electromyography / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal; D009334:Neck Muscles / Q000294:innervation / Q000502:physiology; D010146:Pain; D010147:Pain Measurement; D011930:Reaction Time; D012018:Reflex / Q000502:physiology*; D012684:Sensory Thresholds; D013116:Spinal Cord / Q000502:physiology*; D013997:Time Factors; D014276:Trigeminal Nerve / Q000502:physiology*; D034941:Upper Extremity / Q000502:physiology