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The Journal of Neuroscience, July 15, 2002, 22(14):5803-5807
BRIEF COMMUNICATION
Automatic Postural Responses Are Delayed by Pyridoxine-Induced
Somatosensory Loss
Paul J.
Stapley1,
Lena
H.
Ting1,
Manuel
Hulliger2, and
Jane M.
Macpherson1
1 Neurological Sciences Institute, Oregon Health and
Science University, Beaverton, Oregon 97006-3499, and
2 Department of Clinical Neurosciences, University of
Calgary, Alberta, T2N 4N1, Canada
 |
ABSTRACT |
Pyridoxine given in large doses is thought to destroy selectively
the large-diameter peripheral sensory nerve fibers, leaving motor
fibers intact. This study examined the effects of pyridoxine-induced somatosensory loss on automatic postural responses to sudden
displacements of the support surface in the standing cat. Two cats were
trained to stand on four force plates mounted on a movable platform.
They were given pyridoxine (350 mg/kg, i.p.) on 2 successive days (0 and 1). Electromyographic (EMG) activity was recorded from selected hindlimb muscles during linear ramp-and-hold platform displacements in
each of 12 directions at 15 cm/sec. In control trials onset latencies
of evoked activity in hindlimb flexor and extensor muscles ranged from
40 to 65 msec after the onset of platform acceleration. After injection
the EMG latencies increased over days, becoming two to three times
longer than controls by day 7. Excursions of the body center of mass
(CoM) in the direction opposite to that of platform translation were
significantly greater at day 7 compared with controls, and the time at
which the CoM subsequently reversed direction was delayed. Both animals
were ataxic from day 2 onward. Histological analysis of cutaneous and
muscle nerves in the hindlimb revealed a significant loss of fibers in
the group I range. Our results suggest that large afferent fibers are
critical for the timing of automatic postural responses to ensure
coordinated control of the body CoM and balance after unexpected
disturbances of the support surface.
Key words:
posture and balance; EMG; cat; pyridoxine; somatosensory
loss; peripheral neuropathy
 |
INTRODUCTION |
Automatic postural responses (APRs)
are highly stereotyped patterns of electromyographic (EMG) activity in
various muscles, triggered in response to sudden disturbances of
balance. It is thought that somatosensory, vestibular, and visual
inputs are integrated for assessing postural equilibrium (Horak and
Macpherson, 1996 ). It is not clear, however, which sensory channel is
responsible for triggering and shaping the rapid response to sudden
movements of the support surface. Somatosensory or vestibular inputs or both could, in theory, trigger rapid postural reactions to sudden disturbances, whereas vision generally is regarded as being too slow (Horak and Macpherson, 1996 ).
Previously, somatosensation has been accorded a modulatory role in
motor control. For example, goal-directed arm and leg movements and
rhythmic movements can be performed without somatosensory feedback
(Prochazka, 1996 ). Central pattern generators used to produce stepping
and paw shakes also do not require sensory feedback (Grillner, 1975 ;
Koshland and Smith, 1989 ), and patients with large-fiber peripheral
neuropathy who lack cutaneous or proprioceptive inputs can rely on
vision to guide multijoint arm movements (Sanes et al., 1985 ; Ghez et
al., 1995 ; Larue et al., 1995 ). If somatosensory inputs are only
facilitatory for posture as well, then vestibular afferents should be
critical for the appropriate timing of postural responses. However, the
removal of vestibular input does not alter the temporal or spatial
pattern of APRs, even in the acute phase immediately after lesion and
in the absence of vision (Inglis and Macpherson, 1995 ). Because
vestibular input is not essential for triggering responses to support
surface disturbance, somatosensation should be critical to balance
control, although there is no direct evidence for this. In this study
we investigated the role of somatosensory information in the response
to unexpected support surface translations in the standing cat, using
the neurotoxicity of pyridoxine as a tool.
Pyridoxine (vitamin B6) given in high doses
produces selective large-fiber sensory loss in humans (Schaumburg et
al., 1983 ), dogs (Hoover and Carlton, 1981 ), and rats (Krinke et al.,
1978 ; Xu et al., 1989 ) and currently is being developed as a
noninvasive technique of large-fiber deafferentation in the cat [Allum
et al., 1998 , their pp. 226-233; Hulliger et al. (2000) ]. The
mechanism of pyridoxine toxicity is unknown. However, histological
studies in animals have shown that the toxic effects of pyridoxine are limited to the peripheral and central processes of large myelinated primary afferent fibers but that neurons of the CNS are not
affected directly (Windebank et al., 1985 ; Xu et al., 1989 ). This study used pyridoxine to remove selectively the large-diameter somatosensory inputs in the cat. We provide clear new evidence that somatosensation is essential to the correct timing of APRs to support surface translations.
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MATERIALS AND METHODS |
Two adult female cats (Wo and Kn) weighing 3.2 and 4 kg,
respectively, were trained by using positive reinforcement to stand quietly on four miniature triaxial force plates mounted on a movable platform. The animals were required to distribute their weight equally
between the left and right sides. Details of equipment and training
procedures have been described previously (Macpherson et al., 1987 ).
The position of the force plates was adjusted to each cat's
"preferred" stance distance, determined from its natural fore-hindpaw distance while standing on the floor. Stance distances were 26 cm along the anteroposterior axis and 8 cm mediolateral for
both cats and were conserved for the entire duration of the experiments. Once trained, the animals were implanted with chronic indwelling electrodes into left forelimb and hindlimb muscles under
general anesthesia (Saffan), using aseptic techniques (for details, see
Macpherson, 1988 ). Muscles assessed for this report included gluteus
medius (GLUT), anterior sartorius (SRTA), middle biceps femoris (BFMM),
lateral gastrocnemius (LGAS), soleus (SOL), posterior semimembranosus
(SEMP), and anterior semimembranosus (SEMA).
A hydraulically driven force platform interfaced to a computer for data
acquisition and control delivered linear translations of the entire
support surface in 12 equally spaced directions in the horizontal
plane. An initial data acquisition period of 300 msec was followed by a
ramp-and-hold platform displacement (55 mm amplitude; mean peak
velocity, 15 cm/sec). The total data collection period was 3 sec, after
which the platform returned to its initial position. Within each
session five trials were collected in each direction. Perturbations
were given when animals were standing quietly with their heads facing
forward and their weight distribution met the training criteria.
Once all control data were collected, each cat was given an injection
of pyridoxine (350 mg/kg, i.p.) in the evening on each of 2 successive
days (days 0 and 1, respectively). Postural data were collected every
day until day 8 (Wo) or 13 (Kn). One experimenter stood behind the
animal to prevent falls during loss of balance.
Increases in EMG activity after translation were deemed significant
when the amplitude exceeded the mean background by >2.5 SD for a
minimum of 10 msec. The latency of the EMG burst was specified as the
time when the signal exceeded mean background + 0.3 SD. Only latencies
of <100 msec were considered for further analysis in the control data,
whereas the postpyridoxine series included latencies 300 msec because
responses were delayed considerably. This report focuses on the
differences between control data and those collected at day 7, when
both cats showed the greatest delay in postural response latencies.
Response latencies did not return to control values before the
deaths of the animals.
For each direction the position of the center of mass (CoM) in the
horizontal plane was calculated from force-time curves (for details,
see Macpherson, 1994 ). Briefly, horizontal plane forces were summed
across the four paws and divided by the animal's mass to give CoM
acceleration along each axis, lateral and longitudinal. Traces were
integrated twice to obtain position, with the mean position of the
center of pressure during quiet stance providing the initial CoM position.
We quantified the effects of pyridoxine by analyzing changes in EMG
latency with respect to platform onset, and the trajectory of the CoM,
between control data and those collected at day 7. A one-way ANOVA for
unequal numbers was used to analyze differences between days for (1)
latency of EMG activation, (2) maximum CoM displacement, and (3) time
of maximum CoM displacement.
We monitored the severity of motor deficits associated with pyridoxine
deafferentation by recording various reflexes. First, stretch reflexes
in the gastrocnemius muscle were elicited by tapping briskly on the
Achilles tendon with a small Plexiglas bar with a curved cutout that
fit over the tendon. The bar was instrumented with a relay that
delivered one pulse for each tap. EMGs and the pulse were
recorded on-line at 3000 samples/sec for 100 msec. Ten trials of 40 taps were recorded during control sessions and every day after
pyridoxine. Second, reflex responses evoked by free fall were recorded
during sudden dropping of the animal. The cat was placed in a bag, and
vision was occluded with a muzzle that covered the eyes but did not
obstruct breathing. A linear accelerometer was attached to the
connector on the head. EMGs of forelimb and hindlimb muscles and head
acceleration were recorded on-line while animals were suspended 2 m above the floor and dropped into the arms of a second experimenter
who caught them with a gentle decelerating motion.
After the completion of data collection each cat was anesthetized
deeply and perfused intracardially for harvesting of peripheral nerves.
Control material came from an intact animal not used in this series of
studies. Two animals (control, Kn) were heparinized and perfused with
4% paraformaldehyde, followed by 5% glutaraldehyde, both in 0.15 M phosphate buffer; the third (Wo) was perfused with heparinized Ringer's, followed by 3% paraformaldehyde plus 2% glutaraldehyde in 0.15 M phosphate buffer. Cutaneous and
muscle nerves were harvested from both sides of the body immediately after fixation, placed in glutaraldehyde, and subsequently stored in
0.15 M cacodylate buffer. For consistency across animals,
sampling locations were based on anatomical landmarks. Nerves were
postfixed in 2% osmium tetroxide and infiltrated and embedded in Spurr
epoxy resin. They were sectioned transversely at 1 µm thickness and stained with toluidine blue. Tissue sections were viewed with a light
microscope, digitized, and then analyzed with the MetaMorph image
analysis system (Universal Imaging, West Chester, PA). The cross-sectional area of all myelinated fibers was measured, and fiber
diameters were estimated assuming a circular cross section. In this
study the data from the distal saphenous (cutaneous) and the medial
gastrocnemius (mixed) nerves will be reported. In all cats the
saphenous nerve was harvested 20 mm proximal to the ankle joint. The
medial gastrocnemius nerve was taken 10 mm from its insertion into the muscle.
 |
RESULTS |
Clear signs of ataxia appeared on day 2 in the form of occasional
foot misplacement or tilting during gait. Symptoms progressed through
days 3 and 4 such that cats often slipped or were unbalanced when
turning during locomotion. By day 5 both animals staggered, showing
poor control of the trunk, but they did not lose the ability to walk
independently. However, they did have difficulty balancing independently on the platform and required almost continuous lateral stabilization. The need for assistance may have been attributable, in
part, to a sense of insecurity on the elevated surface, which is
relatively small. On day 7, animals had accommodated sufficiently to be
able to stand without assistance during data collection. Symptoms of
ataxia did not change after day 7 up to the time of death.
On the platform both cats were able to remain balanced during and after
translation on days 1 and 2. On days 3 and 4 they stepped or fell
during translations for ~25% of trials. By day 4 (Wo) or day 5 (Kn)
the cats required lateral stabilization while standing on the platform
during both quiet stance and translations, although they could maintain
independent weight support. Although the need for lateral stabilization
on the platform was transient, nevertheless translations evoked falls
or stepping for 40-45% of trials even on day 7. We present data for
day 7 because the animals did not require external support, and so the
ground reaction forces accurately reflected all of the forces acting on
the animal.
EMG responses to unexpected platform displacements are delayed
significantly after pyridoxine administration
Onset latencies were increased significantly by day 7 after
injection (see Table 1), although
directional tuning of muscles remained similar to controls. Figure
1 shows typical EMG activity of selected
hindlimb muscles before and after pyridoxine administration. During
control trials the latencies ranged from 40 to 65 msec after the onset
of platform acceleration, whereas after pyridoxine the latencies ranged
from 91 to 222 msec. This represents a twofold to threefold increase
with respect to control values. Increases were highly statistically
significant for all of the hindlimb muscles that were studied. In
addition, the timing and amplitude of evoked activity were considerably
more variable both within and across muscles for each cat (Fig. 1).

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Figure 1.
Representative averaged EMG activity of hindlimb
muscles for cat Wo before (black) and on day 7 after
pyridoxine (gray). The translation directions
that are illustrated are those for which each muscle was activated
maximally in the control condition. The dashed vertical
line indicates the onset of platform acceleration. For muscles
SEMP and LGAS the baseline EMG activity is indicated by
horizontal dotted lines to clarify initial burst onset.
Under each trace, arrows indicate response onset during
control trials and at day 7. GLUT, Gluteus medius;
BFMM, middle biceps femoris; SRTA,
anterior sartorius; SEMP, posterior semimembranosus;
LGAS, lateral gastrocnemius. Inset shows
coordinate reference for direction of translation.
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Delayed automatic postural response impairs balance control
The fact that both animals stepped or fell at day 7 indicates they
had difficulty controlling their balance. Figure
2A shows typical
examples of horizontal CoM trajectories before and after pyridoxine
administration for both cats in one selected direction of translation
(240°). During control trials (Fig. 2A, black
trajectories) the CoM moved opposite to the direction of
translation, reversed trajectory, and returned close to its original
position. After pyridoxine (Fig. 2A, gray
trajectories) the CoM of both cats traveled a greater distance in
the direction opposite to translation before reversing toward the
initial position. The CoM of cat Kn in particular often failed to
return close to its initial position. The maximum displacement of the
CoM was significantly greater after pyridoxine (Fig.
2B). Moreover, the time of maximum displacement at
which the CoM reversed direction was significantly longer for both cats (Fig. 2C).

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Figure 2.
A, Representative horizontal plane
center of mass (CoM) trajectories for each cat in control
(black) and postpyridoxine (gray)
conditions for one selected direction (240°). For comparison, control
and postpyridoxine trajectories are aligned to the same initial
position (open circles). B, Amplitude of
maximum initial displacement of the CoM from its origin (see region
labeled Max Displ in A).
C, Time of maximum displacement with respect to the
onset of platform translation. Error bars indicate SE. **Significantly
different from control values (p < 0.001).
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Tendon tap reflex responses are eliminated by pyridoxine, but
reflex responses to dropping remain intact
Ankle extensor muscles (LGAS and SOL for Wo and Kn, respectively)
showed early (10 msec latency) and brisk responses to tapping of the
Achilles tendon in control trials, but responses declined gradually and
disappeared after pyridoxine administration. Between days 1 and 3 the
amplitude of tap response decreased, and by day 5 both cats failed to
show any tendon tap responses at all. This absence of response
persisted until each cat was killed.
The reflex response to sudden dropping did not change after pyridoxine
administration. Animals attained free fall ~200 msec after the
beginning of release and remained in free fall for ~250 msec.
Forelimb and hindlimb muscles were activated ~30-50 msec before the
attainment of free fall in control trials. On day 8 both cats
demonstrated similar latency and amplitude of muscular responses to
drops, as in the control trials. These reflex responses are presumed to
originate in the otoliths of the vestibular system (Watt, 1976 ).
Post-rotatory nystagmus also could be elicited both before and after
pyridoxine administration. These results suggest that vestibular
function likely was not impaired by pyridoxine intoxication.
Histological quantification of the effects of pyridoxine
Both saphenous and gastrocnemius nerves in the pyridoxine-treated
animals showed significant loss or damage of fibers in the range above
7 µm in diameter. Many large fibers showed signs of degeneration,
including empty myelin profiles and shriveled axons with heavily
stained, clumped inclusions. The diameters of the normal-appearing
fibers were used to generate frequency histograms and cumulative plots
in control and pyridoxine-treated animals. Fibers of the normal
saphenous nerve had two peaks in the frequency distribution, at ~4
and 9 µm (Fig. 3, left,
open histograms). The treated animals showed a marked
decrease in the numbers of fibers in the larger peak (Fig. 3,
left, gray filled histograms). The cumulative
distribution plots diverged at ~7 µm, indicating that the loss of
fibers was predominantly above this value, which includes both group I
and some group II fibers.

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Figure 3.
Frequency versus diameter of all myelinated nerve
fibers for saphenous (cutaneous) and medial gastrocnemius (mixed motor
and sensory) nerves for both pyridoxine cats
(gray) and one control (black). In
each, the main plot shows absolute counts for diameters in 1 µm bins,
and the inset at top right
shows cumulative frequency plots of the same data. The saphenous nerve
was sampled 2 cm above the ankle and the gastrocnemius at 1 cm from its
entry point to the muscle.
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The medial gastrocnemius nerve of the control cat showed two peaks in
fiber diameters at ~6 and 15 µm (Fig. 3, right). As with
the saphenous nerve, there was a significant loss of fibers predominantly in the large-diameter range. Note that many of the remaining large-diameter fibers are efferents from -motoneurons, which remain unaffected by pyridoxine. The fiber counts suggest that
the saphenous nerve may have been affected somewhat more severely than
the gastrocnemius, with losses in fibers >7 µm as opposed to ~10
µm. More data are needed to confirm this observation, but there is
some evidence that the conduction velocity of different afferent
pathways may be affected differentially by pyridoxine (Schaeppi and
Krinke, 1985 ).
 |
DISCUSSION |
In summary, pyridoxine intoxication induced an increase in latency
of APRs resulting in impairment of the balance control system and was
accompanied by a loss of large-diameter sensory afferent fibers.
Somatosensory information is critical for the timing of automatic
postural responses
It is believed that the characteristics of APRs are shaped by a
combination of somatosensory, vestibular, and visual inputs (Horak and
Macpherson, 1996 ). APRs are rapid muscular responses that restore
balance after unexpected disturbances. They are highly stereotyped,
with a fixed latency in the cat between 45 and 60 msec after the onset
of the disturbance. The amplitude of the initial EMG burst reflects the
direction and velocity of the disturbance (Diener et al., 1988 ;
Macpherson, 1988 ).
Our results show that APRs were delayed when large somatosensory
afferent fibers were damaged after pyridoxine administration. In
contrast, the timing of APRs was unaffected by loss of vestibular information after bilateral labyrinthectomy, even when vision was
absent (Inglis and Macpherson, 1995 ). We suggest, therefore, that
large-diameter rapidly conducting somatosensory afferents are critical
for the appropriate timing of balance responses, and visual and
vestibular systems together are not able to compensate for delays in
latency, at least during the period that was studied. These data
support the hypothesis (Inglis et al., 1994 ) that postural delays in
patients with diabetic peripheral neuropathy are attributable primarily
to somatosensory conduction delays, although nerve conduction velocities were reduced for both sensory (afferent) and motor (efferent) nerves.
Delays in response have a significant effect on
balance control
The timing of the APR is critical to maintaining balance, and it
is likely that there is only a limited time period in which the
response must occur to maintain control of the CoM. The role of the APR
after a perturbation is to decelerate the CoM and return it to a
position that ensures the maintenance of balance. After pyridoxine the
increase in response latency was associated with a larger displacement
of the CoM away from the original position and a longer time to reverse
trajectory. Behaviorally, the animals were ataxic and often stepped or
fell during translations, indicating that the effect on the CoM
trajectory had a significant impact on balance control.
The increased variability in amplitude and timing of the EMG responses
was accompanied by increased variability in CoM trajectory. The
relationship between muscle activation and CoM motion in the ataxic cat
is difficult to determine, in part because the mechanical effect of the
imposed disturbance is more pronounced at the time the muscles are
finally activated and the initial passive motion of the body is likely
more variable. More subjects are required to assess adequately this
question of variability in evoked response.
A previous study (Inglis and Macpherson, 1995 ) showed that vestibular
loss produced ataxia that is similar in appearance to that of the
pyridoxine cats, but the underlying cause is different. In the
vestibular-loss animals the latency of the APR was normal, but the
amplitude was increased. During translation the CoM initially moved
opposite to the perturbation, but the displacement was shorter than in
controls and reversed direction earlier in time, unlike the pyridoxine
cats in which the CoM moved further and reversed later. The return
phase in the vestibular loss animals was characterized by a large
overshoot with subsequent oscillation about the final position. In
other words, the hypermetric response resulted in overbalancing and
increased body sway after a perturbation. Thus, ataxia can result from
either abnormal timing or abnormal amplitude of automatic postural responses.
Triggering of the early postural response
Which fibers of the somatosensory system are responsible for
triggering the early postural response? Our histological analysis showed that pyridoxine affected peripheral nerve fibers mainly in the
group I range (12-22 µm) but also some fibers in the group II range
(5-12 µm) (Boyd and Davey, 1968 ). Group I fibers innervate muscle
spindle primary receptors that signal velocity of muscle stretch and
Golgi tendon organs that signal changes in muscle force. Fibers from
large cutaneous mechanoreceptors also may have diameters in the lower
end of the group I range. Group II fibers innervate spindle secondaries
and cutaneous receptors, among others. Because the most profound loss
was in the group I range, it may be that the rapidly conducting fibers
of this group are most accountable for the early timing of the postural
response to unexpected support surface translations. Muscle receptors
are more likely to be the trigger than cutaneous mechanoreceptors in
the paw pads, because studies have shown that blocking afferents from
the foot in humans does not delay the timing of balance responses to
perturbation (Diener et al., 1984 ; Do et al., 1990 ).
In a recent study those patients with loss of large-diameter sensory
and motor fibers also showed delays of the postural response, in this
case to platform rotation (Nardone et al., 2000 ). However, the authors
attributed the delay to efferent, rather than afferent, slowing and
suggested that it was group II spindle afferents that triggered the
postural response. In our study the remaining group II fibers were not
sufficient to evoke a postural response with the normal timing,
although they may have contributed to triggering of the response that
was delayed. Although the question remains of which sensory receptor
type is responsible for triggering APRs, it is clear that somatosensory
afferents are critical to the timing of postural responses to sudden disturbances.
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FOOTNOTES |
Received Feb. 20, 2002; revised May 1, 2002; accepted May 1, 2002.
This work was supported by National Institutes of Health Grant NS29025.
L.H.T. is an O'Donnell Foundation Fellow of the Life Sciences Research
Foundation. We gratefully acknowledge the skilled technical assistance
of Stephanie Jensen, Dr. Charles J. Russell, and Nancy R. Schuff.
Correspondence should be addressed to Dr. Jane M. Macpherson,
Neurological Sciences Institute, Oregon Health and Science University, West Campus 505 Northwest 185th Avenue, Beaverton, OR 97006-3499. E-mail: macphers{at}ohsu.edu.
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Dose-dependent expression of neuronopathy after experimental pyridoxine intoxication.
Neurology
39:1077-1083[Abstract/Free Full Text].
Copyright © 2002 Society for Neuroscience 0270-6474/02/22145803-05$05.00/0
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