感觉传入对帕金森病患者TMS运动诱发电位的影响

发布时间：2018-01-04 21:10

本文关键词：感觉传入对帕金森病患者TMS运动诱发电位的影响　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的研究早期和中晚期帕金森病(PD)患者运动皮层兴奋性以及感觉运动整合功能变化情况,早期和中晚期PD患者感觉运动整合功能是否存在差异。方法研究对象为PD患者16例,分为早期PD组(PD-E,n=10)、中晚期PD组(PD-L,n=6)和正常对照组(n=10)。采用经颅磁刺激(TMS)刺激运动皮层,在对侧拇短展肌运动诱发电位(MEP),记录静息运动阈值(RMT)、静息期(SP)、强度反应曲线比较三组背景运动皮层兴奋性。运用配对关联刺激(PAS)技术观察外周正中神经感觉传入对TMS诱发的拇短展肌MEP幅度影响,分析感觉运动整合功能变化。将正中神经电刺激与对侧运动皮层TMS组成PAS作为条件刺激(PAS间隔16ms、20m、24ms、28ms、100ms及200ms),将单一TMS刺激作为非条件刺激。分别记录不同刺激间隔条件刺激和非条件刺激拇短展肌MEP,以条件刺激MEP幅度与非条件刺激MEP幅度比值(MEP')表示外周感觉传入对MEP幅度影响。结果 PD-E组及PD-L组RMT均低于正常对照组且差异具有统计学意义(P0.05),PD-E组与PD-L组两组之间RMT无显著差异(P0.05);PD-L组静息期显著小于正常对照组(P0.05),PD-E组MEP静息期与正常对照组比较差异不具有统计学意义(P0.05)。三组强度反应曲线均表现为MEP波幅随刺激强度递增而递增,TMS刺激强度自130%RMT增长至150%RMT时,PD-L组MEP波幅均小于PD-E组及正常对照组且差异具有统计学意义(P均0.05)。PAS实验显示三组MEP’随着PAS的ISI值不同而变化(MEP’1或1),提示外周感觉传入对大脑皮层运动区兴奋性具有抑制或易化效应。当ISI为24ms、200ms时,PD-L组PAS对运动皮层兴奋性的影响不同与正常对照组及PD-E组。ISI为24ms时,正常对照组PAS对MEP波幅无明显影响(MEP’:0.98±0.40),在PD-E组呈现轻度抑制效应(MEP’:0.75±0.44),PD-L组则呈现易化效应(MEP’:1.71±0.67),PD-L组MEP’与正常对照组及PD-E组比较具有显著差异(P均0.05),提示ISI为24ms时晚期PD患者外周感觉传入对运动皮层抑制效应减弱并发生反转。ISI为200ms时,正常对照组和PD-E组PAS对MEP波幅呈现易化效应(MEP’分别为1.37±0.66、1.35±0.64),PD-L组则呈现抑制效应(MEP’:0.84±0.35),但MEP’三组间无统计学差异(P0.05)。PD-E组与正常对照组PAS对MEP波幅的影响类似,各ISI对应MEP’无统计学差异。结论外周感觉信息传入随潜伏期不同对运动皮层有易化或抑制效应,早期PD患者与正常人比较差异不显著,中晚期PD患者24ms短潜伏期传入抑制效应反转为兴奋效应,提示其感觉运动整合功能与正常人及早期PD相比存在差异。结论配对关联刺激随刺激间隔不同对诱发运动电位波幅有易化或抑制效应,早期PD患者外周感觉传入对运动皮层兴奋性的影响与正常人比较差异不显著,中晚期PD患者24ms短潜伏期传入抑制效应减弱并反转为兴奋效应,提示其感觉运动整合功能存在紊乱。
[Abstract]:Objective to study the changes of motor cortex excitability and sensorimotor integration function in patients with early and advanced Parkinson's disease (PD). Methods 16 patients with PD were divided into early PD group and early PD group. The motor cortex was stimulated by transcranial magnetic stimulation (TMS) and the contralateral abductor pollicis brevis motor evoked potential (MEP). The resting exercise threshold value (RMTT) was recorded, and the rest period (SPV) was recorded. The intensity response curve was used to compare the excitability of the background motor cortex in the three groups. The effects of peripheral median nerve sensory afferent on the MEP amplitude of abductor pollicis brevis induced by TMS were observed by paired associated stimulation (pass) technique. The changes of sensorimotor integration function were analyzed. PAS was made up of median nerve electrical stimulation and contralateral motor cortex TMS as conditioned stimulation of pas interval of 16 Ms ~ 20 m ~ (24) Ms ~ (28 Ms). 100ms and 200ms respectively, single TMS stimulation was used as unconditioned stimulus. MEP of abductor pollicis brevis was recorded under different stimulus interval and unconditioned stimulation. Using the ratio of conditioned MEP amplitude to unconditioned stimulus MEP amplitude to determine the ratio of MEP amplitude to MEP amplitude. Results the RMT of PD-E group and PD-L group were lower than that of normal control group (P 0.05). There was no significant difference in RMT between PD-E group and PD-L group (P 0.05). The rest period of PD-L group was significantly lower than that of normal control group (P0.05). There was no significant difference in the resting period of MEP between the PD-E group and the normal control group (P 0.05). The intensity response curves of the three groups showed that the amplitude of MEP increased with the increase of the stimulus intensity. The intensity of TMS increased from 130 RMT to 150 RMTs. The amplitude of MEP in PD-L group was lower than that in PD-E group and normal control group (P < 0.05). Pas experiment showed that three groups of MEP 'varied with the ISI value of PAS. The results suggest that peripheral sensory afferents can inhibit or facilitate the excitability of the motor area of the cerebral cortex when the ISI is 24ms / 200ms. The effects of PAS on the excitability of motor cortex in PD-L group were different from those in normal control group and PD-E group (.ISI = 24 Ms). There was no significant effect of PAS on the amplitude of MEP in the normal control group, but there was a slight inhibitory effect in the PD-E group (0. 75 卤0. 44). In PD-L group, there were significant differences between MEP 'and normal control group and PD-E group (P < 0.05). It was suggested that the inhibitory effect of peripheral sensory afferent on motor cortex was attenuated in late PD patients when ISI was 24ms and the inversion occurred at 200ms. The facilitation effect of PAS on the amplitude of MEP in normal control group and PD-E group was 1.37 卤0.666 卤1.35 卤0.64, respectively. In PD-L group, the inhibitory effect was 0.84 卤0.35). However, there was no statistical difference among the three groups. The effect of PAS on the amplitude of MEP was similar in P0.05U. PD-E group and normal control group. Conclusion Peripheral sensory information afferent has facilitation or inhibition effect on motor cortex with different incubation period, but there is no significant difference between early PD patients and normal people. The afferent inhibitory effect of 24ms short latency was reversed to excitatory effect in patients with advanced PD. Conclusion pairing associated stimuli can facilitate or inhibit the amplitude of evoked motor potential with different stimulus intervals. The effect of peripheral sensory afferent on the excitability of motor cortex in early PD patients was not significantly different from that in normal controls. The inhibitory effect of 24 Ms short latency afferent afferent in middle and late stage PD patients was weakened and reversed to excitatory effect. The results suggest that the sensory and motor integration function is in disorder.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.5

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