利用配对关联刺激检测帕金森病患者感觉运动整合功能的变化
发布时间：2018-07-24 13:44
【摘要】：目的:研究早期和中晚期帕金森病(Parkinson’s disease,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(transcranial magnetic stimulation,TMS)刺激运动皮层,在对侧拇短展肌产生运动诱发电位(motor evoked potential,MEP),记录静息运动阈值(resting motor threshold,RMT)、静息期(silent period,SP)、强度反应曲线比较3组背景运动皮层兴奋性。运用配对关联刺激(paired associative stimulation,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16、20、24、28、100、200 ms),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2组之间RMT无统计学差异(P0.05);PD-L组SP小于正常对照组(P0.05),PD-E组SP与正常对照组比较差异无统计学意义(P0.05)。3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波幅均小于其余2组且差异具有统计学意义(均P0.05)。PAS实验显示3组MEP’随着PAS的ISI值不同而变化(MEP’1或MEP’1)。ISI为24 ms时,PAS对PD-L组则呈现易化效应[MEP’:(1.71±0.67)],正常对照组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MEP’与其余2组比较具有统计学差异(均P0.05),提示ISI为24 ms时中晚期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200 ms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’3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: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24 ms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 early and advanced Parkinson's disease (PD) patients, and whether there are differences in sensorimotor integration function between early and late PD patients. Methods: sixteen patients with PD were divided into three groups: early PD group (PD 10), middle and late stage PD group (PD-Ln P6) and normal control group (n = 10). The motor cortex was stimulated by transcranial magnetic stimulation (transcranial magnetic). The motor evoked potential (motor evoked potentialm) was generated in the contralateral abductor pollicis brevis muscle. The resting exercise threshold (resting motor threshold), the rest period (silent periodod SP), and the intensity response curve were recorded to compare the excitability of the background motor cortex in the three groups. The effect of peripheral median nerve sensory afferent on the MEP amplitude of abductor pollicis brevis induced by TMS was observed by pairing associated stimulation (paired associative stimulation pas (pairing stimulation pas) technique, and the changes of sensorimotor integration function were analyzed. Median nerve electrical stimulation and contralateral motor cortex TMS were used as PAS as conditioned stimulus (PAS spacer 1620 ~ 24 ~ 28100200 ms),) and single TMS stimulation as unconditioned stimulus. MEP of abductor pollicis brevis muscle was recorded under different stimulus interval and MEP amplitude ratio of conditioned stimulation and unconditioned stimulation (MEP') was used to indicate the effect of peripheral sensory afferent on MEP amplitude. Results there was no significant difference in RMT between PD-E group and PD-L group (P0.05). The SP in PD-L group was lower than that in normal control group (P0.05). There was no significant difference in SP between PD-E group and PD-L group (P0.05). The intensity response curves of group (P0.05) .3 showed that the amplitude of MEP increased with the increase of intensity of stimulation. When the intensity of TMS increased from 130%RMT to 150%RMT, the amplitude of MEP in PD-L group was lower than that in the other two groups, and the difference was statistically significant (P0.05). Pas experiment showed that the three groups had MEP. 'with the change of ISI value of PAS (MEP'1 or MEP'1) .ISI = 24 Ms, pas showed facilitation effect on PD-L group [MEP: (1. 71 卤0. 67)], normal control group showed no significant effect on MEP amplitude [MEP: (0. 98 卤0. 40)], and mild inhibitory effect was observed in PD-E group [MEP: (0. 75 卤0. 44)] MEP' in PD-L group. The results showed that the inhibitory effect of peripheral sensory afferent on motor cortex was weakened and the reverse was observed at 200ms when ISI was 24 Ms, compared with the other two groups (P0.05). PAS in normal control group and PD-E group showed facilitation effect on MEP amplitude [MEP'= (1.37 卤0.66), (, 1.35 卤0.64), respectively] and PD-L group showed inhibitory effect [MEP: (0.84 卤0.35)], but there was no significant difference between MEP'3 group and MEP'3 group (P0.05). The effect of PAS on MEP amplitude in PD-E group was similar to that in normal control group. There was no statistical difference between ISI and MEP'. Conclusion: pairing associated stimuli can facilitate or inhibit the amplitude of evoked motor potential with different stimulus intervals, but the effect of peripheral sensory afferent on motor cortex excitability in early PD patients is not significantly different from that of normal subjects. The afferent inhibitory effect of 24 Ms short latency in middle and late stage PD patients was weakened and reversed to excitatory effect, which indicated that the sensory motor integration function was in disorder.
【作者单位】： 安徽医科大学第一附属医院神经内科;
【基金】：安徽省自然科学基金资助项目(编号:1608085MH170) 安徽高校自然科学研究资助项目(编号:KJ2015A138)
【分类号】：R742.5
本文编号：2141568
[Abstract]:Objective: to study the changes of motor cortex excitability and sensorimotor integration function in early and advanced Parkinson's disease (PD) patients, and whether there are differences in sensorimotor integration function between early and late PD patients. Methods: sixteen patients with PD were divided into three groups: early PD group (PD 10), middle and late stage PD group (PD-Ln P6) and normal control group (n = 10). The motor cortex was stimulated by transcranial magnetic stimulation (transcranial magnetic). The motor evoked potential (motor evoked potentialm) was generated in the contralateral abductor pollicis brevis muscle. The resting exercise threshold (resting motor threshold), the rest period (silent periodod SP), and the intensity response curve were recorded to compare the excitability of the background motor cortex in the three groups. The effect of peripheral median nerve sensory afferent on the MEP amplitude of abductor pollicis brevis induced by TMS was observed by pairing associated stimulation (paired associative stimulation pas (pairing stimulation pas) technique, and the changes of sensorimotor integration function were analyzed. Median nerve electrical stimulation and contralateral motor cortex TMS were used as PAS as conditioned stimulus (PAS spacer 1620 ~ 24 ~ 28100200 ms),) and single TMS stimulation as unconditioned stimulus. MEP of abductor pollicis brevis muscle was recorded under different stimulus interval and MEP amplitude ratio of conditioned stimulation and unconditioned stimulation (MEP') was used to indicate the effect of peripheral sensory afferent on MEP amplitude. Results there was no significant difference in RMT between PD-E group and PD-L group (P0.05). The SP in PD-L group was lower than that in normal control group (P0.05). There was no significant difference in SP between PD-E group and PD-L group (P0.05). The intensity response curves of group (P0.05) .3 showed that the amplitude of MEP increased with the increase of intensity of stimulation. When the intensity of TMS increased from 130%RMT to 150%RMT, the amplitude of MEP in PD-L group was lower than that in the other two groups, and the difference was statistically significant (P0.05). Pas experiment showed that the three groups had MEP. 'with the change of ISI value of PAS (MEP'1 or MEP'1) .ISI = 24 Ms, pas showed facilitation effect on PD-L group [MEP: (1. 71 卤0. 67)], normal control group showed no significant effect on MEP amplitude [MEP: (0. 98 卤0. 40)], and mild inhibitory effect was observed in PD-E group [MEP: (0. 75 卤0. 44)] MEP' in PD-L group. The results showed that the inhibitory effect of peripheral sensory afferent on motor cortex was weakened and the reverse was observed at 200ms when ISI was 24 Ms, compared with the other two groups (P0.05). PAS in normal control group and PD-E group showed facilitation effect on MEP amplitude [MEP'= (1.37 卤0.66), (, 1.35 卤0.64), respectively] and PD-L group showed inhibitory effect [MEP: (0.84 卤0.35)], but there was no significant difference between MEP'3 group and MEP'3 group (P0.05). The effect of PAS on MEP amplitude in PD-E group was similar to that in normal control group. There was no statistical difference between ISI and MEP'. Conclusion: pairing associated stimuli can facilitate or inhibit the amplitude of evoked motor potential with different stimulus intervals, but the effect of peripheral sensory afferent on motor cortex excitability in early PD patients is not significantly different from that of normal subjects. The afferent inhibitory effect of 24 Ms short latency in middle and late stage PD patients was weakened and reversed to excitatory effect, which indicated that the sensory motor integration function was in disorder.
【作者单位】： 安徽医科大学第一附属医院神经内科;
【基金】：安徽省自然科学基金资助项目(编号:1608085MH170) 安徽高校自然科学研究资助项目(编号:KJ2015A138)
【分类号】：R742.5
【相似文献】
相关期刊论文 前4条
1 梅海云;单纯运动性轻偏瘫和感觉运动性中风[J];国外医学.神经病学神经外科学分册;1995年05期
2 M.A.Rocca;M.Absinta;L.Moiola;A.Ghezzi;B.Colombo;V.Martinelli;范丽;;小儿和成人复发缓解型多发性硬化症发病时运动网状系统功能和结构的连接性[J];国际医学放射学杂志;2010年02期
3 Kübler A.;Nijboer F.;Mellinger J. ;J.R. Wolpaw;李一明;;ALS患者能利用感觉运动节律控制人脑-电脑接口[J];世界核心医学期刊文摘(神经病学分册);2005年09期
4 ;[J];;年期
，本文编号：2141568
本文链接：https://www.wllwen.com/yixuelunwen/shenjingyixue/2141568.html
最近更新
教材专著
