Movement disorders-帕金森病伴肌张力障碍与否,皮层和下丘脑有何改变?

2022-06-26 Freeman MedSci原创

运动皮层和STN场电位的频谱功率在重复肢体运动时有明显的不同。

肌张力障碍--一种扭曲的、持续的、常常是痛苦的不自主运动--是帕金森病(PD)的一种未被充分研究的运动表现。作为年轻发病的PD的标志,肌张力障碍通常开始于身体受影响较大的一侧的脚,并随着疾病的发展而扩散到其他解剖位置。

图1: 论文封面图

对PD相关肌张力障碍的发病率的准确估计一直难以获得。肌张力障碍可能是年轻患者的PD的表现症状,发生在14-50%的年轻发病的PD患者身上。有帕金基因突变的PD患者的发病率更高,估计约为78%。大约30%的左旋多巴患者有某种形式的肌张力障碍,肌张力障碍的严重程度随着病程的延长而增加,病程<5年、6-9年和>10年时的患病率分别为2%、12%和56%。

丘脑下部核团(STaN)的深部脑刺激(DBS)是治疗与PD相关的肌张力障碍的有效方法;然而,对其电路层面的电生理学知之甚少。然而,人们对原发性肌张力障碍的电生理学了解更多。越来越多的证据表明,原发性肌张力障碍的特点是在静止状态下球状苍白球间有过度的θ和α振荡(<13 Hz),而PD则与β频率范围(13-30 Hz)的过度功率有关。

最近的一项荟萃分析表明,与PD相比,STN在静止状态下的θ和α功率有类似的增加,而在β波段没有明显差异。在同一荟萃分析中,初级运动皮层(M1)的静息局部场电位(LFPs)在任何频段都没有显著差异。据我们所知,没有任何研究对患有和不患有肌张力障碍的PD患者的皮质和皮质下LFPs进行过比较。


肌张力障碍通常因自主运动而加重,并可在自主运动中自发出现在其他身体部位。另外,原发性肌张力障碍有多种表现形式(局灶性、颈椎性、全身性等,而PD相关肌张力障碍在足部最为常见。上肢和下肢运动时的脑电生理学可以帮助描述运动回路对PD症状(如肌张力障碍)的贡献。最近的一项研究报告说,下肢和上肢运动开始时分别与STN和运动皮层的高和低β异步化相吻合。其他研究分析了静止、坐着、站立和行走时的自发LFPs,发现与运动相关的STNβ异步化的结果不一。对特定肢体运动时STN场电位的变化有更多的机理了解,可以更好地理解病理生理学和新的治疗策略。

图2:论文结果图

藉此, 美国University of Alabama at Birmingham的Joseph W. Olson等人,调查了PD患者和无肌张力障碍的患者在DBS手术期间从感觉运动皮层和STN平行记录的LFPs。他们从感觉运动皮层的 "手旋钮 "上的皮质电图(ECoG)条和放置在STN背外侧的定向DBS导线上进行记录。

他们分析了PD患者静止时和对侧手脚运动时的频谱功率,以检验两个主要假设:
(1)PD患者手脚运动时皮质和/或皮质下LFP频谱功率不同(与肌张力障碍状态无关);
(2)PD患者与无肌张力障碍的患者皮质和/或皮质下频谱功率不同。

他们研究了接受深部脑刺激手术的PD患者的肌张力障碍的发生率和分布。在手术过程中,并记录了运动皮层的颅内电生理和丘脑下核(STN)的方向性电极在静止状态和自定节奏的重复性对侧手脚运动时的情况。小波变换和混合模型描述了肌张力障碍患者和非肌张力障碍患者的光谱内容的变化。

他们发现:肌张力障碍在入院时非常普遍(61%),最常发生在脚部。无论肌张力障碍状况如何,皮层记录显示运动时与休息时的β(13-30Hz)不同步,而STN信号显示低频功率增加(手和脚运动的峰值频率分别为6.0±3.3和4.2±2.9 Hz)。

在深部脑刺激手术期间,PD伴肌张力障碍的患者与没有肌张力障碍的患者相比,在休息时显示出更大的M1β功率和运动时STN低频功率。

该研究的重要意义在于发现了:运动皮层和STN场电位的频谱功率在重复肢体运动时有明显的不同,皮层β不同步,皮层下低频同步,尤其是在PD伴肌张力障碍的患者。对人类运动回路中场电位动态的更多了解可以为PD的肌张力障碍病理生理学提供信息,并指导新的治疗方法。

原文出处:
Olson JW, Nakhmani A, Irwin ZT, et al. Cortical and Subthalamic Nucleus Spectral Changes During Limb Movements in Parkinson’s Disease Patients with and Without Dystonia. _Movement Disorders_. Published online June 14, 2022:mds.29057. doi:[10.1002/mds.29057](https://doi.org/10.1002/mds.29057)

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topicName=null, topicId=null, topicList=[TopicDto(id=80918, encryptionId=fa348091883, topicName=肌张力)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=524213265654, createdName=gujh, createdTime=Tue Jun 28 03:02:26 CST 2022, time=2022-06-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1558364, encodeId=f8e0155836491, content=<a href='/topic/show?id=c8a7208e8a8' target=_blank style='color:#2F92EE;'>#丘脑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20878, encryptionId=c8a7208e8a8, topicName=丘脑)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fb8814960000, createdName=xlwang2696, createdTime=Tue Jun 28 03:02:26 CST 2022, time=2022-06-28, status=1, ipAttribution=)]
    2022-06-27 zhmscau
  4. 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  5. 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  6. 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CST 2022, time=2022-06-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1436633, encodeId=393f143663314, content=<a href='/topic/show?id=ccad8092032' target=_blank style='color:#2F92EE;'>#肌张力障碍#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80920, encryptionId=ccad8092032, topicName=肌张力障碍)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Tue Jun 28 03:02:26 CST 2022, time=2022-06-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540599, encodeId=cbf21540599e7, content=<a href='/topic/show?id=fa348091883' target=_blank style='color:#2F92EE;'>#肌张力#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80918, encryptionId=fa348091883, topicName=肌张力)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=524213265654, createdName=gujh, createdTime=Tue Jun 28 03:02:26 CST 2022, time=2022-06-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1558364, encodeId=f8e0155836491, content=<a href='/topic/show?id=c8a7208e8a8' target=_blank style='color:#2F92EE;'>#丘脑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20878, encryptionId=c8a7208e8a8, topicName=丘脑)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fb8814960000, createdName=xlwang2696, createdTime=Tue Jun 28 03:02:26 CST 2022, time=2022-06-28, status=1, ipAttribution=)]
    2022-07-27 cmsvly
  7. 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encryptionId=67cc600242, topicName=disorder)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3fc52500170, createdName=12498cbcm00(暂无昵称), createdTime=Fri Dec 16 07:02:26 CST 2022, time=2022-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1738138, encodeId=a7d71e38138a2, content=<a href='/topic/show?id=e10b600329' target=_blank style='color:#2F92EE;'>#disorders#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6003, encryptionId=e10b600329, topicName=disorders)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=efbf34357637, createdName=ms2186806800017884, createdTime=Sun Jul 10 03:02:26 CST 2022, time=2022-07-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1784521, encodeId=60621e845218d, content=<a href='/topic/show?id=a727600194' target=_blank style='color:#2F92EE;'>#Disord#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6001, encryptionId=a727600194, topicName=Disord)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aad0444, createdName=cmsvly, createdTime=Wed Jul 27 04:02:26 CST 2022, time=2022-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1435959, encodeId=749d14359595d, content=<a href='/topic/show?id=c8ba20119d1' target=_blank style='color:#2F92EE;'>#下丘脑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20119, encryptionId=c8ba20119d1, topicName=下丘脑)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Tue Jun 28 03:02:26 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  8. [GetPortalCommentsPageByObjectIdResponse(id=1878548, encodeId=fc0418e854870, content=<a href='/topic/show?id=c157696175' target=_blank style='color:#2F92EE;'>#ERS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6961, encryptionId=c157696175, topicName=ERS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e93e105, createdName=anminleiryan, createdTime=Sun Oct 02 17:02:26 CST 2022, time=2022-10-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2013913, encodeId=ef34201391380, content=<a href='/topic/show?id=7d69598468' target=_blank style='color:#2F92EE;'>#Dis#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5984, encryptionId=7d69598468, topicName=Dis)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c689267, 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encryptionId=67cc600242, topicName=disorder)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3fc52500170, createdName=12498cbcm00(暂无昵称), createdTime=Fri Dec 16 07:02:26 CST 2022, time=2022-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1738138, encodeId=a7d71e38138a2, content=<a href='/topic/show?id=e10b600329' target=_blank style='color:#2F92EE;'>#disorders#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6003, encryptionId=e10b600329, topicName=disorders)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=efbf34357637, createdName=ms2186806800017884, createdTime=Sun Jul 10 03:02:26 CST 2022, time=2022-07-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1784521, encodeId=60621e845218d, content=<a href='/topic/show?id=a727600194' target=_blank style='color:#2F92EE;'>#Disord#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6001, encryptionId=a727600194, topicName=Disord)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aad0444, createdName=cmsvly, createdTime=Wed Jul 27 04:02:26 CST 2022, time=2022-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1435959, encodeId=749d14359595d, content=<a href='/topic/show?id=c8ba20119d1' target=_blank style='color:#2F92EE;'>#下丘脑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20119, encryptionId=c8ba20119d1, topicName=下丘脑)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Tue Jun 28 03:02:26 CST 2022, time=2022-06-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1436633, encodeId=393f143663314, content=<a href='/topic/show?id=ccad8092032' target=_blank style='color:#2F92EE;'>#肌张力障碍#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80920, encryptionId=ccad8092032, topicName=肌张力障碍)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Tue Jun 28 03:02:26 CST 2022, time=2022-06-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540599, encodeId=cbf21540599e7, content=<a href='/topic/show?id=fa348091883' target=_blank style='color:#2F92EE;'>#肌张力#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80918, encryptionId=fa348091883, topicName=肌张力)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=524213265654, createdName=gujh, createdTime=Tue Jun 28 03:02:26 CST 2022, time=2022-06-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1558364, encodeId=f8e0155836491, content=<a href='/topic/show?id=c8a7208e8a8' target=_blank style='color:#2F92EE;'>#丘脑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20878, encryptionId=c8a7208e8a8, topicName=丘脑)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fb8814960000, createdName=xlwang2696, createdTime=Tue Jun 28 03:02:26 CST 2022, time=2022-06-28, status=1, ipAttribution=)]
  9. 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beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6001, encryptionId=a727600194, topicName=Disord)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aad0444, createdName=cmsvly, createdTime=Wed Jul 27 04:02:26 CST 2022, time=2022-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1435959, encodeId=749d14359595d, content=<a href='/topic/show?id=c8ba20119d1' target=_blank style='color:#2F92EE;'>#下丘脑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20119, encryptionId=c8ba20119d1, topicName=下丘脑)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Tue Jun 28 03:02:26 CST 2022, time=2022-06-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1436633, encodeId=393f143663314, content=<a href='/topic/show?id=ccad8092032' target=_blank style='color:#2F92EE;'>#肌张力障碍#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80920, encryptionId=ccad8092032, topicName=肌张力障碍)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Tue Jun 28 03:02:26 CST 2022, time=2022-06-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540599, encodeId=cbf21540599e7, content=<a href='/topic/show?id=fa348091883' target=_blank style='color:#2F92EE;'>#肌张力#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80918, encryptionId=fa348091883, topicName=肌张力)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=524213265654, createdName=gujh, createdTime=Tue Jun 28 03:02:26 CST 2022, time=2022-06-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1558364, encodeId=f8e0155836491, content=<a href='/topic/show?id=c8a7208e8a8' target=_blank style='color:#2F92EE;'>#丘脑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20878, encryptionId=c8a7208e8a8, topicName=丘脑)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fb8814960000, createdName=xlwang2696, createdTime=Tue Jun 28 03:02:26 CST 2022, time=2022-06-28, status=1, ipAttribution=)]
    2022-06-28 gujh
  10. 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    2022-06-28 xlwang2696

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