利用配對關(guān)聯(lián)刺激檢測帕金森病患者感覺運動整合功能的變化
發(fā)布時間：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)患者運動皮層興奮性以及感覺運動整合功能變化情況,早期和中晚期PD患者感覺運動整合功能是否存在差異。方法:研究對象為PD患者16例,分為早期PD組(PD-E,n=10)、中晚期PD組(PD-L,n=6)和正常對照組(n=10)。采用經(jīng)顱磁刺激(transcranial magnetic stimulation,TMS)刺激運動皮層,在對側(cè)拇短展肌產(chǎn)生運動誘發(fā)電位(motor evoked potential,MEP),記錄靜息運動閾值(resting motor threshold,RMT)、靜息期(silent period,SP)、強度反應(yīng)曲線比較3組背景運動皮層興奮性。運用配對關(guān)聯(lián)刺激(paired associative stimulation,PAS)技術(shù)觀察外周正中神經(jīng)感覺傳入對TMS誘發(fā)的拇短展肌MEP幅度影響,分析感覺運動整合功能變化。將正中神經(jīng)電刺激與對側(cè)運動皮層TMS組成PAS作為條件刺激(PAS間隔16、20、24、28、100、200 ms),將單一TMS刺激作為非條件刺激。分別記錄不同刺激間隔條件刺激和非條件刺激拇短展肌MEP,以條件刺激MEP幅度與非條件刺激MEP幅度比值(MEP’)表示外周感覺傳入對MEP幅度影響。結(jié)果:PD-E組及PD-L組RMT均低于正常對照組且差異具有統(tǒng)計學(xué)意義(P0.05),PD-E組與PD-L組2組之間RMT無統(tǒng)計學(xué)差異(P0.05);PD-L組SP小于正常對照組(P0.05),PD-E組SP與正常對照組比較差異無統(tǒng)計學(xué)意義(P0.05)。3組強度反應(yīng)曲線均表現(xiàn)為MEP波幅隨刺激強度遞增而遞增,TMS刺激強度自130%RMT增長至150%RMT時,PD-L組MEP波幅均小于其余2組且差異具有統(tǒng)計學(xué)意義(均P0.05)。PAS實驗顯示3組MEP’隨著PAS的ISI值不同而變化(MEP’1或MEP’1)。ISI為24 ms時,PAS對PD-L組則呈現(xiàn)易化效應(yīng)[MEP’:(1.71±0.67)],正常對照組MEP波幅無明顯影響[MEP’:(0.98±0.40)],在PD-E組呈現(xiàn)輕度抑制效應(yīng)[MEP’:(0.75±0.44)],PD-L組MEP’與其余2組比較具有統(tǒng)計學(xué)差異(均P0.05),提示ISI為24 ms時中晚期PD患者外周感覺傳入對運動皮層抑制效應(yīng)減弱并發(fā)生反轉(zhuǎn)。ISI為200 ms時,正常對照組和PD-E組PAS對MEP波幅呈現(xiàn)易化效應(yīng)[MEP’分別為(1.37±0.66)、(1.35±0.64)],PD-L組則呈現(xiàn)抑制效應(yīng)[MEP’:(0.84±0.35)],但MEP’3組間無統(tǒng)計學(xué)差異(P0.05)。PD-E組與正常對照組PAS對MEP波幅的影響類似,各ISI對應(yīng)MEP’無統(tǒng)計學(xué)差異。結(jié)論:配對關(guān)聯(lián)刺激隨刺激間隔不同對誘發(fā)運動電位波幅有易化或抑制效應(yīng),早期PD患者外周感覺傳入對運動皮層興奮性的影響與正常人比較差異不顯著,中晚期PD患者24 ms短潛伏期傳入抑制效應(yīng)減弱并反轉(zhuǎn)為興奮效應(yīng),提示其感覺運動整合功能存在紊亂。
[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 鹵0. 67)], normal control group showed no significant effect on MEP amplitude [MEP: (0. 98 鹵0. 40)], and mild inhibitory effect was observed in PD-E group [MEP: (0. 75 鹵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 鹵0.66), (, 1.35 鹵0.64), respectively] and PD-L group showed inhibitory effect [MEP: (0.84 鹵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.
【作者單位】： 安徽醫(yī)科大學(xué)第一附屬醫(yī)院神經(jīng)內(nèi)科;
【基金】：安徽省自然科學(xué)基金資助項目(編號:1608085MH170) 安徽高校自然科學(xué)研究資助項目(編號:KJ2015A138)
【分類號】：R742.5
本文編號：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 鹵0. 67)], normal control group showed no significant effect on MEP amplitude [MEP: (0. 98 鹵0. 40)], and mild inhibitory effect was observed in PD-E group [MEP: (0. 75 鹵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 鹵0.66), (, 1.35 鹵0.64), respectively] and PD-L group showed inhibitory effect [MEP: (0.84 鹵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.
【作者單位】： 安徽醫(yī)科大學(xué)第一附屬醫(yī)院神經(jīng)內(nèi)科;
【基金】：安徽省自然科學(xué)基金資助項目(編號:1608085MH170) 安徽高校自然科學(xué)研究資助項目(編號:KJ2015A138)
【分類號】：R742.5
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