Cortical and spinal abnormalities in psychogenic dystonia
Cortical and spinal abnormalities in psychogenic dystonia
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DOI：
10.1002/ana.20837
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发表时间：
2006-05-01
影响因子：
11.2
通讯作者：
Chen, R
中科院分区：
文献类型：
--
作者：
Espay, AJ;Morgante, F;Chen, R
目的：心因性肌张力障碍的病理生理尚未被研究，但越来越多的文献表明，重复运动的异常感觉输入可导致可塑性皮质变化。在器质性肌张力障碍中，皮质和脊髓抑制减少是有据可查的。我们通过测试心因性肌张力障碍患者来检验这一假设，即与异常的感觉输入相关的异常感觉输入可能会导致类似的异常。方法：我们评估了10例临床确诊的心因性肌张力障碍患者、8例器质性肌张力障碍患者和12例年龄匹配的健康对照者的皮层和脊髓抑制回路以及与随意运动相关的皮层活动。三项皮质抑制措施，休息短和长间隔皮质内抑制和皮质沉默期，减少了心因性肌张力障碍和有机肌张力障碍。在心因性和器质性肌张力障碍中，脊髓回路介导的皮肤静默期增加。心因性肌张力障碍前臂脊髓相互抑制减少。解释：心因性肌张力障碍和器质性肌张力障碍有相似的生理异常。以前发现的异常皮质和脊髓兴奋性的器质性肌张力障碍，部分可能是一个后果，而不是一个原因的肌张力障碍。或者，这些发现可能代表内表型异常，易患两种类型的肌张力障碍。
Objective: The pathophysiology of psychogenic dystonia has not been examined, but a growing body of literature suggests that abnormal sensory input from repetitive movements can lead to plastic cortical changes. Reduced cortical and spinal inhibition is well documented in organic dystonia. We tested the hypothesis that aberrant sensory input associated with abnormal Posture may cause similar abnormalities by testing patients with psychogenic dystonia.Methods: We assessed cortical and spinal inhibitory circuits and cortical activity associated with Voluntary movement in 10 patients with clinically definite psychogenic dystonia, 8 patients with organic dystonia, and 12 age-matched healthy control subjects.Results: Three measures of cortical inhibition, resting short- and long-interval intracortical inhibition and cortical silent period, were reduced in both psychogenic dystonia and organic dystonia. Cutaneous silent period mediated by spinal circuitries was increased in psychogenic and organic dystonia. Forearm spinal reciprocal inhibition was reduced in psychogenic dystonia.Interpretation: Psychogenic and organic dystonia share similar physiological abnormalities. Previous findings of abnormal cortical and spinal excitability in organic dystonia may, in part, be a consequence rather than a cause of dystonia. Alternatively, these findings may represent endophenotypic abnormalities that predispose to both types of dystonia.