Pallidal stimulation modifies after-effects of paired associative stimulation on motor cortex excitability in primary generalised dystonia
Pallidal stimulation modifies after-effects of paired associative stimulation on motor cortex excitability in primary generalised dystonia
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DOI：
10.1016/j.expneurol.2007.03.027
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发表时间：
2007-07-01
影响因子：
5.3
通讯作者：
Limousin, Patricia
中科院分区：
文献类型：
--
作者：
Tisch, Stephen;Rothwell, John C.;Limousin, Patricia
目的：为了确定苍白球内（GPi）脑深部电刺激（DBS）对运动皮层可塑性的影响，在原发性全身性肌张力障碍患者。方法：我们研究了10例原发性全身性肌张力障碍（5 DYT1+，5特发性，5名女性，平均年龄42岁）以下GPi DBS和10名健康受试者。使用经颅磁刺激（TMS）运动皮层和正中神经的配对联合刺激（PAS）评估运动皮层可塑性，该方法已在健康受试者中显示出产生LTP样效应。确定产生ImV的静息运动诱发电位（MEP）的持续时间和TMS强度。记录PAS前后静息MEP波幅和刺激反应曲线。在单独的会话中记录患者打开和关闭DBS。结果：当DBS关闭和开启时，产生I mV静息MEP的平均TMS强度为最大刺激器输出的54%和52%。PAS后15分钟，静息MEP振幅在患者OFF DBS和对照组中增加，而在患者ON DBS中降低。类似地，PAS后，DBS关闭时刺激反应曲线的平均振幅增加，但DBS开启时这种效应消失。此外，对慢性DBS有最大临床反应的患者在DBS开启与关闭时PAS的效应差异也最大。结论：在PAS之后，当GPi DBS关闭时，原发性全身性肌张力障碍患者表现出与健康受试者相似的运动皮层兴奋性增加模式，这些结果表明，GPi DBS可能会降低LTP样运动皮质的可塑性，这可能有助于其在肌张力障碍中的作用机制。(C))2007爱思唯尔公司All rights reserved.
Objective: To determine the effect of globus pallidus internus (GPi) deep brain stimulation (DBS) on motor cortex plasticity in patients with primary generalised dystonia.Methods: We studied 10 patients with primary generalised dystonia (5 DYT1+, 5 idiopathic, 5 female, mean age 42) following GPi DBS and 10 healthy subjects. Motor cortex plasticity was assessed using transcranial magnetic stimulation (TMS) paired associative stimulation (PAS) of motor cortex and median nerve, a method which has been shown in healthy subjects to produce LTP-like effects. Thresholds and TMS intensity to produce a resting motor evoked potential (MEP) of I mV were determined. Resting MEP amplitude and stimulus response curves were recorded before and after PAS. Patients were recorded ON and OFF DBS in separate sessions. Results: The mean TMS intensity to produce a resting MEP of I mV was 54% of maximum stimulator output when OFF and 52% ON DBS. Fifteen minutes after PAS the resting MEP amplitude increased in patients OFF DBS and in control subjects whereas it decreased in patients ON DBS. Similarly, after PAS, the mean amplitude of the stimulus response curve increased OFF DBS, but this effect was abolished with DBS ON. Furthermore, patients who had the largest clinical response to chronic DBS also had the largest difference in the effect of PAS with DBS ON vs. OFF.Conclusions: After PAS, patients with primary generalised dystonia showed a similar pattern of increased motor cortex excitability as healthy subjects when GPi DBS was OFF but not with GPi DBS ON. These results suggest that GPi DBS may reduce LTP-like motor cortex plasticity, which could contribute to its mechanism of action in dystonia. (C)) 2007 Elsevier Inc. All rights reserved.