Increased motor cortical facilitation and decreased inhibition in Parkinson disease
Increased motor cortical facilitation and decreased inhibition in Parkinson disease
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DOI：
10.1212/wnl.0b013e3182919029
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发表时间：
2013-05-01
期刊：
影响因子：
9.9
通讯作者：
Chen, Robert
中科院分区：
文献类型：
--
作者：
Ni, Zhen;Bahl, Nina;Chen, Robert
目的：目的：研究帕金森病（PD）患者运动皮层易化回路和抑制回路的时程变化及其相互作用，探讨PD患者运动皮层易化回路和抑制回路的变化规律。12例PD患者在开和关药物状态和12个年龄匹配的健康对照进行了测试。第一个实验测试了PD和对照组中SICF的时间过程。第二个实验在SICF波峰和波谷对应的不同时间测试SICI，以研究SICF是否影响SICI。结果：SICF在PD OFF状态下增加，多巴胺能药物降低。SICF从OFF到ON状态的降低与PD运动体征的改善相关。PD关闭状态下SICI降低，多巴胺能药物仅部分恢复正常。在SICF峰值，药物治疗SICI的改善与PD运动体征的改善相关。主成分分析显示，PD OFF组SICF和SICI的变化仅由同一主成分解释，提示OFF状态下SICI的降低与SICF的增加有关。结论：PD患者运动皮层易化增强，抑制减弱。皮层易化作用的增强部分解释了抑制作用的降低，但PD中突触抑制作用也有损害。皮层易化增加可能是PD的一种代偿机制。神经病学（R）2013;80：1746-1753
Objective: To identify the changes in motor cortical facilitatory and inhibitory circuits in Parkinson disease (PD) by detailed studies of their time courses and interactions.Methods: Short-interval intracortical facilitation (SICF) and short-interval intracortical inhibition (SICI) were measured with a paired-pulse paradigm using transcranial magnetic stimulation. Twelve patients with PD in both ON and OFF medication states and 12 age-matched healthy controls were tested. The first experiment tested the time course of SICF in PD and controls. The second experiment tested SICI at different times corresponding to SICF peaks and troughs to investigate whether SICI was affected by SICF.Results: SICF was increased in PD OFF state and was reduced by dopaminergic medications. The reduction in SICF from the OFF to ON state correlated with the improvement in PD motor signs. SICI was reduced in PD OFF state and was only partially normalized by dopaminergic medications. At SICF peaks, improvement in SICI with medication correlated with improvement in PD motor sign. Principal component analysis showed that variations of SICF and SICI were explained by the same principal component only in the PD OFF group, suggesting that decreased SICI in the OFF state is related to increased SICF.Conclusions: Motor cortical facilitation is increased and inhibition is decreased in PD. Increased cortical facilitation partly accounts for the decreased inhibition, but there is also impairment in synaptic inhibition in PD. Increased cortical facilitation may be a compensatory mechanism in PD. Neurology (R) 2013;80:1746-1753