Motor responses of muscles supplied by cranial nerves to subthalamic nucleus deep brain stimuli
Motor responses of muscles supplied by cranial nerves to subthalamic nucleus deep brain stimuli
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DOI：
10.1093/brain/awl336
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发表时间：
2007-01-01
期刊：
影响因子：
14.5
通讯作者：
Tolosa, Eduardo
中科院分区：
文献类型：
--
作者：
Costa, Joao;Valls-Sole, Josep;Tolosa, Eduardo
人类皮质球运动兴奋性和抑制性输出的分布尚不完全清楚。特别是，尚不清楚面部上下肌肉的神经支配模式是否相同，以及导致这种神经支配的运动皮质区域是什么。我们使用植入帕金森氏病患者丘脑底核(STN)的电极来激活皮质下水平的运动束。采用双侧面、颈、上肢肌肉记录，观察单侧单侧STN深部脑刺激(sSTN-DBS)对14例患者的兴奋和抑制效应。测量运动诱发电位(MEP)的潜伏期和波幅、静默期的潜伏期和持续时间，并比较同侧和对侧的反应以及不同肌肉的反应。单侧sSTN-DBS在斜方肌、三角肌、二头肌和大鱼际肌诱发严格对侧MEP。相同的刺激总是在眼轮匝肌、口轮匝肌、咬肌和胸锁乳突肌诱发双侧MEP，潜伏期平均为6.0-9.1ms。眼轮匝肌和口轮匝肌的MEP潜伏期明显长于咬肌和胸锁乳突肌(P<；0.01)。在同侧眼轮匝肌中记录到一个短潜伏期的小动作电位，这可能是由眼外肌激活所产生的。在持续自主肌肉收缩过程中，两侧记录到一段起搏潜伏期相似的静默期。眼轮匝肌的这一时间段明显短于咬肌和同侧的咬肌(P<；0.01)。SSTN-DBS能激活皮质球束的下行投射纤维，引起双侧MEP和面部和颅肌的静止期。这表明在STN的水平上，到达IPSI和对侧运动核团的纤维一起下降。这些发现与人类面部上下肌肉神经支配的讨论有关，也与对先前经颅皮质刺激获得的结果的解释有关。
The distribution of human corticobulbar motor excitatory and inhibitory output is not fully understood. In particular, it is unclear whether the pattern of innervation is the same for upper and lower facial muscles, and what is the motor cortical area giving rise to such innervation. We used electrodes implanted in the subthalamic nucleus (STN) in patients with Parkinson's disease to activate motor tracts at a subcortical level. We examined the excitatory and inhibitory effects of unilateral single STN deep brain stimulation (sSTN-DBS) in 14 patients by taking recordings from facial, cervical and upper limb muscles on both sides. We measured the latency and amplitude of the motor-evoked potentials (MEPs), and the latency and duration of the silent periods, and compared ipsilateral with contralateral responses and responses obtained in different muscles. Unilateral sSTN-DBS induced strictly contralateral MEPs in the trapezius, deltoid, biceps and thenar muscles. The same stimulus always induced bilateral MEPs in the orbicularis oculi, orbicularis oris, masseter and sternocleidomastoid at a mean latency in the range 6.0-9.1 ms. MEP latencies in the orbicularis oculi and orbicularis oris were significantly longer than in the masseter and sternocleidomastoid (P < 0.01). A short latency small action potential was recorded in the ipsilateral orbicularis oculi that was likely generated by activation of extraocular muscles. During sustained voluntary muscle contraction, a silent period was recorded at similar onset latency on both sides. This period was significantly shorter in orbicularis oculi than in masseter, and in the ipsilateral side for both muscles (P < 0.01). sSTN-DBS is able to activate the descending projecting fibres in the corticobulbar tract eliciting bilateral MEPs and silent periods in facial and cranial muscles. This suggests that fibres to both ipsi- and contralateral motor nuclei descend together at the level of the STN. These findings are relevant in the discussion of the innervation of upper and lower facial muscles in humans and in the interpretation of previous results obtained with transcranial cortical stimulation.