Dysfunction of the basal ganglia, but not the cerebellum, impairs kinaesthesia
Dysfunction of the basal ganglia, but not the cerebellum, impairs kinaesthesia
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DOI：
10.1093/brain/awg230
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发表时间：
2003-10-01
期刊：
影响因子：
14.5
通讯作者：
Konczak, J
中科院分区：
文献类型：
--
作者：
Maschke, M;Gomez, CM;Konczak, J
关于肢体位置和方向的精确知识对于神经系统计划和控制随意运动的能力至关重要。虽然已经确定来自外周感受器的本体感受信号对于感知肢体位置和运动是必要的，但尚不清楚哪些棘上结构介导最终导致肢体位置的有意识（动觉）的信号。最近的功能成像研究表明，小脑，而不是基底神经节，参与被动和主动运动引起的本体感受信息的感觉处理。然而，心理物理学研究表明，基底神经节在动觉中发挥着重要作用。本研究通过调查小脑和基底神经节对肢体位置感知的贡献来解决这一明显的二分法。使用被动运动任务，我们检查手肘的位置感与基底神经节功能障碍的患者（帕金森病，n=9），小脑变性患者[脊髓小脑共济失调（SCA）6和8型，n=6]和年龄匹配的健康对照组（n=11）。与健康对照组相比，帕金森病患者，但不是SCA患者，在正确检测位移的能力显着受损。在对照组和SCA患者的试验中，10度前臂位移的正确识别率>75%，但在帕金森病患者中仅为55%。只有在60度位移时，帕金森病患者才表现出与其他两组相似的反应率。正常人75%正确反应的阈值为1.03度，小脑患者为1.15度，帕金森病患者为2.10度。帕金森病患者的运动觉损害与疾病严重程度显著相关，由统一帕金森病评定量表（r=-0.7，P =0.03）和疾病持续时间（r=-0.7，P =0.05）确定。相比之下，表现与每日左旋多巴等效剂量之间没有显著相关性。这些结果意味着完整的脑-基底神经节回路对于肢体位置的意识至关重要，并表明基底神经节而不是小脑在运动感觉中具有选择性作用。
Precise knowledge about limb position and orientation is essential for the ability of the nervous system to plan and control voluntary movement. While it is well established that proprioceptive signals from peripheral receptors are necessary for sensing limb position and motion, it is less clear which supraspinal structures mediate the signals that ultimately lead to the conscious awareness of limb position (kinaesthesia). Recent functional imaging studies have revealed that the cerebellum, but not the basal ganglia, are involved in sensory processing of proprioceptive information induced by passive and active movements. Yet psychophysical studies have suggested a prominent role of the basal ganglia in kinaesthesia. This study addresses this apparent dichotomy by investigating the contributions of the cerebellum and the basal ganglia to the perception of limb position. Using a passive movement task, we examined the elbow position sense in patients with a dysfunction of the basal ganglia (Parkinson's disease, n=9), patients with cerebellar degeneration [spinocerebellar ataxia (SCA) types 6 and 8, n=6] and age-matched healthy control subjects (n=11). In comparison with healthy control subjects, Parkinson's disease patients, but not SCA patients, were significantly impaired in the ability to detect displacements correctly. A 1degrees forearm displacement was correctly recognized in >75% of trials by control subjects and SCA patients, but only in 55% of Parkinson's disease patients. Only at 6degrees displacement did Parkinson's disease patients exhibit a response rate similar to those of the two other groups. Thresholds for 75% correct responses were 1.03degrees for controls, 1.15degrees for cerebellar patients and 2.10degrees for Parkinson's disease patients. This kinaesthetic impairment significantly correlated with the severity of disease in Parkinson's disease patients, as determined by the Unified Parkinson's Disease Rating Scale (r=-0.7, P=0.03) and duration of disease (r=-0.7, P=0.05). In contrast, there was no significant correlation between performance and the daily levodopa equivalent dose. These results imply that an intact cerebro-basal ganglia loop is essential for awareness of limb position and suggest a selective role of the basal ganglia but not the cerebellum in kinaesthesia.