The pathophysiology of parkinsonian tremor: a review
The pathophysiology of parkinsonian tremor: a review
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DOI：
10.1007/pl00007781
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发表时间：
2000-09-01
影响因子：
6
通讯作者：
Krack, P
中科院分区：
文献类型：
--
作者：
Deuschl, G;Raethjen, J;Krack, P
帕金森震颤最有可能是由于中枢神经系统内神经元活动的振荡。综上所述，外周因素在PD震颤的发生、维持和调节中只起很小的作用。最近的研究表明，不是一个，而是多个振荡器负责。产生这些振荡的最有可能的候选是基底神经节环，它的地形组织可能负责分离成不同的振荡，然而，通常产生相同的频率。这些振荡背后的神经元机制尚不清楚，但有三种假设与目前从动物模型和患者记录的数据相一致。第一种是皮质-丘脑下-苍白球-丘脑回路，第二种是由外苍白球和丘脑下核组成的起跳器，第三种是整个纹状体-苍白球-丘脑通路由于机制未知而导致分离丧失的异常同步。假设振荡器位于基底神经节通路内，立体定向手术的机制可能是基底神经节-丘脑-皮质通路或小脑-丘脑-皮质通路活动的不同步。
Parkinsonian tremor is most likely due to oscillating neuronal activity within the CNS. Summarizing all the available evidence, peripheral factors only play a minor role in the generation, maintenance and modulation of PD tremor. Recent studies have shown that not a single but multiple oscillators are responsible. The most likely candidate producing these oscillations is the basal ganglia loop and its topographic organization might be responsible for the separation into different oscillators which, nevertheless, usually produce the same frequency. The neuronal mechanisms underlying these oscillations are not yet clear, but three hypotheses would be compatible with the presently available data from animal models and data recorded in patients. The first is a cortico-subthalamo-pallido-thalamic loop, the second is a pacemaker consisting of the external pallidum and the subthalamic nucleus, and the third is abnormal synchronization due to unknown mechanisms within the whole striato-pallido-thalamic pathway leading to a loss of segregation. Assuming the oscillator within the basal ganglia pathway, the mechanism of stereotactic surgery might be a desynchronization of the activity of the basal ganglia-thalamo-cortical or the cerebello-thalamo-cortical pathway.