The integrative role of the pedunculopontine nucleus in human gait
The integrative role of the pedunculopontine nucleus in human gait
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DOI：
10.1093/brain/awv047
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发表时间：
2015-05-01
期刊：
影响因子：
14.5
通讯作者：
Karachi, Carine
中科院分区：
文献类型：
--
作者：
Lau, Brian;Welter, Marie-Laure;Karachi, Carine
脑干脚桥核在步态控制中可能发挥作用，但尚不清楚，是治疗顽固性步态障碍的潜在脑深部刺激靶点。这些疾病是老年人群的主要治疗挑战，特别是在帕金森病中，步态和平衡障碍可能对多巴胺能药物和丘脑底核刺激产生抗性。在这里，我们提出的电生理证据表明，脚桥和丘脑底核参与步态的不同方面使用运动想象任务在14例帕金森病患者接受手术植入脚桥或丘脑底核脑深部刺激电极。我们在两个阶段进行了电生理记录，一次是在手术期间，另一次是在手术后几天对一部分患者进行记录。大多数脚桥核神经元（57%）记录intrasonically表现出不同的任务组件相关的活动的变化，与视觉刺激期间调制29%，调制41%在自愿的手运动，和49%调制在想象的步态。在视觉和运动事件期间，在β和γ波段调制手术后记录的脚桥核局部场电位，并且我们观察到持续想象步态的持续时间和空间定位在脚桥核内的α和β波段同步。相比之下，显着较少的丘脑底核神经元（27%）记录intrasysterically调制在运动的图像，与大多数增加或减少活动阶段性的手运动，发起或终止想象的步态。我们的数据支持这一假设，脚桥核影响步态控制的方式延伸到简单的驾驶模式的产生。相比之下，丘脑底核似乎控制着不太可能是步态特异性的运动执行。这些数据突出了这两个核在运动控制中的关键作用，并阐明了人类侧中脑的复杂功能。
The brainstem pedunculopontine nucleus has a likely, although unclear, role in gait control, and is a potential deep brain stimulation target for treating resistant gait disorders. These disorders are a major therapeutic challenge for the ageing population, especially in Parkinson's disease where gait and balance disorders can become resistant to both dopaminergic medication and subthalamic nucleus stimulation. Here, we present electrophysiological evidence that the pedunculopontine and subthalamic nuclei are involved in distinct aspects of gait using a locomotor imagery task in 14 patients with Parkinson's disease undergoing surgery for the implantation of pedunculopontine or subthalamic nuclei deep brain stimulation electrodes. We performed electrophysiological recordings in two phases, once during surgery, and again several days after surgery in a subset of patients. The majority of pedunculopontine nucleus neurons (57%) recorded intrasurgically exhibited changes in activity related to different task components, with 29% modulated during visual stimulation, 41% modulated during voluntary hand movement, and 49% modulated during imaginary gait. Pedunculopontine nucleus local field potentials recorded post-surgically were modulated in the beta and gamma bands during visual and motor events, and we observed alpha and beta band synchronization that was sustained for the duration of imaginary gait and spatially localized within the pedunculopontine nucleus. In contrast, significantly fewer subthalamic nucleus neurons (27%) recorded intrasurgically were modulated during the locomotor imagery, with most increasing or decreasing activity phasically during the hand movement that initiated or terminated imaginary gait. Our data support the hypothesis that the pedunculopontine nucleus influences gait control in manners extending beyond simply driving pattern generation. In contrast, the subthalamic nucleus seems to control movement execution that is not likely to be gait-specific. These data highlight the crucial role of these two nuclei in motor control and shed light on the complex functions of the lateral mesencephalus in humans.