The impact of ventrolateral thalamotomy on tremor and voluntary motor behavior in patients with Parkinson's disease
The impact of ventrolateral thalamotomy on tremor and voluntary motor behavior in patients with Parkinson's disease
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DOI：
10.1007/s00221-005-0198-4
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发表时间：
2006-04-01
影响因子：
2
通讯作者：
Sadikot, AF
中科院分区：
文献类型：
--
作者：
Duval, C;Panisset, M;Sadikot, AF
帕金森病震颤缓解的首选靶点是丘脑腹外侧部。本研究的目的是确定涉及“运动”丘脑假定的小脑和苍白球受体区域的损害如何改变10名帕金森氏病(PD)患者的震颤和运动行为。在VL丘脑切断术前和一周后，使用激光位移传感器量化震颤幅度、功率分散(震颤功率谱锐度的测量)和功率分布。此外，手术对运动过程中所见震颤的影响在手动跟踪(MT)任务中被量化。震颤引起的噪音(衡量运动过程中出现的震颤量)和误差(受试者的表现与目标之间的差异)被量化。最后，用快速交替运动(RAM)任务评估运动迟缓。计算腕旋前-旋后周期的持续时间、范围和幅度不规则性。这两项运动任务都使用高灵敏度的前臂旋转传感器进行了量化。年龄匹配的健康对照组受试者也接受了测试。使用核磁共振图像和完整的丘脑核团图谱来确定病变位置。结果表明，病变集中于丘脑腹外侧核(VLP)的后部，包括腹外前核(VLA)的后部，并向后延伸至感觉腹后核(VPLa)的最远端。丘脑VL切开术明显降低了所有病例的震颤幅度。功率离散度显著增加，与对照组相近。能量分布的变化表明丘脑切开术选择性地针对帕金森病震颤振荡。在MT任务中检测到的震颤也明显减少，与对照组相似。患者在MT期间的误差率也显著减少。手术对RAM持续时间和范围没有明显影响，与健康对照组相比，患者的表现仍然受损。总之，这些结果表明，涉及运动丘脑的“小脑”和“苍白球”受体部分的损害不会加重运动迟缓，这表明苍白球-丘脑-皮质环路以外的神经回路可能参与了帕金森病运动缓慢的过程。本文对替代途径进行了综述。
A preferred target for parkinsonian tremor alleviation is the ventrolateral (VL) thalamus. The goal of the present study is to determine how lesions involving the presumed cerebellar and pallidal recipient areas of the "motor" thalamus would alter the tremor and motor behavior of ten patients with Parkinson's disease (PD). Tremor amplitude, power dispersion (a measure of sharpness of the power spectrum of tremor), and power distribution were quantified using a laser displacement sensor prior to, and a week after, VL thalamotomy. As well, the impact of surgery on tremor seen during movement was quantified in a manual-tracking (MT) task. Tremor-induced noise (a measure of the amount of tremor present during movement) and ERROR (difference between subject's performance and target) were quantified. Finally, bradykinesia was assessed with a rapid alternating movement (RAM) task. Duration, range, and amplitude irregularity of wrist pronation-supination cycles were computed. Both motor tasks were quantified using a highly sensitive forearm rotational sensor. Healthy age-matched control subjects were also tested. Magnetic resonance images with an integrated atlas of thalamic nuclei were used to confirm lesion location. Results show that the lesions were centered upon the posterior portion of the ventral lateral (VLp) nucleus of the thalamus, included the posterior part of the ventral lateral anterior nucleus (VLa), and extended posteriorly to encroach upon the most rostral sector of the sensory ventral posterior nucleus (VPLa). VL thalamotomy significantly decreased tremor amplitude in all cases. Power dispersion was increased significantly so that it became similar to that of control subjects. Changes in power distribution indicate that thalamotomy selectively targeted PD tremor oscillations. Tremor detected during the MT task was also markedly decreased, becoming similar to that of controls. Patients also showed significant decrease in ERROR during MT. RAM duration and range were not significantly modified by the surgery, and patients' performance remained impaired compared to healthy control subjects. Collectively, these results suggest that lesions involving the presumed "cerebellar" and "pallidal" recipient sectors of the motor thalamus do not worsen bradykinesia, suggesting that neural circuits other than the pallido-thalamo-cortical loop may be involved in slowness of movement in PD. A review of alternate pathways is presented.