Abnormalities of cortical excitability and cortical inhibition in cervical dystonia -: Evidence from somatosensory evoked potentials and paired transcranial magnetic stimulation recordings
Abnormalities of cortical excitability and cortical inhibition in cervical dystonia -: Evidence from somatosensory evoked potentials and paired transcranial magnetic stimulation recordings
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DOI：
10.1007/s00415-003-0942-2
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发表时间：
2003-01-01
影响因子：
6
通讯作者：
Rektor, I
中科院分区：
文献类型：
--
作者：
Kanovsky, P;Bares, M;Rektor, I
对21例特发性旋转性颈肌张力障碍患者的皮质兴奋性和皮质抑制进行了检测。颈部肌肉多谱图，体感诱发电位记录，以及成对的经颅磁刺激被用来评估肌张力障碍。这一结果与16名年龄匹配的健康志愿者进行了比较。比较F[3，4]和C[3，4]电极位置测得的P22/N30成分的平均幅值，患者组与对照组之间差异有统计学意义。患者组P22/N30平均波幅在与头部偏斜方向相反的两个电极位置均显著高于正常对照组(P<0.05)。计算两组在F[3，4]和C[3，4]电极位置的平均P22/N30波幅比：两组间差异有统计学意义。平均比值(患者组的对侧/同侧计算，对照组的左侧/右侧计算)在患者组显著高于对照组(p<0.05)。比较短刺激间期和中刺激间期(ISI)成对刺激后MEP波幅均值，两组间差异有统计学意义。当同时考虑3ms ISI和5ms ISI时，患者组在短ISI时记录的幅度降低百分比显著低于3ms ISI和5ms ISI，并且刺激与头部偏斜方向对侧的大脑半球时，患者组的幅度降低百分比显著低于对照组。刺激偏头方向的同侧大脑半球也有差异，但差异不显著(p<0.5)。当患者组与对照组相比，在较长的ISI，即10、15和20ms时，几乎所有配对刺激后的幅度变化都与对照组有显著差异：当刺激同侧大脑半球时，三种配对刺激(ISI为10、15和20ms)的条件反应幅度在p<0.05或等于0.05的显著水平上显著高于对侧；当刺激对侧大脑半球时，在10和20ms ISI配对刺激后，条件反应的幅度显著高于对照组(P<0.05)。患者组只有在使用3和5ms(短)ISI和15和20ms(中)ISI的成对刺激时，大脑半球之间的差异才显著。刺激偏头方向对侧大脑半球时，在3ms和5ms的ISI时，抑制作用明显低于同侧(p<0.05)。同样，刺激偏头方向对侧大脑半球时，15和20ms时的易化性显著高于同侧(p<0.05)。结果表明，颈性肌张力障碍患者存在皮质兴奋性和皮质内抑制两种功能障碍，且这种功能障碍是偏侧的，即位于头部偏斜方向的对侧半球内。
Cortical excitability and cortico-cortical inhibition were examined in twenty-one patients suffering from idiopathic rotational cervical dystonia. Polymyography of cervical muscles, somatosensory evoked potential recordings, and paired transcranial magnetic stimulation were used to assess the dystonic disorder. The results were compared with those obtained in a group of sixteen healthy age-matched volunteers. Statistically significant differences between the patient group and the control group were found when the amplitude values of the mean P22/N30 component measured at F [3, 4] and C [3, 4]' electrode positions were compared. The mean amplitude of P22/N30 in both of these electrode positions contralaterally to the direction of head deviation was significantly higher in the patient group (p less than or equal to 0.05). The mean side-to-side P22/N30 amplitude ratio was calculated in both groups in the F [3, 4] and C [3, 4]' electrode positions: there was a significant difference between the two groups. The mean ratio (calculated contralaterally/ipsilaterally in the patient group and left/right side in the control group) was significantly higher in the patient group (p less than or equal to 0.05). There were statistically significant differences between the two groups when the mean values of MEP amplitudes following paired stimuli at short and medium interstimulus intervals (ISI) were compared. The percentage of amplitude reduction registered at short ISI was significantly lower in the patient group when both 3 ms ISI and 5 ms ISI were considered, and when the hemisphere contralateral to the direction of head deviation was stimulated. There was also a difference (with the short ISI) when the hemisphere ipsilateral to the direction of head deviation was stimulated, but this difference was not significant (p less than or equal to 0.5). Almost all of the amplitude changes following the paired stimulus at the longer ISI, i.e. 10, 15, and 20 ms were significantly different when the patient group was compared with control group: when the ipsilateral hemisphere was stimulated, the amplitude of conditioned responses was significantly higher following all three paired stimuli (with 10, 15, and 20 ms ISI) at the p less than or equal to 0.05 significance level; when the contralateral hemisphere was stimulated, they were significantly higher following the 10 and 20 ms ISI paired stimuli (significance level p less than or equal to 0.05). The interhemispheric difference in the patient group was significant only for the paired stimuli using 3 and 5 ms (short) ISI and 15 and 20 ms (medium) ISI. There was a significantly decreased inhibition at 3 and 5 ms ISI when the hemisphere contralateral to the direction of head deviation was stimulated, as compared with the hemisphere ipsilateral (p less than or equal to 0.05). Similarly, there was a significantly increased facilitation at 15 and 20 ms when the hemisphere contralateral to the direction of head deviation was stimulated, as compared with the hemisphere ipsilateral (p less than or equal to 0.05). The results indicate that a disorder of both cortical excitability and intracortical inhibition exists in patients with cervical dystonia, and that this disorder is lateralized, i.e. it is located within the hemisphere contralateral to the direction of head deviation.