PHYSIOLOGICAL OBSERVATIONS IN STEREOTAXIC OPERATIONS IN EXTRAPYRAMIDAL MOTOR DISTURBANCES
PHYSIOLOGICAL OBSERVATIONS IN STEREOTAXIC OPERATIONS IN EXTRAPYRAMIDAL MOTOR DISTURBANCES
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DOI：
10.1093/brain/83.2.337
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发表时间：
1960-01-01
期刊：
影响因子：
14.5
通讯作者：
GANGLBERGER, JA
中科院分区：
文献类型：
--
作者：
HASSLER, R;RIECHERT, T;GANGLBERGER, JA
本文报告了1950-1958年329例锥体外系运动障碍的立体定向治疗经验。他们特别关注的神经生理学观察刺激过程中，以及在消除苍白球结构和丘脑的口腹侧核，和术中脑电图的结果。刺激内苍白球对运动过度和震颤的外观和模式的影响取决于刺激频率和初始情况。单一刺激引起的抽搐是对侧肢体不同的肌肉模式。较高的刺激率可能会增加震颤或阻止它。主动交替运动和序列的发音较慢或受阻。更高的刺激频率会导致对侧手臂缓慢弯曲，眼睛向对侧张开和转动，类似于临床唤醒，或者有时会短暂中断意识的连续性。凝固消除或减少僵硬，甚至震颤。在大部分苍白球凝固结束时，可能会出现短暂的嗜睡、自发性下降和短暂的意识模糊状态。刺激丘脑口腹核（对应VL）对震颤和多动模式的影响更大。刺激这些核（4-8/秒）可能引起静止时的震颤和整个同侧半球（在两个半球都受到较强刺激的情况下）的募集样放电，主要发生在额区。类似觉醒的临床状态不伴有EEG节律的去周期化。更高频率的刺激可能会引起主动交替运动的加速，有时是补充运动区描述的行为效应。消除这些丘脑核团的结果消除或震颤和僵硬和运动过度的模式显着减少。静止时的震颤和肌阵挛对口腹核后部的凝固反应最好。电凝后常出现术侧局部脑电图异常和α节律普遍减慢，但在6周内消失。
Experiences based on 329 stereotaxic interventions in extrapyramidal motor disturbances (1950-1958) have been reported. They concern especially neurophysiological observations during stimulation as well as during and after elimination of pallidal structures and the oral ventral nuclei of thalamus, and intra-operative EEG findings. The effect of stimulation of the inner pallidum upon the appearance and pattern of hyperkinesia and tremor depends on stimulus-frequency and initial situation. Single stimuli elicit twitching is the contralateral limbs of varying muscular pattern. Higher stimulus-rates may increase the tremor or block it. Active alternating movements and the utterance of sequences are slower or blocked. Higher stimulus frequencies cause slow flexions of contralateral arm, opening and turning of eyes to the contralateral side, resembling clinical arousal, or sometimes transient interruptions of continuity of consciousness. Coagulations abolish or reduce rigidity and even the tremor. At the end of coagulation of greater parts of the pallidum transient drowsiness, decrease of spontaneity and perhaps brief con-fusional states may occur. Stimulations of oral ventral nuclei of thalamus (which correspond with VL) show an even greater effect upon tremor and hyperkinetic patterns. Stimulation of these nuclei (4-8/sec.) may cause a tremor at rest and recruiting-like discharges over the whole ipsilateral hemisphere (In case of stronger stimuli over both hemispheres) mainly in the frontal region. Clinical states resembling arousal were not accompanied by desynchronlzation of EEG rhythms. Higher frequency stimuli may elicit acceleration of active alternating movements, sometimes a behavioral effect as described from the supplementary motor area. Elimination of these thalamic nuclei results in abolition or marked decrease of tremor and rigidity and of hyperkinetic patterns. Tremor at rest and myoclonus respond best to coagulation of the posterior portion of the oral ventral nucleus. After coagulation local EEG abnormalities on the side of operation and general deceleration of alpha rhythm were usually found but disappeared within 6 weeks.