The multifarious studies in the function and the dysfunction of human thalamocortical tract - Neurosurgical treatment in cases with intractable functional diseases of the brain (intractable pain and abnormal involuntary movement)

(1)对丘脑有明确损害(以浅表疼痛为主)的中枢性疼痛患者，采用深度显微记录技术对丘脑进行电生理研究，发现VIM核及其周围的自发神经活动(SNA)明显降低。但板内核团(CL=中央外侧核)的SNA高于VIM，尤其是背侧核。尾侧腹核周围经常出现不规则的爆发式放电，尤其是板层内核团的背侧，沿着走向CL的轨迹。在这些病例中，与患侧中央沟周围(CXC)的大脑皮质的氧代谢相比，浅表疼痛的严重程度越严重，局部脑葡萄糖代谢的相对值越高。此外，该地区的区域氧气提取率也有所提高。因此，在中枢(丘脑)疼痛患者中，丘脑板内核团的应激状态和CXC内异常(增加)的神经活动可能在中枢性疼痛，特别是浅表疼痛的发生中起重要作用。(2)在强直型帕金森病(PD)中，豆状核糖代谢高，CXC低。相比之下，舞蹈组在豆状核糖代谢较低，但在运动前皮质和运动前皮质糖代谢较高。提示强直型帕金森病患者的基底节和大脑皮质的神经功能与运动亢进患者完全不同。在偏瘫患者中，CXC和对侧运动丘脑的葡萄糖代谢水平较高。我们推测，基底节、丘脑和大脑皮质等结构在维持和调节异常不自主运动中起着重要作用。(3)用微透析法对正常和实验性震颤猴的基底节和丘脑进行了神经递质的测定。

(1) In the central pain patients with definite thalamic damage (superficial pain dominant), electrophysiological study of the thalamus using the depth microrecording showed that spontaneous neural activity(SNA) was markedly decreased in and around VIM (ventralis intermedius) nucleus. SNA in intralaminar nuclei (CL=centralis lateralis) was, however, higher than in VIM, especially in its dorsal part. Often, irregular burst discharge was encountered around the VC (ventralis caudalis) nucleus, especially in the dorsal part of the intralaminar nuclei along trajectories toward CL. In these cases, the greater the severity of superficial pain, the higher was the relative value of regional cerebral glucose metabolism as compared to oxygen metabolism in the cerebral cortex around central sulcus(Cxc) on the lesioned side. Also, regional oxygen extraction ratio increased in this area. Therefore, in central(thalamic) pain patients, the irritable state of thalamic intralaminar nuclei and the abnormal (increased) neural activity developed in the Cxc might play important roles for the genesis of central pain, especially superficial pain.(2) In rigid type Parkinson's disease(PD), the glucose metabolism was high in the lenticular nucleus but low in the Cxc. In contrast, chorea group showed low glucose metabolism in the lenticular nucleus but high in the motor and premotor cortex. The neural function of the basal ganglia and the cerebral cortex in rigid type PD are suggested to be totally different from that in hyperkinesia. In cases with hemitremor, the glucose metabolism was high in the Cxc as well as in the motor thalamus on the contralateral side. We postulated that those structures, as basal ganglia, thalamus and cerebral cortex, played important roles in maintaining and mediating abnormal involuntary movements.(3) Measurement of neurotransmitter using microdialysis was performed in the basal ganglia and the thalamus of normal or experimental tremor monkey.