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Study on the pathophysiology of pallido-, spino-thalamo-cortical system in cases with intractable functional disorders

顽固性功能障碍患者苍白球、脊髓丘脑皮质系统的病理生理学研究

基本信息

批准号：
09671408
负责人：
HIRATO Masafumi
金额：
$ 1.34万
依托单位：
Gunma University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
1997
资助国家：
日本
起止时间：
1997 至 1999
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-09671408/
关键词：
Parkinson's disease rigid-akinesia tremor central(thalamic) pain depth microrecording PET scan functional MRI Gamma Knife termor n. ventralis intermedius depth microrecorking central(thalamic)trigeminal neuralgia Parkinson‘s dis

项目摘要

(1) In cases with rigid-akinesia type Parkinson's disease(PD), frontal regional cerebral glucose metabolism(rCMRglu) was correlated with dopamine contents in the CSF of 3rd ventricle. Stereotactic posteroventral pallidotomy(PVP) was carried out in 13 cases with rigid-akinesia type PD with aid of depth microrecording. Before operation, a PET study has revealed low regional cerebral glucose metabolism in the prefrontal area in all the patients. Unilateral sequential opposite finger movement(SOFM) induced increase of regional cerebral blood flow(rCBF) both in the supplementary and primary motor area in the effective response groups. Electrophysiological study during the operation showed continuous high-frequency and high-amplitude spike discharges in the internal segment of globus pallidus(Gpi) in the effective response group. If the effect of nigrostriatal dysfunction was restricted in the nigro-striato-pallidal connections, characterized by overactivity in Gpi neurons, without extensive … More ly affecting the motor-related structures in the frontal cortex, we could expect to alleviate the parkinsonian symptoms, such as rigidity or bradykinesia, by pallidotomy(PVP). If, however, the dysfunction extended into the network of motor-related structures in the frontal cortex, particularly in the supplementary motor area, we could no longer expect to improve the parkinsonian symptoms.(2) Functional mapping study using PET scan and depth microrecording was carried out to elucidate the thalamocortical relation involved in tremor in cases with tremor type Parkinson's disease. In this type of PD, PET study revealed spot-shaped increased zone of rCMRglu and/or rCBF in the frontal precentral area on the side contralateral to tremor. Unilateral SOFM evoked increase of rCBF in the similar precentral area. Moreover, unilateral thumb brushing caused increase of rCBF in the postcentral area just caudal to the precentral rCBF increased zone. The cortical mapping studies revealed that rCMRglu and/or rCBF mainly increased in the primary motor cortex during the appearance of tremor. Both PET and functional MRI study showed spot-shaped high signal area (increased zone of rCBF) in the thalamic ventro-lateral area. Moreover, depth microrecording study showed rhythmic discharges synchronous with contralateral limb tremor in the similar area(=thalamic VIM : nucleus ventralis intermedius). It was postulated that both thalamic VIM and the cortical precentral area, which was functionally identified by brain mapping study, may play important roles in mediating and maintaining tremor in tremor type PD.(3) Based on the data obtained for the selective thalamotomy with aid of depth microrecording, it was postulated that functional change has occurred in the thalamic sensory nucles just rostral or bottom to original cerebrovascular lesion and in the cerebral cortex adjacent to the central sulcus in cases with thalamic pain.These changes may cause aberrant conduction of sensory signal or hypersensitivity to peripheral sensory stimulation. The therapeutic lesion created by thermo-coagulation or Gamma Knife aimed to ameliorate these abnormal functional states may relieve thalami pain.(4) A retrospective study was conducted to evaluate the effectiveness of Gamma Knife radiosurgery in the management of idiopathic trigeminal neuralgia. Radiosurgery was performed with a signal 4 mm isocenter targeted at the nerve root entry zone. Gamma Knife radiosurgery is an effective surgical attempt in the management of this intractable pain. These results also showed that peripheral sensory input may play important roles for the genesis of intractable trigeminal neuralgia. Less

(1)强直性瘫痪帕金森病(PD)患者额叶局部脑葡萄糖代谢(RCMRglu)与第三脑室脑脊液中多巴胺含量呈正相关。采用立体定向苍白球腹后部切开术(PVP)，对13例强直性静止型帕金森病患者进行深度显微记录。手术前，正电子发射计算机断层扫描显示所有患者前额叶局部葡萄糖代谢降低。在有效反应组中，单侧对指序贯运动(SOFM)引起辅助运动区和主运动区局部脑血流量(RCBF)的增加。术中电生理检查显示，有效反应组大鼠苍白球内段可见持续高频、高幅度的棘波放电。如果黑质纹状体功能障碍的影响仅限于黑质-纹状体-苍白球连接，其特征是GPI神经元过度活跃，而没有广泛的…更多地影响额叶皮质的运动相关结构，我们可以预期通过苍白球切开术(PVP)来缓解帕金森病症状，如僵硬或运动迟缓。然而，如果功能障碍延伸到额叶皮质的运动相关结构网络，特别是辅助运动区，我们就不能指望帕金森病的症状得到改善。(2)利用PET扫描和深度显微记录进行功能标测研究，以阐明震颤型帕金森病患者震颤与丘脑皮质的关系。在这种类型的PD中，PET检查显示震颤对侧额前中央前区rCMRglu和/或rCBF呈点状增高区。单侧SOFM可引起类似中央前区rCBF的增加。此外，单侧刷拇指导致中央后区rCBF增加，恰好位于中央前rCBF增高区的尾侧。皮层标测显示震颤出现时rCMRglu和/或rCBF主要在初级运动皮质增加。PET和功能MRI检查均显示丘脑腹外侧区点状高信号区(rCBF增高区)。此外，深度显微记录研究显示，节律性放电与相似区域的对侧肢体震颤同步(=丘脑Vim：腹中核)。推测震颤型帕金森病患者丘脑VIM和皮层中央前区在震颤的调节和维持中可能起重要作用。(3)根据深度显微记录选择性丘脑切开术的资料，推测丘脑痛患者丘脑感觉核团发生了功能改变，这些改变可能导致感觉信号传导异常或对外周感觉刺激敏感。通过热凝或伽玛刀治疗，可以缓解丘脑疼痛。(4)对伽玛刀治疗特发性三叉神经痛的疗效进行了回顾性研究。放射外科以4 mm等中心信号指向神经根入口区。伽玛刀放射外科是治疗这种顽固性疼痛的一种有效的外科尝试。这些结果还表明，外周感觉输入可能在顽固性三叉神经痛的发生中起重要作用。较少