PHYSIOLOGICAL ANALYSIS OF INVOLUNTARY MOVEMENTS

肌阵挛和其他一些快速的不自主运动， 临床上很难分类。 临床和生理 对一系列患者的分析导致了新的 分类和病理生理学见解。 一个新的应用 我们的神经生理学工作一直是鉴别诊断 肌阵挛和抽动障碍的对比 腭咽闭合不全患者的正电子发射断层扫描研究 肌阵挛表明下橄榄过度活跃 对偏侧震颤患者的PET研究显示， 同侧纹状体的活动减退可能是一个负责任的 功能性病变 原发性震颤患者的PET研究 已经揭示了劣质橄榄在生长过程中 震颤，但不是当病人休息。 手部任务特异性局灶性肌张力障碍，如书写痉挛 和钢琴家的抽筋进行了分析， 生理特征已经被定义。 似乎 独立控制手指的能力减弱， 随意运动体感诱发电位门控 不正常 痉挛本身被描述为 不同的模式。 眨眼反射的消失 在肌张力障碍中被发现。 我们已经在一份 我们自己的病人的数量，现在正在应用这项测试， 局部手痉挛的患者。 这些患者也被 用特定试验研究，以分析相互抑制 在手臂中。在手臂中的相互抑制减弱， 显示局部肌张力障碍，但不是在非肌张力障碍的手臂。 局灶性手痉挛的生理异常 是这些患者中最客观的实验室异常， 病人，现在是最有力的证据反对心因性 疾病的起源。

Myoclonus and a number of other rapid involuntary movements have been difficult to classify clinically. Clinical and physiological analysis of a continuing series of patients has led to new classifications and pathophysiological insights. A new application of our neurophysiological work has been the differential diagnosis of myoclonus versus tic disorder. Positron emission tomography (PET) studies of patients with palatal myoclonus have revealed that the inferior olives are hyperactive. PET studies of patients with hemiballismus have revealed that hypoactivity of the ipsilateral striatum may be a responsible functional lesion. PET studies of patients with essential tremor have revealed that the inferior olives are hypermetabolic during the tremor, but not when the patients are at rest. Task specific focal dystonias of the hands such as writer's cramp and pianist's cramp have been analyzed and a number of physiological characteristics have been defined. There appears to be diminished ability to control the fingers independently and gating of somatosensory evoked potentials with voluntary movement is abnormal. The spasms themselves have been characterized into different patterns. Abnormalities of the blink reflex have been identified in dystonic disorders. We have verified this in a number of our own patients and are now applying this test to the patients with focal hand cramps. These patients have also been studied with a specific test for analysis of reciprocal inhibition in the arm. Reciprocal inhibition is diminished in the arm which shows the focal dystonia, but not in the arm which is not dystonic. This finding of a physiological abnormality in focal hand cramps is the most objective laboratory abnormality seen in these patients, and is now the strongest evidence against the psychogenic origin on the disorder.