Restorative-neurological study for central motor disorders using spinal reflex

1.帕金森病(PD)患者皮质运动控制不当：我们观察了经颅磁刺激(TMS)对比目鱼肌H反射的调节作用。短潜伏期阈值下TMS的刺激强度在每种情况下都保持在运动阈值的-5%，但对帕金森病患者在强直性趾屈(PF)期间和PF开始时的比目鱼肌H反射没有促进作用，这与正常人的情况一样。在一些患者中，在PF发作时出现矛盾抑制。与静息状态相比，PF发作时的易化性增加与UPDRS和僵硬程度呈负相关。穹隆切开术改善了这种调节和临床评分。在PD中，正确执行激动剂和拮抗剂之间相互控制的皮质活动受到干扰。2.帕金森病患者的α-γ连接异常：我们将其作为帕金森病患者肌腱反射的一种大小进行检查。用机械刺激器记录静息状态、紧张性PF时和PF开始时比目鱼肌的H反射和T反射。正常人安静时最大H反射(Hmax)为最大M反应的55%，T反射(Tmax)为30%，PD组分别为36%和31%。PD患者静息时Tmax/Hmax的大小比值(Tmax/Hmax)大于正常，并与强直程度、运动迟缓、Hoehn&Yahr分期、10m步态时间相关。Tmax与运动迟缓和10m步态时间相关。Hmax与任何临床表现均无相关性。在帕金森病患者中，H反射的大小随着TPF的增加而增大，而T反射的大小在TPF期间减小，与正常相反。这些结果提示帕金森病患者在静息状态下纺锤运动活性可能升高，而在动静息状态下可能降低，这可能反映了帕金森病患者α-γ基因的不正确连接。

1.Inappropriate cortical motor control in Parkinson's disease (PD) : We examined conditioning effects of transcranial magnetic stimulation (TMS) on the soleus H-reflex. Short latency subthreshold TMS stimulation at an intensity that kept -5% of the motor threshold in each situation did not facilitate the soleus H-reflex during tonic plantarflexion (PF) nor at PF onset in the patients with Parkinson's disease, as was the case for normal subjects. In some patients, paradoxical inhibition appeared at PF onset. The facilitation increase at PF onset, as compared to that at rest, was negatively correlated to UPDRS and to the rigidity grade. Pallidotomy improved both this modulation and the clinical scores. Cortical activity for the proper execution of reciprocal control between the agonist and antagonist is disturbed in PD.2.Abnormal α-γ linkage in Parkinson's disease : We examined this as a size of tendon reflex in PD. Soleus H-reflex and T-reflex evoked by tendon tap with a mechanical stimulator were recorded at rest, during tonic PF, and at the onset of PF. The maximal H-reflex (Hmax) at rest was 55% of the maximal M-response and T-reflex (Tmax) 30% in normal subjects, and they were 36 and 31% respectively in PD. The size ratio of Tmax and Hmax (Tmax/Hmax) at rest in PD was larger than normal, which was correlated with the grade of rigidity, bradykinesia, Hoehn & Yahr stage, and time for 10m gait. Tmax was correlated with bradykinesia and time for 10m gait. There were no such correlations between Hmax and any clinical findings. In PD, the size of H-reflex increased with TPF as in normal subjects, but T-reflex decreased during TPF that was opposite of normal. These findings indicate that the fusimotor activity might be increased at rest and decreased during TPF in PD, which may reflect inappropriate α-γ linkage in PD.