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)在明确丘脑损伤（浅表疼痛为主）的中枢性疼痛患者中，采用深度微记录的丘脑电生理研究显示，VIM核及其周围的自发神经活动（SNA）明显减少。层间核（CL=中央外侧核）的SNA高于VIM，特别是在其背侧。通常，不规则的爆裂性放电在VC（尾侧）核周围出现，特别是在层间核的背侧，沿着向CL的轨迹。在这些病例中，浅表疼痛越严重，与损伤侧中央沟（Cxc）周围大脑皮层的氧代谢相比，区域脑葡萄糖代谢的相对值越高。区域抽氧率也有所提高。因此，在中枢性（丘脑）疼痛患者中，丘脑层内核的易激状态和Cxc神经活动的异常（增加）可能在中枢性疼痛，特别是浅表性疼痛的发生中起重要作用。(2)刚性型帕金森病（PD）的糖代谢在透镜状核高，而在Cxc低。相比之下，舞蹈病组在透镜状核表现为低糖代谢，而在运动和运动前皮层表现为高糖代谢。刚性型PD的基底神经节和大脑皮层的神经功能与运动亢进症完全不同。在半失忆症患者中，Cxc和对侧运动丘脑的葡萄糖代谢高。我们假设这些结构，如基底神经节、丘脑和大脑皮层，在维持和调节异常的不自主运动中发挥了重要作用。(3)用微透析法测定正常或实验性震颤猴基底神经节和丘脑的神经递质。

(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.