CLINICAL STUDY CONCERNING WITH A ROLE OF THE SUPPLEMENTARY MOTOR AREA AND CINGULATE MOTOR AREA IN HUMAN BEHAVIORAL CONTROL

我调查了34例近期因中风而单侧内侧半球壁受损的患者的病理性抓握现象和相关的抓握行为。现象被归类为抓握反射或本能抓握反应。本能抓握反应又可细分为衣服反应、最后抓握反应、陷阱反应、磁铁反应和视觉摸索反应。为了确定病变的确切位置和范围，我检查了磁共振图像。涉及辅助运动区，特别是其尾部的损害的患者，不断表现出抓握反射，主要是在对侧的病变。另一方面，在涉及扣带回前部，特别是其中部和尾部的损伤的患者中，观察到诸如本能抓握反应的磁体反应和视觉摸索等摸索运动，主要发生在病变对侧的手。在辅助运动区或扣带回前部受损的患者中观察到其他种类的本能抓握反应。这些观察结果表明，抓握反射调制主要是由尾侧部分的辅助运动区，而摸索运动主要是由中部和尾部的前扣带回。我还发现，除了抓握动作外，一些患者还表现出典型的强迫性操作放在桌子上或展示在他们面前的工具，用手对着病变。这些患者继续使用物体，直到他们用另一只顺从的手限制运动。这类患者有严重的，广泛的损害，前扣带回毗邻的胼胝体和前体，以及胼胝体的参与。

I investigated pathological grasping phenomena and related prehensile behavior in 34 patients with recent damage to a unilateral medial hemispheric wall from stroke. Phenomena were categorized as either the grasp reflex or the instinctive grasp reaction. The instinctive grasp reaction was subdivided into clothing reaction, final grip, trap reaction, magnet reaction, and visual groping. To determine the exact location and extent of the lesions, I examined magnet resonance images. The patients with damage involving the supplementary motor area, especially its caudal part, constantly exhibited the grasp reflex, mainly in the hand contralateral to the lesion. On the other hand, in the patients with damage involving the anterior cingulate gyrus, especially its middle and caudal parts, the groping movements such as the magnet reaction and visual groping of the instinctive grasp reaction were observed, mainly in the hand contralateral to the lesion. Other varieties of the instinctive grasp reaction were observed in the patients with damage to either the supplementary motor area or the anterior cingulate gyrus. These observations indicate that the grasp reflex is modulated mainly by the caudal part of the supplementary motor area, while the groping movements are primarily controlled by the middle and caudal parts of the anterior cingulate gyrus. I also found that some patients manifested, in addition to grasping movements, typical compulsive manipulation of tools placed on the table or shown before them, with the hand contralateral to the lesion. These patients continued to use objects until they restrained the movements using the other obedient hand. Such patients had severe, extensive damage to the anterior cingulate gyrus adjoining the genu and anterior body of the corpus callosum, as well as the callosal involvement.