PHYSIOLOGICAL ANALYSIS OF INVOLUNTARY MOVEMENTS

肌阵挛和其他一些快速不自主运动 在临床上很难分类。临床和生理学 对一系列持续的患者的分析导致了新的 分类和病理生理学见解。一个新的应用程序 我们的神经生理学工作的一部分就是鉴别诊断 肌阵挛与抽动障碍的对比。 腭裂患者的正电子发射断层扫描研究 肌阵挛显示下层橄榄是过度活跃的。 对偏侧斜视患者的宠物研究表明， 同侧纹状体活动不足可能是 功能性损伤。特发性震颤患者的PET研究 已经揭示了劣质橄榄在 震颤，但不是当病人休息时。 任务特异性手部局限性肌张力障碍，如作家抽筋 和钢琴家的抽筋已经被分析和一些 生理特征已经被定义。似乎有一种 被削弱了独立控制手指的能力 具有自主运动功能的体感诱发电位门控 是不正常的。痉挛本身的特征是 不同的图案。眨眼反射的异常一直是 被鉴定为肌张力障碍。我们已经在一份 我们自己的患者的数量，现在正在将这一测试应用于 局灶性手部抽筋的患者。这些患者也一直在 对相互抑制的分析进行了特定的检验 在手臂上。相互抑制在手臂上减弱， 显示局灶性肌张力障碍，但不是在非肌张力障碍的手臂。 局灶性手部抽筋的生理异常发现 最客观的实验室异常是在这些 患者，现在是反对心理原因的最有力的证据 关于这种混乱的起源。

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.