Limousin P, Brown R G, Jahanshahi M, Asselman P, Quinn N P, Thomas D, Obeso J A, Rothwell J C
MRC Human Movement and Balance Unit, Institute of Neurology, London, UK.
Brain. 1999 Feb;122 ( Pt 2):315-27. doi: 10.1093/brain/122.2.315.
We studied the effect of posteroventral pallidotomy on movement preparation and execution in 27 parkinsonian patients using various motor tasks. Patients were evaluated after overnight withdrawal of medication before and 3 months after unilateral pallidotomy. Surgery had no effect on initiation time in unwarned simple and choice reaction time tasks, whereas movement time measured during the same tasks was improved for the contralesional hand. Movement times also improved for isometric and isotonic ballistic movements. In contrast, repetitive, distal and fine movements measured in finger-tapping and pegboard tasks were not improved after pallidotomy. Preparatory processes were investigated using both behavioural and electrophysiological measures. A precued choice reaction time task suggested an enhancement of motor preparation for the contralesional hand. Similarly, movement-related cortical potentials showed an increase in the slope of the late component (NS2) when the patients performed joystick movements with the contralesional hand. However, no significant change was found for the early component (NS1) or when the patient moved the ipsilesional hand. The amplitude of the long-latency stretch reflex of the contralesional hand decreased after surgery. In summary, the data suggest that pallidotomy improved mainly the later stages of movement preparation and the execution of proximal movements with the contralesional limb. These results provide detailed quantitative data on the impact of posteroventral pallidotomy on previously described measures of upper limb akinesia in Parkinson's disease.
我们使用各种运动任务研究了后腹侧苍白球切开术对27例帕金森病患者运动准备和执行的影响。在单侧苍白球切开术前和术后3个月，患者在夜间停药后接受评估。手术对未预警的简单和选择反应时间任务中的起始时间没有影响，而在相同任务中测量的对侧手的运动时间有所改善。等长和等张弹道运动的运动时间也有所改善。相比之下，在手指敲击和钉板任务中测量的重复性、远端和精细运动在苍白球切开术后没有改善。使用行为和电生理测量方法研究了准备过程。一个预先提示的选择反应时间任务表明对侧手的运动准备有所增强。同样，当患者用对侧手进行操纵杆运动时，运动相关皮层电位显示晚期成分（NS2）的斜率增加。然而，早期成分（NS1）或患者用同侧手运动时未发现显著变化。手术后对侧手的长潜伏期牵张反射幅度降低。总之，数据表明苍白球切开术主要改善了运动准备的后期阶段以及对侧肢体近端运动的执行。这些结果提供了关于后腹侧苍白球切开术对帕金森病中先前描述的上肢运动不能测量指标影响的详细定量数据。
