Berardelli Alfredo, Currà Antonio, Fabbrini Giovanni, Gilio Francesca, Manfredi Mario
Dept. of Neurological Sciences and Istituto Neurologico Mediterraneo, NEUROMED IRCCS, Pozzilli (IS) University of Rome La Sapienza, Rome, Italy.
J Neurol. 2003 Jul;250(7):781-7. doi: 10.1007/s00415-003-1102-4.
Tics are involuntary movements that can affect one or more muscles producing simple or complex movements. Blink reflex and startle reflex studies disclose an increased excitability of brainstem interneurons. Analysis of voluntary movement shows that when advance visual information is reduced, patients with tics and Tourette syndrome become progressively slower in completing motor sequences. Sensorimotor integration is abnormally processed. Studies of the contingent negative variation demonstrate abnormalities of movement preparation and the investigation of premotor potentials shows that in some patients tics are not preceded by a normal premotor potential. Magnetic stimulation studies demonstrate an increased excitability of cortical motor cortex. Functional MRI, PET and SPECT studies show abnormal activation of cortical and subcortical areas. Dysfunction of basal ganglia-thalamo-cortical projections affects sensorimotor, language and limbic cortical circuits, and may explain why patients with Tourette syndrome have difficulty in inhibiting unwanted behaviors and impulses.
抽动是一种不自主运动,可影响一块或多块肌肉,产生简单或复杂的动作。眨眼反射和惊吓反射研究显示脑干中间神经元兴奋性增加。对自主运动的分析表明,当预先的视觉信息减少时,抽动症和妥瑞氏综合征患者完成运动序列的速度会逐渐变慢。感觉运动整合过程异常。关联性负变研究显示运动准备存在异常,运动前电位研究表明,在一些患者中,抽动之前没有正常的运动前电位。磁刺激研究显示皮质运动皮质的兴奋性增加。功能磁共振成像、正电子发射断层扫描和单光子发射计算机断层扫描研究显示皮质和皮质下区域激活异常。基底神经节 - 丘脑 - 皮质投射功能障碍会影响感觉运动、语言和边缘皮质回路,这可能解释了为什么妥瑞氏综合征患者难以抑制不必要的行为和冲动。