Quatrale R, Manconi M, Gastaldo E, Eleopra R, Tugnoli V, Tola M R, Granieri E
Department of Neurology, S. Anna Hospital, University of Ferrara, C.so Giovecca, 203 I-44100 Ferrara, Italy.
Clin Neurophysiol. 2003 Sep;114(9):1638-45. doi: 10.1016/s1388-2457(03)00137-8.
To test the variations in cerebral motor excitability in patients with primary restless legs syndrome (RLS) by using electrophysiological techniques. In RLS patients periodic legs movements (PLMs) in sleep and wake have been described and it is hypothesised that PLMs result from a sleep-related disinhibition of descending central motor inhibitory pathways. Moreover, in primary RLS, these modifications are still debated.
In 15 patients with primary RLS, transcranial magnetic stimulation (TMS) was carried out using several paradigms, particularly paired pulse TMS with short interstimulus intervals (ISI) in abductor digiti minimi (ADM) and tibialis anterior (TA) muscles.
Short ISI paired TMS showed a significant decrease in inhibition and increase in facilitation in ADM muscles. This result was even more evident in TA muscles of patients as compared to the controls and these modifications were more evident in the limbs which were more affected by PLM. Moreover, intracortical (corticocortical) inhibition (ICI) and intracortical facilitation (ICF) unchanged their biphasic time course.
In our study the changes in short paired-pulse ICI and ICF revealed the presence of an altered excitability of central motor pathways, with good correlation with asymmetric distribution of symptoms.
运用电生理技术检测原发性不宁腿综合征（RLS）患者大脑运动兴奋性的变化。在RLS患者中，已描述了睡眠和清醒时的周期性腿部运动（PLMs），并且推测PLMs是由与睡眠相关的下行中枢运动抑制通路的去抑制作用引起的。此外，在原发性RLS中，这些改变仍存在争议。
对15例原发性RLS患者，采用多种模式进行经颅磁刺激（TMS），特别是在小指展肌（ADM）和胫前肌（TA）中使用短刺激间隔（ISI）的配对脉冲TMS。
短ISI配对TMS显示ADM肌肉的抑制作用显著降低，易化作用增强。与对照组相比，患者TA肌肉的这一结果更为明显，并且这些改变在受PLM影响更严重的肢体中更为明显。此外，皮质内（皮质-皮质）抑制（ICI）和皮质内易化（ICF）的双相时间进程未改变。
在我们的研究中，短配对脉冲ICI和ICF的变化揭示了中枢运动通路兴奋性的改变，与症状的不对称分布具有良好的相关性。
