Fellows Stuart J, Kronenbürger Martin, Allert Niels, Coenen Volker A, Fromm Christoph, Noth Johannes, Weiss Peter H
Neurologische Klinik, Universitätsklinikum der RWTH Aachen, Germany.
Parkinsonism Relat Disord. 2006 Apr;12(3):149-54. doi: 10.1016/j.parkreldis.2005.12.001. Epub 2006 Mar 23.
We have studied grip force performance in a group of 10 patients who were in a stable state after implantation of bilateral stimulating electrodes in the subthalamic nuclei (Stn) to counter drug-resistant or drug-induced symptoms of advanced Parkinson's disease. The patients were required to use a precision grip to lift an object which recorded grip force development and lift dynamics. Lifting was performed with stimulation on and with stimulation off under optimal medication. Post-operatively, dyskinesia was absent in all patients in both conditions, but in the 'off' state the patients showed the profound bradykinesia and excessive levels of grip force development associated with Parkinson's disease from its early stages. In the stimulation 'on' state both the rate of grip force development and the speed of the lifting phase were increased significantly. The excessive levels of grip force present in the stimulation 'off' state, and present from the early stages of the disease, however, were even more marked with Stn stimulation on. It is suggested that this results from a failure to modify stored motor programs developed over a long period under the influence of bradykinesia, leading to an inappropriately prolonged duration of grip force development when this influence is removed by Stn stimulation. Thus although Stn stimulation achieved a dramatic improvement in the mobility of the patients in general, and in the dynamics of hand movements specifically, by improving rates of force development and lifting dynamics, it does not restore, and may even worsen, the ability to match lifting parameters to actual conditions.
我们对一组10名患者的握力表现进行了研究，这些患者在双侧丘脑底核（Stn）植入刺激电极后处于稳定状态，以对抗晚期帕金森病的耐药性或药物诱发症状。要求患者使用精确握力来举起一个物体，该物体可记录握力发展和举起动态。在最佳药物治疗下，分别在刺激开启和刺激关闭的情况下进行举起操作。术后，在两种情况下所有患者均无运动障碍，但在“关”状态下，患者表现出与帕金森病早期相关的严重运动迟缓以及过高的握力发展水平。在刺激“开”状态下，握力发展速率和举起阶段的速度均显著增加。然而，在刺激“关”状态下以及疾病早期就存在的过高握力水平，在丘脑底核刺激开启时更为明显。这表明，这是由于未能修改在运动迟缓影响下长期形成的存储运动程序，导致当丘脑底核刺激消除这种影响时，握力发展持续时间过长。因此，尽管丘脑底核刺激总体上使患者的运动能力，特别是手部运动动态有了显著改善，通过提高力量发展速率和举起动态，但它并未恢复，甚至可能恶化将举起参数与实际情况相匹配的能力。
