帕金森病中比目鱼肌振动的姿势反应:随着疾病进展,缩放功能恶化。

Postural reactions to soleus muscle vibration in Parkinson's disease: scaling deteriorates as disease progresses.

作者信息

Valkovic Peter, Krafczyk Siegbert, Bötzel Kai

机构信息

Department of Neurology, Ludwig-Maximilians University, Marchioninistrasse 15, 81366 Munich, Germany.

出版信息

Neurosci Lett. 2006 Jun 19;401(1-2):92-6. doi: 10.1016/j.neulet.2006.02.073. Epub 2006 Mar 29.

Abstract

Previous research has shown that Parkinson's disease (PD) patients, especially those with postural instability, respond hyperactively to visual, vestibular, and neck proprioceptive sensory manipulation. To determine if this impairment of the sensory information scaling holds true for the lower leg proprioceptive system, we studied postural responses to mechanical vibration (which affects the muscle spindle Ia afferents) applied to the soleus muscles of PD subjects and healthy controls. Early-stage and advanced-stage PD patients as well as age-matched control subjects participated. Each group comprised 11 subjects. Nine pulses of 3-s long vibration were applied randomly to both soleus muscles while subjects kept their eyes closed. Postural responses to these stimuli were measured by static posturography. The effect of dopaminergic medication was established by testing patients in both ON and OFF treatment phases. There was no intergroup difference in the pattern or latencies of responses. However, the amplitudes were significantly larger in advanced PD patients; controls did not differ from early-stage PD patients. Dopaminergic medication had no significant effect on any of the measures. The scaling of postural reactions triggered by lower leg proprioception is disturbed in advanced PD. Neither afferent proprioceptive deficits nor inaccurate timing is involved. This study gives further evidence for the generalized impairment of the scaling of postural responses evoked whenever there is a sudden change of sensory conditions, as occurs with the progression of PD. Such impairment could play a significant role in the pathophysiology of postural instability and falls in PD patients.

摘要

先前的研究表明,帕金森病(PD)患者,尤其是那些存在姿势不稳的患者,对视觉、前庭和颈部本体感觉的感觉操纵反应过度活跃。为了确定这种感觉信息缩放受损是否也适用于小腿本体感觉系统,我们研究了对帕金森病患者和健康对照者比目鱼肌施加机械振动(影响肌梭Ia传入纤维)后的姿势反应。早期和晚期帕金森病患者以及年龄匹配的对照受试者参与了研究。每组有11名受试者。在受试者闭眼时,随机对双侧比目鱼肌施加9次持续3秒的振动脉冲。通过静态姿势描记法测量对这些刺激的姿势反应。通过在药物治疗开启和关闭阶段对患者进行测试来确定多巴胺能药物的作用。反应模式或潜伏期在组间没有差异。然而,晚期帕金森病患者的反应幅度明显更大;对照组与早期帕金森病患者没有差异。多巴胺能药物对任何测量指标均无显著影响。晚期帕金森病患者小腿本体感觉触发的姿势反应缩放受到干扰。既不涉及传入性本体感觉缺陷,也不涉及计时不准确。这项研究进一步证明,只要感觉条件突然改变,如帕金森病进展时发生的情况,姿势反应缩放就会普遍受损。这种损害可能在帕金森病患者姿势不稳和跌倒的病理生理过程中起重要作用。

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