Bäumer Tobias, Demiralay Cüneyt, Hidding Ute, Bikmullina Rosalia, Helmich Rick C, Wunderlich Silke, Rothwell John, Liepert Joachim, Siebner Hartwig R, Münchau Alexander
Department of Neurology, University of Hamburg, Hamburg, Germany.
Mov Disord. 2007 Jan;22(1):81-90. doi: 10.1002/mds.21219.
Previous studies demonstrated functional abnormalities in the somatosensory system, including a distorted functional organization of the somatosensory cortex (S1) in patients with writer's cramp. We tested the hypothesis that these functional alterations render S1 of these patients more susceptible to the "inhibitory" effects of subthreshold 1 Hz repetitive transcranial magnetic stimulation (rTMS) given to S1. Seven patients with writer's cramp and eight healthy subjects were studied. Patients also received rTMS to the motor cortex hand area (M1). As an outcome measure, short-latency afferent inhibition (SAI) was tested. SAI was studied in the relaxed first dorsal interosseous muscle using conditioning electrical stimulation of the index finger and TMS pulses over the contralateral M1. Baseline SAI did not differ between groups. S1 but not M1 rTMS reduced SAI in patients. rTMS had no effects on SAI in healthy subjects. Because SAI is mediated predominantly at a cortical level in the sensorimotor cortex, we conclude that there is an abnormal responsiveness of this area to 1 Hz rTMS in writer's cramp, which may represent a trait toward maladaptive plasticity in the sensorimotor system in these patients.
以往的研究表明,体感系统存在功能异常,包括书写痉挛患者体感皮层(S1)的功能组织紊乱。我们检验了这样一个假设,即这些功能改变使这些患者的S1更容易受到给予S1的阈下1赫兹重复经颅磁刺激(rTMS)的“抑制性”影响。对7名书写痉挛患者和8名健康受试者进行了研究。患者还接受了对运动皮层手部区域(M1)的rTMS。作为一项结果指标,测试了短潜伏期传入抑制(SAI)。在放松状态下,使用示指的条件性电刺激和对侧M1上的TMS脉冲,对第一背侧骨间肌的SAI进行了研究。两组之间的基线SAI没有差异。患者中,S1而非M1的rTMS降低了SAI。rTMS对健康受试者的SAI没有影响。由于SAI主要在感觉运动皮层的皮质水平介导,我们得出结论,书写痉挛患者该区域对1赫兹rTMS存在异常反应,这可能代表了这些患者感觉运动系统中适应不良可塑性的一种特征。