Costa João, Valls-Solé Josep, Valldeoriola Francesc, Rumià Jordi, Tolosa Eduardo
Department of Neurology, Santa Maria University Hospital, Institute of Molecular Medicine, Lisbon Faculty of Medicine Lisbon, Portugal.
Brain. 2007 Jan;130(Pt 1):245-55. doi: 10.1093/brain/awl336. Epub 2006 Dec 5.
The distribution of human corticobulbar motor excitatory and inhibitory output is not fully understood. In particular, it is unclear whether the pattern of innervation is the same for upper and lower facial muscles, and what is the motor cortical area giving rise to such innervation. We used electrodes implanted in the subthalamic nucleus (STN) in patients with Parkinson's disease to activate motor tracts at a subcortical level. We examined the excitatory and inhibitory effects of unilateral single STN deep brain stimulation (sSTN-DBS) in 14 patients by taking recordings from facial, cervical and upper limb muscles on both sides. We measured the latency and amplitude of the motor-evoked potentials (MEPs), and the latency and duration of the silent periods, and compared ipsilateral with contralateral responses and responses obtained in different muscles. Unilateral sSTN-DBS induced strictly contralateral MEPs in the trapezius, deltoid, biceps and thenar muscles. The same stimulus always induced bilateral MEPs in the orbicularis oculi, orbicularis oris, masseter and sternocleidomastoid at a mean latency in the range 6.0-9.1 ms. MEP latencies in the orbicularis oculi and orbicularis oris were significantly longer than in the masseter and sternocleidomastoid (P < 0.01). A short latency small action potential was recorded in the ipsilateral orbicularis oculi that was likely generated by activation of extraocular muscles. During sustained voluntary muscle contraction, a silent period was recorded at similar onset latency on both sides. This period was significantly shorter in orbicularis oculi than in masseter, and in the ipsilateral side for both muscles (P < 0.01). sSTN-DBS is able to activate the descending projecting fibres in the corticobulbar tract eliciting bilateral MEPs and silent periods in facial and cranial muscles. This suggests that fibres to both ipsi- and contralateral motor nuclei descend together at the level of the STN. These findings are relevant in the discussion of the innervation of upper and lower facial muscles in humans and in the interpretation of previous results obtained with transcranial cortical stimulation.
人类皮质延髓运动兴奋性和抑制性输出的分布尚未完全明确。特别是,目前尚不清楚支配上、下面部肌肉的神经支配模式是否相同,以及产生这种神经支配的运动皮质区域是什么。我们使用植入帕金森病患者丘脑底核(STN)的电极,在皮质下水平激活运动传导束。我们通过记录14例患者双侧面部、颈部和上肢肌肉的情况,研究了单侧单次丘脑底核深部脑刺激(sSTN-DBS)的兴奋和抑制作用。我们测量了运动诱发电位(MEP)的潜伏期和波幅,以及静息期的潜伏期和持续时间,并比较了同侧与对侧反应以及不同肌肉获得的反应。单侧sSTN-DBS在斜方肌、三角肌、二头肌和鱼际肌中诱发严格的对侧MEP。相同的刺激总是在眼轮匝肌、口轮匝肌、咬肌和胸锁乳突肌中诱发双侧MEP,平均潜伏期在6.0-9.1毫秒范围内。眼轮匝肌和口轮匝肌中的MEP潜伏期明显长于咬肌和胸锁乳突肌(P<0.01)。在同侧眼轮匝肌中记录到一个潜伏期短的小动作电位,可能是由眼外肌激活产生的。在持续的随意肌肉收缩过程中,两侧记录到的静息期起始潜伏期相似。眼轮匝肌中的这个时期明显短于咬肌,且在两侧的同侧肌肉中也是如此(P<0.01)。sSTN-DBS能够激活皮质延髓束中的下行投射纤维,在面部和颅部肌肉中诱发双侧MEP和静息期。这表明,支配同侧和对侧运动核的纤维在STN水平共同下行。这些发现对于讨论人类上、下面部肌肉的神经支配以及解释先前经颅皮质刺激获得的结果具有重要意义。