Agostino Rocco, Dinapoli Loredana, Modugno Nicola, Iezzi Ennio, Gregori Bruno, Esposito Vincenzo, Romanelli Pantaleo, Berardelli Alfredo
Neuromed Institute, "Sapienza," University of Rome, Italy.
Mov Disord. 2008 Sep 15;23(12):1718-24. doi: 10.1002/mds.22203.
Unilateral STN-DBS significantly improves the performance of contralateral sequential arm movements. Whether unilateral STN-DBS also improves ipsilateral sequential movement is unclear. In this study in unmedicated parkinsonian patients, we tested the effect of unilateral STN-DBS on the performance of ipsilateral sequential movements and compared it with the performance of contralateral sequential movements. Three-dimensional movements were recorded with the ELITE system and three kinematic variables were considered: total movement time (TMT), total inter-onset latency (IOL), and spatial accuracy. Unilateral STN-DBS significantly decreased TMT in the contralateral arm and only tended to do so also in the ipsilateral arm, whereas it significantly decreased IOL and worsened spatial accuracy only on the contralateral side. Before unilateral STN-DBS a positive correlation was present between the clinical impairment and the TMTs in the contralateral and ipsilateral sides. After unilateral STN-DBS the UPDRS scores improved in the contralateral and to a lesser extent also in the ipsilateral side. Correlation analysis between clinical and kinematic data showed no differences between the contralateral and ipsilateral sides. Our kinematic findings show that after STN-DBS parkinsonian patients' performance of a sequential motor task improves significantly on the contralateral but only tended to do so on the ipsilateral side. Ipsilateral changes can be explained by the observation that the output structures of the basal ganglia send large ipsilateral and less dense contralateral projections to the thalamus.
单侧丘脑底核深部脑刺激(STN-DBS)可显著改善对侧连续手臂运动的表现。单侧STN-DBS是否也能改善同侧连续运动尚不清楚。在这项针对未用药帕金森病患者的研究中,我们测试了单侧STN-DBS对同侧连续运动表现的影响,并将其与对侧连续运动的表现进行比较。使用ELITE系统记录三维运动,并考虑三个运动学变量:总运动时间(TMT)、总起始潜伏期(IOL)和空间准确性。单侧STN-DBS显著缩短了对侧手臂的TMT,同侧手臂仅呈现出缩短趋势,而它仅显著缩短了对侧的IOL,并使对侧的空间准确性变差。在单侧STN-DBS之前,临床损伤与对侧和同侧的TMT之间存在正相关。单侧STN-DBS后,对侧的统一帕金森病评定量表(UPDRS)评分有所改善,同侧也有较小程度的改善。临床和运动学数据的相关性分析显示,对侧和同侧之间没有差异。我们的运动学研究结果表明,STN-DBS后,帕金森病患者在连续运动任务中的表现对侧显著改善,同侧仅呈现出改善趋势。同侧的变化可以通过以下观察结果来解释:基底神经节的输出结构向丘脑发送大量同侧投射和较少的对侧投射。