Crenna P, Carpinella I, Lopiano L, Marzegan A, Rabuffetti M, Rizzone M, Lanotte M, Ferrarin M
1Institute of Human Physiology I, LAMB Pierfranco & Luisa Mariani,University of Milan , Milan, Italy.
Brain. 2008 Dec;131(Pt 12):3410-20. doi: 10.1093/brain/awn272. Epub 2008 Oct 24.
Clinical evidence of impaired arm swing while walking in patients with Parkinson's disease suggests that basal ganglia and related systems play an important part in the control of upper limb locomotor automatism. To gain more information on this supraspinal influence, we measured arm and thigh kinematics during walking in 10 Parkinson's disease patients, under four conditions: (i) baseline (no treatment), (ii) therapeutic stimulation of the subthalamic nucleus (STN), (iii)L-DOPA medication and (iv) combined STN stimulation and L-DOPA. Ten age-matched controls provided reference data. Under baseline conditions the range of patients' arm motion was severely restricted, with no correlation with the excursion of the thigh. In addition, the arm swing was abnormally coupled in time with oscillation of the ipsilateral thigh. STN stimulation significantly increased the gait speed and improved the spatio-temporal parameters of arm and thigh motion. The kinematic changes as a function of gait speed changes, however, were significantly smaller for the upper than the lower limb, in contrast to healthy controls. Arm motion was also less responsive after L-DOPA. Simultaneous deep brain stimulation and L-DOPA had additive effects on thigh motion, but not on arm motion and arm-thigh coupling. The evidence that locomotor automatisms of the upper and lower limbs display uncorrelated impairment upon dysfunction of the basal ganglia, as well as different susceptibility to electrophysiological and pharmacological interventions, points to the presence of heterogeneously distributed, possibly partially independent, supraspinal control channels, whereby STN and dopaminergic systems have relatively weaker influence on the executive structures involved in the arm swing and preferential action on those for lower limb movements. These findings might be considered in the light of phylogenetic changes in supraspinal control of limb motion related to primate bipedalism.
帕金森病患者行走时摆臂受损的临床证据表明，基底神经节及相关系统在控制上肢运动自主性方面起着重要作用。为了获取更多关于这种脊髓上影响的信息，我们在四种情况下测量了10名帕金森病患者行走时的手臂和大腿运动学：（i）基线（未治疗），（ii）丘脑底核（STN）的治疗性刺激，（iii）左旋多巴药物治疗，以及（iv）STN刺激与左旋多巴联合使用。10名年龄匹配的对照者提供了参考数据。在基线条件下，患者手臂运动范围严重受限，与大腿摆动无相关性。此外，摆臂在时间上与同侧大腿的摆动异常耦合。STN刺激显著提高了步态速度，并改善了手臂和大腿运动的时空参数。然而，与健康对照者相比，上肢运动学变化随步态速度变化的幅度明显小于下肢。左旋多巴治疗后手臂运动的反应性也较低。同时进行深部脑刺激和左旋多巴对大腿运动有累加效应，但对手臂运动和手臂 - 大腿耦合无影响。上肢和下肢运动自主性在基底神经节功能障碍时表现出不相关的损害，以及对电生理和药物干预的不同敏感性，这一证据表明存在分布不均一、可能部分独立的脊髓上控制通道，其中STN和多巴胺能系统对参与摆臂的执行结构影响相对较弱，而对下肢运动的执行结构有优先作用。这些发现可能与灵长类双足行走相关的脊髓上肢体运动控制的系统发育变化有关。
