Department of Neurosciences, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Exp Neurol. 2010 Apr;222(2):219-25. doi: 10.1016/j.expneurol.2009.12.030. Epub 2010 Jan 6.
Ablation or deep brain stimulation in the internal segment of the globus pallidus (GPi) is an effective therapy for the treatment of Parkinson's disease (PD). Yet many patients receive only partial benefit, including varying levels of improvement across different body regions, which may relate to a differential effect of GPi surgery on the different body regions. Unfortunately, our understanding of the somatotopic organization of human GPi is based on a small number of studies with limited sample sizes, including several based upon only a single recording track or plane. To fully address the three-dimensional somatotopic organization of GPi, we examined the receptive field properties of pallidal neurons in a large cohort of patients undergoing stereotactic surgery. The response of neurons to active and passive movements of the limbs and orofacial structures was determined, using a minimum of three tracks across at least two medial-lateral planes. Neurons (3183) were evaluated from 299 patients, of which 1972 (62%) were modulated by sensorimotor manipulation. Of these, 1767 responded to a single, contralateral body region, with the remaining 205 responding to multiple and/or ipsilateral body regions. Leg-related neurons were found dorsal, medial and anterior to arm-related neurons, while arm-related neurons were dorsal and lateral to orofacial-related neurons. This study provides a more detailed map of individual body regions as well as specific joints within each region and provides a potential explanation for the differential effect of lesions or DBS of the GPi on different body parts in patients undergoing surgical treatment of movement disorders.
苍白球内节(GPi)的消融或深部脑刺激是治疗帕金森病(PD)的有效疗法。然而,许多患者仅获得部分益处,包括不同身体区域的改善程度不同,这可能与 GPi 手术对不同身体区域的不同影响有关。不幸的是,我们对人类 GPi 躯体定位组织的理解基于少数具有有限样本量的研究,包括几项研究仅基于单个记录轨迹或平面。为了全面描述 GPi 的三维躯体定位组织,我们在接受立体定向手术的大量患者中检查了苍白球神经元的感受野特性。使用至少三个跨越至少两个内外平面的轨迹,确定神经元对肢体和口面部结构的主动和被动运动的反应。从 299 名患者评估了 3183 个神经元,其中 1972 个(62%)被感觉运动操作所调制。其中,1767 个神经元对单个对侧身体区域有反应,其余 205 个神经元对多个和/或同侧身体区域有反应。与腿部相关的神经元位于手臂相关神经元的背侧、内侧和前方,而手臂相关神经元位于口面部相关神经元的背侧和外侧。这项研究提供了个体身体区域以及每个区域内特定关节的更详细图谱,并为接受运动障碍手术治疗的患者中 GPi 的病变或 DBS 对不同身体部位的不同影响提供了潜在解释。