苍白球内侧和腹外侧丘脑神经元的放电与帕金森病运动症状有关。

Neuronal firing in the globus pallidus internus and the ventrolateral thalamus related to parkinsonian motor symptoms.

机构信息

Beijing Institute of Functional Neurosurgery, Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.

出版信息

Chin Med J (Engl). 2009 Oct 5;122(19):2308-14.

PMID:20079131

Abstract

BACKGROUND

It has been proposed that parkinsonian motor signs result from hyperactivity in the output nucleus of the basal ganglia, which suppress the motor thalamus and cortical areas. This study aimed to explore the neuronal activity in the globus pallidus internus (GPi) and the ventrolateral thalamic nuclear group (ventral oral posterior/ventral intermediate, Vop/Vim) in patients with Parkinson's disease (PD).

METHODS

Twenty patients with PD who underwent neurosurgery were studied. Microelectrode recording was performed in the GPi (n = 10) and the Vop/Vim (n = 10) intraoperatively. Electromyography (EMG) contralateral to the surgery was simultaneously performed. Single unit analysis was carried out. The interspike intervals (ISI) and coefficient of variation (CV) of ISI were calculated. Histograms of ISI were constructed. A unified Parkinson's disease rating scale (UPDRS) was used to assess the clinical outcome of surgery.

RESULTS

Three hundred and sixty-three neurons were obtained from 20 trajectories. Of 175 GPi neurons, there were 15.4% with tremor frequency, 69.2% with tonic firing, and 15.4% with irregular discharge. Of 188 thalamic neurons, there were 46.8% with tremor frequency, 22.9% with tonic firing, and 30.3% with irregular discharge. The numbers of three patterns of neuron in GPi and Vop/Vim were significantly different (P < 0.001). ISI analysis revealed that mean firing rate of the three patterns of GPi neurons was (80.9 +/- 63.9) Hz (n = 78), which was higher than similar neurons with 62.9 Hz in a normal primate. For the Vop/Vim group, ISI revealed that mean firing rate of the three patterns of neurons (n = 95) was (23.2 +/- 17.1) Hz which was lower than similar neurons with 30 Hz in the motor thalamus of normal primates. UPDRS indicated that the clinical outcome of pallidotomy was (64.3 +/- 29.5)%, (83.4 +/- 19.1)% and (63.4 +/- 36.3)%, and clinical outcome of thalamotomy was (92.2 +/- 12.9)%, (68.0 +/- 25.2)% and (44.3 +/- 27.2)% for tremor, rigidity and bradykinesia, respectively. A significant difference of tremor and rigidity was found between GPi and Vop/Vim (P < 0.05).

CONCLUSIONS

Different changes in neuronal firing rate and the pattern in GPi and Vop/Vim are likely responsible for parkinsonian motor signs. The results support the view that abnormal neuronal activity in GPi and Vop/Vim are involved in the pathophysiology of parkinsonism.

摘要

背景

有人提出，帕金森病的运动症状是基底神经节输出核过度活跃的结果，这种过度活跃会抑制运动丘脑和皮质区。本研究旨在探讨帕金森病患者的苍白球 internus（GPi）和腹侧口腔后核/腹侧中间核群（ventral oral posterior/ventral intermediate，Vop/Vim）中的神经元活动。

方法

研究了 20 名接受神经外科手术的帕金森病患者。术中在 GPi（n=10）和 Vop/Vim（n=10）中进行微电极记录。同时对手术对侧进行肌电图（EMG）记录。进行了单细胞分析。计算了峰间间隔（ISI）和 ISI 的变异系数（CV）。构建了 ISI 的直方图。使用统一帕金森病评定量表（UPDRS）评估手术的临床疗效。

结果

从 20 条轨迹中获得了 363 个神经元。在 175 个 GPi 神经元中，有 15.4%具有震颤频率，69.2%具有紧张性放电，15.4%具有不规则放电。在 188 个丘脑神经元中，有 46.8%具有震颤频率，22.9%具有紧张性放电，30.3%具有不规则放电。GPi 和 Vop/Vim 中三种神经元模式的数量有显著差异（P<0.001）。ISI 分析显示，三种模式的 GPi 神经元的平均放电率为（80.9±63.9）Hz（n=78），高于正常灵长类动物中 62.9Hz 的类似神经元。对于 Vop/Vim 组，ISI 显示三种模式的神经元（n=95）的平均放电率为（23.2±17.1）Hz，低于正常灵长类动物运动丘脑的 30Hz 的类似神经元。UPDRS 表明苍白球切开术的临床疗效为（64.3±29.5）%、（83.4±19.1）%和（63.4±36.3）%，丘脑切开术的临床疗效为（92.2±12.9）%、（68.0±25.2）%和（44.3±27.2）%分别为震颤、僵硬和运动迟缓。GPi 和 Vop/Vim 之间的震颤和僵硬有显著差异（P<0.05）。