CNRS, UMR 6149, Pôle 3C, Equipe Développement et Pathologie de l'Action, Université de Provence & CNRS, Centre Saint Charles, Marseille, France.
Mov Disord. 2010 Dec 15;25(16):2747-55. doi: 10.1002/mds.23378.
Transcranial magnetic stimulation (TMS) parameters were recorded in a lower limb muscle and correlated with the gait parameters of 25 patients with Parkinson's disease (PD) with and without dopamine substitution treatment (DST) and 10 control subjects. Single and paired-pulse TMS were recorded in the tibialis anterior muscle (TA). Gait analysis was performed using a 3D motion analysis system. Parkinsonian patients (PP) did not differ from the control subjects (CS) in terms of relaxed motor threshold, active motor threshold (AMT), cortical silent period (CSP), motor-evoked potential (MEP) amplitude and area, or paired-pulse TMS with short interstimulus intervals (ISI). At longer ISIs, paired-pulse TMS showed that the amplitudes of the conditioned MEPs were lower in untreated PP than in CS. DST partially compensated for this difference. Gait analysis showed that the gait of PP undergoing no treatment was slower and the stride length shorter than normal. Both of these parameters improved under DST, however. Analysis of data obtained on all the subjects combined showed that both of the latter parameters were correlated with the paired-pulse MEP amplitude and area at longer ISIs. In PP, the cortical areas responsible for the lower limb movements seem to undergo intracortical facilitation (ICF) impairments, whereas the intracortical inhibition process is normal. The ICF level was found to be associated to the stride length and the velocity. The fact that only these two gait parameters were found to be dopa responsive indicates that dopaminergic treatment may improve gait disorders by restoring the ICF.
经颅磁刺激 (TMS) 参数记录于下肢肌肉，并与 25 名有或无多巴胺替代治疗 (DST) 的帕金森病 (PD) 患者和 10 名对照者的步态参数相关联。单脉冲和双脉冲 TMS 记录于胫骨前肌 (TA)。步态分析采用三维运动分析系统进行。帕金森病患者 (PP) 在静息运动阈值、主动运动阈值 (AMT)、皮质静息期 (CSP)、运动诱发电位 (MEP) 幅度和面积或短刺激间隔 (ISI) 的双脉冲 TMS 方面与对照组 (CS) 无差异。在较长的 ISI 时，双脉冲 TMS 显示未经治疗的 PP 的条件 MEP 幅度低于 CS。DST 部分补偿了这种差异。步态分析显示，未接受治疗的 PP 的步态较慢，步幅较短。然而，在 DST 下，这两个参数都得到了改善。对所有受试者的数据进行综合分析表明，这两个参数都与较长 ISI 时的双脉冲 MEP 幅度和面积相关。在 PP 中，负责下肢运动的皮质区似乎经历了皮质内易化 (ICF) 损伤，而皮质内抑制过程是正常的。发现 ICF 水平与步幅和速度相关。只有这两个步态参数被发现对多巴胺反应表明，多巴胺能治疗可能通过恢复 ICF 来改善步态障碍。
