Flor-Henry P
Service des Admissions, Hôpital Alberta d'Edmonton, Canada.
Encephale. 1990 Jul-Aug;16 Spec No:325-9.
Neuropsychological studies of the obsessional syndrome reveal bilateral frontal dysfunction. Early onset is characteristic of males, who have a more chronic course than females, and who are more often non-dextral. Hypermetabolic activity of the frontal and caudate, bilaterally, is found in most PET investigations, although one report is of relative hypofrontality and global cortical hypometabolism for absolute values. Given the frequency with which basal ganglia disease leads to obsessive-compulsive phenomena (Cf Sydenham's Chorea, Gilles de La Tourette) and frontal lobe inertia, a perturbation of frontal-caudate regulatory motor and ideational sub-systems in the obsessional syndrome appears probable. Bilateral caudate atrophy on CT scan has been reported. Further, EP investigations, both somatosensory and auditory, implicate the left hemisphere in obsessions; together with reduced P300 latencies and during imaginal flooding there is increased left (frontal) hemisphere flow (rCBF). Single case studies document the relationship of obsessions to left frontal-left caudate unilateral pathology. It is suggested that lateralized dysregulation of the left fronto-caudate network is the major cerebral determinant of obsessive-compulsive states.
对强迫综合征的神经心理学研究显示双侧额叶功能障碍。男性发病较早，病程比女性更慢性，且更多为非右利手。在大多数正电子发射断层扫描（PET）研究中发现双侧额叶和尾状核代谢亢进，尽管有一份报告称就绝对值而言存在相对额叶功能低下和全脑皮质代谢减退。鉴于基底节疾病导致强迫现象（如西德纳姆舞蹈病、吉尔·德·拉·图雷特综合征）和额叶惰性的频率，强迫综合征中额叶 - 尾状核调节运动和观念子系统的紊乱似乎是可能的。CT扫描报告显示双侧尾状核萎缩。此外，体感和听觉的事件相关电位（EP）研究表明，强迫观念与左半球有关；P300潜伏期缩短，在想象暴露期间，左（额叶）半球血流量增加（rCBF）。单病例研究记录了强迫观念与左额叶 - 左尾状核单侧病变的关系。有人提出，左额 - 尾状核网络的侧化调节异常是强迫状态的主要大脑决定因素。
