Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, Queen Square, London, WC1N 3BG, UK.
J Neurol. 2013 Apr;260(4):1132-5. doi: 10.1007/s00415-012-6774-1. Epub 2012 Nov 30.
Dopamine transporter imaging is typically abnormal in Parkinson's disease and shows reduced striatal uptake, which is typically greater contralateral to the clinically more affected side. However, tremor-dominant Parkinson's disease patients may have significantly lower uptake in the striatum ipsilateral to the rest-tremor compared to akinetic-rigid PD patients, implying a possible role of an ipsilateral deficit in the generation of rest-tremor.We report here three patients with rest-tremor and the unexpected finding of an ipsilateral presynaptic dopaminergic deficit with normal uptake contralateral to the rest-tremor in dopamine transporter imaging. We divided them in two groups, with and without a corresponding structural lesion in brain imaging. These data may suggest a role of ipsilateral dopaminergic deficit in the generation of rest-tremor. An explanation of these findings could be damage of crossed dopaminergic fibres from the substantia nigra to thalamus, which can cause motor impairment ipsilateral to dopamine depletion experimentally. This is speculative but there is no doubt that these cases exist and we encourage others to report similar cases, as this may assist in the better understanding of the yet unknown pathophysiology of rest-tremor.
多巴胺转运体成像在帕金森病中通常异常，表现为纹状体摄取减少，通常在临床影响较大的对侧更为明显。然而，震颤为主的帕金森病患者与无动性僵硬型 PD 患者相比，对侧震颤侧纹状体的摄取明显降低，这意味着在静止性震颤的产生中可能存在同侧缺陷的作用。我们在此报告了 3 例静止性震颤患者，他们在多巴胺转运体成像中出现了意想不到的同侧节前多巴胺能缺陷，而对侧静止性震颤的摄取正常。我们将他们分为两组，一组在脑成像中有相应的结构病变，另一组没有。这些数据可能表明同侧多巴胺能缺陷在静止性震颤的产生中起作用。对这些发现的一种解释可能是来自黑质的交叉多巴胺能纤维到丘脑的损伤，这可能导致多巴胺耗竭后同侧运动障碍，这在实验中是可以观察到的。这只是一种推测，但毫无疑问，这些病例确实存在，我们鼓励其他人报告类似病例，因为这可能有助于更好地了解静止性震颤的未知病理生理学。
