Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands.
Curr Neurol Neurosci Rep. 2013 Sep;13(9):378. doi: 10.1007/s11910-013-0378-8.
We review recent evidence about the pathophysiology of essential tremor and tremor in Parkinson's disease. We believe that a network perspective is necessary to understand this common neurological symptom, and that knowledge of cerebral network dysfunction in tremor disorders will help to develop new therapies. Both essential tremor and Parkinson's tremor are associated with increased activity in the cerebellothalamocortical circuit. However, different pathophysiological mechanisms lead to tremulous activity within this circuit. In Parkinson's disease, evidence suggests that dopaminergic dysfunction of the pallidum triggers increased activity in the cerebellothalamocortical circuit. In essential tremor, GABAergic dysfunction of the cerebellar dentate nucleus and brain stem, possibly caused by neurodegeneration in these regions, may lead to tremulous activity within the cerebellothalamocortical circuit. In both disorders, network parameters such as the strength and directionality of interregional coupling are crucially altered. Exciting new research uses these network parameters to develop network-based therapies, such as closed-loop deep brain stimulation and transcranial magnetic or direct current stimulation.
我们回顾了有关特发性震颤和帕金森病震颤的病理生理学的最新证据。我们认为，需要从网络的角度来理解这一常见的神经症状，并且对震颤障碍中大脑网络功能障碍的了解将有助于开发新的治疗方法。特发性震颤和帕金森病震颤均与小脑-丘脑-皮质回路活动增加有关。然而，不同的病理生理机制导致了该回路中的震颤活动。在帕金森病中，有证据表明苍白球的多巴胺能功能障碍引发了小脑-丘脑-皮质回路的活动增加。在特发性震颤中，小脑齿状核和脑干的 GABA 能功能障碍可能是这些区域的神经退行性变引起的，可能导致小脑-丘脑-皮质回路中的震颤活动。在这两种疾病中，网络参数（如区域间耦合的强度和方向性）都发生了关键性改变。令人兴奋的新研究使用这些网络参数来开发基于网络的治疗方法，例如闭环深部脑刺激和经颅磁或直流电刺激。
