Futamura Akinori, Kawamura Mitsuru
Department of Neurology, Showa University School of Medicine.
Brain Nerve. 2014 Apr;66(4):451-60.
Apraxia is the inability to perform actions or move different parts of the body in the intended manner, despite normal physical capability of movement. Based on his studies, Liepmann divided apraxia into three types: ideational apraxia, ideomotor apraxia, and limb-kinetic apraxia. Clinical findings such as ideomotor apraxia in Broca's area and apraxia in patients with Parkinson's disease (PD) and parietal ataxia suggest sensorimotor integration and action control in the parietofrontal circuits. Based on studies of the mirror neuron system, disorders in gesture production could be associated with disorders of gesture understanding. We recently reported ideomotor apraxia in association with lesions in Broca's area. Broca's area is the center of speech production, and also mediates action production. Although apraxia is not a typical clinical feature of PD, varying degrees of apraxia have been reported. The dysfunction of the motor and premotor areas, which send projections to the basal ganglia, causes this apraxia. Parietal ataxia is caused by lesions in the parietal lobe, which are thought to be caused by disconnection between the cerebellum and Brodmann area 5 in the parietal lobe.
失用症是指尽管身体具备正常的运动能力,但却无法以预期的方式执行动作或移动身体的不同部位。基于他的研究,利佩曼将失用症分为三种类型:观念性失用症、观念运动性失用症和肢体运动性失用症。诸如布洛卡区的观念运动性失用症以及帕金森病(PD)和顶叶共济失调患者的失用症等临床发现表明,顶叶-额叶回路中存在感觉运动整合和动作控制。基于对镜像神经元系统的研究,手势产生障碍可能与手势理解障碍有关。我们最近报告了与布洛卡区病变相关的观念运动性失用症。布洛卡区是言语产生的中枢,也介导动作产生。尽管失用症并非帕金森病的典型临床特征,但已有不同程度失用症的报道。向基底神经节投射的运动区和运动前区功能障碍导致了这种失用症。顶叶共济失调由顶叶病变引起,这些病变被认为是由小脑与顶叶的布罗德曼5区之间的联系中断所致。