Lu Ming-Kuei, Chiou Shang-Ming, Ziemann Ulf, Huang Hui-Chun, Yang Yu-Wan, Tsai Chon-Haw
Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan; School of Medicine, Medical College, China Medical University, Taichung, Taiwan; Graduate Institute of Neural and Cognitive Science, China Medical University, Taichung, Taiwan.
School of Medicine, Medical College, China Medical University, Taichung, Taiwan; Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan.
Clin Neurophysiol. 2015 Dec;126(12):2330-6. doi: 10.1016/j.clinph.2015.02.010. Epub 2015 Feb 28.
The pathogenesis of tremor in Parkinson's disease (PD) and essential tremor (ET) is not fully understood. This study tested the role of primary motor cortex (M1), supplementary motor area (SMA) and cerebellar cortex on PD and ET tremor by single- and paired-pulse transcranial magnetic stimulation (TMS).
Ten PD patients with resting tremor, six of them also with postural tremor, and ten ET patients with postural tremor were studied. Randomized single- and paired-pulse TMS with an interstimulus interval of 100 ms were delivered over M1, SMA and cerebellum. TMS effects were evaluated by calculating a tremor-resetting index (RI).
Single- vs. paired-pulse TMS showed no difference. M1-TMS and SMA-TMS but not by cerebellar TMS induced a significant RI in PD and ET. M1-TMS resulted in a significantly higher RI in PD than ET. Furthermore, M1-TMS in PD but not in ET resulted in a significantly higher RI than SMA-TMS.
Findings suggest a stronger involvement of M1 in resting and postural tremor in PD than postural tremor in ET.
RI provides a useful marker to explore the differential functional role of M1, SMA and cerebellum in PD vs. ET tremor.
帕金森病（PD）和特发性震颤（ET）震颤的发病机制尚未完全明确。本研究通过单脉冲和双脉冲经颅磁刺激（TMS）测试初级运动皮层（M1）、辅助运动区（SMA）和小脑皮层在PD和ET震颤中的作用。
研究了10例有静止性震颤的PD患者，其中6例也有姿势性震颤，以及10例有姿势性震颤的ET患者。在M1、SMA和小脑上施加随机的单脉冲和双脉冲TMS，刺激间隔为100毫秒。通过计算震颤重置指数（RI）评估TMS效应。
单脉冲与双脉冲TMS无差异。M1-TMS和SMA-TMS而非小脑TMS在PD和ET中诱导出显著的RI。M1-TMS在PD中导致的RI显著高于ET。此外，PD中的M1-TMS而非ET中的M1-TMS导致的RI显著高于SMA-TMS。
研究结果表明，M1在PD的静止性和姿势性震颤中的参与程度比ET的姿势性震颤更强。
RI为探索M1、SMA和小脑在PD与ET震颤中的不同功能作用提供了一个有用的标志物。
