Pierrot-Deseilligny C, Rivaud S, Pillon B, Fournier E, Agid Y
Unité INSERM U 289, Hôpital de la Salpêtrière, Paris, France.
Brain. 1989 Apr;112 ( Pt 2):471-87. doi: 10.1093/brain/112.2.471.
Lateral visually-guided saccades were studied electro-oculographically in 40 patients with progressive supranuclear palsy (PSP) in order to increase understanding of the pathophysiology of the oculomotor syndrome and the suprareticular control of saccades. In the two main paradigms used, the central fixation point was removed just before the appearance of a lateral target, the subject being told either to look at the target (gap task) or, particularly to test frontal lobe influence, in the direction opposite to the target (antisaccade task). Saccade latency distribution in the gap task was significantly more scattered in patients as compared with 40 normal control subjects, although mean latencies did not differ greatly. In particular, many patients had latencies shorter or longer than those of control subjects. In the PSP group, the percentage of errors in the antisaccade task (misdirected saccades made towards the target) was strongly correlated with latency in the gap task, high percentages of errors corresponding to short latencies. There was also a correlation between latency and the frontal dysfunction evaluated by neuropsychological tests. These correlations suggest that short latencies could result from a severe impairment of the frontal inhibitory system involved in saccade initiation. Long latencies would result from damage to diverse excitatory suprareticular pathways (such as the superior colliculus) or to circuits responsible for shifts in visual attention. Lastly, 20 patients were followed longitudinally (for 3-12 months). The initially great intersubject variability of saccade latency in the gap task significantly decreased over a period of several months. This finding could result from a secondary balance between the impairment of the frontal inhibitory system and that of the diverse excitatory pathways.
为了增进对动眼综合征病理生理学以及扫视超网状控制的理解，对40例进行性核上性麻痹（PSP）患者进行了眼电图研究，以观察外侧视觉引导的扫视。在两种主要的实验范式中，在外侧目标出现前，中央注视点消失，告知受试者要么看向目标（间隙任务），要么特别是为了测试额叶影响，看向与目标相反的方向（反扫视任务）。与40名正常对照受试者相比，PSP患者在间隙任务中的扫视潜伏期分布明显更分散，尽管平均潜伏期差异不大。特别是，许多患者的潜伏期比对照受试者短或长。在PSP组中，反扫视任务中的错误百分比（向目标的错误定向扫视）与间隙任务中的潜伏期密切相关，高错误百分比对应短潜伏期。潜伏期与通过神经心理学测试评估的额叶功能障碍之间也存在相关性。这些相关性表明，短潜伏期可能是由于参与扫视启动的额叶抑制系统严重受损所致。长潜伏期则可能是由于不同的兴奋性超网状通路（如上丘）或负责视觉注意力转移的回路受损所致。最后，对20例患者进行了纵向随访（3至12个月）。间隙任务中扫视潜伏期最初受试者间的巨大变异性在几个月内显著降低。这一发现可能是由于额叶抑制系统损伤与不同兴奋性通路损伤之间的继发性平衡所致。
