Vanbellingen Tim, Wapp Manuela, Stegmayer Katharina, Bertschi Manuel, Abela Eugenio, Kübel Stefanie, Nyffeler Thomas, Müri René, Walther Sebastian, Nef Tobias, Hallett Mark, Bohlhalter Stephan
Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Lucerne, Switzerland.
Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, Bern, Switzerland.
J Neural Transm (Vienna). 2016 Dec;123(12):1387-1393. doi: 10.1007/s00702-016-1614-6. Epub 2016 Sep 12.
Dorsal pre-motor cortex (PMd) is thought to play a role in fine motor control. The aim of the present study was to investigate whether inhibitory or excitatory stimulation of PMd would have an impact on manual dexterity in Parkinson's disease (PD). Fifteen patients with PD participated in this study. High resolution structural MRI was used for neuro-navigated TBS. Participants were targeted with one train of TBS in three experimental sessions: sham stimulation over vertex, continuous TBS (cTBS) over PMd and intermittent TBS (iTBS) over PMd, respectively. Dexterity was measured by a coin rotation task (CRT), which is a valid measure to detect limb kinetic apraxia (LKA). Neither cTBS or iTBS significantly interfered with CRT. Post hoc sub-analysis in a group of PD patients (n = 5) with stronger baseline impairment, indicating LKA, revealed further deterioration of dexterous performance for the cTBS condition (p = 0.04). This sham controlled pilot study demonstrates that TBS over PMd does not significantly interfere with dexterity in PD. However, patients with dexterous impairment qualifying for LKA may be more susceptible to TBS.
背侧运动前区皮质（PMd）被认为在精细运动控制中发挥作用。本研究的目的是调查对PMd进行抑制性或兴奋性刺激是否会对帕金森病（PD）患者的手部灵活性产生影响。15名PD患者参与了本研究。高分辨率结构MRI用于神经导航经颅磁刺激（TBS）。在三个实验环节中，对参与者施加一组TBS：分别在头顶进行假刺激、在PMd进行连续TBS（cTBS）以及在PMd进行间歇性TBS（iTBS）。通过硬币旋转任务（CRT）测量灵活性，这是检测肢体运动性失用症（LKA）的有效指标。cTBS和iTBS均未显著干扰CRT。在一组基线损伤较重、提示存在LKA的PD患者（n = 5）中进行的事后亚分析显示，cTBS条件下的灵巧表现进一步恶化（p = 0.04）。这项有假刺激对照的初步研究表明，对PMd进行TBS不会显著干扰PD患者的灵活性。然而，符合LKA标准的手部灵巧性受损患者可能对TBS更敏感。
