Department of Neurology, University of Florida, Gainesville, Florida, USA.
Department of Neurology, University of California, San Francisco, California, USA.
J Neurol Neurosurg Psychiatry. 2018 Dec;89(12):1296-1300. doi: 10.1136/jnnp-2017-317098. Epub 2018 Jan 11.
Subthalamic nucleus deep brain stimulation (STN DBS) surgery is clinically effective for treatment of cervical dystonia; however, the underlying physiology has not been examined. We used transcranial magnetic stimulation (TMS) to examine the effects of STN DBS on sensorimotor integration, sensorimotor plasticity and motor cortex excitability, which are identified as the key pathophysiological features underlying dystonia.
TMS paradigms of short latency afferent inhibition (SAI) and long latency afferent inhibition (LAI) were used to examine the sensorimotor integration. Sensorimotor plasticity was measured with paired associative stimulation paradigm, and motor cortex excitability was examined with short interval intracortical inhibition and intracortical facilitation. DBS was turned off and on to record these measures.
STN DBS modulated SAI and LAI, which correlated well with the acute clinical improvement. While there were no changes seen in the motor cortex excitability, DBS was found to normalise the sensorimotor plasticity; however, there was no clinical correlation.
Modulation of sensorimotor integration is a key contributor to clinical improvement with acute stimulation of STN. Since the motor cortex excitability did not change and the change in sensorimotor plasticity did not correlate with clinical improvement, STN DBS demonstrates restricted effects on the underlying physiology.
NCT01671527.
丘脑底核深部脑刺激（STN DBS）手术对治疗颈肌张力障碍具有临床疗效；然而，其潜在的生理学机制尚未得到研究。我们使用经颅磁刺激（TMS）来检查 STN DBS 对感觉运动整合、感觉运动可塑性和运动皮层兴奋性的影响，这些被认为是肌张力障碍的关键病理生理学特征。
使用短潜伏期传入抑制（SAI）和长潜伏期传入抑制（LAI）的 TMS 范式来检查感觉运动整合。使用成对关联刺激范式测量感觉运动可塑性，使用短间隔皮质内抑制和皮质内易化来检查运动皮层兴奋性。记录这些测量值时，关闭和开启 DBS。
STN DBS 调节 SAI 和 LAI，与急性临床改善密切相关。虽然运动皮层兴奋性没有变化，但 DBS 发现可以使感觉运动可塑性正常化；然而，这与临床改善没有相关性。
感觉运动整合的调节是 STN 急性刺激改善临床的关键因素。由于运动皮层兴奋性没有改变，并且感觉运动可塑性的变化与临床改善没有相关性，因此 STN DBS 对潜在的生理学显示出有限的作用。
NCT01671527。
