丘脑下刺激诱发的皮质电位在人类中显示出短潜伏期的超直接通路。
Cortical Potentials Evoked by Subthalamic Stimulation Demonstrate a Short Latency Hyperdirect Pathway in Humans.
机构信息
Department of Neurology, Emory University, Atlanta, Georgia 30329,
Departments of Neurological Surgery.
出版信息
J Neurosci. 2018 Oct 24;38(43):9129-9141. doi: 10.1523/JNEUROSCI.1327-18.2018. Epub 2018 Sep 10.
A monosynaptic projection from the cortex to the subthalamic nucleus is thought to have an important role in basal ganglia function and in the mechanism of therapeutic subthalamic deep-brain stimulation, but in humans the evidence for its existence is limited. We sought physiological confirmation of the cortico-subthalamic hyperdirect pathway using invasive recording techniques in patients with Parkinson's disease (9 men, 1 woman). We measured sensorimotor cortical evoked potentials using a temporary subdural strip electrode in response to low-frequency deep-brain stimulation in patients undergoing awake subthalamic or pallidal lead implantations. Evoked potentials were grouped into very short latency (<2 ms), short latency (2-10 ms), and long latency (10-100 ms) from the onset of the stimulus pulse. Subthalamic and pallidal stimulation resulted in very short-latency evoked potentials at 1.5 ms in the primary motor cortex accompanied by EMG-evoked potentials consistent with corticospinal tract activation. Subthalamic, but not pallidal stimulation, resulted in three short-latency evoked potentials at 2.8, 5.8, and 7.7 ms in a widespread cortical distribution, consistent with antidromic activation of the hyperdirect pathway. Long-latency potentials were evoked by both targets, with subthalamic responses lagging pallidal responses by 10-20 ms, consistent with orthodromic activation of the thalamocortical pathway. The amplitude of the first short-latency evoked potential was predictive of the chronic therapeutic stimulation contact. This is the first physiological demonstration of the corticosubthalamic hyperdirect pathway and its topography at high spatial resolution in humans. We studied cortical potentials evoked by deep-brain stimulation in patients with Parkinson's disease undergoing awake lead implantation surgery. Subthalamic stimulation resulted in multiple short-latency responses consistent with activation of hyperdirect pathway, whereas no such response was present during pallidal stimulation. We contrast these findings with very short latency, direct corticospinal tract activations, and long-latency responses evoked through polysynaptic orthodromic projections. These findings underscore the importance of incorporating the hyperdirect pathway into models of human basal ganglia function.
从大脑皮层到丘脑底核的单突触投射被认为在基底神经节功能和丘脑底核深部脑刺激的机制中具有重要作用,但在人类中,其存在的证据有限。我们使用侵入性记录技术在帕金森病患者(9 名男性,1 名女性)中寻求皮质-丘脑底核超直接通路的生理证实。我们使用临时硬膜下条电极测量感觉运动皮层诱发电位,以响应在接受清醒丘脑底核或苍白球导联植入的患者中进行的低频深部脑刺激。诱发电位根据刺激脉冲的起始分为非常短潜伏期(<2 ms)、短潜伏期(2-10 ms)和长潜伏期(10-100 ms)。丘脑底核和苍白球刺激在原发性运动皮层中产生 1.5 ms 的非常短潜伏期诱发电位,同时伴有与皮质脊髓束激活一致的肌电图诱发电位。只有丘脑底核刺激而不是苍白球刺激在广泛的皮质分布中产生三个短潜伏期诱发电位,潜伏期为 2.8、5.8 和 7.7 ms,与超直接通路的逆行激活一致。长潜伏期诱发电位由两个靶点引起,丘脑底核反应滞后于苍白球反应 10-20 ms,与丘脑皮质通路的顺行激活一致。第一个短潜伏期诱发电位的幅度可预测慢性治疗性刺激接触。这是首次在人类中以高空间分辨率对皮质-丘脑底核超直接通路及其拓扑结构进行的生理学证明。我们研究了在接受清醒导联植入手术的帕金森病患者中,深部脑刺激引起的皮质电位。丘脑底核刺激产生多个与超直接通路激活一致的短潜伏期反应,而苍白球刺激则没有。我们将这些发现与非常短潜伏期的直接皮质脊髓束激活以及通过多突触顺行投射引起的长潜伏期反应进行对比。这些发现强调了将超直接通路纳入人类基底神经节功能模型的重要性。
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