原发性抽动障碍中自动但完整的意志抑制受损。
Impaired automatic but intact volitional inhibition in primary tic disorders.
机构信息
Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, Queen Square, London, UK.
出版信息
Brain. 2020 Mar 1;143(3):906-919. doi: 10.1093/brain/awaa024.
The defining character of tics is that they can be transiently suppressed by volitional effort of will, and at a behavioural level this has led to the concept that tics result from a failure of inhibition. However, this logic conflates the mechanism responsible for the production of tics with that used in suppressing them. Volitional inhibition of motor output could be increased to prevent the tic from reaching the threshold for expression, although this has been extensively investigated with conflicting results. Alternatively, automatic inhibition could prevent the initial excitation of the striatal tic focus-a hypothesis we have previously introduced. To reconcile these competing hypotheses, we examined different types of motor inhibition in a group of 19 patients with primary tic disorders and 15 healthy volunteers. We probed proactive and reactive inhibition using the conditional stop-signal task, and applied transcranial magnetic stimulation to the motor cortex, to assess movement preparation and execution. We assessed automatic motor inhibition with the masked priming task. We found that volitional movement preparation, execution and inhibition (proactive and reactive) were not impaired in tic disorders. We speculate that these mechanisms are recruited during volitional tic suppression, and that they prevent expression of the tic by inhibiting the nascent excitation released by the tic generator. In contrast, automatic inhibition was abnormal/impaired in patients with tic disorders. In the masked priming task, positive and negative compatibility effects were found for healthy controls, whereas patients with tics exhibited strong positive compatibility effects, but no negative compatibility effect indicative of impaired automatic inhibition. Patients also made more errors on the masked priming task than healthy control subjects and the types of errors were consistent with impaired automatic inhibition. Errors associated with impaired automatic inhibition were positively correlated with tic severity. We conclude that voluntary movement preparation/generation and volitional inhibition are normal in tic disorders, whereas automatic inhibition is impaired-a deficit that correlated with tic severity and thus may constitute a potential mechanism by which tics are generated.
抽动的特征是可以通过意志的努力暂时抑制,从行为水平上看,这导致了抽动是由于抑制失败而产生的概念。然而,这种逻辑将产生抽动的机制与抑制它们的机制混淆了。运动输出的意志抑制可以增加以防止抽动达到表达的阈值,尽管这已经被广泛研究过,但结果相互矛盾。或者,自动抑制可以防止纹状体抽动焦点的初始兴奋——这是我们之前提出的假设。为了调和这些相互竞争的假设,我们在一组 19 名原发性抽动障碍患者和 15 名健康志愿者中检查了不同类型的运动抑制。我们使用条件停止信号任务探测了前摄和反应性抑制,并用经颅磁刺激作用于运动皮层,以评估运动准备和执行。我们使用掩蔽启动任务评估自动运动抑制。我们发现,原发性抽动障碍患者的意志运动准备、执行和抑制(前摄和反应性)没有受损。我们推测,这些机制在意志性抽动抑制中被募集,并通过抑制抽动发生器释放的新生兴奋来防止抽动的表达。相比之下,自动抑制在抽动障碍患者中异常/受损。在掩蔽启动任务中,健康对照组存在正性和负性相容性效应,而抽动障碍患者表现出强烈的正性相容性效应,但没有负性相容性效应,表明自动抑制受损。患者在掩蔽启动任务中的错误也比健康对照组多,且错误类型与自动抑制受损一致。与自动抑制受损相关的错误与抽动严重程度呈正相关。我们得出结论,原发性抽动障碍患者的意志运动准备/产生和意志抑制正常,而自动抑制受损——这一缺陷与抽动严重程度相关,因此可能构成抽动产生的潜在机制。
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