Kaji Ryuji
Department of Clinical Neuroscience, Tokushima University, Tokushima, Japan.
National Hospital Organization Utano Hospital, Kyoto, Japan.
Front Neurol. 2022 Aug 24;13:912818. doi: 10.3389/fneur.2022.912818. eCollection 2022.
Dystonia is the second most common movement disorder next to tremor, but its pathophysiology remains unsettled. Its therapeutic measures include anti-cholingerics and other medications, in addition to botulinum neurotoxin injections, and stereotaxic surgery including deep brain stimulation (DBS), but there still remain a number of patients resistant to the therapy. Evidence has been accumulating suggesting that basal ganglia in association with the cerebellum are playing a pivotal role in pathogenesis. Clinical observations such as sensory tricks and the effects of muscle afferent stimulation and blockage suggest the conflict between the cortical voluntary motor plan and the subcortical motor program or controlling the intended action semi-automatically. In this review, the current understanding of the possible pathways or loops involved in dystonia is presented, and we review promising new targets for Deep Brain Stimulation (DBS) including the cerebellum.
肌张力障碍是仅次于震颤的第二常见运动障碍，但其病理生理学仍未明确。其治疗措施包括抗胆碱能药物和其他药物，此外还有肉毒杆菌神经毒素注射以及包括深部脑刺激（DBS）在内的立体定向手术，但仍有许多患者对治疗有抵抗性。越来越多的证据表明，基底神经节与小脑共同在发病机制中起关键作用。诸如感觉技巧以及肌肉传入刺激和阻断的效果等临床观察表明，皮质自主运动计划与皮质下运动程序之间存在冲突，或者半自动控制预期动作。在本综述中，介绍了目前对肌张力障碍可能涉及的通路或环路的理解，并综述了包括小脑在内的深部脑刺激（DBS）的有前景的新靶点。
