足底皮肤振动觉受损是否导致帕金森病的轴性运动症状？药物治疗和丘脑底核深部脑刺激的影响。
Does Impaired Plantar Cutaneous Vibration Perception Contribute to Axial Motor Symptoms in Parkinson's Disease? Effects of Medication and Subthalamic Nucleus Deep Brain Stimulation.
作者信息
Heß Tobias, Themann Peter, Oehlwein Christian, Milani Thomas L
机构信息
Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany.
Department of Neurology and Parkinson, Clinic at Tharandter Forest, 09633 Halsbruecke, Germany.
出版信息
Brain Sci. 2023 Dec 6;13(12):1681. doi: 10.3390/brainsci13121681.
OBJECTIVE
To investigate whether impaired plantar cutaneous vibration perception contributes to axial motor symptoms in Parkinson's disease (PD) and whether anti-parkinsonian medication and subthalamic nucleus deep brain stimulation (STN-DBS) show different effects.
METHODS
Three groups were evaluated: PD patients in the medication "on" state (PD-MED), PD patients in the medication "on" state and additionally "on" STN-DBS (PD-MED-DBS), as well as healthy subjects (HS) as reference. Motor performance was analyzed using a pressure distribution platform. Plantar cutaneous vibration perception thresholds (VPT) were investigated using a customized vibration exciter at 30 Hz.
RESULTS
Motor performance of PD-MED and PD-MED-DBS was characterized by greater postural sway, smaller limits of stability ranges, and slower gait due to shorter strides, fewer steps per minute, and broader stride widths compared to HS. Comparing patient groups, PD-MED-DBS showed better overall motor performance than PD-MED, particularly for the functional limits of stability and gait. VPTs were significantly higher for PD-MED compared to those of HS, which suggests impaired plantar cutaneous vibration perception in PD. However, PD-MED-DBS showed less impaired cutaneous vibration perception than PD-MED.
CONCLUSIONS
PD patients suffer from poor motor performance compared to healthy subjects. Anti-parkinsonian medication in tandem with STN-DBS seems to be superior for normalizing axial motor symptoms compared to medication alone. Plantar cutaneous vibration perception is impaired in PD patients, whereas anti-parkinsonian medication together with STN-DBS is superior for normalizing tactile cutaneous perception compared to medication alone. Consequently, based on our results and the findings of the literature, impaired plantar cutaneous vibration perception might contribute to axial motor symptoms in PD.
目的
探讨足底皮肤振动觉受损是否会导致帕金森病（PD）的轴性运动症状，以及抗帕金森药物和丘脑底核深部脑刺激（STN-DBS）是否有不同的效果。
方法
评估三组对象：处于药物“开”状态的PD患者（PD-MED）、处于药物“开”状态且同时进行STN-DBS的PD患者（PD-MED-DBS），以及作为对照的健康受试者（HS）。使用压力分布平台分析运动表现。使用定制的振动刺激器在30Hz频率下研究足底皮肤振动觉阈值（VPT）。
结果
与HS相比，PD-MED和PD-MED-DBS的运动表现特征为姿势摆动更大、稳定范围限制更小、步态更慢，原因是步幅更短、每分钟步数更少且步幅更宽。比较患者组，PD-MED-DBS的整体运动表现优于PD-MED，尤其是在稳定性和步态的功能限制方面。与HS相比，PD-MED的VPT显著更高，这表明PD患者足底皮肤振动觉受损。然而，PD-MED-DBS的皮肤振动觉受损程度低于PD-MED。
结论
与健康受试者相比，PD患者的运动表现较差。与单独使用药物相比，抗帕金森药物联合STN-DBS在使轴性运动症状正常化方面似乎更具优势。PD患者的足底皮肤振动觉受损，而与单独使用药物相比，抗帕金森药物联合STN-DBS在使触觉皮肤感觉正常化方面更具优势。因此，根据我们的研究结果和文献发现，足底皮肤振动觉受损可能导致PD的轴性运动症状。
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