Obeso J A, Rothwell J C, Marsden C D
Brain. 1985 Mar;108 ( Pt 1):193-24. doi: 10.1093/brain/108.1.193.
The purpose of this paper is to draw attention to the wide range of clinical motor phenomena which may be caused by abnormal sensorimotor cortical discharge. Eleven selected patients with cortical myoclonus are described. In all cases the brief muscle jerks appeared to involve cerebral cortical mechanisms, for there were enlarged cerebral evoked potentials to somatosensory or visual stimuli and (in 5 of the 6 cases investigated in this way) a time-locked cortical event preceded spontaneous or action-induced jerking. In some patients, cortical myoclonus occurred only in response to a variety of afferent inputs (cortical reflex myoclonus). In others, the myoclonus occurred only during movement, when cortical mechanisms were activated voluntarily (cortical action myoclonus), or the cortical discharge occurred spontaneously (spontaneous cortical myoclonus and epilepsia partialis continua), and even spread to cause focal motor epilepsy (Jacksonian seizures). Some patients showed combinations of stimulus sensitive and spontaneous myoclonus, epilepsia partialis continua, focal motor epilepsy and generalized grand mal seizures. Such variations probably represent subtle differences in the site of abnormality in sensorimotor cortical neuronal mechanisms.
本文旨在引起人们对由异常感觉运动皮层放电可能导致的广泛临床运动现象的关注。描述了11例选定的皮质肌阵挛患者。在所有病例中，短暂的肌肉抽搐似乎涉及大脑皮层机制，因为对体感或视觉刺激有扩大的脑诱发电位，并且（在以这种方式研究的6例中的5例）在自发或动作诱发的抽搐之前有一个时间锁定的皮层事件。在一些患者中，皮质肌阵挛仅在对各种传入输入作出反应时发生（皮质反射性肌阵挛）。在其他患者中，肌阵挛仅在运动期间发生，此时皮层机制被主动激活（皮质动作性肌阵挛），或者皮层放电自发发生（自发性皮质肌阵挛和持续性部分性癫痫），甚至扩散导致局灶性运动性癫痫（杰克逊癫痫发作）。一些患者表现出刺激敏感性和自发性肌阵挛、持续性部分性癫痫、局灶性运动性癫痫和全身性大发作的组合。这些变化可能代表感觉运动皮层神经元机制异常部位的细微差异。
