Pullman S L, Elibol B, Fahn S
Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY.
Neurology. 1994 Oct;44(10):1861-4. doi: 10.1212/wnl.44.10.1861.
We analyzed rest and postural hand tremors in a Parkinson's disease patient who developed and recovered from a right radial nerve palsy at the spiral groove, and found that, despite complete paralysis of all extensors below the elbow, tremor frequencies remained unchanged while tremor amplitudes actually increased. This provides compelling evidence for a central generation of parkinsonian tremor frequency that is not influenced by the effects of peripheral modulation. In addition, the increase in tremor amplitudes may be due to disinhibited flexor activity caused by normally operating spinal segmental mechanisms interacting with central tremor generators programmed to alternate between antagonist muscles. Peripheral treatment of tremors--with muscle paralysis or botulinum toxin, for example--therefore may not be effective in stopping tremor oscillations in Parkinson's disease and may even worsen tremor amplitudes if all antagonists of a tremoring joint are not treated equally.
我们分析了一名帕金森病患者的静止性和姿势性手部震颤情况，该患者在螺旋沟处发生右侧桡神经麻痹并恢复。我们发现，尽管肘部以下所有伸肌完全麻痹，但震颤频率保持不变，而震颤幅度实际上却增加了。这为帕金森震颤频率的中枢产生提供了令人信服的证据，该频率不受外周调节作用的影响。此外，震颤幅度的增加可能是由于正常运作的脊髓节段机制与被编程为在拮抗肌之间交替的中枢震颤发生器相互作用，导致屈肌活动去抑制所致。因此，例如用肌肉麻痹或肉毒杆菌毒素进行外周震颤治疗，可能无法有效阻止帕金森病中的震颤振荡，而且如果震颤关节的所有拮抗肌没有得到同等治疗，甚至可能使震颤幅度恶化。
