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多巴胺对帕金森病患者姿势控制的影响:缩放、定势和张力。

Effects of dopamine on postural control in parkinsonian subjects: scaling, set, and tone.

作者信息

Horak F B, Frank J, Nutt J

机构信息

R.S. Dow Neurological Sciences Insitute, Portland, Oregon 97209, USA.

出版信息

J Neurophysiol. 1996 Jun;75(6):2380-96. doi: 10.1152/jn.1996.75.6.2380.

DOI:10.1152/jn.1996.75.6.2380
PMID:8793751
Abstract
  1. This study investigates the effects of parkinsonism and of dopamine replacement therapy (levodopa) on scaling the magnitude of automatic postural responses based on sensory feedback and on predictive central set. Surface reactive torques and electromyographic (EMG) activity in response to backward surface translations were compared in patients with parkinsonism ON and OFF levodopa and in elderly control subjects. Correlations between the earliest postural responses [initial rate of change of torque and integrated EMG (IEMG)] and translation velocity provided a measure of postural magnitude scaling using somatosensory feedback. Correlations of responses with expected translation amplitude provided a measure of scaling dependent on predictive central set because the responses preceded amplitude completion. 2. Parkinsonian EMG responses in six leg and trunk muscles were not later than in elderly control subjects. In fact, quadriceps antagonist latencies were earlier than normal, resulting in coactivation at the knee not present in control subjects. EMG activation was fragmented, with short burst durations and high tonic levels that often returned to baseline with multiple bursts. In addition, parkinsonian responses showed smaller-than-normal agonist extensor bursts and larger-than-normal activation in tibialis and rectus femorus antagonist flexors. 3. Although parkinsonian subjects scaled postural responses to both displacement velocities and amplitudes, their torque response were smaller than those of elderly controls, especially in response to the largest displacement amplitudes. The gain (slope) of postural response magnitude scaling to displacement velocity was similar for parkinsonian and control subjects, although parkinsonian subjects had smaller torques. Parkinsonian subjects were also able to use prediction to scale responses to small expected displacement amplitudes, but many patients did not generate the larger plantarflexion torques required at larger displacement amplitudes. Reduced torque at large amplitudes was associated with less agonist gastrocnemius IEMG, increased tibialis antagonist burst responses, and increased tibialis tonic background activity. 4. Levodopa further reduced the already low magnitude of initial torque and IEMG responses to displacement velocities and amplitudes in parkinsonian patients. The ability to scale postural responses to velocity feedback was not affected by levodopa, but the ability to scale responses to large displacement amplitudes based on central set was worsened by levodopa. Levodopa also significantly reduced the tonic, background levels of EMG, particularly the distal gastrocnemius and tibialis activity. 5. High baseline muscle tone was apparent in parkinsonian subjects from their high background EMG activity in quiet stance, especially in tibialis and quadriceps, and the slow initial velocity of center of mass falling in response to displacements. By reducing tone, levodopa reduced passive stiffness to perturbations without increasing EMG burst magnitudes, resulting in less resistance to external displacements and thus faster center of body mass (COM) displacements. 6. The biggest postural deficit in parkinsonian subjects was not in response latency, pattern, or reactive or predictive scaling of response magnitude, but in quickly generating an adequate level of postural force. Dopamine improved tonic background postural tone but further weakened automatic postural responses to external displacements. Thus the basal ganglia may participate in postural control by regulating appropriate levels of background postural tone and by enabling adequate force generation for resisting external displacements.
摘要
  1. 本研究调查帕金森病及多巴胺替代疗法(左旋多巴)对基于感觉反馈和预测性中枢定势来调整自动姿势反应幅度的影响。比较了帕金森病患者服用左旋多巴和未服用左旋多巴时以及老年对照受试者对向后表面平移的表面反应性扭矩和肌电图(EMG)活动。最早姿势反应[扭矩的初始变化率和积分肌电图(IEMG)]与平移速度之间的相关性提供了一种利用体感反馈来衡量姿势幅度调整的方法。反应与预期平移幅度之间的相关性提供了一种依赖于预测性中枢定势的调整衡量方法,因为反应先于幅度完成。2. 帕金森病患者六条腿部和躯干肌肉的肌电图反应并不比老年对照受试者晚。事实上,股四头肌拮抗剂的潜伏期比正常情况更早,导致对照组中不存在的膝关节共同激活。肌电图激活是碎片化的,爆发持续时间短且紧张性水平高,常常通过多次爆发恢复到基线水平。此外,帕金森病患者的反应显示出比正常情况更小的主动肌伸肌爆发以及比正常情况更大的胫骨前肌和股直肌拮抗剂屈肌激活。3. 尽管帕金森病患者能根据位移速度和幅度调整姿势反应,但他们的扭矩反应比老年对照组小,尤其是对最大位移幅度的反应。帕金森病患者和对照受试者对位移速度的姿势反应幅度调整增益(斜率)相似,尽管帕金森病患者的扭矩较小。帕金森病患者也能够利用预测来调整对小预期位移幅度的反应,但许多患者在较大位移幅度时无法产生所需的更大跖屈扭矩。大振幅时扭矩降低与主动肌腓肠肌IEMG减少、胫骨前肌拮抗剂爆发反应增加以及胫骨前肌紧张性背景活动增加有关。4. 左旋多巴进一步降低了帕金森病患者对位移速度和幅度的初始扭矩和IEMG反应的本已较低的幅度。根据速度反馈调整姿势反应的能力不受左旋多巴影响,但基于中枢定势对大位移幅度反应的调整能力因左旋多巴而变差。左旋多巴还显著降低了肌电图的紧张性、背景水平,尤其是远端腓肠肌和胫骨前肌的活动。5. 帕金森病患者在安静站立时高背景肌电图活动显示出高基线肌张力,尤其是在胫骨前肌和股四头肌,以及对位移反应时质心下降的初始速度较慢。通过降低肌张力,左旋多巴降低了对扰动的被动刚度,而不增加肌电图爆发幅度,导致对外部位移的阻力减小,从而使身体重心(COM)位移更快。6. 帕金森病患者最大的姿势缺陷不在于反应潜伏期、模式或反应幅度的反应性或预测性调整,而在于快速产生足够水平的姿势力。多巴胺改善了紧张性背景姿势张力,但进一步削弱了对外部位移的自动姿势反应。因此,基底神经节可能通过调节适当水平的背景姿势张力以及通过使能产生足够的力来抵抗外部位移而参与姿势控制。

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