Kato M
Department of Neurology, Yamaguchi University School of Medicine.
Rinsho Shinkeigaku. 1997 Nov;37(11):969-75.
Magnetic stimulation (MS) was performed in 9 patients with clinically diagnosed corticobasal degeneration (CBD), 10 patients with Parkinson's disease (PD) (under L-dopa therapy) and 10 age-matched healthy subjects (HS). Motor evoked potentials (MEPs) were recorded from the abductor pollicis brevis muscle (APB) in response to cortical stimulation and cervical stimulation (C7). In all patients with CBD, the duration of inhibitory period (IP), which was a transient suppression of muscle action potentials following MEPs by cortical stimulation, was significantly shorter than that in PD and HS. In 4 patients with CBD who presented with focal and distal myoclonus of one limb, long latency reflexes following electrical stimulation of the median nerve showed C-reflex, which had a latency of about 40 ms, but a giant SEP and a jerk-locked cortical potential were not demonstrated. With cervical MS, these 4 patients also showed long-latency (about 30 ms) evoked potentials (LEPs), which were much greater in latency from cervical stimulation-induced MEPs (cervical MEPs). LEPs may be mediated via a transcortical loop, because the sum of the latency of C-reflex and compound muscle action potential approximates that of LEP and cervical MEP. In patients with CBD, these findings suggest disturbance within the basal ganglia-thalamocortical motor circuit and a damage of the motor cortices including the primary motor cortex, premotor cortex and supplementary motor cortex.
对9例临床诊断为皮质基底节变性(CBD)的患者、10例帕金森病(PD)患者(接受左旋多巴治疗)和10名年龄匹配的健康受试者(HS)进行了磁刺激(MS)。记录拇短展肌(APB)对皮质刺激和颈部刺激(C7)的运动诱发电位(MEP)。在所有CBD患者中,抑制期(IP)的持续时间,即皮质刺激后MEP引起的肌肉动作电位的短暂抑制,明显短于PD患者和HS。在4例出现单肢局灶性和远端肌阵挛的CBD患者中,正中神经电刺激后的长潜伏期反射显示出潜伏期约为40 ms的C反射,但未显示出巨大体感诱发电位(SEP)和抽搐锁定皮质电位。进行颈部磁刺激时,这4例患者还显示出长潜伏期(约30 ms)的诱发电位(LEP),其潜伏期比颈部刺激诱发的MEP(颈部MEP)长得多。LEP可能通过皮质环路介导,因为C反射潜伏期与复合肌肉动作电位潜伏期之和近似于LEP和颈部MEP的潜伏期之和。在CBD患者中,这些发现提示基底节-丘脑皮质运动环路存在紊乱,以及包括初级运动皮质、运动前皮质和辅助运动皮质在内的运动皮质受损。