早期帕金森病患者肌强直增强现象的TMS-MEP研究

Study on muscle rigidity enhancement phenomenon by TMS-MEP in patients with early Parkinson's disease

运用经颅磁刺激(TMS)研究早期帕金森病(PD)患者肌强直增强现象相关的运动诱发电位(MEP)幅度变化,探讨其可能机制。研究对象为偏侧(右侧)肢体运动障碍为主的早期PD患者(PD组)10例,健康志愿者(对照组)10例。与对侧肢体静止状态下比较,对侧肢体用力握拳时两组拇短展肌MEP波幅均增大,且其增幅随着握拳力量增大而增大。TMS阈强度刺激,在20%、40%、60%左手最大握力(MVC)握拳时PD组对侧肢体用力握拳时MEP幅度/静止状态下MEP幅度(AMPa/AMPr)显著低于对照组(P<0.05)。提示早期PD患者肌强直增强现象可能与相应运动皮层兴奋性变化有关。

To investigate the alteration of motor evoked potentials related to the phenomenon of rigidity enhancement in Parkinson＇s disease by transcranial magnetic stimulation,and to explore its possible mechanism. 10 patients with early Parkinson＇s disease（ PD group） with unilateral rigidity and 10 healthy volunteers（ control group） were enrolled in this study. The MEP amplitudes of right abductor pollicis brevis in both groups were increased during active contraction of contralateral hand（ clenching fists） in comparison to resting state under serial TMS intensities.The MEP amplitudes increased with the escalation of contraction forces of contralateral hand. Under threshold intensity stimulation of TMS,the ratio of amplitude of MEP under contraction（ AMPa） to that under relaxation（ AMPr）（ AMPa/AMPr） were significantly lower in the PD group than that of control group while the contralateral hand maintained contraction with 20%,40%,60% MVC（ P〈0. 05 at all force levels）. The phenomenon of rigidity enhancement may be related to the alterations of excitability of motor cortex.