帕金森病患者丘脑底核的微电极定位技术

Microrecording techniques for subthalamic nucleus targeting in patients with Parkinson's disease

目的 研究帕金森病(PD)患者丘脑底核(STN)及其邻近结构神经元电活动的特点,指导手术靶点的准确定位。方法 30例PD患者在行STN电极埋植(8例)或毁损术(22例)时,应用微电极和EMG记录技术,采集STN及其邻近结构的细胞外电活动和肢体的EMG活动。分析其电活动的特点。结果 在31个记录针道中,共记录到388个STN神经元,其中14%呈紧张性放电,28%呈规律性簇状放电,58%呈不规则或簇状放电。放电频率20～50Hz,平均42.2±11.6Hz。确认震颤细胞,节律为3.8～6Hz,与肢体震颤密切相关(r=0.63,P<0.01)。多数(82%)震颤细胞位于STN中上部分。黑质神经元呈均匀的紧张性放电,放电频率72.5±17.9Hz。结论 STN及其邻近结构存在特征性的电活动,微电极记录技术为STN手术的精确定位提供了可靠的技术保证。

Objective To investigate the electrophysiological characteristics within and around subthalamic nucleus(STN) in patients with Parkinson's disease(PD) for accurate targeting of STN surgery. Methods Extracellular microrecording was performed intraoperatively in 30 PD patients who underwent unilateral subthalamotomy ( n =22) and implantation ( n =8) of deep brain stimulation(DBS). The electromyogram (EMG) of contralateral limb of surgery was recorded simultaneously. Single unit analysis and relationship between neuronal firing patterns, frequency, rhythmic and limbic tremor were carried out.Results In 31 recording trajectories, 388 STN neurons were identified. An irregular or bursty discharge pattern at a frequency range of 20~50 Hz was seen in 225 neurons (58%). While a tonic discharge pattern showed in 55 neurons(14%). 108 neurons bursting at a limbic tremor rhythm were identified as “tremor cells”. Most of those tremor cells were located in the dorsal half portion of STN.The average rate of neuronal firing in STN was 42.2±11.6 Hz. Ventral to STN, 45 STN neurons showed a more regular tonic firing at a mean discharge rate of 72.5±17.9 Hz.Conclusions There are typical electrophysiological characteristics of neuronal firing within STN and its adjacent area. Microrecording techniques assure the precisely targeting of STN surgery.