原发性痉挛性斜颈感觉运动整合的研究进展

肌张力障碍是一种不自主、持续性肌肉收缩引起的扭曲、重复运动或姿势异常的综合征,其病理生理机制尚不明确。根据其症状分布,可以分为：局灶型、节段型、多灶型、全身型和偏身型。痉挛性斜颈（spasmodic torticollis）是成人发病的局灶性肌张力障碍中最常见的一种,可表现为头颈部不自主的扭转、侧倾、前屈和后仰,常伴有姿势性震颤及相应肌肉的痉挛性疼痛,通常可累及胸锁乳突肌、头夹肌、     

书写痉挛患者感觉运动整合功能的异常

书写痉挛患者发病机制仍不明确,神经电生理和神经影像学的研究揭示了感觉运动整合的异常在其中起到重要的作用,并为其治疗提供了新的可能.     

经颅磁刺激结合运动训练与局灶性脑梗死大鼠健侧感觉运动皮质锥体细胞树突和突触结构的改变

经颅磁刺激联合运动训练对脑梗死后健侧大脑感觉运动皮质突触和锥体细胞影响的报道几乎未见,实验拟揭示经颅磁刺激和运动训练促进脑梗死后运动功能恢复的机制。结果显示,经颅磁刺激和运动训练均能改善脑梗死大鼠神经功能,能使动物健侧感觉运动皮质锥体细胞突触界面曲率增加,突触后致密物厚度增加、突触间隙变窄,穿孔突触比例增加。经过4周经颅磁刺激和运动训练后脑梗死大鼠健侧感觉运动皮质区锥体细胞树突总长度、 一级数突分支和单位长度树突的树突棘密度明显增加,这些变化在经颅磁刺激和运动训练联合后更为明显。表明经颅磁刺激和运动训练治疗可以使健侧感觉运动皮质锥体细胞树突和突触结构参数发生改变,从而促使健侧脑的代偿作用,改善脑梗死大鼠的神经功能。     

脑血管病患者涨颅磁刺激运动诱发电位的研究

采用经颅磁刺激运动诱发电位（ＭＥＰ）对７２例脑血管病（ＣＶＤ）患者５０例正常人进行检测。结果：ＣＶＤ患者瘫痪侧上肢磁刺激无反应或皮层潜伏期和中枢传导时间（ＣＭＣＴ）较正常对照组和健侧显著延长（Ｐ〈０．００１）；瘫痪侧下肢磁刺激无反应或ＣＭＣＴ较正常对照组和健侧显著延长（Ｐ〈０．０５）。脑出血与脑梗塞患者ＭＥＰ异常率无显著差异（Ｐ〉０．０５），而与临床病情轻重和病变部位密切相关。提示ＭＥＰ能客观反应     

癫痫患者经颅磁刺激的安全性观察

评估癫痫患者经颅磁刺激激的安全性。方法以单脉冲磁刺激检测３５例癫痫患者和３０例对照组的双侧运动传导通路,依次刺激肘部,锁骨上窝,第７颈椎和运动皮质诸部位,周围段刺激间隔≥３秒,皮质刺激间隔≥１０秒,每部位刺激总数≤１２次,记录运动诱发电位。结论单脉冲磁刺激对癫患者是一种安全的电生理检测手段,可应用于研究癫痫的病理生理,指导抗癫痫药物的应用。     

经颅磁刺激在强迫症治疗中的研究进展

尽管经颅磁刺激已被广泛应用于强迫症的治疗,如何选择最佳刺激靶点、频率等治疗参 数仍有待进一步研究。现从线圈、刺激频率及刺激靶点 3 个参数入手,对经颅磁刺激治疗强迫症的效果 进行综述,认为仍需要更多的随机对照试验证实经颅磁刺激治疗强迫症的疗效及患者耐受性,未来应 着重关注个体化刺激方案的选择和优化。     

功能性电刺激结合重复经颅磁刺激用于缺血性脑卒中偏瘫患者步行障碍恢复的临床观察

目的 观察功能性电刺激结合重复经颅磁刺激用于缺血性脑卒中偏瘫患者步行障碍恢复的临床疗效。方法 将53例缺血性脑卒中偏瘫患者随机分为对照组、治疗组、假治疗组3组,在均接受常规康复训练的基础上对照组接受功能性电刺激治疗,治疗组接受功能性电刺激及重复经颅磁刺激治疗,假治疗组接受功能性电刺激及假重复经颅磁刺激治疗; 治疗前及治疗8周后采用步态运动学参数、时间参数、距离参数及Amer-Lindholm分级对3组患者的下肢综合运动功能进行评定。结果 治疗前3组患者步态运动学参数、时间参数、距离参数及Amer-Lindholm分级评分均无显著差异(P>0.05),治疗8周后3组患者上述指标明显改善且治疗组改善幅度明显优于其余2组(P<0.05)。结论 功能性电刺激联合重复经颅磁刺激治疗有利于改善缺血性脑卒中偏瘫患者的步行运动功能。     

经颅磁刺激治疗抑郁症的研究进展

经颅磁刺激是利用一定的时变磁场在脑内诱发电场,产生感应电流,影响脑内诸多代谢及电活动的无痛无创的检测和治疗技术.现就经颅磁刺激基本物理学原理、抗抑郁治疗及机制作一综述.     

经颅磁刺激脑电图同步记录技术及其在神经精神系统疾病诊断和评估中的应用进展

经颅磁刺激脑电图(TMS-EEG)同步记录技术可测量大脑各区接受磁脉冲刺激后的脑电信号, 时间分辨率高, 结合恰当的信号分析技术后可用于评估各皮层的兴奋性、脑震荡活动和脑区间连接属性, 具有重要研究价值。近年来该技术的实现设备和分析方法得到了快速发展, 应用领域逐步推广, 本文现围绕该技术及其在神经精神系统疾病诊断和评估中的应用进展综述如下。     

经颅磁刺激在精神科的应用

经颅磁刺激是近年兴起的一种物理诊断与治疗方法 ,主要用于神经学领域 ,但一些研究者发现经颅磁刺激可以影响人的情绪、认知、记忆等心理功能 ,且具有无痛无创、操作方便等特点。于是他们通过各种实验去探讨它在精神科中的潜在应用价值 ,本文概述了近几年经颅磁刺激的研究及将来的可能发展     

Priming sensorimotor cortex to enhance task-specific training after subcortical stroke

ObjectiveThis double-blind sham-controlled crossover study investigated the interactions between primary sensory and motor cortex after stroke and their response to Theta Burst Stimulation (TBS).MethodsThirteen chronic subcortical stroke patients with upper limb impairment performed standardised dexterity training primed with ipsilesional M1 intermittent TBS (iTBS_iM1), contralesional M1 continuous TBS (cTBS_cM1) or sham TBS. The effects on sensorimotor integration, corticomotor excitability, sensation and grip-lift kinetics were examined.ResultsAfter iTBS_iM1, improvements in paretic grip-lift performance were accompanied by an immediate facilitation of ipsilesional M1 excitability and a subsequent increase in ipsilesional short latency afferent inhibition (SAI) during training. Precision grip-lift performance improved after cTBS_cM1 and training, alongside increased ipsilesional M1 excitability with no effect on ipsilesional SAI. There were no effects on sensory performance.ConclusionPrimary motor cortex iTBS not only modulates M1 corticospinal excitability but also increases M1 receptiveness to sensory input.SignificancePriming with iTBS_iM1 may enhance ipsilesional sensorimotor integration and facilitate better quality sensorimotor training after subcortical stroke.     

Contribution of transcranial magnetic stimulation in restless legs syndrome: pathophysiological insights and therapeutical approaches

Transcranial magnetic stimulation (TMS) may offer a reliable means to characterize significant pathophysiologic and neurochemical aspects of restless legs syndrome (RLS). Namely, TMS has revealed specific patterns of changes in cortical excitability and plasticity, in particular dysfunctional inhibitory mechanisms and sensorimotor integration, which are thought to be part of the pathophysiological mechanisms of RLS rather than reflect a non-specific consequence of sleep architecture alteration.If delivered repetitively, TMS is able to transiently modulate the neural activity of the stimulated and connected areas. Some studies have begun to therapeutically use repetitive TMS (rTMS) to improve sensory and motor disturbances in RLS. High-frequency rTMS applied over the primary motor cortex or the supplementary motor cortex, as well as low-frequency rTMS over the primary somatosensory cortex, seem to have transient beneficial effects. However, further studies with larger patient samples, repeated sessions, an optimized rTMS setup, and clinical follow-up are needed in order to corroborate preliminary results.Thus, we performed a systematic search of all the studies that have used TMS and rTMS techniques in patients with RLS.     

A型肉毒毒素治疗抽动障碍

目的 探讨A型肉毒毒素治疗抽动障碍患者运动性抽动症状的疗效.方法 25例抽动障碍患者(男性20例,女性5例)接受国产A型肉毒毒素注射,治疗主要针对患者最突出的运动性抽动的表现.治疗前进行耶鲁综合抽动严重程度量表(YGTSS)基线评分,治疗1、4周和1年内分别进行YGTSS和Jankovic评分,并记录疗效的潜伏期、持续时间、副作用、患者的主观感觉和感觉先兆的变化以及再次注射情况.结果 在25例患者总共29人次的治疗中,肉毒毒素疗效平均潜伏期5.0 d,平均总体疗效持续4.6个月,平均最佳疗效Jankovic评分3.4分,根据YGTSS减分率统计62.1%(18/29)明显有效,34.5%(10/29)好转,3.4%(1/29)无效.85.7%(18/21)的患者感觉先兆减轻,平均改善72.4%(20%～100%).主要副作用为注射部位短暂而轻微的无力和皮疹.症状复发者再次注射仍然有效.结论 A型肉毒毒素对于控制抽动障碍的运动性抽动症状安全有效.     

Motor responses to afferent stimulation in juvenile myoclonic epilepsy

PURPOSE: To document whether the mechanisms responsible for myoclonic jerks in juvenile myoclonic epilepsy (JME) are similar to those causing other forms of myoclonus. METHODS: We studied somatosensory evoked potentials, the conditioning effect of cutaneous afferents on motor potentials evoked by transcranial magnetic stimulation (TMS), and intracortical inhibition and facilitation in response to paired TMS in a group of nine patients with JME and 20 normal controls. RESULTS: Intracortical inhibition was abnormal, whereas cortical somatosensory evoked potentials and TMS conditioned by cutaneous afferents were unaltered in JME patients. CONCLUSIONS: Abnormal processing of cutaneous afferents would not appear to contribute to myoclonus in JME.     

Modulations in corticomotor excitability during passive upper-limb movement: is there a cortical influence?

Modulations in the excitability of corticomotor pathways to forearm musculature have previously been demonstrated during passive wrist movement [Brain Res. 900 (2001) 282]. Investigations were conducted to determine the level of the neuroaxis at which these modulations arise, and to establish the influence of proprioceptive task constraints on pathway excitability. Forearm motor evoked potentials (MEPs) in response to transcranial magnetic stimulation (TMS) were examined during passive wrist movement while subjects maintained a low-level muscle activation, thus stabilising the excitability of the motoneuron pool. Modulations in response amplitude during movement were evident in both forearm flexor and extensor muscles. The pattern of modulation generally mirrored that seen in quiescent musculature during movement, with responses potentiated during the phases where the muscle was in a shortened position. Variations in MEP amplitude were not detected while the wrist was constrained statically at various joint angles. This suggests a dynamic influence of movement, most likely mediated by spindle receptors, arising at a supraspinal level. We also investigated the influence of a kinesthetic tracking task on corticomotor excitability during passive movement of the wrist joint. MEPs were recorded from the target driven limb while the contralateral limb was stationary, while the contralateral limb actively tracked the movements of the target limb, and while the contralateral limb moved actively in time with a metronome. The results revealed no differences in MEP characteristics in the driven limb between the three conditions. Placing the movement elicited afferent information in an active movement context does not appear to enhance the modulations in cortical excitability.     

New-onset tic disorder following circumscribed brain injury

Adult-onset tics represent either a secondary tic disorder (“tourettism”) or a late presentation of childhood tics, which may have been previously unrecognised. Head trauma has been recognised as an infrequent cause of adult-onset tic disorder, which exhibits variable temporal relationship to the inciting injury and response to therapy. We present a patient who presented with late-onset tics seven years after a circumscribed brain injury, responding well to antidopaminergic treatment. A review of all the previously reported cases of post-traumatic tic disorder is provided. Our patient is unusual in that the injury presumed to be responsible for the development of tics was of a very focal nature, akin to previously described tic disorder following vascular insults. We discuss the rare occurrence of tourettism after such focal brain lesions and analyse the insights this provides into the anatomical substrates underlying tic disorders.     

抽动障碍大鼠模型的建立与选择

目的 观察阿扑吗啡(APO)和亚氨基二丙腈(IDPN)诱导的抽动障碍(TD)模型大鼠的刻板运动和头动次数,挑选可以全面体现TD特征性行为变化的造模方法. 方法 SD大鼠30只按随机数字表法分为正常组、APO组、IDPN组,每组10只.APO组大鼠给予APO 2 mg/kg腹腔注射,IDPN组大鼠给予IDPN 150 mg/kg腹腔注射,正常组给予生理盐水腹腔注射,给药体积均为1mL/100 g、每天1次、连用7d,注射结束5 min后记录各组大鼠5～10 min、15～20 min、25～30 min、35～40 min、45～50 min、55～60 min时间段的刻板行为评分和5 min内大鼠头部抽动次数. 结果 IDPN组和APO组的大鼠头动次数明显比正常组多,IDPN组大鼠的头动次数多于APO组,差异均有统计学意义(P＜0.05);APO组大鼠在5～10 min、15～20 min、25～30 min、35～40 min时间段刻板行为评分高于正常组,IDPN组大鼠各个时段的刻板行为学评分均高于正常组,IDPN组大鼠在45～50min和55～60 min时间段刻板行为评分高于APO组,差异均有统计学意义(P＜0.05). 结论 IDPN诱导的TD模型能比较全面的再现TD的特征性行为变化,是较理想的动物模型.