不同重复经颅磁刺激模式对脑卒中后上肢运动功能障碍干预效果的网状Meta分析

背景 上肢运动功能障碍是脑卒中后常见的后遗症之一,严重影响患者日常生活能力。重复经颅磁刺激（rTMS）作为常见的神经电生理技术对治疗脑卒中后上肢运动功能障碍有较好的疗效,但临床对不同rTMS干预模式的选择仍缺乏循证依据。目的 采用网状Meta分析方法比较rTMS的4种模式对脑卒中后上肢运动功能障碍患者的临床疗效。方法 计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库、中国知网、万方数据知识服务平台、维普网中有关rTMS治疗脑卒中后上肢运动功能障碍的随机对照试验,并通过追溯Meta分析的参考文献作为补充。检索时间均为建库至2022年2月,采用主题词和自由词结合方式进行。2名研究者进行文献筛选、资料提取及质量评价。采用RevMan 5.0软件和Stata 16.0软件进行统计学分析。结果 最终纳入17篇文献,790例患者,共涉及6种干预措施：高频rTMS(HF-rTMS)、低频rTMS(LF-rTMS)、间断性theta节律刺激（iTBS）、连续性theta节律刺激（cTBS）、假刺激、常规疗法。网状Meta分析结...     

Surface EMG in the recording of fasciculations.

The usefulness of multichannel surface recording of fasciculations was evaluated by a retrospective study of 116 patients with various neurological disorders. Eight channels of a conventional electroencephalograph were used with plate electrode recordings from the upper arms and legs. Wide-spread fasciculations (defined as five or more of the eight muscle groups) were recorded in 48 of 54 patients with motor neuron disease, spinal muscular atrophy or postpolio syndrome, but noted on routine clinical examination at presentation in only 6. Eleven of 23 patients with peripheral neuropathy or myelopathy had fasciculations in five or more leads compared to one clinically, and 3 of 39 with other neurological diseases had fasciculations electrically but in only one were they clinically observed. The method is a noninvasive and sensitive adjunct to clinical examination for detecting fasciculations. Its diagnostic value is limited by the relatively high incidence of fasciculations in neuropathies and myelopathies. However, this study suggests that "false negatives" are rare and that the diagnosis of motor neuron disease should be reconsidered when less than five leads shows fasciculations.     

Quantification of motor deficit in Parkinson's disease with a motor performance test series

Summary It was the purpose of the present study to quantify the expected motor deficit in parkinsonian patients with the computer assisted Motor Performance Test Series (MPS), version 05.87 by Schuhfried (1987) and to examine which of the motor test variables found correlate at a significance level of p<0.01 with items of motor examination recorded at neurological examination and activities of daily living of the Unified Parkinson's Disease Rating Scale (UPDRS), version 3.0.38 patients with idiopathic Parkinson's disease (PD) stages I–IV according to Hoehn and Yahr, aged 41 to 73 years were studied. The study design, i.e. initial rating by the physician followed immediately by testing of motor function with MPS was strictly adhered to in each patient.Physician's rating of rigor and the scores of the semiquantitative tests (finger taps, hand movements and alternating movements) as expression of hypokinesia and the activities of daily living correlated with the 3 factors of the Motor Performance Test Series at a highly significant level independent of disease stage. Tremor is only partly and never significantly reflected in the motor data measured. Stages I–II and II–IV (Hoehn and Yahr) differ significantly in the representative data of the Motor Performance Test Series.The results of the study support the assumption that MPS is a valid instrument for quantitative measurement of the motor deficit in parkinsonian patients, but that only some subtests are pathognomonic.     

Cerebellar connections with the motor cortex and the arcuate premotor area: an analysis employing retrograde transneuronal transport of WGA-HRP

We have employed transneuronal transport to examine the anatomical relationships between the deep cerebellar nuclei and 2 cortical motor areas: the primary motor cortex and the arcuate premotor area (APA). In the same animals, we have also examined the patterns of labeling in the thalamus and the red nucleus to provide evidence for the potential routes of transneuronal transport to the cerebellum. When the appropriate technical procedures were employed, cortical injections of wheat germ agglutinin conjugated to horseradish peroxidase (WGA-HRP) resulted in transneuronal labeling within portions of the contralateral deep cerebellar nuclei. Injections into the primary motor cortex labeled neurons in the dentate and in the 2 subdivisions of the interpositus. Injections into the APA labeled neurons in the dentate and in only the posterior subdivision of the interpositus. In most instances, dentate neurons were more intensely labeled following the cortical injections than interpositus neurons. The transneuronal labeling observed in the dentate nucleus was topographically organized. The dentate region that was labeled following injections into the "arm area" of the APA was caudal and ventral to the dentate region that was labeled following injections into the "arm area" of the primary motor cortex. This observation provides evidence for two "arm areas" in the dentate: one anatomically related to the APA, and the other related to the primary motor cortex. More than one route of transport may be responsible for the labeling of cerebellar neurons. We propose that the labeling observed in the dentate nucleus reflects the pattern of connections in the cerebellothalamocortical pathways that link the dentate with the cerebral cortex. Thus, our observations support the concept proposed by Schell and Strick (J. Neurosci. 4:539-560, '84)--that the cortical targets of the dentate nucleus include both the primary motor cortex and the APA.     

Plateau potentials evoked by climbing-fibre stimulation are restricted to the Purkinje cell dendrites of the cat

The present study investigated the duration of afterdepolarizations in Purkinje cell somata following climbing-fibre activation. Intracellular recordings revealed that, in cells with membrane potentials more negative than -50 mV and with normal spike-generating capabilities, climbing-fibre activation resulted in somatic responses with short afterdepolarizations. As the cell deteriorated and the resting membrane potential became more positive, the duration and form of the climbing-fibre response resembled the plateau potentials recorded from proximal dendrites. The absence of plateau potentials in undamaged Purkinje cell somata was confirmed by extracellular recording of test spike amplitudes following evoked climbing-fibre responses.     

Prolyl-leucyl-glycinamide shares some effects with oxytocin but decreases oxytocin levels

Oxytocin treatment in rats induces long-lasting antistress and growth promoting effects. This study investigated whether prolyl-leucyl-glycinamide (PLG) (the c-terminal tripeptide of oxytocin) or tocinoic acid (the ring structure of oxytocin) could induce some of these effects in male rats. For this purpose, PLG (2 or 10 mg/kg, s.c.) or tocinoic acid (1 mg/kg, s.c.) was administered to rats once a day for 3 or 5 days. Blood pressure, heart rate, spontaneous motor activity, nociceptive thresholds, and the survival of ischaemic musculocutaneous flaps were measured. In addition, endogenous oxytocin levels and plasma levels of some hormones known to be influenced by oxytocin were determined. PLG (2 mg/kg, s.c., but not 10 mg/kg, s.c.) decreased diastolic blood pressure (p<0.05) and locomotor activity (p<0.05). PLG (10 mg/kg, s.c.) decreased gastrin (p<0.05) and endogenous oxytocin levels in plasma (p<0.01). Tocinoic acid decreased locomotor activity (p<0.05), but did not affect any of the other parameters measured. In conclusion, this study showed that both PLG and tocinoic acid decrease locomotor activity. In addition, PLG also induced some other effects similar to those induced by oxytocin treatment but when administered in high doses it decreased oxytocin levels.     

猫运动皮层内篮状细胞的立体重构,递质性质及突触分布

用细胞内HRP染色的方法显示该神经元位于猫运动皮层十字沟后,在第Ⅱ/Ⅲ层之间(软膜以下438μm处),胞体截面积为15.6×28.1μm~2,呈多极形,树突呈串珠状,向四周扩展,无侧棘,轴突由胞体下方伸出,返折向上,包绕胞体周围,以软膜平行的吻尾方向行走为主,有一分枝向白质方向延伸.从立体重构图的不同角度观察,其形态不对称,如沿X轴方向旋转60°后,其形态呈扁平形,用胶体金免疫电镜观察,该神经元的递质性质为GABA能的.胞体及树突上分布有非对称型和对称型的突触,对称型的突触中有的是GABA能的,有的是非GABA能的.其轴突有髓鞘包绕,末梢与其它神经元的胞体形成一处以上相连或不相连的对称型突触,也可与其它树突形成对称型的突触.根据该神经元的形态,递质性质及突触分布的特征,可确认它是篮状细胞.     

大鼠运动皮层投射神经元与Parvalbumin免疫阳性神经纤维终末的关系──免疫荧光、Confocal显微镜观察

Parvalburnin是细胞内一种钙结合蛋白。同时又可作为中枢神经系统内与GABA共存的神经元亚群的特异标记物，主要标记篮状及苔烛细胞。用PAP方谈染色可见大鼠Parvalbumin免疫阳性神经终末在运动皮层锥体神经元胞体周围形成包篮现象，但因该方法的局限性．较难明确二者的关系。为进一步了解Parvalbumin阳性终未在锥体神经元脑体、树突与轴突整体上的分布状况以及运幼皮层内不同传出神经元是否均接受同样的支配，本实验利用FastBlue送行标记、固定脑片细胞内注入LueiferYellow结合免疫荧光、Confocal显微镜观察，研究运动皮层内皮质丘脑（束旁核）、皮质效状体及皮质脊髓三种投射神经元与Parvalbumin阳性终末的关系。通过1．μ连续扫描图像的分析及立体对观察，Parvalbumin阳性终末清晰可见，与LuciferYellow标记的锥体细胞的关系也容易辨别．在三种投射神经元胞体上均可见Parvalbumin阳性终末包绕，形成明显包篮现象，但三种神经元上的终末数未见明显区别·阳性终未还分布于近端树突上，距胞体越远越稀疏：但在距脑体50μm以上的顶树突、30μm以上的基树突及其二、三级分枝的远端树突上仍偶有终末分布．此外，三种神经元轴突起始段上也有少量终末接触，但未形成明显的cartridge现象．这一结果揭示，Parvalb     

Influence of transcranial magnetic stimulation on the execution of memorised sequences of saccades in man

Memorised sequences of saccades are cortically controlled by the supplementary motor area (SMA), as shown in animal experiments and in humans with isolated SMA lesions. We applied transcranial magnetic stimulation (TMS) in eight healthy subjects executing memorised sequences of saccades. Sequences of three targets were presented. Then, upon a go-signal, the subjects had to execute the appropriate sequences. Ten to fifteen sequences were performed in each experiment, and the number of errors were counted. The number of errors increased significantly if TMS was given 80 ms before or 60 ms after the go-signal, with the stimulation coil overlying the SMA. There was no significant increase in errors if different stimulation intervals were chosen (160ms and 120ms before the go-signal; 100 ms, 140 ms or 240 ms after the go-signal), if the coil was positioned inappropriately (e.g. over the occipital cortex), or if the stimulator output was too low. We conclude that TMS can interfere specifically with the function of the SMA during a critical time interval close to the go-signal.     

Medullary control of the pontine swallowing neurones in sheep

Summary The origin of the inputs from the medullary swallowing centre (dorsal region including the nucleus of the solitary tract, or ventral region corresponding to the reticular formation surrounding the nucleus ambigous) to the pontine swallowing neurones (PSNs) was studied in sheep anaesthetized with halothane.Out of 101 PSNs located in the posterior part of the trigeminal (Vth) motor nucleus, 46 were activated by stimulating either the dorsal (21 neurones) or the ventral (25 neurones) region of the ipsilateral medullary swallowing centre, 3–4 mm rostral from the obex. Thirty-one neurones out of the 46 were identified as a motoneurones supplying swallowing muscles (mylohyoïd, anterior body of digastric and medial pterygoïd). Their average activation latency through stimulation of the dorsal medullary region was about 1 ms longer than through stimulation of the ventral region (3.63 ms±0.81 versus 2.72 ms±0.32).To determine the origin of the medullary input to the PSNs, we tried to activate the medullary swallowing neurones (MSNs) antidromically through stimulating the posterior part of the Vth motor nucleus, which contains the swallowing motoneurones. Seventy-three MSNs were tested (25 located in the dorsal and 48 in the ventral region). None of the dorsal neurones tested could be antidromically activated by pontine stimulation: 15 ventral neurones showed a clear antidromic response (collision test) with an average latency of 2.5 ms±0.73. These neurones, which send their axons into the pons, were all located in the reticular formation, above the nucleus ambiguus, 3–4 mm rostral from the obex.These results suggest that MSNs in the ventral reticular formation connect the medullary swallowing centre to the Vth motor nucleus. They also suggest that during swallowing, inputs originating from the dorsal region of the medullary centre (interneurones programming the motor sequence) are relayed in the ventral region (reticular formation adjacent to the nucleus ambiguus) before reaching the PSNs.This work was supported, in part, by grants from CNRS (LA 205), INRA and M.R.I. (82 E 0685)