伴有左旋多巴诱发异常运动的帕金森病患者基底节神经电活动

目的 探讨伴有左旋多巴诱发的异常运动(LID)的帕金森病(PD)患者基底节核团的神经元电活动特点.方法 16例原发性PD患者其中8例患者伴有严重的LID,帕金森病统一评分量表(UPDRS)Ⅳ平均评分为6.8±1.5]在接受内苍白球(GPi)毁损术(8例)或丘脑底核(STN)电极埋置术(8例)的同时采集核团细胞电活动和肢体EMG.应用单细胞和峰间隔(ISI)及其变异系数(CV)分析方法探讨不同的细胞放电模式和频率.方差分析和Bonferroni检验比较不同放电模式的神经元的ISI和CV.结果 在22个针道(GPi:8;STN:14)中共甄别出238个神经元,其中22.3%为与肢体震颤相关的放电活动,33.2%为快速的紧张性放电活动和29.0%为不规则放电活动,同时还发现8.0%高度不规则的簇状放电活动和7.6%的低频放电活动.方差分析显示不规则放电活动、高度不规则簇状放电活动和低频放电活动的ISI和CV差异均有统计学意义(均P＜0.05).卡方检验表明高度不规则簇状放电活动和低频放电活动主要存在于伴有LID患者的GPi和STN(P＜0.05).结论 基底节GPi和STN细胞放电频率和模式的改变与LID相关.

Patterns of neuronal activity in the basal ganglia nucleus in parkinsonian patients with levodopa induced dyskinesia

Objective To explore the patterns of neuronal activity in the basal ganglia nucleus in parkinsonian patients with levodopa-induced dyskinesia ( LID). Methods Sixteen idiopathic parkinsonian patients, 11 males and 5 female;5; aged 56. 1±11. 9, with the mean disease duration of ( 10. 1±6.6) . Years and Hoehn & Yahr score ranging 2 -4, all with the symptoms of tremor, rigidity, and bradykinesia, 8 with severe LID with the mean unified Parkinson's disease rating scale (UPDRS) IV score of 6. 1±1. 5 underwent pallidotomy ( n = 8) or subthalamic nucleus ( STN) deep brain stimulation (DBS) implantation (6 bilaterally and 2 unilaterally). Microrecording was performed in the globus pallidus internus (Gpi) and STN. Electromyogram (EMG) on the contralateral limbs to surgery was simultaneously recorded. Single unit analysis was performed. The interspike interval (ISI) and coefficient of variation ( CV) of ISI were calculated. One-way ANOVA and rank test were employed to compare the ISI and CV among the patients. Results Two hundred and thirty-eight neurons were identified from the Gpi ( n = 8) and STN n = 14). 22. 6% of them were tremor-related neurons, 33. 8% were rapid tonic neuronal activity related, and 29. 0% were irregular neuronal activity-related. It was discovered that 8. 0% of the neurons from Gpi and STN were with grouped discharge following long period pause with the CV of 87±0. 55, and 7. 5% of the neurons were with low frequency firing with the mean frequency of (17. 7±5. 9) Hz. ANOVA revealed that in the STN the CV of the neurons with irregular with grouped discharge was significantly higher than those of the neurons with irregular neuronal activity and with low frequency firing ( both P < 0. 05 ) , the ISI of the neurons with irregular grouped discharge was .significantly higher than that of the neurons with low frequency firing and significantly higher than that of the neurons irregular neuronal activity ( both P < 0. 05); and in the Gpi the CV of the neurons with irregular grouped discharge was significantly lower than those of the neurons with irregular neuronal activity and those with low frequency firing and the ISI of the neurons with irregular grouped discharge was significantly higher than those of the other groups (all P < 0. 05 ) . Chi square test showed that majority of the neurons with grouped discharge and neurons with low frequency firing mainly existed in the Gpi and STN of the PD patients with LID (all P < 0. 05 ). Conclusion The altered neuronal activity in the basal ganglia nucleus of Gpi and STN plays an important role in the pathophysiology of PD and LID.