帕金森病内侧苍白球和丘脑腹外侧核神经细胞放电特点与临床症状的关系

目的：探讨帕金森病（PD）患者内侧苍白球（GPi）和丘脑腹外侧核团（Vop／Vim）细胞电活动与PD症状的关系。方法：24例患者在接受手术的同时采集细胞电活动（GPi：12个，Vop／Vim：12个）和记录肢体肌电图（EMG）。应用单细胞分析，峰阃隔（ISI）、ISI变异系数（CV）和ISI直方图等方法进行分析。用统一帕金森评分量表（UPDRS）进行疗效评估。结果：199个GPi神经元中，33个（16．6％）为与震颤相关放电活动，136个（68．3％）为紧张性放电活动，30个（15．1％）为不规则放电活动。223个Vop／Vim神经元中，110个（49．3％）为与震颤相关的放电活动，49个（22％）为紧张性放电活动，64个（28．7％）为不规则放电活动。ISI分析发现GPi神经元放电频率为78Hz（n=92）而Vop／Vim为24Hz（n=107）。方差分析显示GPi和Vop／Vim的上述三种不同放电模式神经元的数量之间比较差异有统计学意义（P〈0．05）。UPDRS显示，术后GPi对震颤、僵直和运动迟缓的疗效分别为63％、83％和64％；而Vop／Vim术后对震颤、僵直和运动迟缓的疗效分别为94％、66％和49％，提示GPi对僵直改善明显，而Vim对震颤改善显著（P〈0．05）。结论：GPi和Vop／Vim中不同放电模式的神经元可能与PD运动症状有内在联系，支持PD病理生理模型。

The characteristics of pallidal and thalamic neuronal activity in patients with Parkinson's disease

Objective：To investigate the neuronal activity in the globus pallidus internus （GPi） and the ventrolateral thalamic nuclear group （ventral oral posterior/ventral intermediate, Vop/Vim） in patients with the symptoms of Parkinson＇s disease （PD）. Methods： Twenty four patients with PD underwent pallidotomy or thalamotomy and their symptoms were observed. Microelectrode recording was performed in the GPi （n=12） and the Vop/Vim （n 12） intraoperatively. Eleetromyography （EMG） contralateral to the surgery was simultaneously recorded. Single unit analysis was carried out. Interspike intervals （ISI） and coefficient of variation （CV） of ISI was calculated. Histograms of ISI were constructed. Unified Parkinson＇s disease rating scale （UPDRS） was used to assess the clinical outcome of surgery. Results：Of 199 GPi neurons, there were 33（16.6%） neurons with tremor frequency, 136（68.3%） neurons with tonic firing and 30（15.1% ） neurons with irregular discharge. Of 223 thalamic neurons, there were 110（49.3%） neurons with tremor frequeney,49（22%）neurons with tonic firing and 64（28. 7%）neurons with irregular discharge. The significantly different numbers of three pattern neurons reached between GPi and Vop/Vim （P〈〈0.05）. ISI analysis revealed that the mean firing rate of three patterns of GPi neurons was 78 Hz （n=92） ,whereas the mean firing rate of Vop/Vim neuron was 24 Hz （n=107）. UPDRS indicated that the clinical outcome of pallidotomy was 63%, 83% and 64%, and clinical outcome of thalamotomy was 940/00, 66% and 49% for tremor, rigidity and bradykinesia, respectively. A signifi cant difference of tremor and rigidity was reached between GPi, and Vop/Vim （P〈0.05）. Conclusion： Different neuronal patterns in GPi and Vop/Vim are likely associated with different Parkinsonian motor symptoms, supporting the view of pathophysiology of PD.