The effects of posteroventral pallidotomy on the preparation and execution of voluntary hand and arm movements in Parkinson's disease

被引:50
作者
Limousin, P
Brown, RG
Jahanshahi, M
Asselman, P
Quinn, NP
Thomas, D
Obeso, JA
Rothwell, JC
机构
[1] UCL, Neurol Inst, MRC, Human Movement & Balance Unit, London WC1N 3BG, England
[2] Inst Neurol, Dept Clin Neurol, London WC1N 3BG, England
[3] Inst Neurol, Dept Neurosurg, London WC1N 3BG, England
[4] Clin Quiron, Funct Neurol & Neurosurg Ctr, San Sebastian, Spain
基金
英国惠康基金;
关键词
Parkinson's disease; pallidotomy; motor function;
D O I
10.1093/brain/122.2.315
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
We studied the effect of posteroventral pallidotomy on movement preparation and execution in 27 parkinsonian patients using various motor tasks, Patients were evaluated after overnight withdrawal of medication before and 3 months after unilateral pallidotomy, Surgery had no effect on initiation time in unwarned simple and choice reaction time tasks, whereas movement time measured during the same tasks was improved for the contralesional hand. Movement times also improved for isometric and isotonic ballistic movements. In contrast, repetitive, distal and fine movements measured in finger-tapping and pegboard tasks were not improved after pallidotomy, Preparatory processes were investigated using both behavioural and electrophysiological measures. A precued choice reaction time task suggested an enhancement of motor preparation for the contralesional hand. Similarly, movement-related cortical potentials showed an increase in the slope of the late component (NS2) when the patients performed joystick movements with the contralesional hand. However, no significant change was found for the early component (NS1) or when the patient moved the ipsilesional hand. The amplitude of the long-latency stretch reflex of the contralesional hand decreased after surgery. In summary, the data suggest that pallidotomy improved mainly the later stages of movement preparation and the execution of proximal movements with the contralesional limb, These results provide detailed quantitative data on the impact of posteroventral pallidotomy on previously described measures of upper limb akinesia in Parkinson's disease.
引用
收藏
页码:315 / 327
页数:13
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