Motor function in a patient with bilateral lesions of the globus pallidus

被引:14
作者
Haaxma, R
vanBoxtel, A
Brouwer, WH
Goeken, LNH
vanderGon, JJD
Colebatch, JG
Martin, A
Brooks, DJ
Noth, J
Marsden, CD
机构
[1] UNIV GRONINGEN HOSP, DEPT REHABIL, 9700 RB GRONINGEN, NETHERLANDS
[2] TIBURG UNIV, DEPT PSYCHOL, TIBURG, NETHERLANDS
[3] UNIV GRONINGEN, TRAFF RES CTR, GRONINGEN, NETHERLANDS
[4] UNIV UTRECHT, DEPT MED & PHYSIOL PHYS, UTRECHT, NETHERLANDS
[5] HAMMERSMITH HOSP, MRC, CYCLOTRON UNIT, LONDON W12 0HS, ENGLAND
[6] ALFRED KRUPP KRANKENHAUS, DEPT NEUROL, ESSEN, GERMANY
[7] UNIV LONDON, NATL HOSP NEUROL & NEUROSURG, INST NEUROL, DEPT CLIN NEUROL, LONDON, ENGLAND
关键词
pallidal lesions; posture; gait; reflexes; voluntary movements; reaction time; sensory feedback; positron emission tomography;
D O I
10.1002/mds.870100610
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
This study describes the long-term motor deficits of a patient who, after a toxic encephalopathy, sustained extensive bilateral damage to both segments of the globus pallidus (GP) and the right substantia nigra (SN). There were no signs of lesions of the pyramidal tracts or of other motor structures. The most obvious deficits were an abnormal gait with an exaggerated knee extension and a tendency to fall slowly, especially when pushed backward. In contrast, Romberg's test on an unstable platform was normal, as were long-latency leg reflexes induced by perturbations. Inadequate anticipatory and compensatory postural responses, in particular across the hip and knee joints, and slow movements seemed responsible for the falls. Muscle tone was normal but reflex studies showed signs of abnormal facilitation and inhibition at various levels of the neuraxis. We conclude that the GP and SN lesions caused defective input to premotor cortical and brain stem target zones, Dysfunctioning of these zones leads to improper control of the descending ventromedial motor system responsible for locomotion, postural control, and reflex status. The deficits in upper extremity motor performance included delayed and slow movements, inaccurate amplitudes of ballistic responses, a lack of predictive control, and deficits in bimanual coordination. Sensory feedback, proprioceptive more than visual, played a powerful compensating role in rapid aiming movements. Regional blood flow (studied using O-15(2)) was reduced in multiple frontal cortical regions, among which are the hand areas of the supplementary and premotor cortex. We hypothesize that this reflected impaired functioning of these areas, caused by defective bilateral output from GP and SN, and resulting in the motor deficits of the arm and hand.
引用
收藏
页码:761 / 777
页数:17
相关论文
共 83 条
[21]   PATIENTS WITH PARKINSONS-DISEASE CAN EMPLOY A PREDICTIVE MOTOR STRATEGY [J].
DAY, BL ;
DICK, JPR ;
MARSDEN, CD .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 1984, 47 (12) :1299-1306
[22]   RECIPROCAL INHIBITION BETWEEN THE MUSCLES OF THE HUMAN FOREARM [J].
DAY, BL ;
MARSDEN, CD ;
OBESO, JA ;
ROTHWELL, JC .
JOURNAL OF PHYSIOLOGY-LONDON, 1984, 349 (APR) :519-534
[23]   ELECTRICAL SIGN OF PARTICIPATION OF MESIAL SUPPLEMENTARY MOTOR CORTEX IN HUMAN VOLUNTARY FINGER MOVEMENT [J].
DEECKE, L ;
KORNHUBER, HH .
BRAIN RESEARCH, 1978, 159 (02) :473-476
[24]   ASSOCIATED POSTURAL ADJUSTMENTS IN PARKINSONS-DISEASE [J].
DICK, JPR ;
ROTHWELL, JC ;
BERARDELLI, A ;
THOMPSON, PD ;
GIOUX, M ;
BENECKE, R ;
DAY, BL ;
MARSDEN, CD .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 1986, 49 (12) :1378-1385
[25]   THE BEREITSCHAFTSPOTENTIAL, L-DOPA AND PARKINSONS-DISEASE [J].
DICK, JPR ;
CANTELLO, R ;
BURUMA, O ;
GIOUX, M ;
BENECKE, R ;
DAY, BL ;
ROTHWELL, JC ;
THOMPSON, PD ;
MARSDEN, CD .
ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY, 1987, 66 (03) :263-274
[26]  
Diener H. C., 1989, PROG BRAIN RES, V80, P479
[27]  
DIENER HC, 1986, DISORDERS POSTURE GA, P41
[28]   PATHOLOGICAL ANATOMY OF POST-HEMIPLEGIC ATHETOSIS [J].
DOOLING, EC ;
ADAMS, RD .
BRAIN, 1975, 98 (MAR) :29-+
[29]  
DUM RP, 1991, LIFE SCI R, V50, P383
[30]   LOCOMOTOR CONTROL IN MACAQUE MONKEYS [J].
EIDELBERG, E ;
WALDEN, JG ;
NGUYEN, LH .
BRAIN, 1981, 104 (DEC) :647-663