スライド 1

パーキンソン病患者における運動誘発電位の運動前促通
平岡浩一・岩田晃（大阪府立大学総合リハビリテーション学部）
野谷優（ガラシア病院リハビリテーションセンター）
南田史子（大阪リハビリテーション病院リハビリテーション室）
阿部和夫（甲南女子大学看護リハビリテーション学部）
背景
ヒトにおいて運動開始前に皮質脊髄下降経路興奮性が増大
＝premovement faciltiation （Starr et al. 1988)
パーキンソン病(PD)患者でpremovement faciltiationの速度低下
(Chen et al.2001)
＝動作緩慢や無動の原因か？
目的
PD患者のpremovement-facilitationの異常性を単純動作と系
列化動作で観察する。
対象
PD患者 7例（68.5+10歳)
健常高齢者 6例（58.3+9.7歳）
PD患者の特徴
ID
Age
Sex
Patient A
79
M
0
II
Patient B
72
M
50
II
Patient C
67
M
250
III
Patient D
52
F
200
III
Patient E
67
F
350
III
Patient F
62
M
450
III
Patient G
81
F
400
IV
LED(mg) H-Y stage
タッピングテストのパフォーマンス
PD
Healthy
41.57143
60.4
80
9.034326 6.913754
*
Tapps/10s
70
60
50
40
30
20
10
0
PD
Healthy
* P<0.05
実験設定
1
2
3
FDI-EMG
ADM-EMG
APB-EMG
Motor tasks
Simple reaction task＝1
Sequenced reaction task=1→2→3
Control
実験手続き
Verbal designation of next
task to be performed
Start signal
on oscilloscope TMS to the vertex (1.1xMT)
Delay to start
FDI-EMG onset
Delay to EMG onset
Recording FDI-MEPs
反応時間
Two-way ANOVA
400
Healthy
PD 350
reaction time (ms)
Healthy
300
PD
250
Simple
Sequenced Between groups (P<0.05)
164.7091
217.9563 Between tasks (N.S.)
Simple
263.1231
247.392
Sequenced
58.56093 83.82822
109.7481 100.0983
200
150
100
50
0
Healthy
2W-ANOVA
PD
A. Simple task
B. Sequenced task
Start cue
FDI
△
△
▲
ADM
▲
APB
2mV
50ms
▲
premovement facilitation
B. Regression lines
A. Pooled averages
PD-sequenced
S
170.9071
199.6848
211.2301
247.2473
246.7266
225.0355
282.5131
382.4403
432.1389
413.2778
307.8601
MEP amplitude (% of control)
150
100
50
Delay to start signal (ms)
300-330
270-300
240-270
210-240
180-210
150-180
120-150
90-120
60-90
30-60
0
0-30
MEP amplitude (% of control)
0-30 500
30-60
450
60-90
90-120
400
120-150
350
150-180
180-210
300
210-240
250
240-270
270-300
200
300-330
Healthy-simple
Healthy-sequenced
PD-simple
Healthy-simple
182.2762
144.8997 148.3534
150.9317
Healthy-sequenced
149.5939 168.006
181.4384
168.7737 173.2763
PD-simple
282.2023
264.1892 207.7735
PD-sequenced
251.3623 202.4432 196.3973
329.9509 290.1984 253.4246
368.6455
395.0147
334.3373
279.9976
434.4167
Healthy-simple C Healthy-sequenced s
60020 82.46841
0 41.73319
線形 (Healthy-simple)
20
50020
20
20
40020
30
30030
30
30
20030
30
10030
30
30
030
300
30
30
134.0819
20 48.8078
線形 (Healthy-sequenced)
45.44177
20 61.15001
線形 (PD-simple)
229.4532
20 135.7641
線形 (PD-sequenced)
60.028
20 43.19775
80.78546
20 145.8623
191.5643
30 330.8834
76.71974
30 364.3008
65.89421
30 51.77405
314.8804
30 61.18752
159.1521
30 92.25196
103.7206
30 164.5926
261.1722
30 65.63309
124.8053
30 358.0915
47.94958
30 118.684
294.159
30 102.0201
282.9362 100
30 200
126.1654
156.6706 Delay to
30 start
316.603
signal
244.9268
30 106.7276
0
0
0
0
20
20
20
20
20
30
30
30
30
30
30
30
300 30
(ms) 30
30
PD-simple
181.3701
226.3376
116.1669
92.93367
83.03357
161.9834
154.4969
63.29608
278.3667
46.85104
27.47815
170.9972
23.12909
144.7051
50.83035
178.6613
400
282.3348
67.45181
127.409
EMG onset直前のMEP振幅
Two-way ANOVA
PD-simple
Between groups (P<0.05)
900 PD-simple
PD-sequenced
Healthy-simple
Healthy-sequenced
PD-sequenced
Between delays (P<0.05)
-200 to -150
263.8331
245.2771
141.7211
143.5748
800
MEP amplitude (% of control)
-150 to -100
700
-100 to -50
600
500
400
Healthy-simple
234.1578
248.9161 178.4327 187.548
Healthy-sequenced
322.7339 422.3093 238.4215 231.4636
*
210.0963 178.2929 123.6849 92.46284
*
195.1357 145.2117 142.2862 143.769
295.7053 382.0799 184.8988 173.6056
*
300
*
200
100
0
-200 to -150
-150 to -100
-100 to -50
Delay to EMG onset (ms)
* P<0.05
PDでは下降運動命令に対する運動ニューロン興奮閾値が高い
RT
Threshold of MN pool to descending
motor command in PD patients
EMG onset (PD)
MEP amp.
Threshold of MN pool to descending
motor command in healthy humans
RT
EMG onset (healthy)
MEP amp.
Amount of descending command
△
Start cue
まとめ
Premovement facilitationの速度はPD患者と健常者で差はない
Premovement facilitationの速度は単純課題と系列課題で差は
ない
運動開始直前でのMEP振幅はパーキンソン病患者で大きい
パーキンソン病では下降運動命令に対する運動ニューロン興奮
閾値が高い

Download Report