【作者】 王莉；

【导师】 胡兴越；

【作者基本信息】 浙江大学 ， 神经病学， 2006， 硕士

【摘要】 背景:书写痉挛(writer’s cramp,WC)是一种最常见的特发性任务相关性局灶性肌张力障碍疾病。主要表现为书写时手部、前臂协同肌和拮抗肌过度不协调同时收缩导致的书写功能障碍。目前该病的发病机制尚未完全阐明。在先前的研究中,我们利用功能磁共振成像(fMRI)发现书写痉挛患者在进行痉挛性书写时,受累手对侧的基底节区(特别是壳核)、运动相关皮层(第一运动区、辅助运动区、运动前区)、感觉皮层(第一感觉区)及同侧小脑较正常对照明显激活,提示该病发病机制与运动相关皮层、皮层下结构(基底节和丘脑)和小脑功能紊乱有关,但其皮层下结构激活规律和相关区域激活与书写痉挛发生的因果关系尚未能明确。 目的:应用功能磁共振成像技术,比较书写痉挛患者接受局部肉毒毒素注射治疗前后脑内激活区的差异,以明确书写痉挛中枢改变和外周表现的因果关联。 方法:采用美国GE公司signa1.5T磁共振成像系统,通过fMRI组块设计,对4名书写痉挛患者接受局部肉毒毒素治疗前后执行书写任务时脑功能活动分别进行全脑扫描。数据分析应用AFNI软件系统,经过空间平滑、头动矫正等处理后,将前后数据进行平均化,通过反卷积分析计算每个体素内的信号变化,定义P<0.001具有显著意义,分别获得肉毒毒素治疗前和治疗后相应的平均脑功能激活图。同时应用一般线性分析,通过任务间相减产生“治疗后减治疗前”的差异脑功更多还原

【Abstract】 Background: Writer’s cramp is the most common task-specific idiopathic focal dystonia with incompletely understood pathophysiology. It is characterized by excessive cocontractions of agonist and antagonist hand and forearm muscles during writing .In previous study ,the patients of writer’s cramp showed greater activation of contra lateral basal ganglion (esp. putamen), ipsilateral cerebellar hemisphere, and contralateral sensorimotor, supplementary motor , premoter, primary sensory cortex in the task of writing with pencils than normal controls. But it is unclear which areas are directly related to the pathogenesis of writer’s cramp.Objective: Using functional magnetic resonance imaging (fMRI), to observe the changes of brain areas activities of writer’s cramp before and after treatment with botulinum toxin.Method: A fMRI block design was used. Four right-handed patients with unilateral writer’s cramp were scanned at 1.5 Tesla magneticresonance imaging scanner while they were performing the visually instructive task writing with pencil with MR Vision 2000 ,before and after they received the treatment with botulinum toxin injection. After image dates were co-registered to correct head motion, spatial normalized , deconverlution ,we got the average functional activated maps using AFNI software. The maps of "pre- minus post- treatment" were also gotten with general linear analyzed. Finally, we got the interesting area by observing the match of stimulating and area activated.Result: We found after the treatment with botulinum toxin, the patients showed significant impaird activation of contralateral primary moter cortex, premotor cortex , sensory cortex;enhanced activation of contralateral frontal association cortex;moderate impaird activation of ipsilateral cerebellar hemisphere and contralateral thalamus;while the mild change of contralateral basal ganglion and no change of putamen.Conclusion: These results indicates that the dysfunction of basal ganglion and subcortical-cortical loop are likely to play the role of the pathophysiology of writer’s cramp. And the changes of motor cortex, sensory cortex , cerebellar and thalamus may be secondary.更多还原