正常與巴金森氏症狀熊下之視丘下核電生理表現

Electrophysiology of Subthalamic Nucleus in Normal and Parkinson's Disease

戴春暉(Chun-Hwei Tai) ； 郭鐘金(Chung-Chin Kuo)

《Acta Neurologica Taiwanica》 15卷3期 (2006/09) Pp. 206-216

https://doi.org/10.29819/ANT.200609.0010

摘要

位於大腦深部的視丘下核(subthalamic nucleus，簡稱STN)，是拉制大腦－基底核迥路的重要結構。具有節律性及自發放電特性的STN，有著獨特的電氣生理特性，在較負的膜電位狀況，STN會由棘波式(spike mode)放電轉換成叢集式(burst mode)放電。STN藉著分泌glutamate興奮性傳導物質的神經纖維，對基底核的輸出結構進行調控，並影響動物的運動功能。近年來對於巴金森氏症病態生理機轉的研究，發現STN在大腦多巴胺缺乏的狀態下會出現叢集式及共振式(oscillation)放電表現增加的狀況，此一表現被視為巴金森氏症病態生理的特徵之一。利用高頻率電流刺激STN，可以藉由改變STN的電生理狀態，使實驗動物之巴金森氏症症狀獲得大幅度改善。這些動物試驗之研究成果，已促成人類巴金森氏症患者接受STN高頻率放電刺激治療的發展，而且成效卓著。因此目前利用STN進行的深部腦刺激術，已成為中度至重度巴金森氏症患者的重要治療方式。本篇文章由介紹STN的基礎生理特性開始，至臨床上利用STN刺激來治療巴金森氏症，將對視丘下核的基礎研究及臨床應用等方面作一簡要的介紹與回顧。

關鍵字

視丘下核 ； 大腦－基底核迴路 ； 電氣生理 ； 運動控制 ； 巴金森氏症 ； 深腦刺激術

並列摘要

Subthalamic nucleus (STN) has been known to play an important role in the regulation of cortico-basal ganglia-thalamo-cortical loop. STN neurons have pacemaking activitiy and their firing pattern can switch from spike mode to bursting mode when membrane potential becomes hyperpolarized. Recent study has shown that STN neurons show marked increase in burst and oscillatory activity during the dopaminedepleting state of Parkinson's disease (PD). This electrophysiological change in activity is now considered as an characterstic pathophysiological feature of PD. High frequency stimulation of STN can modify and ”normalize” the activity of STN neurons in the pathophysiologial state. This electrophysiological treatment applied to STN, known as deep brain stimulation (DBS) clinically, ameliorates the symptoms of PD effectively, and is becoming a standard treatment in patients with advanced PD. This article would review the basic researches concerning electrical activities of STN and try to extend the basic knowledge into clinical applications.

並列關鍵字

Subthalamic nucleus ； Cortical-basal ganglia loop ； Electrophysiololgy ； Motor control ； Parkinson's disease ； Deep brain stimulation