Neurological Surgery 脳神経外科49巻4号

2021年07月発行

特集 定位・機能神経外科の基礎と臨床 Ⅰ　定位・機能神経外科に必須な基礎知識

大脳基底核・視床と神経回路—凝固術や刺激術はどのように作用するのか？

著者： 村瀬永子¹ 平林秀裕²

所属機関： ¹国立病院機構奈良医療センター脳神経内科 ²国立病院機構奈良医療センター脳神経外科

ページ範囲：P.712 - P.723

Point
・基底核には，四肢の運動，眼球運動，情動，認知とかかわる皮質—基底核—視床—皮質を介するループが並列し，体部位特異性がある．
・基底核はハイパー直接路，直接路，間接路といった経路による複雑な興奮（脱抑制）と抑制の回路を成している．
・これら経路による発火モデル（rate model）でパーキンソン病やジストニアといった疾患の病態が説明されてきた．しかしそれで説明できない点もみられる．
・脳深部刺激（DBS）の電極から得られる局所フィールド電位（LFP）の研究から，パーキンソン病では広範囲の異常な同期活動が病態の本質であろうと推察されている．

参考文献

1）Alexander GE, Crutcher MD：Functional architecture of basal ganglia circuits：neural substrates of parallel processing. Trends Neurosci 13：266-271, 1990

2）Iwamuro H, et al：Information processing from the motor cortices to the subthalamic nucleus and globus pallidus and their somatotopic organizations revealed electrophysiologically in monkeys. Eur J Neurosci 46：2684-2701, 2017

3）Nambu A, et al：Dual somatotopical representations in the primate subthalamic nucleus：evidence for ordered but reversed body-map transformations from the primary motor cortex and the supplementary motor area. J Neurosci 16：2671-2683, 1996

4）Yelnik J：Functional anatomy of the basal ganglia. Mov Disord 17 Suppl 3：S15-S21, 2002

5）DeLong MR, Wichmann T：Basal ganglia circuits as targets for neuromodulation in Parkinson disease. JAMA Neurol 72：1354-1360, 2015

6）Karachi C, et al：Three-dimensional cartography of functional territories in the human striatopallidal complex by using calbindin immunoreactivity. J Comp Neurol 450：122-134, 2002

7）Hirabayashi H, et al：Stereotactic imaging of the pallidal target. Mov Disord 17 Suppl 3：S130-S134, 2002

8）Polyakova Z, et al：Cortical control of subthalamic neuronal activity through the hyperdirect and indirect pathways in monkeys. J Neurosci 40：7451-7463, 2020

9）Nambu A, et al：Functional significance of the cortico-subthalamo-pallidal ‘hyperdirect’ pathway. Neurosci Res 43：111-117, 2002

10）渡辺克成：視床下核におけるユニット記録および局所フィールド電位を用いた定位脳手術．機能脳神外（suppl）：S17-S30, 2021

11）知見聡美，南部　篤：12.視床の機能解剖．橋本信夫（監），三國信啓，深谷　親（編）：脳神経外科医が知っておくべきニューロサイエンスの知識．文光堂，東京，2015，pp. 77-78

12）Vitek JL, Johnson LA：Understanding Parkinson's disease and deep brain stimulation：role of monkey models. Proc Natl Acad Sci U S A 116：26259-26265, 2019

13）Mink JW：The basal ganglia：focused selection and inhibition of competing motor programs. Prog Neurobiol 50：381-425, 1996

14）Cui G, et al：Concurrent activation of striatal direct and indirect pathways during action initiation. Nature 494：238-242, 2013

15）Calabresi P, et al：Direct and indirect pathways of basal ganglia：a critical reappraisal. Nat Neurosci 17：1022-1030, 2014

16）Nonomura S, et al：Monitoring and updating of action selection for goal-directed behavior through the striatal direct and indirect pathways. Neuron 99：1302-1314.e5, 2018

17）Vitek JL, et al：Neuronal activity in the basal ganglia in patients with generalized dystonia and hemiballismus. Ann Neurol 46：22-35, 1999

18）Bergman H, et al：Reversal of experimental parkinsonism by lesions of the subthalamic nucleus. Science 249：1436-1438, 1990

19）Burns JM, et al：Analysis of pallidotomy lesion positions using three-dimensional reconstruction of pallidal lesions, the basal ganglia, and the optic tract. Neurosurgery 41：1303-1316；discussion 1316-1318, 1997

20）Murase N, et al：Abnormal premovement gating of somatosensory input in writer's cramp. Brain 123（Pt 9）：1813-1829, 2000

21）Hashimoto T, et al：Stimulation of the subthalamic nucleus changes the firing pattern of pallidal neurons. J Neurosci 23：1916-1923, 2003

22）Xu W, et al：Subthalamic nucleus stimulation modulates thalamic neuronal activity. J Neurosci 28：11916-11924, 2008

23）Brown P, et al：Dopamine dependency of oscillations between subthalamic nucleus and pallidum in Parkinson's disease. J Neurosci 21：1033-1038, 2001

24）Hammond C, et al：Pathological synchronization in Parkinson's disease：networks, models and treatments. Trends Neurosci 30：357-364, 2007

25）Costa RM, et al：Rapid alterations in corticostriatal ensemble coordination during acute dopamine-dependent motor dysfunction. Neuron 52：359-369, 2006

26）Wang DD, et al：Pallidal deep-brain stimulation disrupts pallidal beta oscillations and coherence with primary motor cortex in Parkinson's disease. J Neurosci 38：4556-4568, 2018

27）Silberstein P, et al：Patterning of globus pallidus local field potentials differs between Parkinson's disease and dystonia. Brain 126（Pt 12）：2597-2608, 2003

28）Martínez-Fernández R, et al：Randomized trial of focused ultrasound subthalamotomy for Parkinson's disease. N Engl J Med 383：2501-2513, 2020

29）Na YC, et al：Unilateral magnetic resonance-guided focused ultrasound pallidotomy for Parkinson disease. Neurology 85：549-551, 2015