臺灣博碩士論文加值系統

寫字型手部痙攣症是一種動作專一的肌張力不全症，其主要症狀為寫字時手部肌肉異常收縮造成手部顫動或手部姿勢扭曲。先前研究報導指出肌張力不全患者腦部運動相關迴路的異常，可能是導致肌張力異常的主因，但近來研究發現手部痙攣患者的體感覺處理失調亦可能是致病機轉之一。貝他波的律動與大腦處理感覺及運動活動息息相關，同時種種跡象顯示肌張力不全症患者的大腦處理感覺及運動功能皆有缺失，我們認為貝他波律動能反映寫字型痙攣症患者的感覺與運動功能變化。本研究假設感覺運動整合的異常，可能導致手部痙攣症的發生，而設計了兩個實驗來討論這個議題。實驗一，藉貝他波事件相關同步腦波律動 (event-related beta synchronization, beta ERS) 與體感覺誘發反應評估寫字型痙攣症患者之運動皮質及感覺皮質功能。實驗二，藉由寫字或想像寫字過程分析寫字型痙攣症患者對運動功能對體覺傳入訊息的影響，以評估患者的感覺運動整合功能。研究結果顯示，相較於健康受試者，寫字型痙攣症患者的運動相關 beta ERS有減弱的現象，而於休息狀態下的體感覺誘發反應及 beta ERS 則與對照組沒有顯著差異。再者，在休息、想像寫字及寫字狀態下，病患組的電刺激體感覺誘發反應與對照組相似。但是，病患組於寫字任務中，電刺激左手正中神經所誘發之beta ERS，顯著的降低，可能代表了病患的感覺運動功能失調。由本研究結果推論，寫字型手部痙攣症的病灶可能起因於運動皮質抑制功能降低造成中樞體感覺與運動整合網絡異常，而不是週邊體感覺傳入中樞神經系統的過程。

Writer's cramp is characterized by sustained muscle contractions that cause twisting movements or abnormal postures of hand during writing. It has been reported that malfunction of motor circuitry may cause dystonic movement. Recently studies have shown that deficiencies of sensory processing are another possible mechanism to cause writer’s cramp. The beta-band oscillation in the brain has been widely observed over sensorimotor network. In addition, the deficits in the somatsensory and motor networks could be the neuropathological features in patients with writer's cramp. To investigate the dynamics of beta-band oscillation might be helpful for unveiling the underlying neurophysiological mechanism in patients with writer' cramp. Thus, we hypothesized that the sensorimotor integration is abnormal for writer’s cramp. Two experiments were carried out to study this issue. In experiment I, we explored the event-related beta synchronization (beta ERS) and somatosensory evoked responses to evaluate the function of motor cortex and somatosensory cortex in patients with writer's cramp, respectively. In Experiment II, to evaluate the function of sensorimotor integration in patients, we examined the modulation of the somatosensory evoked field (SEF) in following to median nerve electric stimulation during resting, writing and writing imagery tasks. In compared with control group, the movement-related beta ERS was reduced in patients with writer’s cramp. However, no significant difference of the somatosensory induced beta ERS was found between groups. Moreover, the regulation of electrical-evoked SEF activities were similar between patients with writer’s cramp and healthy controls during rest, writing imagery and writing task. Of note, somatosensory-induced beta ERS for left median nerve stimulation was attenuated significantly in patients during writing task. Our data suggested that the loss of motor inhibition and deficit of sensory-motor integration in patients with writer’s cramp might result in dystonic movement. In conclusion, the major malfunction of writer’s cramp may occur in the sensory-motor networks in the brain but not in the pathway from peripheral to central nerve system.

目錄
中文摘要 I
Abstract III
目錄 V
圖目錄 VII
表目錄 VIII
第一章 前言 1
第二章 文獻回顧 4
寫字型痙攣症 5
腦磁圖儀 6
事件相關(非)同步貝他波律動 (Event-related beta (de)synchronization, ERD/S) 7
體感覺誘發反應 (somatosensory evoked responses) 9
想像運動 (motor imagery) 10
第三章 動機與目的 12
研究動機 13
研究目的 14
實驗內容 14
第四章 寫字型痙攣症患者感覺與運動皮質功能評估 15
背景與動機 16
材料方法 17
受試者 17
腦磁圖測量與收集 17
電刺激正中神經 18
體感覺誘發反應分析 18
自主抬動手指測驗流程 18
抬動手指時間點判讀 19
ERD/ERS 分析方法 19
統計分析 20
結果 20
體感覺誘發反應 21
運動相關與電刺激誘發貝他波 21
討論 22
第五章 寫字型痙攣症患者感覺運動整合功能評估 25
背景與動機 26
材料方法 27
受試者 27
腦磁圖測量與收集 27
電刺激正中神經 28
實驗設計 28
體感覺誘發反應分析 28
ERD/ERS 分析方法 29
統計分析 29
結果 30
討論 31
第六章 綜合討論 35
結論 39
參考文獻 40
圖表 49
附件 61
論文相關著作 62

圖目錄
圖 1 52
圖 2 53
圖 3 55
圖 4 56
圖 5 57
圖 6 58
圖 7 59
圖 8 60

表目錄
表格 1 50
表格 2 51

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