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JPD:下丘脑核团的结构连接改变,和冻结步态的息息相关

2022-05-23 Freemann MedSci原创

STN-DBS可以通过调节与前额叶和运动皮层结构相连的特定通路来减轻FOG的严重程度

步态障碍如步态冻结(FOG)是帕金森病(PD)患者的高致残性症状,影响生活质量、发病率和独立性。FOG患者尽管有意行走,但会突然出现无效的步态,通常被认为是 "粘在地上"。


图1: 论文封面图


当FOG发生在OFF状态时,但可以通过多巴胺能药物治疗得到缓解,这被称为 "左旋多巴反应性冻结 "或 "OFF冻结",而 "左旋多巴无反应性冻结 "对多巴胺能药物治疗的变化无动于衷,甚至可以通过药物治疗恶化为 "ON冻结"。

虽然丘脑下核(STN)的深部脑刺激(DBS)是治疗严重PD运动症状的既定方法,但其对步态困难和FOG的影响一直被讨论得很有争议。此外,皮层刺激方案,如重复经颅磁刺激多个目标,已被引入治疗PD的FOG。 不同的潜在解剖学目标的存在表明,更广泛的网络参与了FOG的治疗,这与目前关于其病理的网络模型是一致的。值得注意的是,FOG通常被理解为一种复杂的综合征,超越了纯粹的运动角度。

相反,一系列的成像研究表明,至少在一些患者的认知甚至边缘回路可能在FOG的出现中进一步发挥关键作用。这种多网络的观点与现象学观察相吻合,即FOG的触发因素可以分为运动(如转弯)、认知(如多任务)或边缘触发(如焦虑)。

因此,FOG被认为是由运动、认知或边缘输入到中脑运动区的信号失调导致的,干扰了步态期间的自动运动。这种多网络的观点表明,平均而言,FOG可能通过调节运动、认知和潜在的边缘通路来改善。

藉此,德国科隆大学的Daniel H. Lencha等人,假设STN-DBS通过调节基底神经节内的特定回路来缓解FOG,反映了运动、认知和边缘功能。其次,假设与间脑运动区的结构连接也是这个有益网络的一部分。

他们探究了47名PD和术前FOG的患者。主要使用步态冻结问卷(FOG-Q)来评估冻结的发生率和严重程度。在18名患者的子集中,评估了标准化步行过程中的诱发FOG。通过使用一个公开的基底神经节通路模型,他们确定了与术后FOG变化有关的刺激依赖性连接。使用疾病特异性规范连接组,对先验定义的间脑区域进行了兴趣区域分析。

 


图2:论文结果图


他们发现:术后6个月步态冻结明显改善,标志是冻结发作的频率和持续时间减少。

改善FOG的最佳刺激量在结构上与运动区、前额叶皮层和球状体相连

这种连通性特征在留置交叉验证中是强有力的。

在皮层下,对穿越小脑幕核和黑质的纤维的刺激与术后改善有关。

该研究的重要意义在于发现了: STN-DBS可以通过调节与前额叶和运动皮层结构相连的特定通路来减轻FOG的严重程度。更加分化的FOG评估可能允许在未来区分特定FOG亚型的通路。


原文出处:
Strelow JN, Baldermann JC, Dembek TA, et al. Structural Connectivity of Subthalamic Nucleus Stimulation for Improving Freezing of Gait. _JPD_. Published online April 11, 2022:1-17. doi:[10.3233/JPD-212997](https://doi.org/10.3233/JPD-212997)

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    2022-11-15 xxxx1061
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    2022-05-24 xlwang2696
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DBS对眼球运动的影响可能为我们提供关键线索,以了解DBS的作用机制,以及受刺激的基底神经节部分的生理功能。本文对这一领域的研究进展进行综述。

帕金森病的睡眠问题:从RBD到不宁腿!

正确认识PD睡眠障碍的类型、病因及治疗方案,将有助于PD睡眠障碍的有效治疗。

JNNP:长期太极拳训练对帕金森病的影响:3.5年随访队列研究

太极拳训练对帕金森病具有长期有益作用,可改善运动和非运动症状,减少并发症。

论著|帕金森病心血管系统自主神经功能与排尿症状相关性研究

本研究旨在探究PD患者自主神经功能改变中心血管系统与排尿症状之间的相关性,揭示可能的共同病理生理机制,进而为PD患者的全面评估和个体化治疗提供理论依据。

病例报告|帕金森病合并重症肌无力1例

PD合并MG较为罕见,结合文献复习阐述其可能的共病机制及治疗策略,以期提高临床医生对此合并症的全面认识与诊治能力。关键词 

2024 NICE 介入程序指南:磁共振成像(MRI)引导的聚焦超声丘脑底核切开术用于治疗帕金森病 [IPG797]

英国国家卫生与临床优化研究所(NICE,National Institute for Health and Clinical Excellence) · 2024-12-18

2024 NICE 介入程序指南:磁共振成像引导的聚焦超声丘脑切开术用于治疗帕金森病中重度震颤 [IPG796]

英国国家卫生与临床优化研究所(NICE,National Institute for Health and Clinical Excellence) · 2024-12-18

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