Parkinson's disease as a system-level disorder.
Parkinson's disease as a system-level disorder.
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DOI：
10.1038/npjparkd.2016.25
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Baldassarre G
中科院分区：
文献类型：
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作者：
Caligiore D;Helmich RC;Hallett M;Moustafa AA;Timmermann L;Toni I;Baldassarre G
传统上，基底神经节被认为是帕金森病的主要脑区。这种单一区域的观点提供了一个有限的临床图片，并限制了治疗方法，因为它忽略了改变基底神经节和其他大脑成分之间的相互作用对帕金森病症状的影响。特别是，基底神经节与皮质和小脑密切合作，以支持运动和认知功能。本文提出了一个理论框架，了解帕金森氏病所造成的功能障碍，整个基底神经节-皮质-小脑系统，而不是孤立的基底神经节。特别是，最近的证据的基础上，我们提出，震颤，冻结和行动顺序障碍的三个关键症状可以解释考虑部分重叠的神经回路，包括基底神经节，皮质和小脑区域。研究这个系统在帕金森病中的参与是设计针对它而不仅仅是基底神经节的创新治疗方法的关键一步。基于这种不同的观点，未来可能的治疗方法进行了讨论。
Traditionally, the basal ganglia have been considered the main brain region implicated in Parkinson’s disease. This single area perspective gives a restricted clinical picture and limits therapeutic approaches because it ignores the influence of altered interactions between the basal ganglia and other cerebral components on Parkinsonian symptoms. In particular, the basal ganglia work closely in concert with cortex and cerebellum to support motor and cognitive functions. This article proposes a theoretical framework for understanding Parkinson’s disease as caused by the dysfunction of the entire basal ganglia–cortex–cerebellum system rather than by the basal ganglia in isolation. In particular, building on recent evidence, we propose that the three key symptoms of tremor, freezing, and impairments in action sequencing may be explained by considering partially overlapping neural circuits including basal ganglia, cortical and cerebellar areas. Studying the involvement of this system in Parkinson’s disease is a crucial step for devising innovative therapeutic approaches targeting it rather than only the basal ganglia. Possible future therapies based on this different view of the disease are discussed.