The cortical signature of symptom laterality in Parkinson's disease.
The cortical signature of symptom laterality in Parkinson's disease.
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DOI：
10.1016/j.nicl.2017.02.010
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Wilson TW
中科院分区：
文献类型：
--
作者：
Heinrichs-Graham E;Santamaria PM;Gendelman HE;Wilson TW
帕金森病 (PD) 患者通常会出现单侧运动症状，并最终扩散到另一侧。这种症状偏侧化在诊断上很重要，因为它可以将帕金森病与其他具有重叠症状的运动障碍区分开来。此外，最近的研究表明，症状发作的一侧对于预后很重要，因为右旋和左旋（RD、LD）患者之间的疾病进展速度和继发症状的发生率存在差异。从生理学角度来看，之前的研究表明整个基底神经节的结构和代谢出现不对称下降，尽管将其与运动功能直接联系起来很困难。为了确定 PD 症状偏侧性的神经生理学基础，我们记录了表现出 RD 或 LD 症状的 PD 患者在左手和右手运动范式期间的脑磁图 (MEG)。然后使用波束形成方法对服务于这些运动的β振荡进行成像，并且我们提取每个运动的左右初级运动皮层中峰值体素的时间序列。此外，使用统一帕金森病评定量表（UPDRS）对每位患者的症状不对称性进行定量，从而评估症状不对称性和神经不对称性之间的关系。我们发现，与有 RD 症状的患者相比，LD 患者在运动过程中具有更强的 β 抑制，以及更大的运动后 β 反弹，与移动的手无关。有趣的是，右手运动期间 β 活性的不对称性与症状不对称性唯一相关，因此症状特征越 LD，β 反应越左偏（即运动的对侧）；相反，症状特征越 RD，β 反应越右侧化（即运动同侧）。这项研究首次直接探讨了 PD 患者运动过程中症状不对称与神经活动偏侧性之间的关系，并表明 LD 患者相对于 RD 患者具有根本不同且更“健康”的振荡模式。帕金森病的右侧主导表达与更快的进展有关。症状不对称与皮质生理学之间的联系仍然未知。测量具有左/右主导症状的患者的皮质运动活动。具有左侧主导症状的患者具有“更健康”的运动反应模式。运动过程中皮质活动的偏侧性与症状偏侧性相关。
Patients with Parkinson's disease (PD) often present with unilateral motor symptoms that eventually spread to the other side. This symptom lateralization is diagnostically important, as it serves to distinguish PD from other motor disorders with overlapping symptom profiles. Further, recent studies have shown that the side of symptom onset is important for prognosis, as there are differences in the rate of disease progression and the incidence of secondary symptoms between right- and left-dominant (RD, LD) patients. Physiologically, previous studies have shown asymmetrical decline in structure and metabolism throughout the basal ganglia, although connecting this directly to motor function has been difficult. To identify the neurophysiological basis of symptom laterality in PD, we recorded magnetoencephalography (MEG) during left- and right-hand movement paradigms in patients with PD who exhibited either RD or LD symptomatology. The beta oscillations serving these movements were then imaged using beamforming methods, and we extracted the time series of the peak voxel in the left and right primary motor cortices for each movement. In addition, each patient's symptom asymmetry was quantitated using the Unified Parkinson's Disease Rating Scale (UPDRS), which allowed the relationship between symptom asymmetry and neural asymmetry to be assessed. We found that LD patients had stronger beta suppression during movement, as well as greater post-movement beta rebound compared to patients with RD symptoms, independent of the hand that was moved. Interestingly, the asymmetry of beta activity during right-hand movement uniquely correlated with symptom asymmetry, such that the more LD the symptom profile, the more left-lateralized (i.e., contralateral to movement) the beta response; conversely, the more RD the symptom profile, the more right-lateralized (i.e., ipsilateral to movement) the beta response. This study is the first to directly probe the relationship between symptom asymmetry and the laterality of neural activity during movement in patients with PD, and suggests that LD patients have a fundamentally different and more “healthy” oscillatory pattern relative to RD patients. Right-dominant expression of Parkinson's has been connected to faster progression. Linkage between symptom asymmetry and cortical physiology remains unknown. Cortical motor activity was measured in patients with left/right-dominant symptoms. Patients with left-dominant symptoms had “healthier” pattern of motor responses. Laterality of cortical activity during movement was related to symptom laterality.