Hypophonia in Parkinson's disease - Neural correlates of voice treatment revealed by PET
Hypophonia in Parkinson's disease - Neural correlates of voice treatment revealed by PET
复制标题
DOI：
10.1212/wnl.60.3.432
复制
发表时间：
2003-02-11
期刊：
影响因子：
9.9
通讯作者：
Fox, PT
中科院分区：
文献类型：
--
作者：
Liotti, M;Ramig, LO;Fox, PT
目的：采用O-15-H2O PET研究Lee Silverman语音治疗方法（VT）语音治疗前后特发性PD（IPD）患者发音减退的神经相关性。研究方法：在IPD受试者VT前后和一组健康对照志愿者中，测量了与静息状态下明显的言语-运动任务相关的局部脑血流量（rCBF）变化。结果：治疗后，声音响度的行为指标明显改善。在VT之前，患者在运动和运动前皮质（M1-mouth，辅助运动皮质[SMA]和下外侧运动前皮质[ILPm]）中有强烈的语言相关激活，VT后这些激活显著减少。与治疗后阶段相似，健康对照组中不存在运动前激动（SMA）或低于统计阈值（M1-口）。此外，VT治疗后，在前岛叶皮层、尾状核头、壳核和背外侧前额叶皮层（DLPFC）中存在显著的右侧激活。最后，VT诱导的神经变化不存在于VT未治疗患者的瞬时实验提示的响度增加。结论：VT语音治疗后IPD发音减退的有效改善伴随着皮质运动-运动前区激活的减少，类似于健康志愿者中观察到的功能模式，并提示正常化，以及右前额叶、尾状核头、壳核和DLPFC的额外招募。这种治疗依赖性的功能重组表明，从异常努力的转变。（运动前皮质）到更自动（基底神经节，前额叶）的语言运动动作的执行。
Objective: To investigate the neural correlates of hypophonia in individuals with idiopathic PD (IPD) before and after voice treatment with the Lee Silverman Voice Treatment method (VT) using O-15-H2O PET. Methods: Regional cerebral blood flow (rCBF) changes associated with overt speech-motor tasks relative to the resting state were measured in the IPD subjects before and after VT, and in a group of healthy control volunteers. Results: Behavioral measures of voice loudness significantly improved following treatment. Before VT, patients had strong speech-related activations in motor and premotor cortex (M1-mouth, supplementary motor cortex [SMA], and inferior lateral premotor cortex [ILPm]), which were significantly reduced post-VT. Similar to the post-treatment session, premotor activations were absent (SMA) or below statistical threshold (M1-mouth) in the healthy control group. In addition, following VT treatment, significant right-sided activations were present in anterior insular cortex, caudate head, putamen, and dorsolateral prefrontal cortex (DLPFC). Finally, the VT-induced neural changes were not present with transient experimenter-cued increases of loudness in VT-untreated patients. Conclusions: Effective improvement of IPD hypophonia following voice treatment with VT was accompanied by a reduction of cortical motor-premotor activations, resembling the functional pattern observed in healthy volunteers and suggesting normalization, and additional recruitment of right anterior insula, caudate head, putamen, and DLPFC. This treatment-dependent functional reorganization suggests a shift from an abnormally effortful. (premotor cortex) to a more automatic (basal ganglia, anterior insula) implementation of speech-motor actions.