Mechanisms underlying gait disturbance in Parkinson's disease - A single photon emission computed tomography study
Mechanisms underlying gait disturbance in Parkinson's disease - A single photon emission computed tomography study
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DOI：
10.1093/brain/122.7.1271
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发表时间：
1999-07-01
期刊：
影响因子：
14.5
通讯作者：
Shibasaki, H
中科院分区：
文献类型：
--
作者：
Hanakawa, T;Katsumi, Y;Shibasaki, H
使用单光子发射计算机断层扫描评估10名帕金森病患者和10名年龄匹配的对照组在跑步机上行走时脑血流的变化。受试者注射[Tc-99m]六甲基丙烯胺肟两次：在以稳定速度移动的跑步机上行走时，以及睁开眼睛躺在床上时。在跑步机上，所有受试者以相同的速度和他们喜欢的步幅行走。与对照组相比，患者表现出典型的低运动步态，步伐加快，步幅减小。在对照组中，在内侧和外侧运动前区、初级感觉运动区、前扣带中心、顶叶上皮层、视觉皮层、脑干背侧、基底神经节和小脑中观察到步态引起的大脑活动增加。帕金森病患者左侧内侧额叶区、右侧楔前叶区和左侧小脑半球相对激活不足，左侧颞叶皮层、右侧脑岛、左侧扣带皮层和小脑蚓部相对活跃。这是第一个实验研究表明，在人类两足步态中，与实验动物的脑干运动区相对应的背侧脑干是活跃的。内侧额叶运动区脑活动减少是帕金森病运动表现的基本异常。与蚓部过度活动相反，左小脑半球活动不足可能与帕金森步态中侧向重力转移的丧失有关。
Single photon emission computed tomography was used to evaluate regional cerebral blood flow changes during gait on a treadmill in 10 patients with Parkinson's disease and 10 age-matched controls. The subjects were injected with [Tc-99m]hexamethyl-propyleneamine oxime twice: while walking on the treadmill, which moved at a steady speed, and while lying on a bed with their eyes open. On the treadmill, all subjects walked at the same speed with their preferred stride length. The patients showed typical hypokinetic gait with higher cadence and smaller stride length than the controls. In the controls, a gait-induced increase in brain activity was observed in the medial and lateral premotor areas, primary sensorimotor areas, anterior cingulate center, superior parietal cortex, visual cortex, dorsal brainstem, basal ganglia and cerebellum. The Parkinson's disease patients revealed relative underactivation in the left medial frontal area, right precuneus and left cerebellar hemisphere, whereas they showed relative overactivity in the left temporal cortex, right insula, left cingulate cortex and cerebellar vermis. This is the first experimental study showing that the dorsal brainstem, which corresponds to the brainstem locomotor region in experimental animals, is active during human bipedal gait. The reduced brain activity in the medial frontal motor areas is a basic abnormality in motor performance in Parkinson's disease. The underactivity in the left cerebellar hemisphere, in contrast to the overactivity in the vermis, could be associated with a loss of lateral gravity shift in parkinsonian gait.