Lesions causing freezing of gait localize to a cerebellar functional network.
Lesions causing freezing of gait localize to a cerebellar functional network.
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导致步态冻结的病变定位于小脑功能网络。
DOI：
10.1002/ana.24845
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发表时间：
2017-01
影响因子：
11.2
通讯作者：
Fox MD
中科院分区：
文献类型：
--
作者：
Fasano A;Laganiere SE;Lam S;Fox MD
步态冻结是帕金森氏症和相关疾病的一种致残症状，但参与症状产生的大脑区域尚不清楚。在这里，我们分析导致急性步态冻结的脑损伤，以确定与症状产生有关的因果区域。从文献中鉴定了14例病变引起的步态冻结，并将病变映射到共同的脑图谱。由于病变引起的症状可能来自与病变位置连接的部位，而不仅仅是病变位置本身，我们还确定了与每个病变位置功能相关的大脑区域。这项名为病变网络映射的技术最近被证明可以识别各种病变诱导的疾病中参与症状产生的区域。病变的位置是不同的，没有一个单一的区域被认为是产生症状所必需的。然而，超过90%(13/14)的病变在功能上与小脑背侧内侧的灶性区域相连。这一小脑区域与先前识别的运动任务激活的区域重叠，称为小脑运动区域。与导致其他运动障碍的病变(偏视或星座)相比，与导致步态冻结的病变相比，该区域的连通性是特有的。导致步态冻结的病变位于一个共同的功能网络内，其特征是与小脑运动区的连接。这些基于因果脑损伤的结果补充了之前对帕金森氏症患者的神经成像研究，促进了我们对步态冻结所涉及的大脑区域的理解。
Freezing of gait is a disabling symptom in Parkinson’s disease and related disorders, but the brain regions involved in symptom generation remain unclear. Here we analyze brain lesions causing acute onset freezing of gait to identify regions causally involved in symptom generation. Fourteen cases of lesion-induced freezing of gait were identified from the literature and lesions were mapped to a common brain atlas. Because lesion-induced symptoms can come from sites connected to the lesion location, not just the lesion location itself, we also identified brain regions functionally connected to each lesion location. This technique, termed lesion network mapping, has been recently shown to identify regions involved in symptom generation across a variety of lesion-induced disorders. Lesion location was heterogeneous and no single region could be considered necessary for symptom generation. However, over 90% (13/14) of lesions were functionally connected to a focal area in the dorsal medial cerebellum. This cerebellar area overlapped previously recognized regions that are activated by locomotor tasks, termed the cerebellar locomotor region. Connectivity to this region was specific to lesions causing freezing of gait compared to lesions causing other movement disorders (hemichorea or asterixis). Lesions causing freezing of gait are located within a common functional network characterized by connectivity to the cerebellar locomotor region. These results based on causal brain lesions complement prior neuroimaging studies in Parkinson’s disease patients, advancing our understanding of the brain regions involved in freezing of gait.