Patterns of Cortical Synchronization in Isolated Dystonia Compared With Parkinson Disease.
Patterns of Cortical Synchronization in Isolated Dystonia Compared With Parkinson Disease.
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DOI：
10.1001/jamaneurol.2015.2561
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发表时间：
2015-11
期刊：
影响因子：
29
通讯作者：
Starr PA
中科院分区：
文献类型：
--
作者：
Miocinovic S;de Hemptinne C;Qasim S;Ostrem JL;Starr PA
孤立性肌张力障碍和帕金森病（PD）是基底神经节丘脑皮质网络的疾病。他们有很大程度上不同的临床概况，但这两种疾病响应脑深部电刺激（DBS）在相同的皮质下目标使用类似的刺激范例，这表明病理生理重叠。我们假设，类似于PD，孤立性肌张力障碍与皮质神经元同步性升高相关。在清醒状态下接受DBS植入术的孤立性肌张力障碍和PD患者中，使用临时硬膜下电极条研究感觉运动皮层手臂相关区域的电生理特征。一项观察性研究招募了加州大学旧金山弗朗西斯科分校和旧金山弗朗西斯科退伍军人事务医疗中心计划进行DBS的患者。数据收集时间为2008年5月1日至2015年4月1日。报告了22例孤立性颈部或节段性肌张力障碍患者（8例有[DYST-ARM]，14例无[DYST]手臂症状）和14例运动不能性僵硬PD患者的结果。分析了2014年11月1日至2015年5月1日的数据。皮质局部场电位、功率谱密度和相位振幅耦合（PAC）。在我们的3组共36例患者中，皮质PAC存在于所有组的主要运动和运动前臂相关区域，但DYST组不太可能表现出PAC增加（P = 0.008）。与PD患者的结果相似，在术中测试刺激之前和期间研究的肌张力障碍患者亚组中，丘脑底DBS可逆性降低了PAC（n = 4）。在静息状态下，DYST-ARM和PD组中初级运动皮层的宽带伽马（50-200 Hz）功率大于DYST组，而所有3组中的α（8-13 Hz）和β（13-30 Hz）功率相当。在运动过程中，DYST-ARM组在初级运动皮层中的β和低γ去皮质化受损。孤立性肌张力障碍和PD在高水平运动皮层同步和丘脑底DBS减少皮层同步方面有生理重叠，为它们对基底神经节刺激的相似治疗反应提供了解释。
Isolated dystonia and Parkinson disease (PD) are disorders of the basal gangliothalamocortical network. They have largely distinct clinical profiles, but both disorders respond to deep brain stimulation (DBS) in the same subcortical targets using similar stimulation paradigms, suggesting pathophysiologic overlap. We hypothesized that, similar to PD, isolated dystonia is associated with elevated cortical neuronal synchronization. To investigate the electrophysiologic characteristics of the sensorimotor cortex arm-related area using a temporary subdural electrode strip in patients with isolated dystonia and PD undergoing DBS implantation in the awake state. An observational study recruited patients scheduled for DBS at the University of California, San Francisco and the San Francisco Veterans Affairs Medical Center. Data were collected from May 1, 2008, through April 1, 2015. Findings are reported for 22 patients with isolated cervical or segmental dystonia (8 with [DYST-ARM] and 14 without [DYST] arm symptoms] and 14 patients with akinetic rigid PD. Data were analyzed from November 1, 2014, through May 1, 2015. Cortical local field potentials, power spectral density, and phase-amplitude coupling (PAC). Among our 3 groups that together included 36 patients, cortical PAC was present in primary motor and premotor arm-related areas for all groups, but the DYST group was less likely to exhibit increased PAC (P = .008). Similar to what has been shown for patients with PD, subthalamic DBS reversibly decreased PAC in a subset of patients with dystonia who were studied before and during intraoperative test stimulation (n = 4). At rest, broadband gamma (50–200 Hz) power in the primary motor cortex was greater in the DYST-ARM and PD groups compared with the DYST group, whereas alpha (8–13 Hz) and beta (13–30 Hz) power was comparable in all 3 groups. During movement, the DYST-ARM group had impaired beta and low gamma desynchronization in the primary motor cortex. Isolated dystonia and PD have physiologic overlap with respect to high levels of motor cortex synchronization and reduction of cortical synchronization by subthalamic DBS, providing an explanation for their similar therapeutic response to basal ganglia stimulation.