NeuroImage: Clinical Loss of inhibition in sensorimotor networks in focal hand dystonia
NeuroImage: Clinical Loss of inhibition in sensorimotor networks in focal hand dystonia
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目的：探讨局灶性手肌张力障碍（FHD）患者GABA能受体密度及相关脑功能和灰质改变。方法：18例右手FHD患者和18例年龄、性别匹配的健康志愿者（HV）参加了这项研究。我们用[ 11 C]氟马西尼测量GABA-A受体的密度，用[ 15 O] H2O测量灌注。还使用解剖图像以基于体素的莫尔测定法（VBM）测量灰质体积。结果如下：在FHD患者中，与HV相比，右侧小脑的蚓部VI和左侧感觉运动皮质的氟马西尼结合电位（FMZ-BP）降低，而纹状体和外侧小脑未显示显著变化。双侧下前额叶皮层FMZ-BP升高，灌注增加，与病程呈负相关。只有左侧感觉运动皮层显示灰质体积减少。释义：小脑和感觉运动皮质区的GABA能神经传递受损可以解释FHD抑制控制丧失的不同方面，前者涉及适应不良可塑性，后者涉及周围抑制。下前额叶皮层的重组，联想网络的一部分，可能是补偿的感觉运动回路的抑制控制的损失。这些发现表明，小脑和大脑GABA能异常可能在肌张力障碍的纹状体-小脑-皮质回路的功能失衡中发挥作用。
Objective: To investigate GABA-ergic receptor density and associated brain functional and grey matter changes in focal hand dystonia (FHD). Methods: 18 patients with FHD of the right hand and 18 age and gender matched healthy volunteers (HV) participated in this study. We measured the density of GABA-A receptors using [ 11 C] Flumazenil and perfusion using [ 15 O] H 2 O. Anatomical images were also used to measure grey matter volume with voxel-based mor- phometry (VBM). Results: In FHD patients compared to HV, the vermis VI of the right cerebellum and the left sensorimotor cortex had a decrease of Flumazenil binding potential (FMZ-BP), whereas the striatum and the lateral cerebellum did not show signi fi cant change. Bilateral inferior prefrontal cortex had increased FMZ-BP and an increase of per- fusion, which correlated negatively with disease duration. Only the left sensorimotor cortex showed a decrease of grey matter volume. Interpretation: Impairments of GABAergic neurotransmission in the cerebellum and the sensorimotor cortical areas could explain di ff erent aspects of loss of inhibitory control in FHD, the former being involved in mala- daptive plasticity, the latter in surround inhibition. Reorganization of the inferior prefrontal cortices, part of the associative network, might be compensatory for the loss of inhibitory control in sensorimotor circuits. These fi ndings suggest that cerebellar and cerebral GABAergic abnormalities could play a role in the functional im-balance of striato-cerebello-cortical loops in dystonia.