Gilman S, Koeppe R A, Chervin R D, Consens F B, Little R, An H, Junck L, Heumann M
Department of Neurology, University of Michigan, Ann Arbor, USA.
Neurology. 2003 Jul 8;61(1):29-34. doi: 10.1212/01.wnl.0000073745.68744.94.
To explore the neurochemical basis of REM sleep behavior disorder (RBD) in multiple-system atrophy (MSA).
In 13 patients with probable MSA, nocturnal, laboratory-based polysomnography was used to rate the severity of REM atonia loss by the percentage of REM sleep with tonically increased electromyographic (EMG) activity and the percentage of REM sleep with phasic EMG bursts. PET with (+)-[11C]dihydrotetrabenazine ([11C]DTBZ) was employed to measure the density of striatal monoaminergic terminals and SPECT with (-)-5-[123I]iodobenzovesamicol ([123I]IBVM) to measure the density of 123I]IBVM.
Age and gender distributions were similar in patient and normal control groups. The MSA subjects showed decreased mean [11C]DTBZ binding in the striatum (p < 0.0001) and decreased [123I]IBVM binding in the thalamus (p < 0.001). Moreover, in the MSA group, striatal [11C]DTBZ binding was inversely correlated with the severity of REM atonia loss (p = 0.003). Thalamic [123I]IBVM binding, however, was not correlated to the severity of REM atonia loss.
Decreased nigrostriatal dopaminergic projections may contribute to RBD in MSA.
探讨多系统萎缩（MSA）中快速眼动睡眠行为障碍（RBD）的神经化学基础。
对13例疑似MSA患者进行基于实验室的夜间多导睡眠图检查，通过伴有持续性肌电图（EMG）活动增加的快速眼动睡眠百分比和伴有相位性EMG爆发的快速眼动睡眠百分比来评估快速眼动失张力丧失的严重程度。采用（+）-[11C]二氢四苯嗪（[11C]DTBZ）正电子发射断层扫描（PET）测量纹状体单胺能终末密度，以及采用（-）-5-[123I]碘苯甲酰甲基溴（[123I]IBVM）单光子发射计算机断层扫描（SPECT）测量[123I]IBVM密度。
患者组和正常对照组的年龄和性别分布相似。MSA患者纹状体中[11C]DTBZ结合均值降低（p < 0.0001），丘脑[123I]IBVM结合降低（p < 0.001）。此外，在MSA组中，纹状体[11C]DTBZ结合与快速眼动失张力丧失的严重程度呈负相关（p = 0.003）。然而，丘脑[123I]IBVM结合与快速眼动失张力丧失的严重程度无关。
黑质纹状体多巴胺能投射减少可能导致MSA中的RBD。
