Tessitore A, Esposito F, Monsurrò M R, Graziano S, Panza D, Russo A, Migliaccio R, Conforti F L, Morrone R, Quattrone A, Di Salle F, Tedeschi G
Second Division of Neurology, Second University of Naples, Piazza Miraglia, 2, Naples 80131, Italy.
Brain Res Bull. 2006 May 15;69(5):489-94. doi: 10.1016/j.brainresbull.2006.01.013. Epub 2006 Mar 27.
To address the potential contribution of subcortical brain regions in the functional reorganization of the motor system in patients with sporadic ALS (sALS) and to investigate whether functional changes in brain activity are different in sALS patients with predominant upper motor neuron (UMN) or lower motor neuron (LMN) dysfunction.
We studied 16 patients with sALS and 13 healthy controls, using BOLD-fMRI, while they performed a simple visually paced motor task. Seven patients had definite clinical UMN signs while nine patients had prevalent clinical and electrophysiological LMN involvement. fMRI data were analyzed with Brain Voyager QX.
Task-related functional changes were identified in motor cortical regions in both patients and healthy controls. Direct group comparisons revealed relatively decreased BOLD fMRI responses in left sensorimotor cortex, lateral premotor area, supplementary motor area and right posterior parietal cortex (p < 0.05 corrected) and relatively increased responses in the left anterior putamen (p < 0.001 uncorrected) in sALS patients. Additional analyses between the two patients subgroups demonstrated significant BOLD fMRI response differences in the anterior cingulate cortex and right caudate nucleus (p < 0.001 uncorrected) with more robust activation of these areas in patients with greater UMN burden. Importantly, there were no significant differences in performance of the motor task between sALS patients and controls as well as between sALS patient subgroups.
Our data demonstrate a different BOLD fMRI pattern between our sALS patients and healthy controls even during simple motor behavior. Furthermore, patients with sALS and greater UMN involvement show a different reorganization of the motor system compared to sALS patients with greater LMN dysfunction.
探讨皮质下脑区在散发性肌萎缩侧索硬化症（sALS）患者运动系统功能重组中的潜在作用，并研究在以主要表现为上运动神经元（UMN）或下运动神经元（LMN）功能障碍的sALS患者中，大脑活动的功能变化是否存在差异。
我们对16例sALS患者和13名健康对照者进行了研究，使用血氧水平依赖性功能磁共振成像（BOLD-fMRI），让他们执行一项简单的视觉节奏运动任务。7例患者有明确的临床UMN体征，而9例患者有明显的临床和电生理LMN受累表现。使用Brain Voyager QX对fMRI数据进行分析。
在患者和健康对照者的运动皮质区域均发现了与任务相关的功能变化。直接的组间比较显示，sALS患者左侧感觉运动皮质、外侧运动前区、辅助运动区和右侧顶叶后皮质的BOLD fMRI反应相对降低（校正后p<0.05），而左侧前壳核的反应相对增加（未校正p<0.001）。对两个患者亚组的进一步分析表明，前扣带回皮质和右侧尾状核的BOLD fMRI反应存在显著差异（未校正p<0.001），UMN负担较重的患者这些区域的激活更强。重要的是，sALS患者与对照组之间以及sALS患者亚组之间在运动任务表现上没有显著差异。
我们的数据表明，即使在简单的运动行为中，我们的sALS患者与健康对照者之间的BOLD fMRI模式也有所不同。此外，与LMN功能障碍较重的sALS患者相比，UMN受累较重的sALS患者运动系统的重组方式不同。
