Ghaffar Omar, Chamelian Laury, Feinstein Anthony
Neuropsychiatry Division, Dept. of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, FG08-2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
J Neurol. 2008 Mar;255(3):406-12. doi: 10.1007/s00415-008-0685-1. Epub 2008 Feb 26.
Pseudobulbar affect (PBA) is defined as episodes of involuntary crying, laughing, or both in the absence of a matching subjective mood state. This neuropsychiatric syndrome can be found in a number of neurological disorders including multiple sclerosis (MS). The aim of this study was to identify neuroanatomical correlates of PBA in multiple sclerosis (MS) using a case-control 1.5T MRI study. MS patients with (n = 14) and without (n = 14) PBA were matched on demographic, disease course, and disability variables. Comorbid psychiatric disorders including depressive and anxiety disorders were absent. Hypo- and hyperintense lesion volumes plus measurements of atrophy were obtained and localized anatomically according to parcellated brain regions. Between-group statistical comparisons were undertaken with alpha set at 0.01 for the primary analysis. Discrete differences in lesion volume were noted in six regions: Brainstem hypointense lesions, bilateral inferior parietal and medial inferior frontal hyperintense lesions, and right medial superior frontal hyperintense lesions were all significantly higher in the PBA group. A logistic regression model identified four of these variables (brainstem hypointense, left inferior parietal hyperintense, and left and right medial inferior frontal hyperintense lesion volumes) that accounted for 70% of the variance when it came to explaining the presence of PBA. In conclusion, MS patients with PBA have a distinct distribution of brain lesions when compared to a matched MS sample without PBA. The lesion data support a widely-dispersed neural network involving frontal, parietal, and brainstem regions in the pathophysiology of PBA.
假性球麻痹（PBA）被定义为在没有匹配的主观情绪状态的情况下出现的不自主哭泣、大笑或两者皆有的发作。这种神经精神综合征可在包括多发性硬化症（MS）在内的多种神经系统疾病中发现。本研究的目的是通过一项病例对照1.5T MRI研究来确定多发性硬化症（MS）中PBA的神经解剖学相关性。有（n = 14）和无（n = 14）PBA的MS患者在人口统计学、病程和残疾变量方面进行了匹配。不存在包括抑郁和焦虑症在内的共病精神障碍。获取了低信号和高信号病变体积以及萎缩测量值，并根据脑区划分在解剖学上进行定位。在主要分析中，将α设定为0.01进行组间统计比较。在六个区域发现了病变体积的离散差异：脑干低信号病变、双侧顶叶下部和额叶内侧下部高信号病变以及右侧额上回内侧高信号病变在PBA组中均显著更高。一个逻辑回归模型确定了其中四个变量（脑干低信号、左侧顶叶下部高信号以及左侧和右侧额叶内侧下部高信号病变体积），在解释PBA的存在时，这些变量占方差的70%。总之，与匹配的无PBA的MS样本相比，有PBA的MS患者有明显不同的脑病变分布。病变数据支持在PBA的病理生理学中涉及额叶、顶叶和脑干区域的广泛分散的神经网络。
