Department of Neurology, University of Munich, Klinikum Grosshadern, Klinikum Grosshadern, Marchioninistr.15, 81377 Munich, Germany.
Restor Neurol Neurosci. 2010;28(1):105-14. doi: 10.3233/RNN-2010-0506.
Patients with neurological gait disorders often present to their doctor with the key symptoms of dizziness and gait unsteadiness (e.g. cerebellar ataxia, progressive supranuclear palsy). In vestibular syndromes, on the other hand, the gait disturbance is a leading sign and many aspects of the syndrome can be recognized from the analysis of posture and gait (e.g. direction of falls). For therapy in particular it is important to better understand the physiological control of posture and gait to adapt rehabilitation programs. We recently succeeded in visualizing the hierarchic network for postural control in humans by means of functional imaging techniques. Growing evidence suggests that so-called "locomotor regions", groups of neurons able to initiate or modulate spinal stepping in the cat in response to electrical or chemical stimulation, also exist in humans. The most important locomotor regions are the mesencephalic, the subthalamic, and the cerebellar locomotor regions. Locomotor signals are transmitted from the midbrain to the spinal cord via the ponto-medullary reticular formation and integrate multisensory input at different levels. Functional imaging also demonstrated that the multisensory cortical areas are inhibited during locomotion, which is relevant for physical therapy of vestibular disorders which therefore should include exercises with different gait patterns and different speeds. The supraspinal network for locomotion is just beginning to be recognized as an important factor in the pathophysiology of common gait disorders. In Parkinson's disease, for example, low-frequency stimulation of the mesencephalic locomotor region (pedunculopontine nucleus) is already used to treat freezing and gait disturbance in selected patients. In this review we summarize different attempts to visualize human supraspinal locomotor control using functional neuroimaging techniques, both in healthy subjects and in patients suffering from balance disorders.
患有神经步态障碍的患者常因头晕和步态不稳（如小脑性共济失调、进行性核上性麻痹）等主要症状就诊于医生。另一方面，在前庭综合征中，步态障碍是主要表现，通过分析姿势和步态（如跌倒方向）可以识别出许多综合征特征。特别是在治疗方面，了解姿势和步态的生理控制以适应康复计划非常重要。我们最近通过功能成像技术成功地可视化了人类姿势控制的层次网络。越来越多的证据表明，在人类中也存在所谓的“运动区”，即能够在猫中响应电或化学刺激而引发或调节脊髓踏步的神经元群。最重要的运动区是中脑、丘脑下核和小脑运动区。运动信号从中脑通过桥脑被盖网状结构传递到脊髓，并在不同水平整合多感觉输入。功能成像还表明，在运动过程中多感觉皮质区被抑制，这对于前庭障碍的物理治疗很重要，因此前庭障碍的治疗应该包括不同步态模式和不同速度的运动。运动的中枢网络才刚刚开始被认为是常见步态障碍病理生理学的一个重要因素。例如，在帕金森病中，已经使用中脑运动区（脚桥核）的低频刺激来治疗特定患者的冻结和步态障碍。在这篇综述中，我们总结了使用功能神经影像学技术在健康受试者和患有平衡障碍的患者中可视化人类中枢运动控制的不同尝试。
