Department of Neurology and IFB, Ludwig-Maximilians-University of Munich, Munich, Germany.
Neurology. 2011 Jul 12;77(2):101-9. doi: 10.1212/WNL.0b013e318223c79d. Epub 2011 May 25.
To determine how postural imbalance and falls are related to regional cerebral glucose metabolism (PET) and functional activation of the cerebral postural network (fMRI) in patients with progressive supranuclear palsy (PSP).
Sixteen patients with PSP, who had self-monitored their frequency of falls, underwent a standardized clinical assessment, posturographic measurement of balance during modified sensory input, and a resting [¹⁸F]FDG-PET. In addition, patients performed an fMRI paradigm using mental imagery of standing. Results were compared to healthy controls (n = 16).
The frequency of falls/month in patients (range 1-40) correlated with total PSP rating score (r = 0.90). Total sway path in PSP significantly correlated with frequency of falls, especially during modulated sensory input (eyes open: r = 0.62, eyes closed: r = 0.67, eyes open/head extended: r = 0.84, eyes open/foam-padded platform: r = 0.87). Higher sway path values and frequency of falls were associated with decreased regional glucose metabolism (rCGM) in the thalamus (sway path: r = -0.80, falls: r = -0.64) and increased rCGM in the precentral gyrus (sway path: r = 0.79, falls: r = 0.64). Mental imagery of standing during fMRI revealed a reduced activation of the mesencephalic brainstem tegmentum and the thalamus in patients with postural imbalance and falls.
The new and clinically relevant finding of this study is that imbalance and falls in PSP are closely associated with thalamic dysfunction. Deficits in thalamic postural control get most evident when balance is assessed during modified sensory input. The results are consistent with the hypothesis that reduced thalamic activation via the ascending brainstem projections may cause postural imbalance in PSP.
确定姿势平衡障碍和跌倒与进行性核上性麻痹（PSP）患者的区域性脑葡萄糖代谢（PET）和大脑姿势网络的功能激活（fMRI）之间的关系。
16 名患者患有 PSP，他们自行监测跌倒的频率，接受了标准化的临床评估、改良感觉输入下平衡的姿势描记术和静息 [¹⁸F]FDG-PET。此外，患者还进行了站立的心理意象 fMRI 范式。结果与健康对照组（n=16）进行了比较。
患者的每月跌倒频率（范围 1-40）与 PSP 总评分（r=0.90）相关。PSP 患者的总摆动路径与跌倒频率显著相关，尤其是在调制感觉输入期间（睁眼：r=0.62，闭眼：r=0.67，睁眼/头伸展：r=0.84，睁眼/泡沫垫平台：r=0.87）。较高的摆动路径值和跌倒频率与丘脑的区域葡萄糖代谢（rCGM）降低（摆动路径：r=-0.80，跌倒：r=-0.64）和中央前回的 rCGM 增加（摆动路径：r=0.79，跌倒：r=0.64）相关。fMRI 中站立的心理意象显示，姿势平衡障碍和跌倒的患者中脑桥被盖的中脑和丘脑的激活减少。
本研究的新的和具有临床意义的发现是，PSP 中的平衡障碍和跌倒与丘脑功能障碍密切相关。在修改后的感觉输入下评估平衡时，丘脑姿势控制的缺陷最为明显。这些结果与通过上行脑干投射减少丘脑激活可能导致 PSP 姿势平衡障碍的假设一致。
