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原发性书写痉挛患者复杂运动而非简单运动的皮质模式改变:一项参数化事件相关 fMRI 研究。

Cortical pattern of complex but not simple movements is affected in writer's cramp: a parametric event-related fMRI study.

机构信息

Dept. of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic.

出版信息

Clin Neurophysiol. 2012 Apr;123(4):755-63. doi: 10.1016/j.clinph.2011.08.002. Epub 2011 Sep 7.

Abstract

OBJECTIVE

Patients with writer's cramp (WC) were studied for differences in cortical activation during movements likely to induce WC (complex movements) and movements which rarely lead to dystonia (simple movements).

METHODS

Eleven WC patients (10F, 1M, mean age 41.5 ± (SD)7.2 years) and eleven age matched controls were examined for Blood oxygenation-level dependent (BOLD) 1.5 T fMRI. The complex task consisted of writing a single letter or random drawing using an especially adapted joystick with the line of trajectory visualized or hidden. The simple task consisted of self-initiated fingers flexion/extension using the affected hand.

RESULTS

Unlike the controls, WC patients performing complex movements exhibited a lower BOLD signal in the primary sensorimotor cortex and in the posterior parietal cortex bilaterally. A hypoactivation was also observed in the right secondary somatosensory area, in the right anterior insula and in the left premotor cortex (p < 0.05 corrected). No significant inter-group differences were found for simple movements.

CONCLUSIONS

Although WC patients' complex movements during fMRI were never associated with dystonic cramp, they exhibited an abnormally low cortical activity. This phenomenon was not observed in simple movements and was unrelated to the character of handwriting or to visual feedback.

SIGNIFICANCE

Our results support the dualistic behavior in the sensorimotor system in WC.

摘要

目的

研究书写痉挛(WC)患者在可能诱发 WC(复杂运动)和很少导致运动障碍(简单运动)的运动过程中的皮质激活差异。

方法

对 11 名 WC 患者(10 名女性,1 名男性,平均年龄 41.5±7.2 岁)和 11 名年龄匹配的对照组进行了血氧水平依赖(BOLD)1.5T fMRI 检查。复杂任务包括使用特别适配的操纵杆以可视化或隐藏轨迹线来书写单个字母或随机绘图。简单任务包括使用受影响的手自行进行手指屈伸。

结果

与对照组不同,进行复杂运动的 WC 患者双侧初级感觉运动皮质和后顶叶皮质的 BOLD 信号较低。在右侧次级体感区、右侧前岛叶和左侧运动前皮质也观察到低激活(p<0.05 校正)。在简单运动中,两组间无显著差异。

结论

尽管 WC 患者在 fMRI 期间的复杂运动从未与痉挛性抽搐相关,但他们表现出异常低的皮质活动。这种现象在简单运动中没有观察到,与手写特征或视觉反馈无关。

意义

我们的结果支持 WC 中感觉运动系统的二元行为。

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