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帕金森病作为一种系统层面的疾病。

Parkinson's disease as a system-level disorder.

作者信息

Caligiore Daniele, Helmich Rick C, Hallett Mark, Moustafa Ahmed A, Timmermann Lars, Toni Ivan, Baldassarre Gianluca

机构信息

Laboratory of Computational Embodied Neuroscience (LOCEN), Istituto di Scienze e Tecnologie della Cognizione, Consiglio Nazionale delle Ricerche (ISTC-CNR), Roma, Italy.

Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands.

出版信息

NPJ Parkinsons Dis. 2016 Dec 1;2:16025. doi: 10.1038/npjparkd.2016.25. eCollection 2016.

Abstract

Traditionally, the basal ganglia have been considered the main brain region implicated in Parkinson's disease. This single area perspective gives a restricted clinical picture and limits therapeutic approaches because it ignores the influence of altered interactions between the basal ganglia and other cerebral components on Parkinsonian symptoms. In particular, the basal ganglia work closely in concert with cortex and cerebellum to support motor and cognitive functions. This article proposes a theoretical framework for understanding Parkinson's disease as caused by the dysfunction of the entire basal ganglia-cortex-cerebellum system rather than by the basal ganglia in isolation. In particular, building on recent evidence, we propose that the three key symptoms of tremor, freezing, and impairments in action sequencing may be explained by considering partially overlapping neural circuits including basal ganglia, cortical and cerebellar areas. Studying the involvement of this system in Parkinson's disease is a crucial step for devising innovative therapeutic approaches targeting it rather than only the basal ganglia. Possible future therapies based on this different view of the disease are discussed.

摘要

传统上,基底神经节被认为是与帕金森病相关的主要脑区。这种单一区域的观点给出了有限的临床图景,并限制了治疗方法,因为它忽略了基底神经节与其他脑区之间相互作用改变对帕金森症状的影响。特别是,基底神经节与皮层和小脑密切协作,以支持运动和认知功能。本文提出了一个理论框架,用于将帕金森病理解为由整个基底神经节 - 皮层 - 小脑系统功能障碍引起,而非仅由基底神经节单独导致。具体而言,基于最近的证据,我们提出震颤、冻结和动作序列受损这三个关键症状,可通过考虑包括基底神经节、皮层和小脑区域在内的部分重叠神经回路来解释。研究该系统在帕金森病中的作用,是设计针对该系统而非仅针对基底神经节的创新治疗方法的关键一步。文中还讨论了基于对该疾病这种不同观点的未来可能治疗方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f5c/5516580/e70c1b297df8/npjparkd201625-f1.jpg

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