Nackaerts Evelien, Michely Jochen, Heremans Elke, Swinnen Stephan P, Smits-Engelsman Bouwien C M, Vandenberghe Wim, Grefkes Christian, Nieuwboer Alice
Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
Department of Neurology, Cologne University Hospital, Cologne, Germany.
Front Neurosci. 2018 Jan 19;12:3. doi: 10.3389/fnins.2018.00003. eCollection 2018.
Despite recent advances in clarifying the neural networks underlying rehabilitation in Parkinson's disease (PD), the impact of prolonged motor learning interventions on brain connectivity in people with PD is currently unknown. Therefore, the objective of this study was to compare cortical network changes after 6 weeks of visually cued handwriting training (= experimental) with a placebo intervention to address micrographia, a common problem in PD. Twenty seven early Parkinson's patients on dopaminergic medication performed a pre-writing task in both the presence and absence of visual cues during behavioral tests and during fMRI. Subsequently, patients were randomized to the experimental ( = 13) or placebo intervention ( = 14) both lasting 6 weeks, after which they underwent the same testing procedure. We used dynamic causal modeling to compare the neural network dynamics in both groups before and after training. Most importantly, intensive writing training propagated connectivity via the left hemispheric visuomotor stream to an increased coupling with the supplementary motor area, not witnessed in the placebo group. Training enhanced communication in the left visuomotor integration system in line with the learned visually steered training. Notably, this pattern was apparent irrespective of the presence of cues, suggesting transfer from cued to uncued handwriting. We conclude that in early PD intensive motor skill learning, which led to clinical improvement, alters cortical network functioning. We showed for the first time in a placebo-controlled design that it remains possible to enhance the drive to the supplementary motor area through motor learning.
尽管最近在阐明帕金森病（PD）康复背后的神经网络方面取得了进展，但长期运动学习干预对PD患者大脑连通性的影响目前尚不清楚。因此，本研究的目的是比较为期6周的视觉提示手写训练（=实验组）与安慰剂干预后皮质网络的变化，以解决PD中的一个常见问题——小写症。27名正在服用多巴胺能药物的早期帕金森病患者在行为测试和功能磁共振成像（fMRI）期间，在有和没有视觉提示的情况下执行书写前任务。随后，患者被随机分为实验组（=13）或安慰剂干预组（=14），两组干预均持续6周，之后他们接受相同的测试程序。我们使用动态因果模型来比较两组训练前后的神经网络动态。最重要的是，强化书写训练通过左半球视觉运动流传播连通性，增加了与辅助运动区的耦合，而安慰剂组未观察到这种情况。训练增强了左视觉运动整合系统中的通信，这与所学的视觉引导训练一致。值得注意的是，无论是否存在提示，这种模式都很明显，表明从有提示的手写转移到无提示的手写。我们得出结论，在早期PD中，导致临床改善的强化运动技能学习会改变皮质网络功能。我们首次在安慰剂对照设计中表明，通过运动学习增强对辅助运动区的驱动仍然是可能的。
