Academic Unit of Neurology, Trinity College Dublin, the University of Dublin, Dublin, Ireland.
Department of Neurology, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany.
J Neurol Neurosurg Psychiatry. 2019 Sep;90(9):1011-1020. doi: 10.1136/jnnp-2018-319581. Epub 2019 Feb 13.
Advanced neuroimaging has increased understanding of the pathogenesis and spread of disease, and offered new therapeutic targets. MRI and positron emission tomography have shown that neurodegenerative diseases including Alzheimer's disease (AD), Lewy body dementia (LBD), Parkinson's disease (PD), frontotemporal dementia (FTD), amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS) are associated with changes in brain networks. However, the underlying neurophysiological pathways driving pathological processes are poorly defined. The gap between what imaging can discern and underlying pathophysiology can now be addressed by advanced techniques that explore the cortical neural synchronisation, excitability and functional connectivity that underpin cognitive, motor, sensory and other functions. Transcranial magnetic stimulation can show changes in focal excitability in cortical and transcortical motor circuits, while electroencephalography and magnetoencephalography can now record cortical neural synchronisation and connectivity with good temporal and spatial resolution.Here we reflect on the most promising new approaches to measuring network disruption in AD, LBD, PD, FTD, MS, and ALS. We consider the most groundbreaking and clinically promising studies in this field. We outline the limitations of these techniques and how they can be tackled and discuss how these novel approaches can assist in clinical trials by predicting and monitoring progression of neurophysiological changes underpinning clinical symptomatology.
高级神经影像学增加了对疾病发病机制和传播的理解，并提供了新的治疗靶点。磁共振成像和正电子发射断层扫描显示，包括阿尔茨海默病（AD）、路易体痴呆（LBD）、帕金森病（PD）、额颞叶痴呆（FTD）、肌萎缩侧索硬化症（ALS）和多发性硬化症（MS）在内的神经退行性疾病与大脑网络的变化有关。然而，驱动病理过程的潜在神经生理途径仍未得到明确界定。现在，通过探索支持认知、运动、感觉和其他功能的皮质神经同步、兴奋性和功能连接的先进技术，可以弥合成像可以辨别和潜在病理生理学之间的差距。经颅磁刺激可以显示皮质和皮质间运动回路中焦点兴奋性的变化，而脑电图和脑磁图现在可以以良好的时间和空间分辨率记录皮质神经同步和连接。在这里，我们反思了测量 AD、LBD、PD、FTD、MS 和 ALS 中网络中断的最有前途的新方法。我们考虑了该领域最具开创性和最有临床前景的研究。我们概述了这些技术的局限性以及如何解决这些问题，并讨论了这些新方法如何通过预测和监测潜在临床症状的神经生理变化的进展，从而帮助临床试验。
