Hans Berger Department for Neurology, Friedrich Schiller University of Jena, Germany; Brain Imaging Center, Friedrich Schiller University Jena, Germany.
Hans Berger Department for Neurology, Friedrich Schiller University of Jena, Germany; Brain Imaging Center, Friedrich Schiller University Jena, Germany.
Neuroimage Clin. 2019;22:101792. doi: 10.1016/j.nicl.2019.101792. Epub 2019 Mar 26.
Idiopathic cervical dystonia (CD) is a chronic movement disorder characterized by impressive clinical symptoms and the lack of clear pathological findings in clinical diagnostics and imaging. At present, the injection of botulinum toxin (BNT) in dystonic muscles is an effective therapy to control motor symptoms and pain in CD.
We hypothesized that, although it is locally injected to dystonic muscles, BNT application leads to changes in brain and network activity towards normal brain function.
Using 3 T functional MR imaging along with advanced analysis techniques (functional connectivity, Granger causality, and regional homogeneity), we aimed to characterize brain activity in CD (17 CD patients vs. 17 controls) and to uncover the effects of BNT treatment (at 6 months).
In CD, we observed an increased information flow within the basal ganglia, the thalamus, and the sensorimotor cortex. In parallel, some of these structures became less responsive to regulating inputs. Furthermore, our results suggested an altered somatosensory integration. Following BNT administration, we noted a shift towards normal brain function in the CD patients, especially within the motor cortex, the somatosensory cortex, and the basal ganglia.
The changes in brain function and network activity in CD can be interpreted as related to the underlying cause, the effort to compensate or a mixture of both. Although BNT is applied in the last stage of the cortico-neuromuscular pathway, brain patterns are shifted towards those of healthy controls.
特发性颈肌张力障碍（CD）是一种慢性运动障碍，其特征是临床症状明显，但在临床诊断和影像学中缺乏明确的病理发现。目前，在痉挛肌肉中注射肉毒毒素（BNT）是一种有效控制 CD 运动症状和疼痛的疗法。
我们假设，尽管 BNT 被局部注射到痉挛肌肉中，但它会导致大脑和网络活动朝着正常大脑功能的方向发生变化。
我们使用 3T 功能磁共振成像以及先进的分析技术（功能连接、格兰杰因果关系和局部一致性），旨在描述 CD 患者的大脑活动（17 名 CD 患者与 17 名对照组），并揭示 BNT 治疗的效果（在 6 个月时）。
在 CD 患者中，我们观察到基底节、丘脑和感觉运动皮层内的信息流增加。同时，这些结构中的一些对调节输入的反应性降低。此外，我们的结果表明感觉整合异常。在接受 BNT 治疗后，我们注意到 CD 患者的大脑功能向正常方向转变，尤其是在运动皮层、感觉皮层和基底节。
CD 患者大脑功能和网络活动的变化可以被解释为与潜在原因、代偿努力或两者的混合有关。尽管 BNT 是在皮质-神经肌肉通路的最后阶段应用的，但大脑模式向健康对照组的模式转变。
