Department of Neurology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
Mol Pain. 2019 Jan-Dec;15:1744806919882272. doi: 10.1177/1744806919882272.
Restless legs syndrome is an important sleep disturbance in Parkinson’s disease. Restless legs syndrome causes an urge to move the legs accompanying sensations which can be difficult to describe but include aching, burning, tingling, or crawling. However, the underlying pathophysiology of restless legs syndrome in Parkinson’s disease remains unknown and no imaging investigation has been conducted to explore its mechanism to date.
This study is to investigate the brain functional changes in Parkinson’s disease with restless legs syndrome (PD-RLS) patients using functional magnetic resonance imaging.
Data of functional magnetic resonance imaging were collected from 14 PD-RLS patients, 20 Parkinson’s disease without restless legs syndrome (PD-RLS) patients, as well as 19 normal controls during restless legs syndrome-free periods. Intraregional brain activity was evaluated by regional homogeneity method and compared between each pair of the three groups. Area with significantly altered regional homogeneity between two patient groups was further selected as seed in subsequent functional connectivity analysis. Correlations between clinical variables and the altered regional homogeneity and functional connectivity were then assessed in patient groups.
Compared with PD-RLS, PD-RLS had much reduced brain activity in the right precentral gyrus, which was negatively associated with restless legs scores in Parkinson’s disease patients. Comparison between PD-RLS and normal controls revealed that brain activities were increased in the left brainstem and reduced in the left lingual, fusiform and inferior occipital gyri, middle cingulate and paracingulate gyri, and supplement motor area. Further functional connectivity analysis between right precentral gyrus and left postcentral/precentral gyri decreased dramatically within PD-RLS patients, which were also negatively correlated with restless legs symptoms in patient groups.
PD-RLS patients showed diminished regional homogeneity and functional connectivity within the precentral and postcentral gyri, which implies that the functional abnormalities in sensorimotor network may disrupt the lateral pain pathway, contributing to restless legs syndrome symptoms in Parkinson’s disease patients. This may provide imaging evidence to explore the pathophysiology of Parkinson’s disease-related restless legs syndrome.
不宁腿综合征是帕金森病中的一种重要睡眠障碍。不宁腿综合征会引起腿部移动的冲动，伴随着难以描述的感觉，包括疼痛、灼热、刺痛或爬行感。然而，帕金森病中不宁腿综合征的潜在病理生理学机制尚不清楚，迄今为止尚无影像学研究来探索其机制。
本研究旨在使用功能磁共振成像研究帕金森病伴不宁腿综合征（PD-RLS）患者的脑功能变化。
在不宁腿综合征缓解期，收集 14 例 PD-RLS 患者、20 例帕金森病不伴不宁腿综合征（PD-RLS）患者和 19 例正常对照者的功能磁共振成像数据。采用局部一致性方法评价局部脑区活动，并比较三组之间的差异。在两个患者组之间选择区域一致性有显著改变的区域作为种子区，进一步进行功能连接分析。然后评估患者组中临床变量与改变的区域一致性和功能连接之间的相关性。
与 PD-RLS 相比，PD-RLS 右侧中央前回的脑活动明显减少，与帕金森病患者的不宁腿评分呈负相关。与正常对照组相比，PD-RLS 患者的左侧脑桥、左侧舌回、梭状回、枕下回、中扣带回和旁扣带回的脑活动增加，左侧补充运动区的脑活动减少。进一步对 PD-RLS 患者的右侧中央前回与左侧中央后回/中央前回的功能连接进行分析，发现功能连接显著下降，且与患者组的不宁腿症状呈负相关。
PD-RLS 患者中央前回和中央后回的区域一致性和功能连接均降低，提示感觉运动网络的功能异常可能破坏了外侧疼痛通路，导致帕金森病患者不宁腿综合征症状。这可能为探索帕金森病相关不宁腿综合征的病理生理学提供影像学证据。
