Cuesta Manuel J, Lecumberri Pablo, Moreno-Izco Lucia, López-Ilundain Jose M, Ribeiro María, Cabada Teresa, Lorente-Omeñaca Ruth, de Erausquin Gabriel, García-Martí Gracian, Sanjuan Julio, Sánchez-Torres Ana M, Gómez Marisol, Peralta Victor
Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain.
IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
Psychol Med. 2021 Jul;51(10):1625-1636. doi: 10.1017/S0033291720000343. Epub 2020 Mar 2.
Motor abnormalities (MAs) are the primary manifestations of schizophrenia. However, the extent to which MAs are related to alterations of subcortical structures remains understudied.
We aimed to investigate the associations of MAs and basal ganglia abnormalities in first-episode psychosis (FEP) and healthy controls. Magnetic resonance imaging was performed on 48 right-handed FEP and 23 age-, gender-, handedness-, and educational attainment-matched controls, to obtain basal ganglia shape analysis, diffusion tensor imaging techniques (fractional anisotropy and mean diffusivity), and relaxometry (R2*) to estimate iron load. A comprehensive motor battery was applied including the assessment of parkinsonism, catatonic signs, and neurological soft signs (NSS). A fully automated model-based segmentation algorithm on 1.5T MRI anatomical images and accurate corregistration of diffusion and T2* volumes and R2* was used.
FEP patients showed significant local atrophic changes in left globus pallidus nucleus regarding controls. Hypertrophic changes in left-side caudate were associated with higher scores in sensory integration, and in right accumbens with tremor subscale. FEP patients showed lower fractional anisotropy measures than controls but no significant differences regarding mean diffusivity and iron load of basal ganglia. However, iron load in left basal ganglia and right accumbens correlated significantly with higher extrapyramidal and motor coordination signs in FEP patients.
Taken together, iron load in left basal ganglia may have a role in the emergence of extrapyramidal signs and NSS of FEP patients and in consequence in the pathophysiology of psychosis.
运动异常（MAs）是精神分裂症的主要表现。然而，MAs与皮质下结构改变之间的关联程度仍未得到充分研究。
我们旨在研究首发精神病（FEP）患者和健康对照者中MAs与基底神经节异常之间的关联。对48名右利手FEP患者和23名年龄、性别、利手和教育程度匹配的对照者进行磁共振成像，以获得基底神经节形状分析、扩散张量成像技术（分数各向异性和平均扩散率）以及弛豫测量（R2*）来估计铁含量。应用了一套全面的运动测试组合，包括对帕金森症、紧张症体征和神经学软体征（NSS）的评估。使用了基于1.5T MRI解剖图像的全自动模型分割算法以及扩散和T2体积与R2的精确配准。
与对照组相比，FEP患者左侧苍白球核出现明显的局部萎缩性变化。左侧尾状核的肥厚性变化与感觉整合得分较高相关，右侧伏隔核的肥厚性变化与震颤子量表得分较高相关。FEP患者的分数各向异性测量值低于对照组，但基底神经节的平均扩散率和铁含量无显著差异。然而，FEP患者左侧基底神经节和右侧伏隔核的铁含量与较高的锥体外系和运动协调体征显著相关。
综上所述，左侧基底神经节的铁含量可能在FEP患者的锥体外系体征和NSS的出现中起作用，进而在精神病的病理生理学中起作用。
