经颅磁刺激和功能磁共振成像评估发音时内收性痉挛性发声障碍。
Transcranial magnetic stimulation and functional magnet resonance imaging evaluation of adductor spasmodic dysphonia during phonation.
机构信息
Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, School of Medicine, University of Minnesota. 426 Church St. SE, Minneapolis, MN, 55455, USA; Non-invasive Neuromodulation Laboratory, MnDRIVE Initiative, University of Minnesota. 247, 717 Delaware St. SE, Minneapolis, MN, 55414, USA.
Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, School of Medicine, University of Minnesota. 426 Church St. SE, Minneapolis, MN, 55455, USA; Department of Neurology, School of Medicine, University of Minnesota, 717 Delaware St., SE. Minneapolis, MN, 55414, USA.
出版信息
Brain Stimul. 2020 May-Jun;13(3):908-915. doi: 10.1016/j.brs.2020.03.003. Epub 2020 Mar 13.
BACKGROUND
Reduced intracortical inhibition is a neurophysiologic finding in focal dystonia that suggests a broader problem of impaired cortical excitability within the brain. A robust understanding of the neurophysiology in dystonia is essential to elucidate the pathophysiology of the disorder and develop new treatments. The cortical silent period (cSP) is a reliable, non-invasive method to measure intracortical inhibition in the primary motor cortex associated with a muscle of interest. In adductor spasmodic dysphonia (AdSD), cSP of the laryngeal motor cortex (LMC) which directly corresponds to the affected musculature, the thyroarytenoid (TA), has not been examined.
OBJECTIVE
This work evaluated the cSP of the LMC and the relationship between cSP and functional magnetic resonance imaging (fMRI) blood-oxygen-level dependent (BOLD) activation in people with AdSD (n = 12) compared to healthy controls (CTL, n = 14).
RESULTS
Shortened LMC cSP were observed bilaterally in people with AdSD vs CTL (F = 19.5226, p < 0.0001), with a large effect size (η = 0.1834). Between-group fMRI analysis revealed greater activation in bilateral LMC in the AdSD > CTL contrast as compared to CTL > AdSD contrast. Correlation analysis showed that people with AdSD have positive correlation of left LMC BOLD activation and the cSP. Further, the right LMC cSP lacks either positive or negative associations with BOLD activation. CTL individuals displayed both positive and negative correlations between cSP and BOLD activation in the left LMC. In CTL, the LMC cSP and BOLD activation showed exclusively negative correlations in both hemispheres.
CONCLUSION
In AdSD, the cortical activation during phonation may not be efficiently or effectively associated with inhibitory processes, leading to muscular dysfunction. These findings may give insight into the maladaptive cortical control during phonation in people with AdSD.
背景
皮质内抑制减少是局灶性肌张力障碍的一种神经生理学发现，表明大脑皮质兴奋性受损。深入了解肌张力障碍的神经生理学对于阐明该疾病的病理生理学和开发新的治疗方法至关重要。皮质静息期（cSP）是一种可靠的、非侵入性的方法，可测量与感兴趣肌肉相关的初级运动皮层内的皮质内抑制。在痉挛性发声障碍（AdSD）中，尚未检查与受累肌肉（即甲状杓肌）直接对应的喉运动皮层（LMC）的 cSP。
目的
本研究评估了 AdSD 患者（n=12）与健康对照组（CTL，n=14）相比，LMC 的 cSP 及其与功能磁共振成像（fMRI）血氧水平依赖性（BOLD）激活之间的关系。
结果
与 CTL 相比，AdSD 患者双侧 LMC 的 cSP 缩短（F=19.5226，p<0.0001），具有较大的效应量（η=0.1834）。AdSD>CTL 与 CTL>AdSD 对比的组间 fMRI 分析显示，双侧 LMC 的激活更强。相关性分析表明，AdSD 患者左侧 LMC 的 BOLD 激活与 cSP 呈正相关。此外，右侧 LMC 的 cSP 与 BOLD 激活无正相关或负相关。CTL 个体的左侧 LMC 的 cSP 和 BOLD 激活之间表现出正相关和负相关。在 CTL 中，LMC 的 cSP 和 BOLD 激活在两个半球都表现出负相关。
结论
在 AdSD 中，发声期间的皮质激活可能不能有效地与抑制过程相关联，导致肌肉功能障碍。这些发现可能深入了解 AdSD 患者发声期间皮质控制的适应性不良。
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