Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Neurology, Mayo Clinic, Rochester, MN, USA.
Ann Neurol. 2020 Dec;88(6):1118-1131. doi: 10.1002/ana.25901. Epub 2020 Oct 2.
Perirolandic atrophy occurs in corticobasal syndrome (CBS) but is not specific versus progressive supranuclear palsy (PSP). There is heterogeneity in the locations of atrophy outside the perirolandic cortex and it remains unknown why atrophy in different locations would cause the same CBS-specific symptoms. In prior work, we used a wiring diagram of the brain called the human connectome to localize lesion-induced disorders to symptom-specific brain networks. Here, we use a similar technique termed "atrophy network mapping" to localize single-subject atrophy maps to symptom-specific brain networks.
Single-subject atrophy maps were generated by comparing cortical thickness in patients with CBS versus controls. Next, we performed seed-based functional connectivity using a large normative connectome to determine brain regions functionally connected to each patient's atrophied locations.
Patients with CBS had perirolandic atrophy versus controls at the group level, but locations of atrophy in CBS were heterogeneous outside of the perirolandic cortex at the single-subject level (mean spatial correlation = 0.04). In contrast, atrophy occurred in locations functionally connected to the perirolandic cortex in all patients with CBS (spatial correlation = 0.66). Compared with PSP, patients with CBS had atrophy connected to a network of higher-order sensorimotor regions beyond perirolandic cortex, matching a CBS atrophy network from a recent meta-analysis. Finally, atrophy network mapping identified a symptom-specific network for alien limb, matching a lesion-induced alien limb network and a network associated with agency in healthy subjects.
We identified a syndrome-specific network for CBS and symptom-specific network for alien limb using single-subject atrophy maps and the human connectome. ANN NEUROL 2020;88:1118-1131.
皮质基底节综合征（CBS）中会出现岛周萎缩，但它与进行性核上性麻痹（PSP）并不具有特异性。岛周皮质外的萎缩部位存在异质性，目前尚不清楚为何不同部位的萎缩会导致相同的 CBS 特异性症状。在之前的研究中，我们使用大脑的连接图（称为人类连接组）将病变引起的紊乱定位到症状特异性的大脑网络。在这里，我们使用类似的技术，即“萎缩网络映射”，将单个患者的萎缩图定位到症状特异性的大脑网络。
通过比较 CBS 患者与对照组的皮质厚度来生成单个患者的萎缩图。然后，我们使用大型规范连接组进行基于种子的功能连接，以确定与每个患者萎缩部位功能相连的大脑区域。
CBS 患者在群体水平上存在岛周萎缩，但在单个患者水平上，CBS 的萎缩部位在岛周皮质外存在异质性（平均空间相关性=0.04）。相比之下，所有 CBS 患者的萎缩都发生在与岛周皮质功能相连的部位（空间相关性=0.66）。与 PSP 相比，CBS 患者的萎缩与岛周皮质外的高级感觉运动区域网络相连，与最近的一项荟萃分析中的 CBS 萎缩网络相匹配。最后，萎缩网络映射确定了一个用于识别外来肢体的症状特异性网络，与病变引起的外来肢体网络和健康受试者的代理相关网络相匹配。
我们使用单个患者的萎缩图和人类连接组，为 CBS 确定了一个综合征特异性网络，并为外来肢体确定了一个症状特异性网络。
