Youn Jinyoung, Kim Mansu, Park Suyeon, Kim Ji Sun, Park Hyunjin, Cho Jin Whan
Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Neuroscience Center, Samsung Medical Center, Seoul, South Korea.
Front Aging Neurosci. 2022 May 6;14:781883. doi: 10.3389/fnagi.2022.781883. eCollection 2022.
Despite the clinical impact of levodopa-induced dyskinesia (LID) in Parkinson's disease (PD), the mechanism, especially the role of basal ganglia (BG), is not fully elucidated yet. We investigated the BG structural changes related to LID in PD using a surface-based shape analysis technique.
We recruited patients with PD who developed LID within 3 years (LID group, 28 patients) and who did not develop it after 7 years (non-LID group, 35 patients) from levodopa treatment for the extreme case-control study. BG structure volumes were measured using volumetry analysis and the surface-based morphometry feature (i.e., Jacobian) from the subcortical surface vertices. We compared the volume and Jacobian of meshes in the regions between the two groups. We also performed a correlation analysis between local atrophy and the severity of LID. Additionally, we evaluated structural connectivity profiles from globus pallidus interna and externa (GPi and GPe) to other brain structures based on the group comparison.
The demographic and clinical data showed no significant difference except for disease duration, treatment duration, parkinsonism severity, and levodopa equivalent dose. The LID group had more local atrophies of vertices in the right GPi than the non-LID group, despite no difference in volumes. Furthermore, the LID group demonstrated significantly reduced structural connectivity between left GPi and thalamus.
This is the first demonstration of distinct shape alterations of basal ganglia structures, especially GPi, related to LID in PD. Considering both direct and indirect BG pathways share the connection between GPi and thalamus, the BG pathway plays a crucial role in the development of LID.
尽管左旋多巴诱发的异动症（LID）对帕金森病（PD）具有临床影响，但其机制，尤其是基底神经节（BG）的作用尚未完全阐明。我们使用基于表面的形状分析技术研究了PD中与LID相关的BG结构变化。
我们招募了在左旋多巴治疗3年内出现LID的PD患者（LID组，28例患者）和7年后未出现LID的患者（非LID组，35例患者）进行极端病例对照研究。使用容积分析和来自皮质下表面顶点的基于表面的形态计量学特征（即雅可比行列式）测量BG结构体积。我们比较了两组之间区域中网片的体积和雅可比行列式。我们还进行了局部萎缩与LID严重程度之间的相关性分析。此外，我们基于组间比较评估了从内侧苍白球和外侧苍白球（GPi和GPe）到其他脑结构的结构连接图谱。
除病程、治疗时间、帕金森病严重程度和左旋多巴等效剂量外，人口统计学和临床数据无显著差异。尽管体积无差异，但LID组右侧GPi的顶点局部萎缩比非LID组更多。此外，LID组显示左侧GPi与丘脑之间的结构连接显著减少。
这是首次证明PD中与LID相关的基底神经节结构，尤其是GPi的明显形状改变。考虑到直接和间接BG通路都共享GPi与丘脑之间的连接，BG通路在LID的发生中起关键作用。
