Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan.
Brain Activity Imaging Center, ATR-Promotions, Inc., Kyoto, Japan.
Mov Disord. 2024 Nov;39(11):1982-1992. doi: 10.1002/mds.29988. Epub 2024 Sep 18.
BACKGROUND: Freezing of gait is one of the most disturbing motor symptoms of Parkinson's disease (PD). However, the effective connectivity between key brain hubs that are associated with the pathophysiological mechanism of freezing of gait remains elusive. OBJECTIVE: The aim of this study was to identify effective connectivity underlying freezing of gait. METHODS: This study applied spectral dynamic causal modeling (DCM) of resting-state functional magnetic resonance imaging in dedicated regions of interest determined using a data-driven approach. RESULTS: Abnormally increased functional connectivity between the bilateral dorsolateral prefrontal cortex (DLPFC) and the bilateral mesencephalic locomotor region (MLR) was identified in freezers compared with nonfreezers. Subsequently, spectral DCM analysis revealed that increased top-down excitatory effective connectivity from the left DLPFC to bilateral MLR and an independent self-inhibitory connectivity within the left DLPFC in freezers versus nonfreezers (>99% posterior probability) were inversely associated with the severity of freezing of gait. The lateralization of these effective connectivity patterns was not attributable to the initial dopaminergic deficit nor to structural changes in these regions. CONCLUSIONS: We have identified novel effective connectivity and an independent self-inhibitory connectivity underlying freezing of gait. Our findings imply that modulating the effective connectivity between the left DLPFC and MLR through neurostimulation or other interventions could be a target for reducing freezing of gait in PD. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
背景:冻结步态是帕金森病(PD)最令人困扰的运动症状之一。然而,与冻结步态的病理生理机制相关的关键大脑中枢之间的有效连通性仍然难以捉摸。
目的:本研究旨在确定与冻结步态相关的有效连通性。
方法:本研究应用基于数据驱动方法确定的特定感兴趣区域的静息态功能磁共振成像的谱动态因果建模(DCM)。
结果:与非冻结者相比,冻结者双侧背外侧前额叶皮层(DLPFC)和双侧中脑运动区(MLR)之间的功能连接异常增加。随后,谱 DCM 分析表明,与非冻结者相比,冻结者中来自左侧 DLPFC 到双侧 MLR 的自上而下的兴奋性有效连接增加,以及左侧 DLPFC 内的独立自我抑制连接增加(>99%的后验概率)与冻结步态的严重程度呈负相关。这些有效连接模式的偏侧化不能归因于初始多巴胺能缺陷,也不能归因于这些区域的结构变化。
结论:我们已经确定了与冻结步态相关的新的有效连接和独立的自我抑制连接。我们的发现表明,通过神经刺激或其他干预调节左侧 DLPFC 和 MLR 之间的有效连接可能是减少 PD 冻结步态的目标。© 2024 作者。运动障碍由 Wiley 期刊代表国际帕金森和运动障碍协会出版。
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