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Objective:To investigate the characteristics of regional brain functional centrality(DC)in patients with levodopa-induced dyskinesia(LID)and to explore the pathogenesis of LID.Methods:A total of 33 PD patients with LID(PD-LID), 41 PD patients without LID(PD-nLID)and 37 healthy controls from the First Affiliated Hospital of Nanjing Medical University were enrolled in this study.Differences in DC among the three groups were compared and the correlation between Z-DC values of the brain regions with differences and the scores of the involuntary movement scale(items 1-7)was analyzed.Results:Compared with Controls, PD-LID patients showed increased DC in the right amygdala(extending to the right globus pallidus)(MNI: x=30, y=-3, z=-18, t=4.00, P<0.05 after AlphaSim correction)and in the right postcentral gyrus(MNI: x=57, y=-9, z=39, t=-3.59; MNI: x=42, y=-33, z=57, t=-4.23, P<0.05 after AlphaSim correction)and reduced DC in the right superior parietal lobule(MNI: x=24, y=-51, z=72, t=-3.95, P<0.05 after AlphaSim correction).Compared with the PD-nLID group, the PD-LID group showed increased DC in the right globus pallidus(MNI: x=30, y=-12, z=-3, t=3.09, P<0.05 after AlphaSim correction).DC changes in the right globus pallidus were positively correlated with AIMS score( r=0.482, P=0.004). Conclusions:The enhancement of DC function in the right globus pallidus may be closely related to the onset and severity of LID.
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Objective:To observe central responses and functional connectivity (FC) during urinary bladder storage in neurogenic overactive bladder (NOAB).Methods:Twenty patients with NOAB were recruited. Resting state functional magnetic resonance imaging (rs-fMRI)were performed in all subjects under the following two conditions: empty bladder state and full bladder (strong desire to void)state. Software MATLAB, SPM8 and DPABI were adopted to analyze the difference of brain imaging between the two conditions. Voxel-based analysis of the REHO was performed to analyze rs-fMRI data including the main excitatory regions and inhibitory areas, peak value(X-axis, Y-axis, Z-axis), clusters size (active volume unit: number of voxel), T value(the excitatory and inhibitory extent of brain active regions). Voxel-based analysis of the REHO maps and FC between empty and full bladder were performed.Results:Increased activity during strong desire to void with NOAB patients was observed in the left orbital part of superior frontal, right middle frontal gyrus, and right superior frontal. Decreased activity was observed in right precentral. FC analysis found that these activated or deactivated brain regions were widely connected with other brain areas, include: frontal lobe, parietal lobe, temporal lobe, cingulate gyrus, lenticular nucleus, insular lobe, angular gyrus, parahippocampal gyrus and anterior and posterior central gyrus.Conclusions:Our results suggested that the right frontal robe may play a role in the control of bladder with NOAB during strong desire to void, and inhibitory areas located in right precentral. In NOAB patients, excitatory and inhibitory connections were increased in frontal lobe and central gyrus, decreased in insular lobe and parhippocampal gyrus.
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Objective: To investigate the changes of insular functional connectivity in patients with uremic restless legs syndrome (uRLS) using seed-based resting-state functional connectivity analysis so as to explore the related risk factors for RLS. Methods: 3D high-resolution structural imaging was applied in 29 patients with uremic restless legs (uRLS group) and 29 healthy volunteers (control group) with maintenance hemodialysis. The greymatter volume of the insular cortex was assessed using a voxel-based morphometry (VBM) analysis and functional connectivity of insular variation was evaluated by a seed-based correlation analysis, while the seed was chosen as the significant difference of grey matter volume. Pearson correlation analysis was used to explore the significant correlation between functional connectivity and RLS score. The relationship between brain alterations and clinical variables were investigated with Logistic stepwise multiple regression analysis. Results: Compared with that in the control group, the area with reduced gray matter volume in the uRLS group was located on the left posterior insula (P<0.05, FWE correction). Taking the left post insular as a seed region, we further found reduced functional connectivity in patients mainly between the insular and primary sensorimotor cortex (S1), supplementary motor areas (SMA), and posterior mid-cingulate gyrus (P<0.05, FDR corrected). In uRLS group, the severity score of RLS was negatively correlated with insular-S1 functional connectivity (P<0.05, FDR corrected), while the hemoglobin level was negetively correlated with functional connectivity degree of insular-S1 (r=-0.449, P=0.015, FDR corrected). Conclusion: The altered morphology of the post insular cortex was revealed in uRLS patients. Abnormal sensorimotor activities in patients with RLS were closely associated with reduced functional connectivity of insular-S1. Low hemoglobin level was the most important risk factor for the abnormal functional connectivity of the brain.