功能性运动障碍的诊断与治疗中国专家共识

功能性运动障碍(functional movement disorders,FMDs)是一类常见的分离/转换性障碍,已成为运动障碍疾病的重要分支,但多数临床医师对此疾病的认知不足。基于此,本文综述了FMDs的临床表现、辅助检查、诊断及鉴别诊断、治疗及预后,以期提高临床医生对FMDs的认识,提高临床诊断正确率,为准确治疗提供可能性。

Properties of oscillatory neuronal activity in the basal ganglia and thalamus in patients with Parkinson’s disease

Background:The cardinal features of Parkinson’s disease(PD)are bradykinesia,rigidity and rest tremor.Abnormal activity in the basal ganglia is predicted to underlie the mechanism of motor symptoms.This study aims to characterize properties of oscillatory activity in the basal ganglia and motor thalamus in patients with PD.Methods:Twenty-nine patients with PD who underwent bilateral or unilateral electrode implantation for subthalamic nucleus(STN)DBS(n=11),unilateral pallidotomy(n=9)and unilateral thalamotomy(n=9)were studied.Microelectrode recordings in the STN,globus pallidus internus(GPi)and ventral oral posterior/ventral intermediate of thalamus(Vop/Vim)were performed.Electromyography of the contralateral limbs was recorded.Single unit characteristics including interspike intervals were analyzed.Spectral and coherence analyses were assessed.Mean spontaneous firing rate(MSFR)of neurons was calculated.Analysis of variance and χ^(2) test were performed.Results:Of 76 STN neurons,39.5% were 4–6 Hz band oscillatory neurons and 28.9% were β frequency band(βFB)oscillatory neurons.The MSFR was 44.2±7.6 Hz.Of 62 GPi neurons,37.1% were 4–6 Hz band oscillatory neurons and 27.4% were βFB neurons.The MSFR was 80.9±9.6 Hz.Of 44 Vop neurons,65.9% were 4–6 Hz band oscillatory neurons and 9%were βFB neurons.The MSFR was 24.4±4.2 Hz.Of 30 Vim oscillatory neurons,70% were 4–6 Hz band oscillatory neurons and 13.3% were β FB neurons.The MSFR was 30.3±3.6 Hz.Further analysis indicated that proportion of βFB oscillatory neurons in STN and GPi was higher than that of similar neurons in the Vop and Vim(P<0.05).Conversely,the proportion of 4–6 Hz band oscillatory neurons and tremor related neurons in the Vim and Vop was higher than that of STN and GPi(P<0.05).The highest MSFR was for GPi oscillatory neurons whereas the lowest MSFR was for Vop oscillatory neurons(P<0.005).Conclusion:The alterations in neuronal activity in basal ganglia play a critical role in generation of parkinsonism.β oscillatory activity is more prominent in basal ganglia than in thalamus suggesting that the activity likely results from dopaminergic depletion.While both basal ganglia and thalamus have tremor activity,the thalamus appears to play a more important role in tremor production,and basal ganglia β oscillatory activity might be the trigger.

Stepping up to meet the challenge of freezing of gait in Parkinson’s disease

There has been a growing appreciation for freezing of gait as a disabling symptom that causes a significant burden in Parkinson’s disease. Previous research has highlighted some of the key components that underlie the phenomenon, but these reductionist approaches have yet to lead to a paradigm shift resulting in the development of novel treatment strategies. Addressing this issue will require greater integration of multi-modal data with complex computational modeling, but there are a number of critical aspects that need to be considered before embarking on such an approach. This paper highlights where the field needs to address current gaps and shortcomings including the standardization of definitions and measurement, phenomenology and pathophysiology, as well as considering what available data exist and how future studies should be constructed to achieve the greatest potential to better understand and treat this devastating symptom.

Photophobia in neurologic disorders

Photophobia is a common symptom seen in many neurologic disorders,however,its pathophysiology remains unclear.Even the term is ambiguous.In this paper,we review the epidemiology and clinical manifestations of photophobia in neurological disorders,including primary headache,blepharospasm,progressive supranuclear palsy,and traumatic brain injury,discuss the definition,etiology and pathogenesis,and summarize practical methods of diagnosis and treatment.

小P值并不能保证可靠结果:以帕金森病的静息态脑功能成像元分析为例

Thousands of resting state functional magnetic resonance imaging(RS-f MRI)articles have been published on brain disorders.For precise localization of abnormal brain activity,a voxel-level comparison is needed.Because of the large number of voxels in the brain,multiple comparison correction(MCC)must be performed to reduce false positive rates,and a smaller P value(usually including either liberal or stringent MCC)is widely recommended[1].

Anatomical correlates of blepharospasm

Background:Focal dystonia is a neurological disorder characterized by unwanted muscle spasms.Blepharospasm is a focal dystonia producing an involuntary closure of the eyelid.Its etiology is unknown.Objective:To investigate if there are structural changes in the white and grey matter of blepharospasm patients,and if the changes are related to disease features.Methods:T1 and diffusion-weighted magnetic resonance imaging scans were collected from 14 female blepharospasm patients and 14 healthy matched controls.Grey matter volumes,fractional anisotropy(FA),and mean diffusivity maps were compared between the groups.Based on grey matter differences within the facial portion of the primary motor cortex,the corticobulbar tract was traced and compared between groups.Results:Changes in grey matter in patients included the facial portion of the sensorimotor area and anterior cingulate gyrus.These changes did not correlate with disease duration.Corticobulbar tract volume and peak tract connectivity were decreased in patients compared with controls.There were no significant differences in FA or mean diffusivity between groups.Conclusions:Grey matter changes within the primary sensorimotor and the anterior cingulate cortices in blepharospasm patients may help explain involuntary eyelid closure and the abnormal sensations often reported in this condition.

Neurophysics Assessment of the Muscle Bioenergy Generated by Transcranial Magnetic Stimulation

Te content of the rectifed motor evoked potential(MEP)induced by transcranial magnetic stimulation(TMS)has ambiguously been assessed without the precision that energy calculation deserves.Tis fact has misled data interpretation and misguided biomedical interventions.To defnitively fll the gap that exits in the neurophysics processing of these signals,we computed,in Walls(̂�),the bioenergy within the rectifed MEP recorded from the human frst digitorum index(FDI)muscle at rest and under isometric contraction.We also gauged the biowork exerted by this muscle.Here we show that bioenergy and biowork can accurately and successfully be assessed,validated,and determined in̂�from MEP signals induced by TMS,regardless of knowing the mathematical expression of the function of the signal.Our novel neurophysics approach represents a dramatic paradigm shif in analysis and interpretation of the content of the MEP and will give a true meaning to the content of rectifed signals.Importantly,this innovative approach allowed unveiling that women exerted more bioenergy than men at the magnetic stimulations used in this study.Revisitation of conclusions drawn from studies published elsewhere assessing rectifed EMG signals that have used ambiguous units is strongly recommended.

Update on Treatment of Parkinson's Disease

Prevention The best treatment is to prevent the illness in the first place or to retard its progression. There is considerable new information about Parkinson's disease genetics and pathophysiology that hopefully will lead to therapy in this regard, but there is still nothing definitive. The only medication for which there are some reasonable data is selegiline, a monoamine oxidase (MAO)-B inhibitor. This drug actually has a symptomatic effect since it prevents the breakdown ofdopamine in the brain. Some trials have shown a beneficial effect separate from its symptomatic effect. The situation is rather controversial, however, and in one study there was an excess of mortality. {4}There are no supportive data for antioxidants such as vitamin E, and a trial of the neurotrophic factor GDNF was not positive. ……

Strategic Directions of the Movement Disorder Society

The Movement Disorder Society (MDS) is the international not-for-profit organization representing and serving clinicians, other health professionals, researchers and policy makers interested in the area of movement disorders. The Society is represented in 68 countries by approximately 1,500 members. The Society has developed regional sections and welcomes affiliation of regional Movement Disorder groups. ……