退行性帕金森综合征中的前庭功能

文献信息

中文摘要

引言： 帕金森病（PD）、多系统萎缩（MSA）和进行性核上性麻痹（PSP）的退行性病理在脑干中具有不同的空间分布。我们的目的是找出这种病理以何种方式影响每种疾病中的脑干前庭反射通路。
方法： 我们研究了30例患者：15例PD、9例PSP（Richardson综合征）和6例MSA（小脑型），并将其结果与37例年龄匹配的健康对照（HC）的结果进行比较。患者组的运动功能采用统一帕金森病评定量表（UPDRS）运动量表进行评估。我们通过视频头脉冲试验（vHIT）评估前庭眼反射（VOR），并通过颈性前庭诱发肌源性电位（cVEMP）评估前庭颈反射。
结果： 我们发现PD组在后半规管和水平半规管中VOR增益降低，cVEMP波幅降低。MSA组在后半规管中VOR增益降低，cVEMP波幅降低，而PSP组在所有半规管中VOR增益正常，cVEMP波幅正常。
结论： 我们通过获得降低的VOR增益和cVEMP波幅表明，脑干前庭反射通路在PD和MSA中受损，但在PSP中未受损。我们提出这些发现是由于这些疾病中下脑干和前庭核中存在突触核蛋白病理。

英文摘要

INTRODUCTION: The degenerative pathology in Parkinson's disease (PD), multisystem atrophy (MSA) and progressive supranuclear palsy (PSP) have different spatial distribution in the brainstem. Our aim was find out in what way this pathology affects brainstem vestibular reflex pathways in each of these diseases.
METHODS: We studied 30 patients: 15 with PD, 9 with PSP (Richardson syndrome) and 6 with MSA (cerebellar) and compared their results with results from 37 age-matched healthy controls (HC). Motor functions of the patient groups were evaluated with the Unified Parkinson's Disease Rating Scale (UPDRS) motor scale. We evaluated the vestibulo-ocular reflex (VOR) with the video Head Impulse Test (vHIT) and the vestibulo-collic reflex with the cervical Vestibular Evoked Mygenic Potential (cVEMP).
RESULTS: We found that PD group have reduced VOR gain in posterior and lateral SCCs and reduced cVEMP amplitude. MSA group have reduced VOR gain in posterior SCCs and reduced cVEMP amplitude while PSP group have normal VOR gain in all SCCs and normal cVEMP amplitude.
CONCLUSION: We show that brainstem vestibular reflex pathways impaired in PD and in MSA but not in PSP by obtaining reduced VOR gain and cVEMP amplitudes. We suggest these findings are due to the presence of synuclein pathology in the lower brainstem and in vestibular nucleus in these diseases.