持续性姿势-知觉性头晕患者前庭康复后脑功能连接变化：一项单病例静息态fMRI研究

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中文摘要

背景： 持续性姿势-知觉性头晕（PPPD）是一种慢性功能性前庭疾病，以持续性头晕和不稳感为特征。静息态功能磁共振成像（rs-fMRI）已发现PPPD患者在前庭、视觉、躯体感觉、空间认知和情绪网络中存在功能障碍。尽管前庭康复已被证明对PPPD有效，但其对这些功能障碍神经网络的效应仍不清楚。
病例： 一名37岁女性PPPD患者，约每6个月出现一次复发性旋转性眩晕，随后出现持续性非旋转性头晕。
评估： 基线评估显示严重的头晕相关失能（头晕残障量表（DHI）评分：66）和抑郁症状（抑郁自评量表（SDS）：40）。姿势描记术显示闭眼时摇摆增加，而视频头脉冲试验未显示明显异常。还进行了rs-fMRI，并使用SPM12和CONN工具箱以感兴趣区-感兴趣区方法分析功能连接。
结果： 在为期8周的前庭康复期间（包括继续药物治疗），DHI评分从66降至16，SDS评分从40降至27。在九个预先设定的ROI-ROI连接中，最大的纵向连接差异见于右侧海马与左侧额极之间，从基线的z = 0.110降至随访时的z = -0.277（Δz = -0.387）。在未校正的探索性水平上，右侧前海马旁皮层与右侧角回之间的连接降低，而右侧顶岛前庭皮层与右侧舌回之间的连接增加。
结论： 前庭康复后的临床改善与PPPD相关功能连接的变化同时出现，尤其是右侧海马与左侧额极之间连接降低。尽管本单患者病例报告没有对照条件、每个时间点仅纳入一次rs-fMRI扫描，并且同时进行药物治疗，但这一发现可能反映空间认知加工中与焦虑相关的情绪变化。

英文摘要

BACKGROUND: Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder characterized by persistent dizziness and unsteadiness. Resting-state functional magnetic resonance imaging (rs-fMRI) has identified dysfunction in vestibular, visual, somatosensory, spatial cognitive, and emotional networks in PPPD. Although vestibular rehabilitation has demonstrated efficacy in PPPD, its effects on these dysfunctional neural networks remain unclear.
CASE: A 37-year-old woman with PPPD had experienced recurrent rotational vertigo approximately every 6 months followed by persistent non-spinning dizziness.
ASSESSMENT: Baseline assessment showed severe dizziness-related disability (Dizziness Handicap Inventory (DHI) score: 66) and depressive symptoms (Self-Rating Depression Scale (SDS): 40). Posturography demonstrated increased sway with eyes closed, whereas video head impulse testing revealed no significant abnormalities. Rs-fMRI was also performed, and functional connectivity was analyzed using SPM12 and the CONN toolbox with a region-of-interest-to-region-of-interest approach.
OUTCOME: During the 8-week period of vestibular rehabilitation, including continued pharmacotherapy, the DHI score decreased from 66 to 16 and the SDS score from 40 to 27. Among the nine prespecified ROI-to-ROI connections, the largest longitudinal connectivity difference was observed between the right hippocampus and left frontal pole, decreasing from z = 0.110 at baseline to z = -0.277 at follow-up (Δz = -0.387). At the uncorrected exploratory level, connectivity decreased between the right anterior parahippocampal cortex and right angular gyrus but increased between the right parieto-insular vestibular cortex and right lingual gyrus.
CONCLUSION: Clinical improvement following vestibular rehabilitation coincided with changes in PPPD-related functional connectivity, particularly reduced connectivity between the right hippocampus and left frontal pole. Although this single-patient case report had no control condition, included only one rs-fMRI scan at each time point, and involved concurrent pharmacotherapy, this finding may reflect anxiety-related mood changes in spatial cognitive processing.