Altered Cerebral Perfusion of Motor Cortex in Patients with Periodic Limb Movement Disorder
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objectives: The pathophysiology of sleep-related motor diseases and sleep dysfunction in movement disorders is widely unknown as yet. Functional brain imaging, in particular radioisotope techniques, is considered to be powerful tool to investigate pathomechanisms of periodic limb movement disorder (PLMD). Methods: We performed 99mTc-ethyl cysteinate dimer brain single-photon emission computed tomography in 25 drug-naive patients with PLMD and 23 age-and gender matched normal cotrols during wakefulness. For statistical parametric mapping analysis, single-photon emission computed tomography images were spatially normalized to the standard template and then smoothed using a 14-mm full width at half maximum Gaussian kernel. Results: Mean age of patients and normal controls was 48.6 years and over half of them were male. Most patients reported the sleep onset and maintenance insomnia due to repetitive leg jerks. Average duration of insomnia was 7.5 years. They denied the history of restless leg syndrome and there was no sleep disorders such as obstructive sleep apnea syndrome which was confirmed by polysomnography. Mean PLM during sleep index and movement arousal index were markedly increased to 45.3/hr and 7.5/hr, respectively. Their sleep quality was poorer than that of normal patients. In PLMD patients, cerebral blood flow was significantly increased in the bilateral precentral gyri as compared to normal controls. There was no brain region showing decreased perfusion in patients. Regional cerebral perfusion was not correlated to any polysomnography parameter including PLMS index or movement arousal index. Conclusions: Different perfusion pattern in bilateral primary motor cortices may provide the evidences of motor cortical impairment in patients with PLMD.
Abstract
Objectives: The pathophysiology of sleep-related motor diseases and sleep dysfunction in movement disorders is widely unknown as yet. Functional brain imaging, in particular radioisotope techniques, is considered to be powerful tool to investigate pathomechanisms of periodic limb movement disorder (PLMD). Methods: We performed 99mTc-ethyl cysteinate dimer brain single-photon emission computed tomography in 25 drug-naive patients with PLMD and 23 age-and gender matched normal cotrols during wakefulness. For statistical parametric mapping analysis, single-photon emission computed tomography images were spatially normalized to the standard template and then smoothed using a 14-mm full width at half maximum Gaussian kernel. Results: Mean age of patients and normal controls was 48.6 years and over half of them were male. Most patients reported the sleep onset and maintenance insomnia due to repetitive leg jerks. Average duration of insomnia was 7.5 years. They denied the history of restless leg syndrome and there was no sleep disorders such as obstructive sleep apnea syndrome which was confirmed by polysomnography. Mean PLM during sleep index and movement arousal index were markedly increased to 45.3/hr and 7.5/hr, respectively. Their sleep quality was poorer than that of normal patients. In PLMD patients, cerebral blood flow was significantly increased in the bilateral precentral gyri as compared to normal controls. There was no brain region showing decreased perfusion in patients. Regional cerebral perfusion was not correlated to any polysomnography parameter including PLMS index or movement arousal index. Conclusions: Different perfusion pattern in bilateral primary motor cortices may provide the evidences of motor cortical impairment in patients with PLMD.
참고문헌 (16)
- American Academy of Sleep Medicine, "The International Classification of Sleep Disorders. Diagnostic & Coding Manual" (2005), The American Academy of Sleep Medicine
- Walters AS, "Toward a better definition of the restless legs syndrome. The International Restless Legs Syndrome Study Group", Mov Disord, 10, pp.634~642 (1995)
- Montplaisir J, "Clinical, polysomnographic, and genetic characteristics of restless legs syndrome: a study of 133 patients diagnosed with new standard criteria", Mov Disord, 12, pp.61~65 (1997)
- Wetter TC, "Sleep and periodic leg movement patterns in drug-free patients with Parkinson’s disease and multiple system atrophy", Sleep, 23, pp.361~367 (2000)
- Staedt J, "Nocturnal myoclonus syndrome (periodic movements in sleep) related to central dopamine D2-receptor alteration", Eur Arch Psychiatry Clin Neurosci, 245, pp.8~10 (1995)
- Turjanski N, "Striatal dopaminergic function in restless legs syndrome: 18F-dopa and 11C-raclopride PET studies", Neurology, 52, pp.932~937 (1999)
- Ruottinen HM, "An FDOPA PET study in patients with periodic limb movement disorder and restless legs syndrome", Neurology, 54, pp.502~504 (2000)
- Joo EY, "Analysis of cortical thickness in narcolepsy patients with cataplexy", Sleep, 34, pp.1357~1364 (2011)
- Chang LT, "A method for attenuation correction in radionuclide computed tomography", IEEE Trans Nucl Sci, NS-25, pp.638~643 (1992)
- Joo EY, "Postoperative alteration of cerebral glucose metabolism in mesial temporal lobe epilepsy", Brain, 128, pp.1802~1810 (2005)
- Joo EY, "Glucose hypometabolism of hypothalamus and thalamus in narcolepsy", Ann Neurol, 56, pp.437~440 (2004)
- Spence JS, "Using a white matter reference to remove the dependency of global signal on experimental conditions in SPECT analyses", Neuroimage, 32, pp.49~53 (2006)
- Trenkwalder C, "Why do restless legs occur at rest?--pathophysiology of neuronal structures in RLS. Neurophysiology of RLS (part 2)", Clin Neurophysiol, 115, pp.1975~1988 (2004)
- Tyvaert L, "Cortical involvement in the sensory and motor symptoms of primary restless legs syndrome", Sleep Med, 10, pp.1090~1096 (2009)
- Quatrale R, "Neurophysiological study of corticomotor pathways in restless legs syndrome", Clin Neurophysiol, 114, pp.1638~1645 (2003)
- Provini F, "Motor pattern of periodic limb movements during sleep", Neurology, 57, pp.300~304 (2001)