Parkinson's disease (PD) is the second most common neurodegenerative disease after Alzheimer's disease and the first one among the nosological entities of parkinsonism. Susceptibility-weighted imaging (SWI), magnetic resonance imaging (MRI) pulse sequence, which allows the in vivo estimation of the values of iron deposition in different areas of the brain, is a potential technique for the early diagnosis of PD and for the study of the pathogenesis of its complications.Objective: to compare the values of iron deposition in the basal ganglia in Stages II and III PD and to determine the relationship of clinical findings to the level of iron deposition according to the SWI findings.Patients and methods. Twenty-four patients with Hoehn and Yahr Stages II (n=24) and III (n=12) PD were examined. All the patients underwent brain MRI on a Siemens TrioTim (3T) MRI scanner by using pulse sequences T1, T2, SWI and subsequently quantifying the iron deposition (SPIN software). The accumulation of iron is visualized as an area of reduced signal intensity on SWI, and its estimation in accordance with the SPIN program has accordingly a smaller value. The regions of interest on both sides were the dentate nucleus, substantia nigra, red nucleus, putamen, globus pallidus, and head of the caudate nucleus. The examination protocol also included tests using the following scales: the Unified Parkinson's Disease Rating Scale (UPDRS), the Mini-Mental State Examination (MMSE), Frontal Assessment Batter (FAB), Freezing of Gait (FOG), Gait and Balance Scale (GABS), the Epworth Daytime Sleepiness Scale, the Parkinson's Disease Quality of Life Questionnaire (PDQ), the Beck Depression Inventory, and the Clock-Drawing Test.Results and discussion. The investigators found significant (p<0.05) correlations between the clinical picture and the level of iron deposition in the regions of interest in patients with Stage II PD: FOG – left caudate nucleus (r=-0.94); GABS – left caudate nucleus (r=-0.94); and in patients with stage III of the disease: UPDRS (full) – left red nucleus (r=-0.82), right globus pallidus (r=-0,80), left putamen (r=-0,96); UPDRS (Section 2) – left red nucleus (r=-0.77), left globus pallidus (r=-0.84); UPDRS (Section 3) – right putamen (r=-0,85), right globus pallidus (r=-0.78), left globus pallidus (r=-0,92); FOG – left globus pallidus (r=-0.81); GABS – left red nucleus (r=-0.96), left putamen (r=0.82), right putamen (r=-0.89), left globus pallidus (r=-0.82), right globus pallidus (r=-0.85), left caudate nucleus (r=-0.82), right caudate nucleus (r=-0.89); Beck Depression Inventory – right substantia nigra (r=-0.82).Conclusion. SWI measurement of the values of iron deposition in the structures of the extrapyramidal system in PD provides an additional insight into the pathological processes occurring in them.
BackgroundRepetitive transcranial magnetic stimulation (rTMS) is one of the high-potential non-pharmacological methods for migraine treatment. The purpose of this study is to define the neuroimaging markers associated with rTMS therapy in patients with migraine based on data from functional MRI (fMRI).Materials and MethodsA total of 19 patients with episodic migraine without aura underwent a 5-day course of rTMS of the fronto-temporo-parietal junction bilaterally, at 10 Hz frequency and 60% of motor threshold response of 900 pulses. Resting-state functional MRI (1.5 T) and a battery of tests were carried out for each patient to clarify their diagnosis, qualitative and quantitative characteristics of pain, and associated affective symptoms. Changes in functional connectivity (FC) in the brain's neural networks before and after the treatment were identified through independent components analysis.ResultsOver the course of therapy, we observed an increase in FC of the default mode network within it, with pain system components and with structures of the visual network. We also noted a decrease in FC of the salience network with sensorimotor and visual networks, as well as an increase in FC of the visual network. Besides, we identified 5 patients who did not have a positive response to one rTMS course after the first week of treatment according to the clinical scales results, presumably because of an increasing trend of depressive symptoms and neuroimaging criteria for depressive disorder.ConclusionsOur results show that a 5-day course of rTMS significantly alters the connectivity of brain networks associated with pain and antinociceptive brain systems in about 70% of cases, which may shed light on the neural mechanisms underlying migraine treatment with rTMS.
ель исследования. Рассмотреть возможности применения стандартных прото-колов магнитно-резонансной томографии, режима SWI, методик постпроцес-синговой обработки данных, включающих морфометрию, трактографию и фМРТ покоя в дифференциальной диагностике синдромов паркинсонизма. Материалы и методы. Проанализированы нейровизуализационные маркеры прогрессирования болезни Паркинсона и развития осложнений по данным МРТ. На ос-нове литературных данных и результатов собственных исследований показана высокая ценность применения новых протоколов нейровизуализации при синдромах паркинсо-низма и болезни Паркинсона.Выводы. Новые методики, как нативной, так и постпроцессинговой МРТ, позво-ляют осуществлять дифференциальную диагностику заболеваний, протекающих с син-дромом паркинсонизма, а также проводить динамическое наблюдение за пациентами с целью раннего выявления групп риска с развитием осложнений и для своевременной коррекции терапии.Ключевые слова: магнитно-резонансная томография, морфометрия, трактогра-фия, фМРТ покоя, нейросети покоя, синдромы паркинсонизма, болезнь Паркинсона. urpose. To assess the use of standard protocols for magnetic resonance imaging, SWI mode, data post-processing techniques, including morphometry, tractography and rest fMRI in differential diagnostics of parkinsonism syndromes. Materials and methods. Neuroimaging markers within the progression of Parkinson's disease and the development of complications from MRI data were analyzed. Based on the published data and own studies results, the high value of the application of the new neuroimaging protocols for Parkinson's syndromes and Parkinson's disease is presented.Conclusions. New methods, both native and post-processing MRI, allow differential diagnosis of diseases occurring with Parkinson's syndrome, as well as dynamic monitoring of patients with the purpose of early detection of risk groups patients with the development of complications and timely correction of therapy..
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