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Abstract
Objective: To determine how postural imbalance and falls are related to regional cerebral glucose metabolism (PET) and functional activation of the cerebral postural network (fMRI) in patients with progressive supranuclear palsy (PSP).
Methods: Sixteen patients with PSP, who had self-monitored their frequency of falls, underwent a standardized clinical assessment, posturographic measurement of balance during modified sensory input, and a resting [18F]FDG-PET. In addition, patients performed an fMRI paradigm using mental imagery of standing. Results were compared to healthy controls (n = 16).
Results: The frequency of falls/month in patients (range 1–40) correlated with total PSP rating score (r = 0.90). Total sway path in PSP significantly correlated with frequency of falls, especially during modulated sensory input (eyes open: r = 0.62, eyes closed: r = 0.67, eyes open/head extended: r = 0.84, eyes open/foam-padded platform: r = 0.87). Higher sway path values and frequency of falls were associated with decreased regional glucose metabolism (rCGM) in the thalamus (sway path: r = −0.80, falls: r = −0.64) and increased rCGM in the precentral gyrus (sway path: r = 0.79, falls: r = 0.64). Mental imagery of standing during fMRI revealed a reduced activation of the mesencephalic brainstem tegmentum and the thalamus in patients with postural imbalance and falls.
Conclusions: The new and clinically relevant finding of this study is that imbalance and falls in PSP are closely associated with thalamic dysfunction. Deficits in thalamic postural control get most evident when balance is assessed during modified sensory input. The results are consistent with the hypothesis that reduced thalamic activation via the ascending brainstem projections may cause postural imbalance in PSP.
Footnotes
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Study funding: Supported by the German Research Foundation (JA 1087/1-1), the Federal Ministry of Education and Science (BMBF), the Hertie Foundation, and the FöFoLe initiative of the Ludwig-Maximilians-University of Munich.
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Editorial, page 92
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Supplemental data at www.neurology.org
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- BOLD=
- blood oxygenation level–dependent;
- FDR=
- false discovery rate;
- MNI=
- Montreal Neurological Institute;
- PD=
- Parkinson disease;
- PSP=
- progressive supranuclear palsy;
- PSPRS=
- Progressive Supranuclear Palsy Rating Scale;
- rCGM=
- regional glucose metabolism;
- ROI=
- region of interest
- Received September 21, 2010.
- Accepted January 19, 2011.
- Copyright © 2011 by AAN Enterprises, Inc.
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