Nadya Pyatigorskaya1, Marie Mongin2, Romain Valabregue2, Lydia Yahia-Cherif2, Claire Ewenczyk2, Cyril Poupon2, Eden Debellemaniere2, Marie Vidailhet2, Isabelle Arnulf2, Stephane Lehéricy2. 1. From Centre de NeuroImagerie de Recherche-CENIR (N.P., M.M., R.V., L.Y-C., I.A., S.L.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris; UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, F-75013 (N.P., M.M., R.V., L.Y-C., E.D., M.V., I.A., S.L.), Sorbonne Universités; Service de Neuroradiologie (N.P., S.L.), Clinique des Mouvements Anormaux, Département des Maladies du Système Nerveux (C.E., M.V.), INSERM, Centre d'Investigation Clinique (CIC9503), Département des Maladies du Système Nerveux (M.V.), and Service des Pathologies du Sommeil (E.D., I.A.), Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière; and NeuroSpin (C.P.), Commissariat à l'Energie Atomique (CEA), Gif-Sur-Yvette, France. nadya.pyatigorskaya@gmail.com. 2. From Centre de NeuroImagerie de Recherche-CENIR (N.P., M.M., R.V., L.Y-C., I.A., S.L.), Institut du Cerveau et de la Moelle Épinière (ICM), Paris; UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, F-75013 (N.P., M.M., R.V., L.Y-C., E.D., M.V., I.A., S.L.), Sorbonne Universités; Service de Neuroradiologie (N.P., S.L.), Clinique des Mouvements Anormaux, Département des Maladies du Système Nerveux (C.E., M.V.), INSERM, Centre d'Investigation Clinique (CIC9503), Département des Maladies du Système Nerveux (M.V.), and Service des Pathologies du Sommeil (E.D., I.A.), Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière; and NeuroSpin (C.P.), Commissariat à l'Energie Atomique (CEA), Gif-Sur-Yvette, France.
Abstract
OBJECTIVE: To characterize medulla oblongata damage using diffusion tensor imaging (DTI) in Parkinson disease (PD) and correlate it with dysfunction of the cardiac sympathetic/vagal balance. METHODS: Fifty-two patients with PD and 24 healthy controls were included in the study. All participants underwent clinical examination and 3T MRI using 3D T1-weighted imaging and DTI. DTI metrics were calculated within manually drawn regions of interest. Heart rate variability was evaluated using spectral analysis of the R-R cardiac interval during REM and slow-wave sleep based on continuous overnight electrocardiographic monitoring. Respiratory frequency was measured in 30-second contiguous epochs of REM and slow-wave sleep. The relationships between imaging and cardiac variables were calculated using partial correlations followed by the multiple comparisons permutation approach. RESULTS: The changes in heart rate and respiratory frequency variability from slow-wave sleep to REM sleep in healthy controls were no longer detectable in patients with PD. There were significant increases in the mean (p = 0.006), axial (p = 0.006), and radial diffusivities (p = 0.005) in the medulla oblongata of patients with PD. In PD, diffusion changes were specifically correlated with a lower heart rate and respiratory frequency variability during REM sleep. CONCLUSIONS: This study provides evidence that medulla oblongata damage underlies cardiac sympathetic/vagal balance and respiratory dysfunction in patients with PD.
OBJECTIVE: To characterize medulla oblongata damage using diffusion tensor imaging (DTI) in Parkinson disease (PD) and correlate it with dysfunction of the cardiac sympathetic/vagal balance. METHODS: Fifty-two patients with PD and 24 healthy controls were included in the study. All participants underwent clinical examination and 3T MRI using 3D T1-weighted imaging and DTI. DTI metrics were calculated within manually drawn regions of interest. Heart rate variability was evaluated using spectral analysis of the R-R cardiac interval during REM and slow-wave sleep based on continuous overnight electrocardiographic monitoring. Respiratory frequency was measured in 30-second contiguous epochs of REM and slow-wave sleep. The relationships between imaging and cardiac variables were calculated using partial correlations followed by the multiple comparisons permutation approach. RESULTS: The changes in heart rate and respiratory frequency variability from slow-wave sleep to REM sleep in healthy controls were no longer detectable in patients with PD. There were significant increases in the mean (p = 0.006), axial (p = 0.006), and radial diffusivities (p = 0.005) in the medulla oblongata of patients with PD. In PD, diffusion changes were specifically correlated with a lower heart rate and respiratory frequency variability during REM sleep. CONCLUSIONS: This study provides evidence that medulla oblongata damage underlies cardiac sympathetic/vagal balance and respiratory dysfunction in patients with PD.
Authors: Jared T Hinkle; Kate Perepezko; Kelly A Mills; Zoltan Mari; Ankur Butala; Ted M Dawson; Alexander Pantelyat; Liana S Rosenthal; Gregory M Pontone Journal: Parkinsonism Relat Disord Date: 2018-08-22 Impact factor: 4.891