目标:非运动症状,比如睡眠障碍,疲劳,神经精神表现,认知障碍,和感觉异常,在特发性宫颈肌张力障碍(ICD)患者中已得到广泛报道。本研究旨在阐明ICD患者的自主神经系统(ANS)受累,这在文献中还不清楚。
方法:我们进行了一项试点病例对照研究,以调查20例ICD患者和20例年龄性别匹配对照的ANS。复合自主系统量表31用于ANS临床评估。激光多普勒血流仪定量分析,应用于皮肤并从指数中记录,被用来在休息时测量,经过副交感神经激活(六个深呼吸)和两个交感神经刺激(等距手柄和心理计算),高频和低频振荡的功率,和低频/高频比。
结果:ICD患者的临床自主神经失调症状高于对照组(p<0.05)。在休息时,在ICD患者中检测到比对照组更低的高频功率带,在≥57岁的年龄组中达到统计学上的显着差异(p<0.05)。在后一年龄组,ICD患者在休息时(p<0.05)和心理计算后(p<0.05)的低频/高频比率低于对照组。不管年龄,在手握过程中,ICD患者显示(i)低频/高频比率较低(p<0.05),(ii)与对照相比,低频振荡分量的增加相似,和(iii)稳定的高频振荡分量,相反,在对照组中有所下降。在深呼吸期间,两组之间没有发现差异。
结论:ICD患者在临床和神经生理水平上表现出ANS功能障碍,反映了异常的副交感神经-交感神经相互作用,可能与异常的颈部姿势和神经递质改变有关。
OBJECTIVE: Non-motor symptoms, such as sleep disturbances, fatigue, neuropsychiatric manifestations, cognitive impairment, and sensory abnormalities, have been widely reported in patients with idiopathic cervical dystonia (ICD). This
study aimed to clarify the autonomic nervous system (ANS) involvement in ICD patients, which is still unclear in the literature.
METHODS: We conducted a pilot case-control
study to investigate ANS in twenty ICD patients and twenty age-sex-matched controls. The Composite Autonomic System Scale 31 was used for ANS clinical assessment. The laser Doppler flowmetry quantitative spectral analysis, applied to the skin and recorded from indices, was used to measure at rest, after a parasympathetic activation (six deep breathing) and two sympathetic stimuli (isometric handgrip and mental calculation), the power of high-frequency and low-frequency oscillations, and the low-frequency/high-frequency ratio.
RESULTS: ICD patients manifested higher clinical dysautonomic symptoms than controls (p < 0.05). At rest, a lower high-frequency power band was detected among ICD patients than controls, reaching a statistically significant difference in the age group of ≥ 57-year-olds (p < 0.05). In the latter age group, ICD patients showed a lower low-frequency/high-frequency ratio than controls at rest (p < 0.05) and after mental calculation (p < 0.05). Regardless of age, during handgrip, ICD patients showed (i) lower low-frequency/high-frequency ratio (p < 0.05), (ii) similar increase of the low-frequency oscillatory component compared to controls, and (iii) stable high-frequency oscillatory component, which conversely decreased in controls. No differences between the two groups were detected during deep breathing.
CONCLUSIONS: ICD patients showed ANS dysfunction at clinical and neurophysiological levels, reflecting an abnormal parasympathetic-sympathetic interaction likely related to abnormal neck posture and neurotransmitter alterations.