背景:Catatonia是一种复杂的精神运动障碍,其特征是运动,情感,和行为症状。尽管已经知道了近150年,其发病机制在很大程度上仍然未知。
方法:对PubMed,WebofScience,并对Scopus进行了神经影像学研究,以确定对患有紧张症的群体或单个个体进行的神经影像学研究。总的来说,33项采用结构磁共振成像的研究(sMRI,n=11),功能磁共振成像(fMRI,n=10),sMRI和fMRI(n=2),功能近红外光谱(fNIRS,n=1),单正电子发射计算机断层扫描(SPECT,n=4),正电子发射断层扫描(PET,n=4),和磁共振波谱(MRS,n=1),检索到171例病例报告。
结果:观察性sMRI研究显示,卡顿强症有许多大脑变化,包括弥漫性萎缩和信号高强度,虽然病例对照研究报告了额顶叶和边缘区域的改变,丘脑,还有纹状体.基于任务和静息状态的fMRI研究发现异常主要位于眶额,内侧前额叶,运动皮质,小脑,和脑干。最后,在基底神经节中观察到代谢和灌注变化,前额叶,和电机区域。大多数病例报告研究描述了广泛的白质病变和额叶,temporal,或基底神经节灌注不足。
结论:Catatonia的特征在于结构,功能,灌注,和代谢皮质下皮质异常。然而,本系统综述中包含的大多数研究和病例报告都受到相当大的异质性的影响,在人群和神经成像技术方面,这需要谨慎的解释。进一步阐明,通过未来的神经影像学研究,可能有很大的潜力来改善神经运动和精神运动机制的描述。
BACKGROUND: Catatonia is a complex psychomotor disorder characterized by motor, affective, and behavioral symptoms. Despite being known for almost 150 years, its pathomechanisms are still largely unknown.
METHODS: A systematic research on PubMed, Web of Science, and Scopus was conducted to identify neuroimaging studies conducted on group or single individuals with catatonia. Overall, 33 studies employing structural magnetic resonance imaging (sMRI, n = 11), functional magnetic resonance imaging (fMRI, n = 10), sMRI and fMRI (n = 2), functional near-infrared spectroscopy (fNIRS, n = 1), single positron emission computer tomography (SPECT, n = 4), positron emission tomography (PET, n = 4), and magnetic resonance spectroscopy (MRS, n = 1), and 171 case reports were retrieved.
RESULTS: Observational sMRI studies showed numerous brain changes in catatonia, including diffuse atrophy and signal hyperintensities, while case-control studies reported alterations in fronto-parietal and limbic regions, the thalamus, and the striatum. Task-based and resting-state fMRI studies found abnormalities located primarily in the orbitofrontal, medial prefrontal, motor cortices, cerebellum, and brainstem. Lastly, metabolic and perfusion changes were observed in the basal ganglia, prefrontal, and motor areas. Most of the case-report studies described widespread white matter lesions and frontal, temporal, or basal ganglia hypoperfusion.
CONCLUSIONS: Catatonia is characterized by structural, functional, perfusion, and metabolic cortico-subcortical abnormalities. However, the majority of studies and case reports included in this systematic
review are affected by considerable heterogeneity, both in terms of populations and neuroimaging techniques, which calls for a cautious interpretation. Further elucidation, through future neuroimaging research, could have great potential to improve the description of the neural motor and psychomotor mechanisms underlying catatonia.