Ubongo. 2013 Jan 31.
Politis M, Loane C, Wu K, O'Sullivan SS, Woodhead Z, Kiferle L, Lawrence AD, Lees AJ, Piccini P.
Kunobva: Chikamu cheBrain Sayenzi, Dhipatimendi reMishonga, Hammersmith Hospital, Imperial College London, London W12 0NN, UK.
ngovepo
Hypersexourse ine inomanikidza kuita zvepabonde chinhu chakakosha kusimba kwevarwere vane chirwere cheParkinson vachigamuchira dopamine kutsiva mishonga yekurapa. Isu tinoziva zvishoma nezve pathophysiology ye hypersexourse muchipatara cheParkinson, uye hazvizivikanwe kuti mafambiro ekuita zvepabonde, akafanana nezviratidziro zvebonde muhutachiona hwezvinobuditsa nhau zvinogona kukanganisa uropi nemaitiro mune akadaro anganganisika vanhu. boka revarwere ve12 vane chirwere cheParkinson vane hypersexuality vachishandisa functional magnetic resonance imaging block design kuvhenekera vatori vechikamu mune zvese zvepabonde, mimwe mibairo inoenderana uye isina divi rekuona. Isu takafungidzira kuti kuratidzwa kwehutachiona hwekuita zvepabonde kwaizokonzeresa chishuwo chebonde muvarwere vane chirwere cheParkinson nehutachiona hwehunyanzvi hunoenderana nekuchinja kwebasa rehuropi kumatunhu ane hukama hwekukurudzira dopaminergically.
Varwere vane chirwere cheParkinson vane hypersexuality vakaongororwa ON uye OFF dopamine zvinodhaka, uye mhedzisiro yavo yakafananidzwa neboka re12 chirwere cheParkinson chinotonga varwere pasina hypersexuality kana kumwe kusingadzoreri kuzvidzora kusagadzikana. Kuratidzwa kwetsika dzebonde kwakawedzera zvakanyanya chishuwo chebonde uye mhinduro dze hedonic muboka reParkinson chirwere hypersexuality boka kana zvichienzaniswa nevarwere vanodzora chirwere cheParkinson. Aya maitiro ekuchinja anoenderana akakosha eropa okisijeni-anoenderana chiratidzo shanduko mumatunhu ari limbic, paralimbic, tempiriti, occipital, somatosensory uye prefrontal cortices inoenderana nemanzwiro, anonzwisisa, anozvimirira, anoona uye anokurudzira maitiro.
Iyo inoshanda yekufungidzira data yakaratidza kuti iyo hypersexourse varwere 'yakawedzera chishuvo chebonde chakapindirana pamwe nekuvandudzwa kwemaitiro mukati meiyo ventral striatum, uye cingulate uye orbitofrontal cortices. Thehen varwere vane chirwere cheParkinson vane hypersexuality vaive OFF mushonga, iyo inoshanda yekufungidzira data yakaratidza kuderera mukutanga panguva yekuratidzwa kwepabonde zvido zvine hama.t.
Aya ma deactivations haana kucherechedzwa apo varwere vaive ON mushonga, kurudzira kuti dopamine zvinodhaka zvinogona kuburitsa chipingaidzo mukati memukati memukati medumbu mucholera iyo inogona kubatsira mukumanikidza kuita zvepabonde..
Izvo zvakawanikwa zvekuongororwa izvi zvine zvazvinoreva pamusoro pesimba rinogona kuitika rekufumurwa kwe cue kuburikidza nekufumurwa kwehuwandu hwezvenhau mukuvandudza libido, iyo mune iri boka revarwere vari panjodzi inogona kutungamira mukuparadza kwemagariro munharaunda uye nguva nenguva, kutonga kwevatariri.
Kukurudzira kuburikidza nekuratidzwa kwehutachiona hwekuona tsika muvarwere vane Parkinson chirwere chine hypersexourse inopa kukurudzira kwekutsvaga uyu mubairo maitiro kuburikidza nekuita uye deactivations yeCorrort cortex.
ziviso
Impulse kudzora matambudziko kusanganisa hypersexuality uye inomanikidza maitiro ekupinda pabonde ndiwo musimboti wekushushikana kune varwere vane chirwere cheParkinson vachigamuchira dopamine kutsiva kurapa (Weintraub and unto., 2006; Evans and unto., 2009; Voon and unto., 2009. Hypersexourse nekumanikidza kugona zvepabonde maitiro anowanzoratidzwa nekunyanyisa zvikumbiro zvepabonde kubva kune mukadzi kana murume / murume / murume, anowedzera zvinonyadzisira kufarira, kuita bonhora, kumanikidza kushanyira pfambi, uye mune vamwe vanhu vanofungidzirwa kufungidzira, kuzviita mifananidzo (semuenzaniso kusuruvara, kurara nemhuka, kutapurirana; Quinn and unto., 1983; Voon and unto., 2006. Kuwanda kwe hypersexourse muchipatara cheParkinson kwaive ∼3.5% mune imwe ongororo yakakura yevarwere vari kugamuchira dopamine agonist kurapwa nevarume vachinyanya kuitika kupfuura vakadzi kuti vangawane hypersexourse (Weintraub and unto., 2010. Chidzidzo chitsva asi chidiki chakaratidza huwandu hwepamusoro hwehutachiona hwechirwere cheParkinson chirwere che7% uye chinongedzo ne l-DOPA (Hassan and unto., 2011. Pakutanga zvidzidzo zvakaratidzawo kubatana pakati l-DOPA uye hypersexuality (Ballivet and unto., 1973; Bhurawuni and unto., 1978; Uitti and unto., 1989).
Zvepabonde mune zvemidhiya zvave zvakajeka uye zvinowanikwa kune ruzhinji rwevanhu, uye zvinonyadzisira zvinowanikwa zviri nyore pa internet. Zvave zvichinzi kuenderera uchionekwa kwezvebonde kugona kukurudzira kwakanyanya kusabvumirana munharaunda nezvebonde mune vamwe vanotambura zviri mubumbiro uye vanhu vanotora dopaminergic zvinodhaka (Rees and unto., 2007. Zvidzidzo mumakonzo zvinoratidza kuti kusangana kwehukama pakati pezvinodhaka zvinodhaka uye tsika dzepabonde zvakanyanyisa kunowedzera kuita zvepabonde kwakanyanya (Pomerantz, 1990. Kukosha kwenyaya dzinoenderana zvikuru nemubayiro kunoenderana nekukurudzira dzidziso, sezvo 'kuda' kuchigadzirwa nesystemgistic yekudyidzana pakati penyika yazvino mesolimbic dopamine system uye kuvapo kwemubairo kana macustoms avo (Zhang and unto., 2009; Berridge, 2012).
PET (Redouté and unto., 2000) uye inoshanda MRI (Arnow and unto., 2002; Hamann and unto., 2004; Walter and unto., 2008) ongororo dzekushandurwa kwekushandurwa kwemafungiro ehupombwe muvanhu vane hutano hwakaratidza kuti matunhu akawanda anosanganisira iyo ventral striatum, hypothalamus, amygdala, cingate uye orbitofrontal cortex inokanganisa pakuona kwekugadzirisa kwepabonde. Mune imwe ongororo ichangobva kuitwa, kushandisa PET uye zvisina kunangana matanho ekubvisa dopamine kuburitswa, zvakaratidzwa kuti varwere vane Parkinson's chirwere impulse control dambudziko vane yakakura ventral striatum dopamine kuburitswa zvichitevera kuburitswa-kwakanangana neyekuoneka cue kuratidzwa pamwe neboka revarwere veParkinson's control control varwereO'Sullivan and unto., 2011. Kutsvaga uku kwaienderana neicho chipfungwa chekusimudzira kunzwa, icho chinokurudzira kuti mubairo wekumanikidza kutsvaga unomuka kubva mukunyanyisa hunhu hwekukurudzira kusavimbika (kana 'kuda') kwemubayiro uye mitezo yavo, semhedzisiro yekufambira mberi neuroadaptations mune dopamine kufungidzira kune ventral striatum-inoenderana. kukurudzira wedunhu (Berridge and unto., 2009).
Ongororo dzekuongorora dzakaratidza kuti dopaminergic neural circries munzvimbo dzakaita se ventral striatum, hypothalamus, amygdala uye medial prefrontal cortex inotora chikamu mukukurudzira zvepabonde uye kutevera, kunyanya pakupindura kune zvepabonde zvido.Pfaus, 2010; Stolzenberg uye Numan, 2011. Kunzwa kudzvanywa ne dopaminergic zvinodhaka kwakaratidzirwa kunowedzera kutsvaga kunyange mibayiro yechisikigo, kusanganisira kukurudzira pabonde (Fiorino naPhillips, 1999; Nocjar naPanksepp, 2002; Afonso and unto., 2009), semhedzisiro yekuwedzeredza kukurudzira kusisitioner kutaurisa kuendesa mibairo. Uyezve, maitiro ekuita zvepabonde uye dopaminergic zvinodhaka zvinogadzirisa huwandu hwevanhu vane neurons mune ventral striatum, amygdala, hypothalamus uye anterior cingate cortex, ichiratidza nzvimbo dzinogona kuwanikwa apo zvinodhaka zvinogona kukanganisa maitiro ekuita zvepabonde (Frohmader and unto., 2010; Holder and unto., 2010).
Zvinoenderana neruzivo rwekuvandudza sensitization, hypersexourse muParkinson's chirwere inogona kuve inosanganiswa nekuwedzera mashandiro mumatunhu ehuropi akabatana nekukurudzirwa kwepabonde uye cue reactivity, uye izvi activation zvinogona kuve zvinokanganiswa nemishonga yekudopaminergic. Muchidzidzo chazvino, takafungidzira kuti varwere vane chirwere cheParkinson vane hypersexourse vairatidze chiitiko chebonde chine chekuita nezvematunhu munzvimbo idzi dzakabatana nekukurudzirwa kwepabonde, iyo yaizogadziriswa nemishonga yedopaminergic, uye yakabatana nekukurudzirwa kwepabonde. Takatsvaga kuti tiongorore izvi nekuongorora ropa okisijeni-inotsamira (BOLD) chiratidzo chinoshandurwa neinoshanda MRI (nekuenzanisa mhinduro mune yekurapa ON yekurapa neine OFF yemishonga scan) uye kurongedza izvo zvinofungidzira mhedzisiro nehunhu hwekuongorora kwekurudziro yebonde.
Varwere uye nzira
Vatori vechikamu uye kliniki maitiro
Makumi maviri nemana evasina kurwara nevarwere vane idiopathic Parkinson chirwere vakadzidza (Tables 1 uye 2. Gumi nemaviri eaya akazadzisa nzira inotsvagirwa yekuongorora maitiro ehukombwe (Voon and unto., 2006; Supplementary Table 1. Vamwe varwere ve12 vane chirwere cheParkinson vaisave nenhoroondo ye hypersexourse kana kumwe kusingadzoreredzi kutambudzika kusagadzikana uye vakashanda seboka rekutonga. Frohmader and unto. (2011) yakaratidza kuti mhedzisiro yedopaminergic zvinodhaka pane yekumanikidza yekuita zvepabonde mumhando yemhuka zvinoenderana nechiitiko chakafanana chedopaminergic zvinodhaka uye ruzivo rwepabonde. Saizvozvo, chinodzvinyirira-chinodzvinyirira chirwere cheParkinson chinongokura chiri mumamiriro ekushandiswa kwakawanda kwemishonga uye hachiitike zvakanyatsoitika mukati. de novo varwere (Giladi and unto., 2007. Nekudaro, isu takafananidza varwere vane chirwere cheParkinson nechirwere che hypersexourse kune boka rekutonga revarwere vanofungidzirwa vane chirwere cheParkinson.
Vatori vechikamu maitiro
| Clinical hunhu | Chirwere chaParkinson chine hypersexuality | Chirwere cheParkinson chinotonga varwere | P-ukoshi |
|---|---|---|---|
| Nhamba yezvidzidzo | 12 | 12 | |
| Age (makore ± SD) | 55.2 ± 9.2 | 62.3 ± 9.7 | 0.077 b |
| Sex | 11 M / 1 F | 10 M / 2 F | |
| Nguva yechirwere (makore ± SD) | 9.6 ± 5.2 | 10.1 ± 6.4 | 0.85b |
| UPDRS OFF mota (Chikamu III) mamakisi (zvinoreva ± SD)a | 40.2 ± 10.1 | 34.9 ± 9.9 | 0.21b |
| UPDRS ON mota (Chikamu III) mamaki uye% kuvandudzwa (zvinoreva ± SD)a | 23.1 ± 8.2 (43.8 ± 9.7%) | 20.0 ± 5.5 (41.4 ± 11.7%) | 0.29 (0.59)b |
| Mini-Mental State Kuongorora (zvinoreva ± SD) | 29.8 ± 0.4 | 28.9 ± 2.2 | 0.30c |
| Zuva nezuva LEDTOTAL (mg ± SD) | 600 ± 327 | 778 ± 278 | 0.17b |
| Zuva nezuva LEDL-DOPA (mg ± SD) | 288 ± 326 | 646 ± 264 | c |
| Zuva nezuva LEDDA (mg ± SD) | 311 ± 183 | 132 ± 143 | c |
a Avhareji yekuongorora shanu pamazuva mashanu akasiyana.
b Asina kubhadharwa t-test.
c Mann-Whitney bvunzo.
Chirwere cheParkinson chinodzora varwere = varwere vane chirwere cheParkinson pasina hypersexuality kana mamwe maitiro asina kurongeka-anomanikidza; M = munhurume; F = mukadzi; SD = kutsauka kwakajairika; UPDRS = Yakabatana chirwere cheParkinson Chikanganiso Chikero Chikero; LED = levodopa yakaenzana. Iyo piritsi inoverengwa zvakafanana kune rapfuura report (Politis and unto., 2010): LED (mg) = (1 × = levodopa) + (0.77 × levodopa CR) + (1.43 × levodopa + entacapone) + (1.11 x levodopa CR + entacapone) + (20 × ropinirole) + (20 × ropinirole) + (100 × ropinirole ER) + (30 × pramipexole) + (10 × rotigotine) + (8 × bromocriptine) + (100 × apomorphine) + (67 × perandisa) + (XNUMX x kabergoline) LED formula, mune levodopa / carbidopa kana benserazide chetevodochlor. zvakaverengerwa.
Varwere vane chirwere cheParkinson vane hypersexuality
| Zvidzidzo | Sex | zera | Rudzi rwe hypersexourse maitiro | Mamwe maICD | Dopaminergic kurapwa | Zuva nezuva LEDDA | Zuva nezuva LEDL-DOPA |
|---|---|---|---|---|---|---|---|
| HS1 | M | 46 | Zvinonyadzisira / zvinodzokorora kuita zvepabonde fungidziro uye kukurudzira | CS | Cabergoline | 280 | 0 |
| HS2 | M | 65 | Kurara nevanhu vaaisawanirana navo / kushandisa nguva yakawandisa vachiona zvepabonde kana kuita zvebonde | Pramipexole | 267 | 0 | |
| HS3 | M | 72 | Kurara nevanhu vaaisawanzobatana navo | Ropinerole, levodopa | 180 | 700 | |
| HS4 | M | 65 | Nyaya dzisina chinhu / kubatanidzwa neinternet zvinonyadzisira | Pramipexole | 200 | 0 | |
| HS5 | M | 50 | Murwere akaramba kuburitsa | IVE, CS | Ropinerole, levodopa | 180 | 800 |
| HS6 | F | 55 | Kuwedzera kuita zvepabonde | CS | Pramipexole | 200 | 0 |
| HS7 | M | 53 | Zvinonyadzisira | Pramipexole, levodopa | 240 | 260 | |
| HS8 | M | 53 | Nyaya dzisina chinhu / pfungwa dzinoona zvepabonde | PG, BE, CS | Ropinerole | 360 | 0 |
| HS9 | M | 60 | Murwere akaramba kuburitsa | IVE, CS | Ropinerole, levodopa | 300 | 600 |
| HS10 | M | 41 | Zvinonyadzisira / kazhinji kushanyira pfambi | DDS | Kabergoline, levodopa | 530 | 500 |
| HS11 | M | 45 | Vhidhiyo inonyadzisira / kubatanidzwa neinternet inonyadzisira | DDS | Pramipexole, levodopa | 200 | 600 |
| HS12 | M | 57 | Kubatanidzwa neinternet inonyadzisira | DDS, PG, IVA | Ropinerole | 800 | 0 |
IVA = kurumwa nekudya; CS = inomanikidza kutenga; DA = dopamine agonist; DDS = dopamine dysregulation syndrome; HS = kusanzwisisika; ICD = kusimbisa kudzora kusagadzikana; PG = kubhejera kwemaitiro.
Kliniki bvunzo yekuongorora inosanganisira Hoehn uye Yahr staging, iyo mota chikamu (Chikamu III) che Unified Parkinson's Disease Rating Scale (UPDRS), Mini-Mental State Examination uye kuverenga kwemazuva ese. l-DOPA yakaenzana dose (LED). Isere yevarwere ve12 vane chirwere cheParkinson hypersexeness yakaratidzirwa kanenge kamwechetekuwedzera kwekumanikidza kudzora dambudziko (Tables 1 uye 2).
Chidzidzo ichi chakawana mvumo yehunhu kubva kuHammersmith neveMambokadzi Charlotte's Hospitals Research Ethics Committee. Yakanyorwa yakanyorwa mvumo yakawanikwa kubva kune vese vatori vechikamu zvinoenderana neChiziviso cheHelsinki.
Kuongorora maitiro
Pamberi uye mushure mekutariswa, vatori vechikamu vakabvunzwa kuyera yavo libido uye zvepabonde chishupa pane anoona analogue sikero (10 cm), yakadzika pakati 'akaderera zvachose' (0 cm = 0 point) uye 'zvakanyanya kupfuura' (10 cm = 10 pfungwa). Izvo zviyero zvese zviri zviviri zvakazvirondedzerwa uye zvine chekuita nekunzwa kwavakaita mukati meawa yekupedzisira chete. Chikamu chechido chechido chimwe chakaratidzwa kuve chakavimbika sekureba mibvunzo yezvinhu zvakawanda (West uye Ussher, 2010. Sezvo vazhinji vevarwere vane chirwere cheParkinson hypersexourse vakave nekuwedzera kusingadzoreki kudzora kusagadzikana, zvakafanana pachezvako-chakataurwa zviyero zvekubhejera, zvinodhaka uye chikafu zvakapihwawo.
Anoshanda magineti resonance kufungidzira kuongorora maitiro
Vatori vechikamu vakaongororwa pamangwanani maviri akapatsanurwa (pakati pe11: 00 uye 13: 00 h) mazuva 7 akaparadzaniswa mune yekuyambuka-pamusoro kurongedza mushure mekutanga kudya kwemangwanani uye kumisa mushonga kanenge 18 h isati yaongorora. Vatori vechikamu vakaongororwa mune yakanyatsotsanangurwa OFF yekurapa mamiriro mune imwe scan uye mune ON mamiriro ekurapa mushure mekugamuchira muromo muromo l-DOPA / benserazide (200/50 mg) inoparadzirwa maminetsi makumi mashanu nemashanu scan scan isati yatanga. Motokari inoshanda yakaongororwa ne UPDRS mota zviyero pachiyero uye nekukurumidza usati waongorora kuti murwere apindure kumushonga (zvinotsanangurwa se> 45% kuvandudzwa muUPDRS-III mota zviyero). Iko kushandiswa kwe l-DOPA yakasarudzwa nekuti varwere vese vairwara nechirwere cheParkinson vaimbotora izvi, nepo havasi vese vaive pane dopamine agonist imwe chete. Uyezve, l-DOPA inogona kuwedzera kukurudzira kwepabonde muchirwere cheParkinson, uye hunhu hunhu hwakaonekwa hwakasanganiswa pamwe chete l-DOPA kurapwa, kwete chete dopamine agonist kurapwa (Ballivet and unto., 1973; Bhurawuni and unto., 1978; Hassan and unto., 2011).
Vatori vechikamu vakaiswa mune scanner nemusoro uye padding kutenderedza musoro, mapfudzi nemaoko kuti ave nenzvimbo diki yekufambisa sezvinobvira. Kufambisa kwakatariswa mukati memakero ose uye mune yekufambisa kwakawandisa, scan yakave yakagadzirwazve kana mavhoriyamu akakodzera akabviswa pakuongororwa (5.2% yekumhanya yakadzoserwa zvekare nekuda kwekubvunda kana dyskinesias). Kutsvaga kwekufungidzira kwakaitwa pane 3 T Philips Intera yakazara-muviri scanner. Yese-brain data yakawanikwa ne 199 mavhoriyamu eT2* -Ihuremu hwe gradient-echo echo-planar imaging mukukwira neine automated yakakwirira-yekuti shim maitiro (slice thickness 3.25 mm; inodzokorora nguva 3000 ms; echo nguva 30 ms; 90 ° flip angle; munda wekuona 190 × 219; matrix 112 × 112). Iyo slice yekutora angle yakaiswa ku −30 ° kubva kune anterior-yepasiripo commissure mutsara kuderedza kumberi lobe chiratidzo kudonha nekuda kwemhepo sinuses, ine z-shim gradient kururamisa kudzoreredza-kuburikidza ne ndege ndege yekukurumidza kubata (Deichmann and unto., 2003; Goridhe and unto., 2009. Imwe yepamusoro-sarudzo T1-inorema turbo munda echo masikirwo akaiswawo akaunganidzwa (echo nguva 4.6 ms; kudzokorora nguva 9.7 ms; 8 ° flip angle; munda wekuona 240 mm).
Anoshanda magineti resonance kufungidzira paradigm
Munguva yekushanda kweMRI scan, mhando shanu dzemifananidzo yemavara dzakaratidzwa muchimiro chechivharo: (i) dopaminergic zvinodhaka zvinodhaka; (ii) kufarira chikafu; (iii) mari uye kubhejera zvikwereti; (iv) tsika dzepabonde; uye (v) kusarerekera nyaya. Ruzhinji rwemabiro ane chekuita nemubairo uye asina kwavakarerekerwa masikosi akawanikwa kubva kuInternational Affective Mufananidzo System (Lang and unto., 2008) uye dzakawedzerwa nemifananidzo inowanikwa nemahara yakawanikwa kubva kumawebhusaiti. Churu chinoona chebonde chakatsanangurwa sekusanganisira kuratidzira kwevanobata kumeso, kutsvoda, kufadza uye kuona mifananidzo yevakadzi kana yevanhurume (gomarara zvichienderana: varume vaiona vakadzi uye vakadzi vaiona varume) vaine miviri yavo yakapfeka. Tsika dzematongerwo enyika dzisingaonekwi dzaisanganisira nzvimbo uye masikirwo ezvakaitika, zvinhu zveimba uye maitiro asina kujairika. Iyo International Affective Mufananidzo System yekuita zvepabonde zvinoratidzwa yakambomisikidzwa uye yakaratidzirwa kuti ipe huwandu hwakakosha hwekuita zvepabonde mune yakamboshanda inoshanda MRI / psychophysiological zvidzidzo (Bradley and unto., 2001; Conaglen naEvans, 2006; Walter and unto., 2008).
Mifananidzo yekugadziriswa kwakafanana yakaiswa mu14.7 s block mumaviri emagetsi anogara 9 min 56 s imwe neimwe. Buri rimwe nerimwe raive nemifananidzo minomwe dzakasiyana kubva muchikamu chimwe chete, paine huwandu hwematanhatu emhando imwechete inoratidzwa mune pseudorandom block Order ine yega yega mufananidzo odhi. Run Order yakarwiswa kune vese vatori vechikamu uye kushanya. Mufananidzo wega wega wakaratidzirwa 2100 ms, uye yega yega module block yakateverwa ne 4000 ms rating slide umo mutambi aifanira kuyera kubva 1 kusvika 5 kuti vangani vaifarira blockchaji yemifananidzo yavakaona (ine 1 ichive 'ndakaivenga' uye 5 kuva 'ndaida'). Iyi ratings yakaitwa nezwi, uye yakanyorwa mukombuta. Chiyero chekuyera chakateverwa ne 1000 ms interstimulus kupindirana kwemuchinjiro wekugadziriswa. Mifananidzo yakaonekwa kuburikidza girazi rakakwidzwa pamusoro pemasere-chiteshi RF musoro coil, iyo yakaratidza mifananidzo kubva purojekiti ichishandisa IFIS-SA mufananidzo mharidzo system (In Vivo) uye E-Prime software (Psychology Software Zvishandiso Inc).
Anoshanda magineti resonance kufungidzira data kuongorora
Kufungidzira data kwakaongororwa uchishandisa Statistical Parametric Mapping vhezheni 5 (Wellcome department reImaging Neuroscience, UCL, UK). Mavhoriyamu mashanu ekutanga emumwe neumwe anoshanda MRI anomhanya akaraswa kuti abvumire kuenzanirana mhedzisiro, uye ese masikirwo anoshanda akaiswa kune yekutanga scan yekumhanya uyezve zvakare kune zvinoreva ese mavhoriyamu ekufamba uye kucheka-nguva-kururamisa. Zvese zviyero zvakabatanidzwa mukupedzisira ongororo zvaisanganisira <2 mm yekufamba munzira imwe neimwe. Isu takaongorora iyo data yezvasara zvivakwa tichishandisa iyo TSDiffAna utility inoitwa mu Statistical Parametric Mapping vhezheni yechishanu, iyo inogadzira zvirevo uye mutsauko mifananidzo yevhoriyamu yega yega inoshanda (http://imaging.mrc-cbu.cam.ac.uk/imaging/DataDiagnostics. Iyo artefact inotsanangurwa sekubatanidzwa kweimwe musiyano chinongedzo uye zvinoreva kusimba inodonha isina kusangana pamwe nekuedza dhizaini. Isu hatina kuona chero artefacts yaida kunyatsoongororwa. Iyo inoreva inoshanda mufananidzo yakanyoreswa kune T1 rakarongedzwa mufananidzo. Iwo echo-planar mifananidzo yakazogadziriswa muMontreal Neurological Institute standard stereotactic nzvimbo vachishandisa parameter kubva kune chikamu cheT.1 muchimiro mufananidzo uye yakanyoroveswa uchishandisa 8 mm yakazara-upamhi pahafu-yepamusoro Gaussian firita.
Yekutanga-nhanho ongororo yakaitwa pane imwechete chikamu chikamu uko kusiyanisa kwakagadzirwa mune yakajairika mutsara muenzanisiro wemubairo wega wega mubayiro baslic (pikicha yematongerwo enyika) uye yebonde minus mimwe mibayiro (zvepabonde kutarisana nemimwe mibayiro). Iyo yetsetse mutsara muenzanisiro waisanganisira matanhatu mafambiro uye nuisance parameter, accounting yekufambisa uye mamwe nuisance artefacts inoitika mumatanho matatu ekushandura (kutama) uye mademo matatu ekutenderera.x, y, z kududzirwa uye x, y, z kutenderera) kwese kumhanya. Misiyano yekufarira yakagadzirwa panguva ino (semuenzaniso bonde nekupesana) yaishandiswa mune yechipiri-nhanho, boka rekunze maitiro ekuongororwa. Chikamu chehuwandu P >> P <0.05 (Genovese and unto., 2002. Coordinates peak voxel activation mukati meuropi yakatemwa pazinga reboka reZVIRI uye OFF zviyero muvarwere vane chirwere cheParkinson chine uye pasina hypersexuality. Isu takaitawo imwe yakawedzera pakati-peboka (chirwere cheParkinson chinotonga varwere vachipesana nechirwere cheParkinson nehutachiona hwepfungwa) uye nepakati-mamiriro (OFF kutarisana nemushonga) ongororo kuti iongorore kana mafambiro parutivi aive akakura mune imwe murwere kana mamiriro eboka pane rimwe uye akawana kuti kufamba haina kusiyana pakati pemapoka nemamiriro ezvinhu (P > 0.1 muzviitiko zvese izvi).
Seyedunhu a priori hypothesis yaivapo, yakawedzera yechipiri-nhanho isina kurongeka mhedzisiro inoongorora (zvepabonde kusapindirana uye kuita zvepabonde zvakapesana nemamwe mibairo inopesana mu ON uye OFF mishonga yekurapa) yakaitirwa kumatunhu akanyanya kufarira uchishandisa MarsBar (Brett and unto., 2002) neiyo imwecheteyo nhamba yezvibalo (yenhema kuwanikwa mwero pa P <0.05). Aya matunhu aive orbitofrontal cortex, anterior cingulate cortex, posterior cingulate cortex, amygdala, ventral striatum uye hypothalamus. Iwo mamodheru eorbitofrontal cortex, anterior cingulate cortex, posterior cingate cortex uye amygdala zvakatorwa kubva kuAutomated Anatomic Labeling raibhurari inoperekedza MarsBar Iyo ventral striatum uye hypothalamus chinhu mepu dzakavakwa nekudhirowa matunhu ekufarira ANALYZE ekurapa imaging software (vhezheni 8.1, Mayo Foundation). Mamepu echinhu aya akazo shandiswa kuburitsa huropi hwese huchibvumira kuenzanisa mukati memamwe mavhoriyamu (1850 mm3 mune yega yega hemisphere ye ventral striatum uye 1380 mm3 mune yega yega hemisphere yeiyo hypothalamus). Kusiyana kwevatori vechikamu mutsauko (semuenzaniso bonde kupesana nekwaakarerekera) kukosha kwenzvimbo yega yega yekufarira vese ON uye OFF mishonga yekurapa yakabviswa kuti ienderane neyekuzvibata data.
Statistical analysis
Ongororo ye Statistical yakaitwa uchishandisa SPSS (shanduro 16, SPSS Inc) yeMacintosh. Kufananidza mukati memapoka (semuenzaniso, chirwere cheParkinson ne hypersexuality OFF scan bonde nekusapindirana) chakaitwa uchishandisa pair. t-zviyedzo uye kuenzanisa pakati pemapoka (semuenzaniso, chirwere cheParkinson nehupombwe HURE kurara pamwe nekusarerekera parutivi-chirwere cheParkinson chinodzora varwere vanoita zvepabonde nekusapindirana) chakaitwa vachishandisa zviviri zvekuenzanisira t-miedzo. Zvekuongororwa kwekiriniki uye maitiro, kusiana homogeneity uye Gaussianity kwakaedzwa pamwe neBartlett neKolmogorov-Smirnov bvunzo. Parametric uye isiri-parametric bvunzo yakashandiswa nenzira kwayo. Pearson kuwirirana kuwirirana r uye Spearman's rho (ρ) (apo zvinyorwa zvaisawanzogoverwa) zvakashandiswa kuongorora hukama pakati pezvido zvebonde mushure mekufumurwa mune zvebonde zvinoonekwa uye munhu mumwe nemumwe BOLD dunhu rekufarira mhedzisiro yekuita bonde nekupesana kusingaenzaniswi mune ON uye OFF mishonga yekudzivirira. Iyo Bonferroni kururamisa yakashandiswa kurwisa dambudziko rekuenzanisa kwakawanda.
Results
Clinical uye maitiro ekuongorora
Varwere vane chirwere cheParkinson vane hypersexeness ivo vaitora zvakanyanya zvakanyanya dopamine agonists uye zvakanyanya kuderera l-DOPA kana ichienzaniswa neParkinson's chirwere chinodzora varwere. Mapoka maviri aya haana kuenderana mune chero humwe humwe hunhu hwekiriniki (zera, bonde, nguva yekurwara, UPDRS chikamu III OFF, ON uye mhinduro mushure l-DOPA, Mini-Mental State Examination, zuva nezuva LEDTOTAL) (Tables 1 uye 2).
Pamberi peCHE uye neYESE scan, varwere vane chirwere cheParkinson vane hypersexeness uye Parkinson's chirwere chinodzora varwere havana kusiyana pazviyero zvekuda zvepabonde.Tafura 3. Mushure meIP uye iyo ON scan apo vatori vechikamu vakave vakasangana nehukombwe, varwere vane chirwere cheParkinson vane hypersexuality vakaratidza kuwedzera kwakanyanya kuchiishuvo chebonde kana vachienzaniswa nekero yavo pamberi pe scan uye yakaratidzawo kuwedzera kwakanyanya zvichienzaniswa nechido chebonde che Chirwere cheParkinson chinotonga varwere, ivo vanopedzisira vasara vakagadzikana isati yasvika nepositi scan. Varwere vane chirwere cheParkinson vane hypersexuality vaive nekuwedzera kwakanyanya mune yavo yekuda zvepabonde mune iyo KUTI ienzaniswe ne OFF scan (Tafura 3. Chirwere cheParkinson chine hypersexuality uye Parkinson chirwere chinotonga mapoka haana kuratidza chero mukati kana pakati peboka musiyano mukudya, kubhejera uye kuda kwezvinodhaka zvisati zvaitika uye shure kweSE uye OFF scans (data isina kuratidzwa).
Chishuwo chebonde pamberi uye mushure mekuratidzwa kwekuita zvepabonde kunooneka
| Pamberi pebonde rekuona kukurudzira | Mushure mekuita zvepabonde zvinoratidzwa | P-value | |
|---|---|---|---|
| OFF scan | |||
| PD kudzora varwere (kureva ± SE) | 1.98 ± 0.59 | 2.25 ± 0.45 | 0.31a |
| PD HS (kureva ± SE) | 2.67 ± 0.56 | 3.70 ± 0.50 | a |
| P-value | 0.40b | b | |
| ON scan | |||
| PD kudzora varwere (kureva ± SE) | 1.32 ± 0.28 | 2.12 ± 0.60 | 0.18d |
| PD HS (kureva ± SE) | 2.01 ± 0.39 | 5.24 ± 0.41 | a |
| P-value | 0.15c | b | |
| OFF scan | ON scan | ||
|---|---|---|---|
| Mushure-pamberi pebonde inooneka kukurudzira | |||
| PD kudzora varwere (kureva ± SE) | 0.28 ± 0.26 | 0.80 ± 0.52 | 0.34d |
| PD HS (kureva ± SE) | 1.04 ± 0.32 | 3.23 ± 0.51 | a |
| P-value | 0.08b | b | |
Paired t-test.
b Asina kubhadharwa t-test.
c Mann-Whitney bvunzo.
d Wilcoxon yakafanana nepamuviri bvunzo.
HS = hypersexourse; PD = chirwere chaParkinson.
Varwere vane chirwere cheParkinson vane hypersexeness vakafarira hutano hwekutarisirwa hunoratidzwa panguva yeiyo inoshanda MRI zvakanyanya kudarika varwere veParkinson chirwere chekudzora varwere (mhando yedata = 85.2%; 3.4 ± 1.2 inopesana 2.1 ± 0.6, zvinoreva ± SD; P <0.05, isina kubhadharwa t-test neWelch kururamisa), asi pakanga pasina musiyano muzviyero zvavo zvezviyero zvemubayiro zvine chekuita nezvinodhaka, mari uye kubhejera, kana chikafu (P > 0.1 mune zvese zviitiko, zvisina kubhadharwa t-test neWelch magadziriso). Hapana misiyano yakawanikwa pakati peSE uye OFF scans.
Dunhu rekufarira rinoshanda magineti resonance kufungidzira kuongorora
Dunhu rekutarisirwa kufarira rakaratidza kuti varwere vane chirwere cheParkinson vane hypersexourse vaive nesimba rakasimba (kuwedzera BON chiratidzo) pane iyo Parkinson's chirwere control varwere panguva yekuratidzwa kwekurara pamwe nekusarerekera kutaridzika kunoonekwa munzvimbo dze OFF mishonga inoti kumatunhu anotevera: orbitofrontal cortex (kuruboshwe : P <0.001, kurudyi: P <0.005), anterior cingulate cortex (kuruboshwe: P <0.005, kurudyi: P <0.001), posterior cingate cortex (kuruboshwe: P <0.001, kurudyi: P <0.001), kuruboshwe amygdala (P <0.05), ventral striatum (kuruboshwe: P <0.05, kurudyi: P <0.05) uye hypothalamus (kuruboshwe: P <0.005, kurudyi: P <0.01) (Fig. 1C-H). Semusiyano mumwecheteyo mu ON mishonga yekurapa, seti yakafanana yedunhu activation yakacherechedzwa, uye pakanga pasina mutsauko wakakura mukushandurwa pakati peSE ne OFF matanho. Patakafananidza mhedzisiro ye OFF dhidi CHETE yemamiriro emishonga kungori muboka revarwere vane chirwere cheParkinson nechirwere chehutsinye, hatina kuwana mutsauko pakushanda.
Inochinjika, coronal uye sagittal zvikamu zvemasvomhu epametric mamepu anoratidza akakurisa BON chiratidzo anowedzera (nzvimbo dzvuku-dzvuku) dzakabatana nekuratidzwa kwakajairika kwepikicha mufanano we 12 Parkinson's chirwere (PD) vanodzora varwere (A uye B) uye mune varwere ve12 vane chirwere cheParkinson chine hypersexuality (PD HS) (C-H) panguva ON uye OFF mishonga zvirevo. BON chiratidzo chinowedzera chinoratidzwa mu (A uye B) kuruboshwe uye kurudyi yepakati tempiriti gyrus (MTG) uye yepakati occipital gyrus (MOG) (x = -48, y = -59, z = 9), (C) ventral striatum (VS) (x = 18, y = 15, z = - 11), (Dhypothalamus (x = -5, y = -4, z = −9), (E) anterior prefrontal cortex (aPFC), anterior cingrate cortex (ACC), yepamusoro parietal lobule (SPL) uye yepasirisheni cingulate cortex (PCC) (x = 8, y = -16, z = 33), (F) kuruboshwe uye kurudyi yepakati tempire gyrus uye yepakati occipital gyrus uye anterior pre mbeleal cortex (x = -8, y = 56, z = 4), uye (G uye H) orbitofrontal cortex (OFC), yepamusoro parietal lobule, posterior cingrate cortex, uye kuruboshwe uye kurudyi pakati tempiriti gyrus uye yepakati occipital gyrus (x = -24, y = 48, z = −8). Muvara wemuvara unoratidza z-values.
Dunhu rekutarisirwa kufarira rakaratidza kuti varwere vane chirwere cheParkinson vane hypersexourse vaive nesimba rakasimba panguva yekuratidzwa kwekurara pamwe nekuenzaniswa nemamwe mibairo yekuona macustoms ePM mishonga yekuMatunhu mumatunhu anotevera: orbitofrontal cortex (kuruboshwe: P <0.001, kurudyi: P <0.001), anterior cingate cortex (Kuruboshwe: P <0.001, Kurudyi: P <0.001), posterior cingate cortex (kuruboshwe: P <0.001, kurudyi: P <0.001), ventral striatum (kuruboshwe: P <0.001, kurudyi: P <0.001) uye hypothalamus (kuruboshwe: P <0.001, kurudyi: P <0.001). Zvakafanana mashandisirwo akaonekwa panguva yeOO mamiriro ekurapa, uye pakange pasina misiyano yakakura mukumisikidza pakati peOV neO ON scans.
Iro-uropi hunowedzera mashandiro emagetsi anoongorora kuongorora
Kujairika kwehuropi zviitiko pakati pevarwere vane chirwere cheParkinson vane hypersexuality uye Parkinson's chirwere chinotonga varwere
Varwere vane chirwere cheParkinson vane hypersexeness uye Parkinson chirwere chinodzora varwere vakaratidzira yakafanana yakakura BON chiratidzo inowedzera panguva yekuratidzwa kwepabonde nekusaenzana neyekutarisirwa maitiro mune ese ari maviri uye OFF emishonga anoti pakati nepakati temperi gyrus uye yepakati occipital gyrus (Fig. 1A uye B; Matafura Ekuwedzera 2A uye C, Supplementary DataA uye C). Semusiyano mumwechete mune yeEU mamiriro, varwere vane chirwere cheParkinson vane hypersexeness uye Parkinson chirwere vanodzora varwere vakaratidzira yakafanana yakakura BON chiratidzo inoderera pamatare mukati isthmus ye cingate gyrus [Brodmann nharaunda (BA) 29 uye 30], parahippocampal gyrus uye cuneus (BA 17 (()Fig. 2A uye B; Matafura Ekuwedzera 2B uye D, Supplementary DataB uye D).
Inopatsanurwa uye chikamu chemakoriyamu emamepu epametric mamepu anoratidza yakakura BOLD chiratidzo kuderera (yakasviba uye yakajeka nzvimbo nzvimbo dzebhuruu) dzakabatana nekufumurwa kwemifananidzo yakajairika yepikicha mu 12 Parkinson's chirwere (PD) kutonga varwere (A uye B) uye mune varwere ve12 vane chirwere cheParkinson ne hypersexuality (HS) (C uye D) panguva ye OFF mishonga yekurapa. BON chiratidzo chinoderera chinoratidzwa mu (A uye B) kuruboshwe uye kurudyi parahippocampal gyrus (PHG), isthmus of cingulate gyrus (ICG) uye cuneus (x = -9, y = -47, z = 2), (C) kuruboshwe uye kurudyi parahippocampal gyrus, cuneus, isthmus ye cingate gyrus, insula uye kurudyi claustrum (x = -42, y = 14, z = 8), uye (D) kuruboshwe uye kurudyi parahippocampal gyrus (x = 22, y = 38, z = −14). Mune iyo ON mishonga yekurapa, muboka revarwere ve12 vane chirwere cheParkinson vane hypersexuality, hapana chiratidzo cheBOLD chinoderera chinowanikwa. Muvara wemuvara unoratidza z-values.
Brain chiitiko chakanangana nevarwere vane chirwere cheParkinson vane hypersexuality
Kuongororwa kwehuropi-hwakagadziriswa kwakasimbisa dunhu rezvinofarira uye kwakaratidza kuwedzera kwakanyanya BONONI chiratidzo chevarwere vane chirwere cheParkinson nehutachiona hwekufananidza nevarwere veParkinson vanorwara nechirwere panguva yekuratidzwa kwezvepabonde nekusarerekera kwekuona mune ye OFF uye ON zvirevo zvemishonga mune. inotevera matunhu: bilateral anterior preteral cortex (BA 10) uye yepamusoro parietal lobule (BA 5 uye 7), uye kurudyi yakazadza activation mune yakaderera parietal lobule (BA 40) (Fig. 1C-H; Matafura Ekuwedzera 2A uye C, Supplementary DataA uye C). Semusiyano mumwechete mune yeEU mamiriro, varwere vane chirwere cheParkinson vane hypersexeness vachienzaniswa neParkinson's chirwere control varwere vakaratidza chakakosha BON chiratidzo chinoderera kaviri mukati insula uye kurudyi claustrum (Fig. 2C uye D; Matafura Ekuwedzera 2B uye D, Supplementary DataB uye D). Pakanga pasina akasiyana BOLD chiratidzo chinowedzera panguva yekuratidzwa kwekurara pamwe nekusarerekera kwekuona maitiro evarwere vane chirwere cheParkinson vane hypersexuality pakati peMUTO uye ON mishonga yekurapa.
Kuongororwa kwehuropi-hwepfungwa zvakare kwakasimbisa dunhu remafariro evarwere vane chirwere cheParkinson vane hypersexuality kana vachienzanisa zvepabonde nekumwe kunopa mubayiro zvionekwe uye kwakaratidza kuwedzera kwakakosha BON chiratidzo chechiratidzo kuwedzera mu OFF uye ON zvirevo zvemishonga mune bilateral dorsolateral prefrontal cortex (BA 9), uye kurudyi yakateedzera activation mu anterior prefrontal cortex (BA 10) uye parahippocampal gyrus.
Migumisiro ye l-DOPA mushonga mukuita kwehuropi muvarwere vane chirwere cheParkinson vane hypersexourse
Muboka revarwere vane chirwere cheParkinson vane hypersexourse iri ON mishonga yekurapa, iyo inoderera inoonekwa muEU state uye mune yeEE uye HURE nyika muParkinson's chirwere chinodzora varwere (yakaderedzwa BON chiratidzo panguva yekuratidzwa kwepabonde inopesana neicho kusatsigira maonero echikamu mune isthmus ye cingate gyrus, parahippocampal gyrus, cuneus, insula uye claustrum) zvakabviswa (Matafura Ekuwedzera 2B uye D, Supplementary DataB uye D).
Brain chiitiko zvinoenderana nemamwe mubairo toni tsika mune varwere vane Parkinson chirwere ane hypersexuality
Hatina kuwana akakosha mukati kana pakati peboka kusiyana kwevarwere vane chirwere cheParkinson vane hypersexeness uye Parkinson chirwere chinotonga varwere mune chero imwe mubairo mamiriro minus baseline (mifananidzo isina kwayakarerekera) (semuenzaniso dopaminergic drug cses inopesana neyakarerekera) mune chero neye OFF yekuvhara.
Kubatana
Muboka revarwere vane chirwere cheParkinson vane hypersexeness, chishuvo chebonde mushure mekuratidzira kune hutano hwekuona hukama hwakapindirana mune OFF mishonga yenyika, nechero chiitiko chinopesana (zvepabonde nekupokana mune zvematongerwo enyika) mune yekupedzisira cingate cortex (r = 0.78, P <0.01) uye ventral striatum (r = 0.80, P <0.01) (Fig. 3A uye B), uye mune ON mishonga yemamiriro ane chiitiko mune anterior cingrate cortex (r = 0.87, P <0.001) uye medial orbitofrontal cortex (r = 0.65, P <0.05) (Fig. 3C uye D). Hapana kuwiriraniswa kwakawanikwa muvarwere vane chirwere cheParkinson chine hypersexourse group pakati 'pekufananidza' tsika dzebonde uye basa reuropi panguva yekuratidzwa kwekuita zvepabonde nekusarerekera kwekuona mumakese ari maviri emu ON uye OFF mishonga yekurapa. Hapana kuwiriraniswa kwakawanikwa pakati pezvishuwo zvekuita uye musiyano wechiitiko muboka reParkinson rekurwara nechirwere muzvirwere zvese zvemuti ON uye ZVOKUDYA.P > 0.1 mune zvese zviitiko).
Mune varwere vane chirwere cheParkinson vane hypersexeness, chishuvo chebonde mushure mekufumurwa kwemifananidzo yebonde inogadzirisa pamwe nekuwedzera kwe activation mu (Aposterior cingate cortex uye (B) ventral striatum mu OFF mishonga yenyika uye nekuwedzera kwe activation mu (Canterior cingate cortex uye (B) uye medial orbitofrontal cortex panguva yeYEMU mamiriro ekurapa.
hurukuro
Hypersexourse chinhu chakajairika chisingadiwe chekurapa dopaminergic chirwere cheParkinson, icho chinogona kupedzisira chaitika nemhedzisiro inoshungurudza munharaunda inosanganisira kurambana, kuparadza zita remunhu uye kunyangwe kusungwa. Chidzidzo chedu chakagadzirirwa kuongorora mashandisirwo ari kuita dopaminergic mushonga unobatanidza hypersexuality mune varwere vane chirwere cheParkinson. Isu takashandisa maitiro ekuongorora ekukurudzira zvepabonde uye takashandisa inoshanda MRI paradigm ine zvinozivikanwa zvekurara kwevanhu (yakafanana neiyo inofungidzirwa nehuwandu hwezvenhau) seyekutarisirwa tsika, uye isu takasimbisa kuti kufumurwa kwenyaya dzakadai kwakakwanira kuwedzera chishuwo chebonde chevarwere vane Chirwere chaParkinson chine hypersexourse nekumisa matunhu ehuropi akabatanidzwa nekukurudzira kwepabonde (ona Tafura 4 kupfupikiswa kwemhinduro).
Pfupiso yemigumisiro inoratidza mutsauko uye yakajairika mudunhu BOLD chiratidzo inowedzera uye inoderera muvarwere vane chirwere cheParkinson vane uye pasina hypersexuality mune yeO uye OFF mishonga yekurapa
| Chirwere chaParkinson chine hypersexuality | Chirwere cheParkinson chinotonga varwere | |||
|---|---|---|---|---|
| OFF uye ON inowedzera | OFF inoderera | ON kuderera | OFF uye ON inowedzera | OFF uye ON kunoderera |
| Middle temporal gyrus | Isthmus ye cingate gyrus | Middle temporal gyrus | Isthmus ye cingate gyrus | |
| Middle occipital gyrus | Parhippocampal gyrus | Middle occipital gyrus | Parhippocampal gyrus | |
| Cuneus | Cuneus | |||
| Ventral striatum | Claustrum | |||
| Amygdala | Insula | |||
| Hypothalamus | ||||
| Anterior cingate cortex | ||||
| Posterior cingate cortex | ||||
| Orbitof Pambal cortex | ||||
| Anterior prefrontal cortex | ||||
| Superior parietal lobule | ||||
| Asina kukwana parietal lobule | ||||
Mukubvumirana kwekushanda kwekufungidzira zvidzidzo zvekuona kwekuita zvepabonde mune vanhu vane hutano (Redouté and unto., 2000; Arnow and unto., 2002; Walter and unto., 2008), kuratidzwa kwehutachiona hwekuona zvepabonde kwakadzoreredzwa parieto-tempiritari-mweya wekuona nzvimbo yekugadzirisa matunhu akadai sepakati pesipital gyrus uye yepakati tempiriti gyrus mumapoka evarwere vane chirwere cheParkinson nechirwere chehutsinye uye chirwere cheParkinson chinodzora varwere. Mune varwere vane chirwere cheParkinson vane hypersexeness, kuratidzwa kwehutachiona hwekutarisirwa mune zvese zviri zviviri ON uye OFF mishonga yekurapa yakaratidza kuwedzera activation mu orbitofrontal cortex, anterior cingulate cortex, posterior cingulate cortex, ventral striatum, anterior prefrontal cortex, parietal lobule, amygdala uye iyo hypothalamus, ichienzaniswa nevarwere vanodzora chirwere cheParkinson. Varwere vane chirwere cheParkinson vane hypersexeness vakaratidza zvakanyanya kuda zvepabonde uye kufarira kwezvepabonde zvichitevera kufumurwa kwetsika dzebonde. Chishuvo chavo chebonde chakawedzera zvakanyanya pavaive ON l-DOPA kana ichienzaniswa neyeMishonga mushure mekuratidzwa kwezvepabonde. Basa rakakosha reimwe anterior cingate cortex, posterior cingate cortex, ventral striatum uye orbitofrontal cortex mukukurudzira kwepabonde kwakaiswa pasi nekuwedzera kwekuti activation munzvimbo idzi dzakapindirana nechido chakawedzera chebonde. Nekudaro, hapana kuwirirana kwakawanikwa pakati penzvimbo dzepfungwa dzeuropi uye 'kuda' zvikoro.
Zvidzidzo zvemhuka zvakaratidza kuti dopamine inobatanidzwa mukukurudzira kwekurara pamwe nekukurudzira kunokonzerwa nehutsika hwepabonde munzvimbo dzinosanganisira ventral striatum, hypothalamus, medial prefrontal cortex, amygdala uye anterior cingate cortex, uye kuti hutongi hwekunzwa dopaminergic zvinodhaka hunogona kutungamira kutsvaga zvepabonde zvakawandisa. kufungidzira (Fiorino naPhillips, 1999; Nocjar naPanksepp, 2002; Afonso and unto., 2009; Pfaus, 2010; Stolzenberg uye Numan, 2011. Kufanana kwechiitiko nemishonga yedopaminergic uye chiitiko chebonde chinodikanwa kuti ive nekuvandudzwa kwehunhu hwepabonde (Frohmader and unto., 2011), Kuona yakanonoka kutanga kwe hypersexeness muchipatara cheParkinson zvichitevera kurapwa nemishonga yedopaminergic (Giladi and unto., 2007. Zvakare, basa razvino rakaratidza kuti zvinodhaka zvekushungurudza zvinogona kumisa mitsipa yakafanana semubairo wepabonde, nekuwandisa kuri kuitika mumatunhu anosanganisira hypothalamus uye anterior cingulate cortex (Frohmader and unto., 2010. Zvatinowana zvakatorwa pamwe neyepamberi mhuka basa zvinotsigira izvo zvinokurudzira kukurudzira pfungwa sisitimu yekunzwisisa mashandiro e dopaminergic drug imposed hypersexourse muParkinson chirwere. Iyo yekurudziro yekunzwa kwefungidziro inobata iyo dopamine inosimudzira kutsvaga mibairo nekutaura kukurudzira kusagadzika kune chekuita nemubhadharo-wakadai (sengepfungwa dzinoonekwa pabonde), kutsvaga chinosimudzira ('kuda') pabonde uye nenyaya yehu hypersexuality, nyaya dzepabonde dzinogona kunge dzichikonzerwa ne-pathological incentive salience (Berridge and unto., 2009. Kukurudzira kwekunzwa pfungwa kunoenderera kunobata kuti 'kuda' mibairo, inosvikirwa neveralral striatum dopamine-inoenderana necocircuitry, inogona kukura panguva yakazvimirira yemubairo 'kuda' sezvo munhu anokudziridza unomanikidza kutsvaga mubayiro.Berridge and unto., 2009), uye zvinotaridzika pano kuti dopamine yakawedzera cue-yakamutswa yekuda zvepabonde ('kuda'), asi isina kuyerwa 'kutaridzwa' kwemifananidzo yebonde muvarwere vane chirwere cheParkinson chine hypersexuality.
Sevazhinji (8 ye12) yevarwere vane chirwere cheParkinson vane hypersexuality vaive neanenge imwechete yekuwedzera chipingamupinyi yekudzivirira (semuenzaniso pathological kubhejera, kudya kudya, nezvimwewo), taida kuyedza kuti kana shanduko muitiro hwekuongorora pamwe nehuropi kurongeka kwotevera mubairo kuratidzwa kweiyo cue kwaive kwakanangana nekuita zvepabonde kana kuitirwa kune imwe mibairo. Kuzvirumbidza pachako kushuvira uye kufarira kubhejera, zvinodhaka uye zvekudya zvainge zvisina kusiyana mukati kana pakati pemapoka evarwere vane chirwere cheParkinson nechirwere chehutsinye uye chirwere cheParkinson chinodzora varwere vasati vasvika uye mushure mekuita ON uye OFF. Saizvozvo, isu hatina kucherechedza chero mutsauko uripakati pevarwere vane chirwere cheParkinson nehutachiona uye chirwere cheParkinson chinotonga varwere mukupindura kwemukati kune mamwe makosi ekuona anoonekwa mune inoshanda MRI kuongororwa inoratidza kuti mhedzisiro yedu mhedzisiro yaive yakanangawo kune hypersexourse. Nekudaro, taida zvakare kuti tiongorore chaihwo huropi zviitiko zvinoenderana nehukadzi hwekuona tsika zvichienzaniswa nemimwe mibayiro. Zvakawanikwa zvakaratidza kusanzwisiswa kwakasimba mune zvese zviri ON uye OFF nyika scans mune orbitof Pambal cortex, anterior cingulate cortex, posterior cingulate cortex, ventral striatum, anterior prefrontal cortex, dorsolateral prefrontal cortex, parahippocampal gyrus uye hypothalamus, ichisimbisa kukosha kwakadai kukurudzira kwepabonde uye chishuwo, zvirinani mune mamiriro eiyo hypersexourse.
Iyi yekuwedzera inosarudzika yemitezo yebonde haina basa. Shanda mumhando dzemhuka naBerridge uye nevamwe (Mahler uye Berridge, 2009, 2012; DiFeliceantonio uye Berridge, 2012) yakaratidza kuti inosimudzira opioid circry mu amygdala uye striatum inogona kutarisa cue-inokonzeresa 'kuda' zvakanyanya zvakamanikana mumukundi-tora-ese mafashoni. Mumamiriro ezvinhu akadai, mubairo mumwe chete waunofarira mubayiro unova simba rine simba 'rinosimudzira' iro rinokwevera kukwezva kwese, nekushayisa mimwe mibairo, kunyangwe mumhuka dzakange dzichikwezwawo nemimwe mibayiro (Mahler uye Berridge, 2009, 2012; DiFeliceantonio uye Berridge, 2012. Zvimwechetezvo, michovha yemubairo wepabonde yaive yakabatana neakagadziridzwa amygdala chiitiko zvinoenderana nemimwe mibairo muvanhu vane hypersexourse uye inogona kuve yakasarudzirwa yakasarudzika nekusimudzira kukurudzira kusagara mu 'kukunda-kutora-zvese nzira', kunyangwe mune avo vanhu vane co-morbid kukanganisa kwekudzora kusagadzikana.
Iyo yakawedzera activation mune ventral striatum inogona kuve nechekuita nekuwedzera kubudiswa kwe dopamine mune ventral striatum (Schott and unto., 2008), inowirirana nePET data (O'Sullivan and unto., 2011) uye dzapfuura zvidzidzo zvinoratidza kuwedzera dopamine kubudiswa kune hukama nehukadzi hwepabonde mukati meiyo ventral striatum yemhuka dzakanzwikwa (Fiorino naPhillips, 1999. Maronda ari mu hypothalamus uye amygdala anozivikanwa kukonzeresa kurudziro yebonde mune murume nemukadzi tsvimbo, uye hypothalamic uye amygdala activation inoteedzera kurara kwepamuviri mune inoshanda MRI zvidzidzo (Hamann and unto., 2004. Iyo hypothalamus yakaratidzirwa kutora chikamu chepakati mune hwepabonde maitiro uye inofungidzirwa kuti inobatanidzwa mune yehutachiona chikamu chehutachiona hwepabonde (Allen and unto., 1989; Kupfermann and unto., 1991; Meisel naSachs, 1994; Georgiadis and unto., 2010).
Iyo anterior cingulate cortex imwezve nzvimbo yeparutivi yakabatana kumatunhu enzvimbo uye inodzora huwandu hwemabasa euronomic uye neuroendocrine (Stoléru and unto., 1999. Zvidzidzo zvakapfuura zvakabatanidza activation yeiyo anterior cingate cortex ine degree re penile tumescence (Redouté and unto., 2000) uye nechinhu chinokurudzira chebonde chamutswa uye kuchiva (Redouté and unto., 2000; Arnow and unto., 2002; Karama and unto., 2002; Walter and unto., 2008. Nzvimbo dzeParietal uye iyo yekupedzisira cingate cortex zvakare yakabatanidzwa kune cue yakanangana mukuda kwemubairo (Garavan and unto., 2000. Iyo orbitofrontal cortex yakabatanidzwa kune yakajeka ratings yemafaro anotarisirwa uye chishuwo, uye zvinofungidzirwa kuti zvine basa mukuyananisa subjential mubairo ruzivo (Kringelbach, 2005. Zvakare, kuiswa kweiyo orbitofrontal cortex uye preortal cortex yakataurwa kuti ibatanidzwe nekunakidzwa kwemuviri kunzwa uchimisikidzwa mukati panguva yekumuka kwepabonde (Stoléru and unto., 2003. Isu takaona kuti yakarongeka yekuda kurara nevanhu kwakabatana nebasa mu cortical kumatunhu (kusanganisira anterior cingrate cortex uye orbitofrontal cortex) kuwedzera kune ventral striatum, iyo inogona kuwirirana nepfungwa yekuti kukurudzira kusaence 'kuda' hakuzivikanwe zvakananga mukuziva kuziva, uye izvo zvakatsanangurwa, kuziva 'kuda' kunoda kuwedzera cortical kugadziriswa kwe ventral striatum kubuda (Berridge naRobinson, 1995).
Muchidzidzo chedu, hunhu hwekuvandudza chiitiko chehuropi mushure mekufumurwa nehukadzi hwepabonde hwaive husina kukanganiswa nehutongi hwe l-DOPA sekurudzirwa neakafanana BOLD chiratidzo chinowedzera mune ON uye OFF mishonga yekurapa. Nekudaro, kusavapo kweakakomba l-DOPA mhedzisiro haibvise mhedzisiro ye synergistic kudyidzana kweMesolimbic dopamine mamiriro uye kuvapo kwemitezo yepabonde mukusimudzira kwakasimudzirwa 'kuda' kwemubairo wepabonde muboka revarwere vane chirwere cheParkinson nechirwere hypersexourse (Berridge, 2012; Oii and unto., 2012. Varwere vane chirwere cheParkinson vane hypersexeness, kunyangwe muHURE state haina mishonga zvachose uye inofungidzirwa kunzwa, uye mune zvipfuyo zvidzidzo, kunyangwe acute amphetamine uye sensitization mhedzisiro inogona kuwedzera (Tindell and unto., 2005), sensitization yakakonzerwa neyekare amphetamine manejimendi inokonzeresa mibairo yekukanganisa kunyanyisa kutsvaga kwavo kwakabatana, kunyangwe kana makonzo anonzwa achiedzwa munzvimbo isina zvinodhaka (Wyvell naBerridge, 2001).
Zvinofadza kuti muboka revarwere vane chirwere cheParkinson nechirwere chehypersexuality mushure mekusagadzikana l-DOPA kunetsekana, iyo inoderera inoonekwa apo OFF yavo zvinodhaka uye mune OFF uye ON nyika muParkinson chirwere chinodzora varwere (yakaderedzwa BON chiratidzo panguva yekuratidzwa kwekuita zvepabonde nekusarerekera kutaridzika kwemadziro echikamu pachiitiko chechiitiko checingate gyrus, parahippocampal gyrus, cuneus, insula uye claustrum) dzakabviswa (semhedzisiro yakafanana yedopaminergic zvinodhaka zvinodhaka mukupindwa muropa nekofi, ona Volkow and unto., 2010. Izvi zvawanikwa zvinoratidza kuti dopamine zvinodhaka zvinogona kubvisa kushomeka kwenzvimbo dzepfungwa, izvo zvingave zvine chekuita nekushanduka kwepurasitiki mukuedza kudzivirira kukurudzira hypersexourse. Kunyangwe zvichinetsa kududzira kuchenjerera kana chipinganidzo chekupwanya neuronal muBON chiratidzo kunowedzera kana kuderera muma activation voxels (Georgiaopoulos and unto., 1982; Batini and unto., 1984), dopamine zvinodhaka zvinogona kuburitsa izvi zvinokanganisa kuburikidza nebasa rezvipingaidzo zvinopinda mukati memukati medumbu remukati medumbu mucervical cortex. Kuburitswa kweanoronal inhibition mune isthmus ye cingate gyrus, parahippocampal gyrus, cuneus, insula uye claustrum kana varwere vari paDopaminergic yavo mishonga inogona kuve yakabatana nekuchinja kwakafanana kwetsika sezvo mune ichi chidzidzo kwaive kwakabatana kuwedzera kwezviratidzo zvehupombwe. Iyi dzidziso inotsigirwa nekuzadzikiswa kwakakwana kweiyo hypersexourse mushure mekubviswa pane dopamine receptor agonist mishonga (Mamikonyan and unto., 2008; Munhoz and unto., 2009).
Kuvhara kwekuvhara kwe insula kuburikidza nedopamine zvinodhaka kunogona kutungamira kune kutaurwa kwemaitiro ekurara kwepfungwa, seiyi nharaunda yeparamende inoumba kubatana kumatunhu akabatanidzwa mune autonomic regulation.Oppenheimer and unto., 1992), inoshamwaridzana zvikuru nekunzwa kweruzivo neruzivo rwekukurudzira (Stoléru and unto., 1999) uye, mukubatanidzwa neyechipiri somatosensory cortex, zvinonzi zvakabatanidzwa mukufunga kunofungidzirwa kuratidza kusapfuura maitiro ehupombwe (Mouras and unto., 2003. Iyo claustrum yakaratidzwawo kuve inobatanidzwa mukupindura kwakasimba uye kwekukurudzira mune zvemhuka (Hamamura and unto., 1997) uye vanhu (Reiman and unto., 1989) uye inofungidzirwa kuve yakabatana nekukurudzira kwepabonde (Rees and unto., 2007. Kuvhara mumatunhu eparahippocampal kwakataurwa zvichitevera kuburitswa kwemavhidhiyo anoratidza zvepabonde; zvisinei, basa rinogona kuita reizvi deactivations harisi kunyatsonzwisiswa (Redouté and unto., 2000).
Mukupedzisa, uku ndiko kuongorora kwekutanga kuongorora mashandisirwo ari kuita hypersexourse chirwere cheParkinson, uye zvakawanikwa zvinopa rutsigiro kuaccount zvichibva mukuwedzeredza kwenyonganiso-yakakonzera kukurudzira-kwakagadzirirwa kukurudzira. Kupfuurirazve, zvatakawana zvine zvimwe zvine chekuita nekukwanisa kuchena-kuvezwa kuburikidza nekuwana midhiya media kukurudzira maitiro ezvepabonde muhurwere hwaParkinson. Kukurudzira neyakajairika tsika dzakajairika dzevanhu vanofarira hypersexeness vanokwanisa kupa inokurudzira yekusimbisa yekutsvaga mubairo wepabonde kuburikidza nekuwedzera uye kwakaderera activations yeCorrort cortex, inogona kutungamira munharaunda uye mupfungwa mupfungwa zvinokuvadza. Kushandiswa kwezvinorambidzwa mhando uye huwandu hwekuratidzira kune zvisingaonekwi zvinoonekwa zvingaite kuti kudzikisira kwekutanga kwakashata kana kutsauka maitiro ehupombwe mune vanhu vasingagone kuita senge avo vanogamuchira zvinodhaka dopaminergic.
Mari
Iri basa raitsigirwa nemari kubva kuParkinson's UK (J-0704).
Supplementary material
Supplementary material Iripo pane pfungwa paIndaneti.
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