Ubuchopho. I-2013 Jan 31.
Politis M, Loane C, Wu K, O'Sullivan SS, I-Woodhead Z, Kiferle L, Lawrence AD, Lees AJ, I-Piccini P.
Umthombo: IDivision of Brain Science, uMnyango Wezokwelapha, Isibhedlela saseHammersmith, Imperial College London, London W12 0NN, UK.
abstract
I-Hypersexuality enokuziphatha kokuya ocansini okucindezelayo kungumthombo obalulekile wokungasebenzi kahle kweziguli ezinesifo sikaParkinson ezithola izindlela zokwelapha eziphindiselwa esikhundleni se-dopamine. Sazi okuncane kakhulu nge-pathophysiology ye-hypersexourse esesifo sikaParkinson, futhi akwaziwa ukuthi ukushukunyiswa kobulili okubukwayo, okufana nokuvezwa kocansi emithonjeni yezindaba esezingeni eliphakeme kungathinta kanjani ubuchopho nokuziphatha kulabo bantu abasengozini .Hhayi, sifunde Iqembu leziguli ze-12 ezinesifo sikaParkinson esine-hypersexeness besebenzisa ukwakheka kwe-magnetic resonance imaging blocking design eveza abahlanganyeli kuzo zombili izinkambo zokubuka ezihlobene nomvuzo nokungathathi hlangothi. Sithole ukuthi ukuvezwa kwezimpawu zocansi ezibonakalayo kuzothuthukisa isifiso sobulili ezigulini ezinesifo sikaParkinson nge-hypersexourse ezingahambelana nezinguquko zomsebenzi wobuchopho ezifundeni ezixhunyaniswe nokukhuthaza ubulili.
Iziguli ezinesifo sikaParkinson ezinama-hypersexeness zaziskenwa ZIKHONA nezidakamizwa ze-dopamine, futhi imiphumela yazo yaqhathaniswa neqembu lezinkinga zokuphathwa kwezifo i-12 Parkinson's control ngaphandle kwe-hypersexuality noma okunye ukuphazamiseka kokulawula okungathinti. Ukuchayeka ezindabeni zocansi kwandise kakhulu isifiso sobulili nezimpendulo ze-hedonic eqenjini leParkinson's hypersexuality group kuqhathaniswa neziguli ezilawula izifo zeParkinson. Lezi zinguquko zokuziphatha zihambelana nezinguquko ezibalulekile zesilinganiso se-oxygen oxygen-esekelwe ezifundeni ngaphakathi kwe-limbic, i-paralimbic, yesikhashana, i-occipital, i-somatosensory kanye ne-preortal cortices ehambelana nezinqubo zemizwa, zokucabanga, ezizimele, ezibukwayo nezishukumisayo.
Idatha yokucabanga esebenza kahle ikhombise ukuthi iziguli ze-hypersexeness 'zanda isifiso sobulili ezihlotshaniswa nokwenziwa okuthuthukile ku-ventral striatum, kanye ne-cingate and orbitof Pambal cortices. WI-hen iziguli ezinesifo sikaParkinson nge-hypersexuality zazingelashwa, imininingwane yokusebenziseka kokubonakalayo ikhombisa ukuncipha kokuqalisa ngesikhathi kwethulwa kwezinkomba zocansi ezihlobene nesixazululot.
Lokhu kwasebenza kungabonakali ngesikhathi iziguli ziseMithi, kuphakamisa ukuthi izidakamizwa ze-dopamine zingakhipha izithiyo ngaphakathi kwemijikelezo yangaphakathi ye-cortex yomgogodla engahle ibe nomthelela ekuziphatheni okubi kocansi.
Ukutholwa kwalolu cwaningo kunemiphumela emayelana nethonya elingaba khona lokuvezwa kwe-cue ngokuchayeka emithonjeni yemidiya ekuthuthukiseni i-libido, okungukuthi kuleli qembu leziguli ezisengcupheni kungaholela emiphumeleni emibi yomphakathi futhi ngezikhathi ezithile, izigwebo zokugcina.
Ukugqugquzeleka ngokuchayeka emibonweni yezocansi ezigulini ezinesifo sikaParkinson nge-hypersexuality kunikeza umfutho oshukumisayo wokufuna lokhu kuziphatha komvuzo ngokwenza kusebenze nangokwenza ubuqili be-cortex yangaphakathi.
Isingeniso
Ukuphazamiseka kokulawula impulse kufaka phakathi i-hypersexuality kanye nokuziphatha okucindezelayo kocansi kungumthombo obalulekile wokungasebenzi kahle kweziguli ezinesifo sikaParkinson ezithola ukwelashwa esikhundleni se-dopamine (Weintraub et al., 2006; Evans et al., 2009; I-Voon et al., 2009). Ubuzwela ngokuziphatha okuphathelene nocansi okuvame kakhulu kuboniswa yizicelo eziningi zokuya ocansini ezivela kumuntu oshade naye noma umlingani, isisusa sezithombe zobulili ezingcolile, ukushaya indlwabu okucindezelayo, ukuziphatha okubi ngokuvakashela izifebe, nakwabanye abantu abebekade bezibanga, Quinn et al., 1983; I-Voon et al., 2006). Ukudlanga kwe-hypersexuality esifo sikaParkinson kwaba yi-∼3.5% ocwaningweni olukhulu lweziguli ezithola i-dopamine agonist therapy nabesilisa kungenzeka ukuthi kunabesifazane ukuthola i-hypersexuality (Weintraub et al., 2010). Ucwaningo olusha kodwa oluncane luphakamise ukubhebhetheka okuthile okuphezulu kwe-hypersexuality kwisifo sikaParkinson se-7% kanye nokuxhumeka l-DOPA (Hassan et al., 2011). Ucwaningo lwakudala lukhombise nokuxhumana phakathi l-DOPA ne-hypersexuality (I-Ballivet et al., 1973; Brown et al., 1978; I-Uitti et al., 1989).
Okuqukethwe kwezocansi kwabezindaba kusobala kakhulu futhi kutholakala emphakathini jikelele, futhi izithombe zocansi zitholakala kalula kwi-inthanethi. Kuvele ukuthi ukutholakala okuningqili kwezinto ezibonakalayo zocansi kuyakwazi ukuvusa inkanuko ngokweqile engamukeleki ngokobulili kubantu abathile abasengozini ngokomthethosisekelo kanye nabantu abathatha izidakamizwa ze-dopaminergic (Izimali et al., 2007). Ucwaningo lwezinkawu lukhombisa ukuthi ukusebenzisana phakathi kwezidakamizwa ze-dopamine nezimpawu zocansi kukhulisa kakhulu isenzo sezocansi ngokweqile (I-Pomerantz, 1990). Ukubaluleka kwezimpawu ezihambisana kakhulu nomvuzo kuyahambisana nomqondo wokukhuthaza okuyisisusa, njengoba 'ukufuna' kukhiqizwa ngokusebenzisana phakathi kwesimo samanje sehlelo le-mesolimbic dopamine kanye nokuba khona kwemivuzo noma izinkambo zazo (Zhang et al., 2009; I-Berridge, i-2012).
I-PET (Redouté et al., 2000) kanye ne-MRI esebenzayo (Arnow et al., 2002; Hamann et al., 2004; Walter et al., 2008) ucwaningo lokucatshangelwa kwe-neural kwesisusa sobulili kubantu abanempilo kukhombisile ukuthi izifunda eziningi kufaka phakathi i-ventral striatum, hypothalamus, amygdala, cingate kanye ne-orbitof Pambal cortex ziyathinteka ekusebenzeni kokubonakalayo kokuvuselelwa kocansi. Ocwaningweni lwakamuva, kusetshenziswa i-PET kanye nezindlela eziqondile zokukhishwa kwe-striatal dopamine, kwaboniswa ukuthi iziguli ezinenkinga yokulawulwa kokuqina kwesifo sokupaka i-Parkinson zazinokukhishwa okuningana kwe-ventral striatum dopamine kulandela ukuvezwa kwengqondo ehlobene nomvuzo ngokuqhathaniswa neqembu leziguli zokulawulwa kwezifo zikaParkinson (O'Sullivan et al., 2011). Lokhu kutholwa bekuhambisana nombono wokukhuthaza ukuzwela, ohlongoza ukuthi ukufuna umvuzo ophoqelelayo kuvela ngokuvela ngokwedlulele kokuqina kokukhuthaza (noma 'ukufuna') imivuzo nezinto zawo, ngenxa yokuqagela okuqhubekayo kwe-neuroadaptations kumiklamo ye-dopamine ehlobene ne-ventral striatum-ephat isisusa sokujikeleza (I-Berridge et al., 2009).
Ucwaningo lokuhlola lukhombisile ukuthi imijikelezo ye-dopaminergic neural district ezindaweni ezinjenge-ventral striatum, hypothalamus, amygdala kanye ne-medial prefrontal cortex idlala indima ekushukumiseleni kwezocansi nasekuphishekeleni, ikakhulukazi ekuphenduleni izinkambo zocansi (I-Pfaus, i-2010; IStolzenberg neNuman, 2011). Ukuzwela okwenziwe izidakamizwa ze-dopaminergic kukhonjisiwe ukuthuthukisa ukulandela imivuzo engokwemvelo, kufaka phakathi izisusa zobulili (Fiorino noPhillips, i-1999; INocjar nePanksepp, 2002; Afonso et al., 2009), ngenxa yesikhuthazo sokuqina kwesisusa senkokhelo sokuvuza. Ngaphezu kwalokho, ukusebenza kocansi nezidakamizwa ze-dopaminergic kuhlanganisa inani lama-neurons ku-ventral striatum, amygdala, hypothalamus kanye ne-anterior cingulate cortex, ehlonza amasayithi angahle lapho izidakamizwa zingathonya khona ukuziphatha kocansi (Frohmader et al., 2010; Umlondolozi et al., 2010).
Ngokuhambisana nombono wokukhuthaza ukuzwela, ukuqina kwethonya lesifo eParkinson kungahlotshaniswa nokusebenza okwandayo ezifundeni zobuchopho ezixhunyaniswe nesisusa socansi kanye nokuhlelwa kabusha kwe-cue, futhi lokhu kusebenze kungabangelwa umuthi we-dopaminergic. Ocwaningweni lwamanje, sathola ukuthi iziguli ezinesifo sikaParkinson ezine-hypersexourse zizokhombisa izinto ezihlobene nokukhombisa ukuya ocansini kulezi zindawo ezixhumene nesisusa sobulili, esizoguqulwa nemithi ye-dopaminergic, futhi sixhunyaniswe nesisusa esithuthukisiwe sobulili. Sifune ukuphenya lokhu ngokuhlola i-oksijini ye-oxygen oxygen-esekela (BOLD) izinguquko ezisebenza nge-MRI esebenzayo (ngokuqhathanisa izimpendulo ekuhlolweni kwemithi ye-ON nge-OFF medical scan) futhi sihambise imiphumela yokucabanga ngokuhlolwa kokuziphatha kwesisusa sobulili.
Iziguli nezindlela
Abahlanganyeli kanye nezimpawu zomtholampilo
Kufundwe iziguli ezingamashumi amabili nane ezinezifo ezine-idiopathic Parkinson (Amathebula 1 futhi 2). Abayishumi nambili kulokhu bagcwalisa izindlela zokuhlonza zokusebenza ezihlongozwayo ze-hypersexuality (I-Voon et al., 2006; Ithebula Lokungezelela 1). Ezinye iziguli ze-12 ezinesifo sikaParkinson zazingenawo umlando we-hypersexuality noma ezinye izinkinga zokuphazamiseka kokulawula futhi zazisebenza njengeqembu elilawulayo. Frohmader et al. (2011) ukhombisile ukuthi imiphumela yezidakamizwa ze-dopaminergic kukuziphatha okucansini okuphoqayo kumamodeli wezilwane kuncike ekuhlangenwe nakho okufanayo kwezidakamizwa ze-dopaminergic kanye nesipiliyoni sobulili. Ngendlela efanayo, i-hypersexeness eyenziwe nge izidakamizwa esifo sikaParkinson iba kuphela esimweni sokusetshenziswa kwemithi okuphindaphindwe futhi ayenzeki de novo iziguli (UGiladi et al., 2007). Ngakho-ke, siqhathanisa iziguli ezinesifo sikaParkinson ne-hypersexuality neqembu elilawulayo leziguli ezinelisiwe ezinesifo sikaParkinson.
Izici zabahlanganyeli zomtholampilo
| Izici zokwelapha | Isifo sikaParkinson nge-hypersexuality | Isifo sikaParkinson silawula iziguli | P-Inani |
|---|---|---|---|
| Inani lezihloko | 12 | 12 | |
| Iminyaka (iminyaka ± SD) | I-55.2 ± 9.2 | I-62.3 ± 9.7 | 0.077 b |
| Sex | I-11 M / 1 F | I-10 M / 2 F | |
| Isikhathi sesifo (iminyaka ± SD) | I-9.6 ± 5.2 | I-10.1 ± 6.4 | 0.85b |
| UPDRS OFF motor (Ingxenye III) amaphuzu (asho ± SD)a | I-40.2 ± 10.1 | I-34.9 ± 9.9 | 0.21b |
| UPDRS ON motor (Ingxenye III) amamaki kanye nokuthuthuka% (kusho ± SD)a | I-23.1 ± 8.2 (43.8 ± 9.7%) | I-20.0 ± 5.5 (41.4 ± 11.7%) | 0.29 (0.59)b |
| I-Mini-Mental State Examination (isho ± SD) | I-29.8 ± 0.4 | I-28.9 ± 2.2 | 0.30c |
| I-LED yansuku zonkeTOTAL (mg ± SD) | I-600 ± 327 | I-778 ± 278 | 0.17b |
| I-LED yansuku zonkeL-DOPA (mg ± SD) | I-288 ± 326 | I-646 ± 264 | c |
| I-LED yansuku zonkeDA (mg ± SD) | I-311 ± 183 | I-132 ± 143 | c |
a Isilinganiso sokuhlolwa okuhlanu ngezinsuku ezinhlanu ezihlukene.
b Akukhokhelwa t-ngaphezulu.
c ukuhlolwa kwe-Mann-Whitney.
Isifo sikaParkinson silawula iziguli = iziguli ezinesifo sikaParkinson ngaphandle kwe-hypersexuality noma ezinye izindlela zokuziphatha ezingaphoqeleli; M = owesilisa; F = insikazi; SD = ukuphambuka okujwayelekile; I-UPDRS = Ubukhulu Bokukhubazeka Kwe-Parkinson's Scale Isilinganiso; I-LED = levodopa elilinganayo. Umthamo ubalwa ngokufana nombiko wangaphambilini (Politis et al., 2010): I-LED (mg) = (1 × = levodopa) + (0.77 × levodopa CR) + (1.43 × levodopa + entacapone) + (1.11 × levodopa CR + entacapone) + (20 × ropinirole) + (20 × ropinirole) + (100 × ropinirole ER) + (30 × pramipexole) + (10 × rotigotine) + (8 × bromocriptine) + (100 × apomorphine) + (67 × perandisa) + (XNUMX × cabergoline) formula ye-LED, ku-levodopa / carbidopa noma ku-benserazide kuphela levodorodide levodopa Leododhl kuphela levodopa. kubaliwe.
Iziguli ezinesifo sikaParkinson nge-hypersexuality
| Tifundvo letifundvwa | Sex | Ubudala | Uhlobo lokuziphatha kwe-hypersexuality | Amanye ama-ICD | Ukwelashwa kwe-Dopaminergic | I-LED yansuku zonkeDA | I-LED yansuku zonkeL-DOPA |
|---|---|---|---|---|---|---|---|
| HS1 | M | 46 | Izithombe zocansi / ukuphindisela ukuzibandakanya emcabangweni wezothando nezocansi | CS | I-Cabergoline | 280 | 0 |
| HS2 | M | 65 | Ukuya ocansini nabantu ayevame ukungazihlanganisi / ukuchitha isikhathi esiningi ecabanga ngocansi noma enza ucansi | I-Pramipexole | 267 | 0 | |
| HS3 | M | 72 | Ukuya ocansini nabantu ayevame ukungazihlanganisi | I-Ropinerole, i-levodopa | 180 | 700 | |
| HS4 | M | 65 | Izindaba ezingenalutho / ukubandakanyeka kwezithombe zocansi ze-inthanethi | I-Pramipexole | 200 | 0 | |
| HS5 | M | 50 | Isiguli senqabile ukudalula | BE, CS | I-Ropinerole, i-levodopa | 180 | 800 |
| HS6 | F | 55 | Ukwanda kwezenzo zocansi | CS | I-Pramipexole | 200 | 0 |
| HS7 | M | 53 | Izithombe zobulili ezingcolile | I-Pramipexole, i-levodopa | 240 | 260 | |
| HS8 | M | 53 | Izindaba ezingenalutho / imicabango yezocansi eyeqisayo | PG, BE, CS | I-Ropinerole | 360 | 0 |
| HS9 | M | 60 | Isiguli senqabile ukudalula | BE, CS | I-Ropinerole, i-levodopa | 300 | 600 |
| HS10 | M | 41 | Izithombe zocansi / ukuhambela njalo izifebe | DDS | ICabergoline, levodopa | 530 | 500 |
| HS11 | M | 45 | Izithombe zocansi / ukubandakanyeka kwezithombe zocansi ze-inthanethi | DDS | I-Pramipexole, i-levodopa | 200 | 600 |
| HS12 | M | 57 | Ukuzibandakanya nezithombe zocansi ze-inthanethi | DDS, PG, BE | I-Ropinerole | 800 | 0 |
BE = ukulunywa ukudla; CS = ukuthenga okuphoqayo; DA = i-dopamine agonist; I-DDS = i-dopamine dysregulation syndrome; I-HS = i-hypesexuality; I-ICD = ukuthinteka kokulawula ukuphazamiseka; PG = ukugembula kwe-pathological.
Ibhethri lokuhlola umtholampilo lifaka i-Hoehn ne-Yahr izitebele, ingxenye yemoto (Ingxenye III) ye-Unified Parkinson's Disease Rating Scale (UPDRS), ukuhlolwa kweMini-Mental State kanye nokubalwa nsuku zonke l-DOPA isilinganiso esifanayo (i-LED). Iziguli eziyisishiyagalombili zeziguli ze-12 ezine-Parkinson's hypersexight zikhonjiswe okungenani eyodwa eyengeziwe yokulawula ukuthinteka kokulawula (Amathebula 1 futhi 2).
Lolu cwaningo luthole ukuvunywa kokuziphatha okuhle kwiHammersmith kanye ne-Queen Charlotte's Hospitals Research Ethics Committee. Imvume ebhaliwe etholwayo yatholakala kubo bonke abahlanganyeli ngokuya ngeSimemezelo saseHelsinki.
Ukuhlolwa kokuziphatha
Ngaphambi nangemva kokuthwetshulwa, ababambiqhaza bacelwe ukukala isifiso sabo se-libido kanye nezocansi esikalini se-analogue (i-10 cm), efakwe phakathi 'kokuphansi kunawo wonke' (0 cm = 0 amaphuzu) kanye 'naphakade' (10 cm = 10 amaphuzu). Zombili izikali zazibikwa futhi zihlobene nokuthi ababambiqhaza bazizwa kanjani ngaphakathi kwehora elidlule kuphela. Isikali sento yento eyodwa sikhonjisiwe ukuthi sinokwethenjwa njengamaphepha emibuzo atholakala entweni ende (I-West kanye ne-Ussher, i-2010). Njengoba iningi leziguli ezinesifo sikaParkinson hypersexourse lalinokuphazamiseka okwengeziwe kokulawulwa kokuthatheka, izikali zesifiso esifanayo sokuzibika sokugembula, izidakamizwa kanye nokudla nazo zaziphathwa.
Izinqubo ezisebenzayo zokuthwebula ngemininingwane kazibuthe
Ababambiqhaza baskenwa ekuseni emibili ehlukene (phakathi kwe-11: 00 ne-13: 00 h) izinsuku ezingama-7 zihlukaniswe ngomklamo onqamlezayo ngemuva kokuqa isidlo sasekuseni nokumisa umuthi okungenani i-18 h ngaphambi kokuskena. Ababambiqhaza baskenwa kwisimo somuthi esichazwe ngokusobala se-OFF kusimo esisodwa sokudokotela nakwisimo somuthi ON ngemuva kokuthola umthamo womlomo l-DOPA / benserazide (200/50 mg) esakazekayo imizuzu engama-45 ngaphambi kokuqala kokuskena. Ukusebenza kwezimoto kuhlolwe nezikolo zezimoto ze-UPDRS ekuqaleni kanye nangaphambi kokuskena ukuqinisekisa ukuthi isiguli siphendule umuthi (kuchazwa njengokuthuthuka okungu-25% kwizikolo zezimoto ze-UPDRS-III). Ukusetshenziswa kwe l-I-DOPA yakhethwa ngoba zonke iziguli ezinesifo sikaParkinson ngaphambili zazikuthatha lokhu, kanti akuzona zonke ezaziku-dopamine agonist efanayo. Ngaphezu kwalokho, l-I-DOPA ingakhulisa ugqozi kwezocansi kwisifo sikaParkinson, futhi ukuziphatha kwe-hypersexourse kubonwe kuhlanganiswa kanye lUkwelashwa kwe-DOPA, hhayi nje ukwelashwa kwe-dopamine agonist (I-Ballivet et al., 1973; Brown et al., 1978; Hassan et al., 2011).
Ababambiqhaza bafakwa kwisithwebuli esinama-headphones nokugoqa ikhanda, amahlombe nezingalo ukuqinisekisa indawo encane yokunyakaza ngangokunokwenzeka. Ukunyakaza kubhekwe kuyo yonke imikhakha futhi esimweni sokunyakaza ngokweqile, ukuskena kungaqalwa kabusha noma imithamo efanelekile isuswe ekuhlaziyeni (i-5.2% yokugijima ibuyiselwe emuva ngenxa yokuthuthumela noma i-dyskinesias). Ukutholwa kokufaniswa kwenziwa ku-3 T Philips Intera isithwebuli somzimba wonke. Imininingwane yomqondo wonke itholwe ngevolumu ye-199 ye-T2*-weighted gradient-echo echo-planar imaging in an kuongezeka inqubo ezenzakalelayo ye-oda shim (usayizi wesigaxa 3.25 mm; ukuphindaphinda isikhathi 3000 ms; isikhathi se-30 ms; 90 ° iflip angle; inkambu yokubukwa 190 × 219; matrix I-112 × 112). I-angle yokutholwa kwesilayida isethelwe ku-−30 ° kusukela kumugqa wokuqala we-anterior-posterior commissure ukuze sinciphise ukuphuma kwesignali ye-lobe yangaphambili ngenxa yezimpawu zomoya, zUkulungiswa kwe-shim gradient ukuze kunxephezelwe ngemisetshenzana yengozi engapheli (UDeichmann et al., 2003; IGolide et al., 2009). Isixazululo esisodwa esingu-T1Isisindo se-turbo field eco organised scan sakhiwo sabuthwa kabusha (isikhathi se-XhoUMX ms; isikhathi sokuphindaphinda i-4.6 ms; i-9.7 ° i-flip angle; inkambu yokubuka i-8 mm).
Umsebenzi we-magnetic resonance imaging paradigm
Ngesikhathi sokuhlolwa kwe-MRI esebenzayo, izinhlobo ezinhlanu zezithombe zemibala zethulwe ngendlela eyakhiwe ngayo: (i) i-dopaminergic drug cues; (ii) ukufaka ithala kokudla; (iii) imali kanye nezindlela zokugembula; (iv) izindlela zocansi; kanye (v) nezindlela zokungathathi hlangothi. Iningi lezinto ezihlobene nomvuzo nezihlobene nokungathathi hlangothi zitholwe ku-International Affective Picture System (Lang et al., 2008) futhi anezelwe izithombe ezitholakala ngokukhululekile ezitholakala kumawebhusayithi. Ukubonwa kwekhono lokuya ocansini kufaka phakathi ukuboniswa kokuthinta okusondelene, ukuqabula intshiseko yothando, ukubukisa ngezithombe ezibonakalayo nezithombe ezivuselayo zabesifazane noma amadoda (ngokususelwa ebulilini: abesilisa babona abesifazane kanye nabesifazane babona abesilisa) ngemizimba yabo igqokile. Izintambo ezibonakalayo ezingathathi hlangothi zifaka imbonakalo yomhlaba nezimo zemvelo, izinto zasendlini namaphethini angahleliwe. Isisusa sokubukwa kocansi kwe-International Affective Photo System senziwe sasebenza ngaphambili futhi sikhonjiswe ukuthi sifaka amazinga aphakeme wokuvuselela ngokocansi ocwaningweni olwenziwe langaphambilini lwe-MRI / psychophysiological (Bradley et al., 2001; UConaglen no-Evans, 2006; Walter et al., 2008).
Izithombe zesinqumo esifanayo zethulwe emabhulokini e-14.7 s kuma-run amabili angahlali ama-9 min 56 s lilinye. Ibhulokhi ngalinye lalinezithombe eziyisikhombisa ezihlukene ezivela esigabeni esifanayo, ezinengqikithi eziyisithupha zamabhulokhi zohlobo ngalunye ezikhonjiswe ku-oda le-pseudorandom block ne-oda yemifanekiso engahleliwe kubhloka ngalinye. I-run oda belinganiselwe kubo bonke abahlanganyeli kanye nokuvakasha. Isithombe ngasinye sakhonjiswa i-2100 ms, futhi ibhulokhi ngalinye elalandelwa lalandelwa yisilayidi sokukhipha i-4000 lapho umhlanganyeli kufanele ukukala ukusuka ku-1 kuya ku-5 ukuthi balithanda kangakanani ibhulokhi lezithombe abazibonile (nge-1 ngokuthi 'ngiyizondile' nokuthi I-5 ngokuthi 'ngiyithandile'). Lezi zilinganiso zenziwa ngezwi, futhi zaqoshwa kukhompyutha. Isilayidi sokulinganisa silandelwe yisikhombimsebenzisi se-1000 ms sokuhlangana kwesiphambano sokulungiswa. Izithombe zabukwa ngesibuko esifakwe ngenhla kwekholaji ye-RF eneziteshi eziyisishiyagalombili, eyayikhombisa izithombe ezivela kunjiniyela ezisebenzisa uhlelo lokufaka isithombe lwe-IFIS-SA (In Vivo) ne-E-Prime software (Psychology Software Tools Inc).
Ukuhlaziywa kwedatha yokusebenza kwezibiliboco ezisebenzayo
Idatha yokufanekisa yahlaziywa kusetshenziswa i-Statistical Parametric Mapping version 5 (Wellcome Department of Imaging Neuroscience, UCL, UK). Amavolumu amahlanu okuqala wokusebenza ngakunye kwe-MRI alahliwe ukuvumela imiphumela yokulingana, futhi wonke amaskena wokusebenza abelwa kabusha ukuskena kokuqala kokugijima futhi aphinde abhekiswa nencazelo yawo wonke amavolumu wokulungiswa kokunyakaza kanye nesikhathi. Zonke izikena ezifakiwe ekuhlaziyweni kokugcina ziqukethe i- <2 mm yokuhamba ngakunye. Sivivinye imininingwane yezinsalela zobuciko ezisetshenzisiwe sisebenzisa insiza ye-TSDiffAna esetshenziswe kuhlobo lwe-Statistical Parametric Mapping version 5, ekhiqiza izithombe ezinencazelo nokwahluka kwevolumu ngayinye esebenzayo (http://imaging.mrc-cbu.cam.ac.uk/imaging/DataDiagnostics). I-artefact ichazwa njengokuvela kokuhlangana kwespikha sokuhlukahluka nokwehla kwesisindo kwegama elingahambelani nokwakhiwa kokuhlola. Asitholanga noma yimaphi ama-artefacts adinga ukuhlolwa okunemininingwane ethe xaxa. Isithombe esisebenzayo sabhaliswa ku-T1 isithombe sokwakheka. Izithombe ze-echo-planar zabe seziguqulwa zaba yindawo evamile ye-Montreal Neurological Institute stereotactic space besebenzisa amapharamitha avela ku-T ehlukanisiwe1 isithombe sokwakheka futhi sabusheleleka kusetshenziswa ububanzi be-8 mm egcwele kububanzi besihlungi seGaussian.
Ukuhlaziywa kweleveli yokuqala kwenziwa kwelinye iqhaza lababambiqhaza lapho kwaqanjwa khona umehluko ngamunye kulayini ojwayelekile womugqa ngamunye wesisekelo (izithombe ezingathathi hlangothi) kanye nokuthola eminye imivuzo yezocansi (ubulili obuphikisana neminye imivuzo). Imodeli ejwayelekile yomugqa ifaka izinhlaka eziyisithupha zokuhamba nezingqondo, ukubalwa kokuhamba kanye nobunye ubuciko bezinzwa okwenzeka ngezikhombisi ezintathu zokuhumusha (ukuthunyelwa) nezimbazo ezintathu zokujikeleza (x, y, z ukuhumusha kanye x, y, z ukuzungeza) ngokugijima ngakunye. Ukuqhathanisa kokuthakaselwayo okukhiqizwe kulesi sigaba (isib. Ubulili nokuqhathaniswa nokungathathi hlangothi) kusetshenziswe ezingeni lesibili, lokuhlaziywa kwemiphumela yeqembu. Umkhawulo wezibalo we P <Ubukhulu obungalungiswanga nobubanzi beqoqo ngaphezulu kwama-voxels ayi-0.001 (10 × 2 × 2 mm) usetshenziselwe ukwenziwa kusebenze kusetshenziswa ukuhlaziywa kwengqondo okuphelele nokulungiswa kokuqhathanisa okuningi kusetshenziswa isilinganiso sokutholwa okungamanga ku P <0.05 (IGenovese et al., 2002). Ama-coordinates we-pex voation activation ngaphakathi kwengqondo anqunywa ezingeni leqembu le-ON ne-OFF scan ezigulini ezinesifo sikaParkinson futhi ngaphandle kwe-hypersexuality. Siphinde sengeza enye phakathi kweqembu (ukuphathwa kwezifo zokuphathwa kwezifo zikaParkinson ngokuqhathaniswa nesifo sikaParkinson nge-hypersexourse) kanye nokuhlaziywa kwesimo (OFF dhidi ON kwemithi) ukuphenya ukuthi ngabe amapharamitha wokuhambisa ayemakhulu esigulini esisodwa noma esimweni esithile kunesinye futhi sathola ukuthi ukunyakaza bezingafani phakathi kwamaqembu nemibandela (P > 0.1 kuzimo zombili).
Njengesifunda a priori I-hypothesis ibikhona, imiphumela eyengeziwe yokuhlola imiphumela engahleliwe esezingeni lesibili (ubulili nokuqhathaniswa nokungathathi hlangothi kanye nokuya ocansini kuqhathaniswa neminye imivuzo e-ON and OFF yezimo zokwelapha) yenzelwa izifunda ezithile zentshisekelo kusetshenziswa iMarsBar (Brett et al., 2002) ngomkhawulo ofanayo wezibalo (isilinganiso sokutholwa kwamanga ku- P <0.05). Lezi zifunda kwakuyi-orbitofrontal cortex, i-anterior cingulate cortex, i-posterior cingulate cortex, i-amygdala, i-ventral striatum ne-hypothalamus. Izinhlobo ze-orbitofrontal cortex, i-anterior cingulate cortex, i-posterior cingate cortex ne-amygdala zithathwe kumtapo wezincwadi we-Automated Anatomic Labeling ohambisana neMarsBar. Amamephu wezinto ze-ventral striatum kanye ne-hypothalamus akhiwe ngokudweba lezi zifunda ezithakazelisayo ku-ANALYZE software imaging medical (version 8.1, Mayo Foundation). Lawa mabalazwe wezinto abese esetshenziselwa ukufihla bonke ubuchopho avumela ukuqhathanisa ngaphakathi kwamavolumu athile (1850 mm3 ku-hemisphere ngayinye ye-ventral striatum ne-1380 mm3 engxenyeni ngayinye ye-hypothalamus). Umehluko walowo nalowo ohlanganyele (isb. Ukuqhathaniswa nobandlululo) amanani wesifunda ngasinye sokuthakazelisa kuzo zombili izikali zemithi ye-ON ne-OFF akhishwe ukuze axhumane nedatha yokuziphatha.
Ukuhlaziywa kwesitatimende
Ukuhlaziywa kwezibalo kwenziwa nge-SPSS (inguqulo 16, SPSS Inc) ye-Macintosh. Ukuqhathanisa emaqenjini (isib. Isifo sikaParkinson esine-hypersexight OFF scan sex dhidi hlangothi) kwenziwa ngendlela yokubhanqanisa t-Izivivinyo nokuqhathanisa phakathi kwamaqembu (isib. isifo sikaParkinson esine-hypersexuality OFF sex ngokobulili nokungathathi hlangothi — isiguli sikaParkinson esilawula iziguli ngokweqile kwezocansi) senziwa kusetshenziswa amasampula amabili t-ivivinyo. Ukuhlaziywa kwezokwelapha nokuziphatha, ukuhlolwa kwe-homogeneity neGaussianity kwavivinywa ngokuhlolwa kukaBartlett noKolmogorov-Smirnov. Ukuhlolwa kwe-Parametric kanye ne-non-parametric kusetshenziswe ngendlela efanele. I-Pearson fitlation fit r kanye ne-Spearman's rho (ρ) (lapho ukuhlukahluka bekungasatshalaliswa ngokujwayelekile) kusetshenziselwe ukuhlola ubudlelwane phakathi kwezimpawu zesifiso sobulili ngemuva kokuchayeka emibonweni yezocansi kanye nesifunda ngasinye se-BOLD samanani okubonisa umehluko wokuqhathaniswa ngokobulili kokungafani kokungathathi hlangothi esifundweni semithi ye-ON ne-OFF. Ukulungiswa kweBonferroni kwakusetshenziselwa ukulwa nenkinga yokuqhathaniswa okuningi.
Imiphumela
Ukuhlaziywa kwemitholampilo nokuziphatha
Iziguli ezinesifo sikaParkinson nge-hypersexeness zazithatha kakhulu ama-dopamine agonists futhi zincipha kakhulu l-DOPA ngokuqhathaniswa neziguli zokulawulwa kwezifo zikaParkinson. Amaqembu womabili awahlukanga ngokwezibalo kunoma yiziphi ezinye izici zomtholampilo (ubudala, ubulili, ubude besifo, i-UPDRS ingxenye III OFF, KUPHELA nokuphendula ngemuva l-DOPA, Mini-Mental State Examination, i-LED yansuku zonkeTOTAL) (Amathebula 1 futhi 2).
Ngaphambi kwe-OFF ne-ON scan, iziguli ezinesifo sikaParkinson ezine-hypersexeness kanye neziguli zokulawulwa kwezifo zikaParkinson azangehluka ngezimpawu zesifiso sobulili (Ithebula 3). Ngemuva kokuhlolwa kwe-OFF kanye ne-ON lapho ababambiqhaza bebekade bevezwe khona izinkomba zocansi, iziguli ezinesifo sikaParkinson ezinomqondo ophakeme zikhombisa ukwanda okukhulu kwesifiso sabo sobulili uma kuqhathaniswa nokukala kwabo ngaphambi kokuskena futhi kukhombise ukwanda okukhulu uma kuqhathaniswa nesifiso sobulili Iziguli zokulawulwa kwezifo zikaParkinson, ezokugcina zihlala zizinzile ngaphambi nangemuva kokuskena. Iziguli ezinesifo sikaParkinson nge-hypersexourse zazikhula kakhulu ezifisweni zazo zobulili ku-ON ziqhathaniswa ne-OFF scan (Ithebula 3). Isifo sikaParkinson esine-hypersexeness kanye namaqembu okulawula izifo kaParkinson awukhombisanga noma yikuphi ngaphakathi noma phakathi kokungafani kweqembu ekudleni, ukugembula kanye nesifiso sezidakamizwa ngaphambi nangemva kokukalwa kwe-ON and OFF (idatha engakhonjisiwe).
Isifiso sobulili ngaphambi nangemva kokuchayeka kukhuthazo olubukwayo lwezocansi
| Ngaphambi kogqozi lokubonwa ngocansi | Ngemuva kokuvuselelwa okubukwayo kocansi | P-ngqayizivele | |
|---|---|---|---|
| I-scan scan | |||
| Iziguli ezilawula i-PD (zisho ± SE) | I-1.98 ± 0.59 | I-2.25 ± 0.45 | 0.31a |
| PD HS (kusho ± SE) | I-2.67 ± 0.56 | I-3.70 ± 0.50 | a |
| P-ngqayizivele | 0.40b | b | |
| I-scan | |||
| Iziguli ezilawula i-PD (zisho ± SE) | I-1.32 ± 0.28 | I-2.12 ± 0.60 | 0.18d |
| PD HS (kusho ± SE) | I-2.01 ± 0.39 | I-5.24 ± 0.41 | a |
| P-ngqayizivele | 0.15c | b | |
| I-scan scan | I-scan | ||
|---|---|---|---|
| Isikhuthazo sokubuka ngocansi ngaphambi | |||
| Iziguli ezilawula i-PD (zisho ± SE) | I-0.28 ± 0.26 | I-0.80 ± 0.52 | 0.34d |
| PD HS (kusho ± SE) | I-1.04 ± 0.32 | I-3.23 ± 0.51 | a |
| P-ngqayizivele | 0.08b | b | |
Umbhangqwana t-ngaphezulu.
b Akukhokhelwa t-ngaphezulu.
c ukuhlolwa kwe-Mann-Whitney.
d U-Wilcoxon uvumelane nokuhlolwa ngababili.
I-HS = hypersexuality; PD = Isifo sikaParkinson.
Iziguli ezinesifo sikaParkinson nge-hypersexeness zithanda izinkomba ezibonakalayo zocansi ezivezwe ngesikhathi se-MRI esebenza kahle ngokungaphezulu kweziguli zokulawulwa kwezifo zikaParkinson (ikhwalithi yedatha = 85.2%; 3.4 ± 1.2 qhathanisa ne2.1 ± 0.6, isho ± SD; P <0.05, engabhangqiwe t-I -est ngokulungiswa kweWelch), kepha akubanga khona mehluko ezilinganisweni zabo zemikhawulo yemivuzo ehlobene nezidakamizwa, imali nokugembula, noma ukudla (P > 0.1 kuzo zonke izimo, ezingabhangqiwe t-I -est kanye nokulungiswa kweWelch). Akukho mehluko owatholwa phakathi kwe-ON ne-OFF scan.
Isifunda sokuhlaziya okusebenzayo kokuhlaziywa kwemibono kobuhlakani
Isifunda sokuhlaziya intshisakalo siveze ukuthi iziguli ezinesifo sikaParkinson nge-hypersexourse zazinomsebenzi onamandla (lenyusa isibonakaliso se-BOLD) kunalezi ziguli zokulawulwa kwezifo zikaParkinson ngesikhathi zichayeka emibonweni yezocansi eqhathaniswa nokungathathi hlangothi ezibhedlela ze-OFF ezifundeni zomuthi ezilandelayo kulezi zindawo ezilandelayo: orbitof Pambal cortex (kwesobunxele : P <0.001, kwesokudla: P <0.005), i-cortex yangaphakathi engaphakathi (kwesobunxele: P <0.005, kwesokudla: P <0.001), i-cortex yangemuva ye-cingulate (kwesobunxele: P <0.001, kwesokudla: P <0.001), i-amygdala yesobunxele (P <0.05), i-ventral striatum (kwesobunxele: P <0.05, kwesokudla: P <0.05) ne-hypothalamus (kwesobunxele: P <0.005, kwesokudla: P <0.01) (I-Fig. 1C-H). Ngom umehluko ofanayo esifundeni semithi ye-ON, isethi esifanayo sokusebenza kwengqondo kwesifunda sabonwa, futhi akubanga khona mehluko omkhulu ekusebenzeni phakathi kwe-ON ne-OFF scan. Lapho siqhathanisa umphumela we-OFF dhidi ON state state yemithi nje eqenjini leziguli ezinesifo sikaParkinson nge-hypersexuality, asitholanga mehluko ku-activation.
Izingxenye eziguqukayo, ezi-coronal kanye ne-sagittal zamamephu wesistimu yezibalo ezibonisa ukwanda okukhulu kwesiginali BOLD (izindawo eziphuzi-ezibomvu) ezihambisana nokuchayeka ezithombeni ezivamile zocansi kwisifo se-12 Parkinson's (PD) control iziguli (A no-B) nasezigulini ze-12 ezinesifo sikaParkinson hypersexuality (PD HS) (C-H. Ukwanda kwesiginali BOLD kuboniswe ku- (A futhi B) i-gyrus (i-MTG) yesobunxele nasesandleni sokudla (i-MTG) kanye ne-occipital gyrus ephakathi nendawo (MOG) (x = -48, y = -59, z = 9), (C) i-ventral striatum (VS) (x = 18, y = 15, z = - 11), (D) i-hypothalamus (x = -5, y = -4, z = −9), (E) i-anterior prefrontal cortex (aPFC), i-cortex ye-anterior cingex (ACC), i-parietal lobule ephakeme (i-SPL) ne-posterior cingulate cortex (PCC) (x = 8, y = -16, z = 33), (F) i-gyrus yesobunxele ephakathi nendawo yangakwesobunxele ne-girus ese-occipital ephakathi kanye ne-anterior prefrontal cortex (x = -8, y = 56, z = 4), kanye (G futhi H) i-orbitof Pambal cortex (OFC), i-parietal lobule ephakeme, i-cortex yangemuva yangaphandle, kanye ne-gypus yangaphakathi neyesikhashana ephakathi nendawox = -24, y = 48, z = −8). Ibha yemibala iyakhombisa z-amagama.
Isifunda sokuhlaziya intshisakalo siveze ukuthi iziguli ezinesifo sikaParkinson nge-hypersexourse zazinomsebenzi oqinile ngesikhathi zichayeka ocansini uma kuqhathaniswa nezinye izinkokhelo ezibonakalayo ezifundazweni zemithi ye-OFF ezifundeni ezilandelayo: orbitof Pambal cortex (kwesobunxele: P <0.001, kwesokudla: P <0.001), i-cortex yangaphakathi engaphandle (Kwesobunxele: P <0.001, Kwesokudla: P <0.001), i-cortex yangemuva ye-cingulate (kwesobunxele: P <0.001, kwesokudla: P <0.001), i-ventral striatum (kwesobunxele: P <0.001, kwesokudla: P <0.001) ne-hypothalamus (kwesobunxele: P <0.001, kwesokudla: P <0.001). Ukusebenza okufanayo kubonwe ngesikhathi semithi ye-ON, futhi bekungekho mehluko ophawulekayo ekusebenzeni phakathi kwe-OFF kanye ne-ON scan.
Ukuhlaziywa kobuchopho bokusebenza kwengqondo okusebenza ngokuphelele
Umsebenzi ojwayelekile wobuchopho phakathi kweziguli ezinesifo sikaParkinson nge-hypersexeness kanye neziguli zokulawula izifo zeParkinson
Iziguli ezinesifo sikaParkinson ezine-hypersexeness kanye ne-Parkinson's control zokulawulwa kwezifo zikhombise ukwanda okufana kakhulu kwe-BOLD ngesilinganiso ngenkathi kuchayeka ezindabeni ezibonakalayo zocansi nezokungathathi hlangothi kuzo zombili izindlela zemithi ye-ON neye-OFF zithi phakathi kwezwe eliphakathi nendawo ne-occipital gyrus ephakathi (I-Fig. 1A no-B; Amathebula angezekile 2A no-C, Idatha eyengeziweA no-C). Ngomunye umehluko esifundazweni sase-OFF, iziguli ezinesifo sikaParkinson ezine-hypersexeness kanye ne-Parkinson's control control yeziguli zikhombisa isibonakaliso esifanayo esibonakalayo se-BOLD sincipha ngaphakathi ezweni ku-isthmus ye-cingulate gyrus [Brodmann ndawo (BA) 29 ne-30], i-parahippocampal gyrus ne-cuneus (BA 17 ) (I-Fig. 2A no-B; Amathebula angezekile 2B no-D, Idatha eyengeziweB no-D).
Izingxenye eziguqukayo nezizwakalayo zamamephu we-parametric wezibalo ezibonisa ukuncipha okuphawulekayo kwe-BOLD (izindawo ezimnyama nezikhanyayo eziluhlaza okwesibhakabhaka) ezihambisana nokuvezwa kwezithombe ezivamile zocansi kwisifo se-12 Parkinson's (PD) iziguli ezilawulayo (A futhi B) nasezigulini ze-12 ezinesifo sikaParkinson nge-hypersexuality (HS) (C futhi D) ngesikhathi SEMithi yokwelashwa. Ukuncipha kwesiginali kwe-BOLD kuboniswe ku- (A futhi B) kwesobunxele nangakwesokudla i-parahippocampal gyrus (PHG), isthmus ye-cingulate gyrus (ICG) ne-cuneus (x = -9, y = -47, z = 2), (C) i-gypus yesobunxele nesobunxele, i-cuneus, isthmus ye-cingulate gyrus, insula ne-claustrum yangakwesokudla (x = -42, y = 14, z = 8), kanye (D) i-gypus yesokunxele nesokudlax = 22, y = 38, z = −14). Esimweni semithi ye-ON, eqenjini leziguli ze-12 ezinesifo sikaParkinson nge-hypersexuality, asikho isibonakaliso se-BOLD esinciphile esitholakalayo. Ibha yemibala iyakhombisa z-amagama.
Umsebenzi wobuchopho oqondene neziguli ezinesifo sikaParkinson nge-hypersexourse
Ukuhlaziywa kobuchopho bomzimba wonke kuqinisekisile isifunda semiphumela yenzalo futhi kukhombisa ukwanda okwengeziwe kwesibonakaliso se-BOLD eqenjini leziguli ezinesifo sikaParkinson nge-hypersexuality kuqhathaniswa neziguli ezilawula izifo zeParkinson ngesikhathi sokuchayeka ocansini kanye nokungathathi hlangothi kokubonakalayo kwezindawo zemithi ye-OFF kanye ne-ON esifundazweni izifunda ezilandelayo: i-bilateral anterior prefrontal cortex (BA 10) ne-parietal lobule ephakeme (BA 5 ne-7), kanye nokuqalisa okuqondile okuqoqiwe ku-parietal lobule ephansi (BA 40) (I-Fig. 1C-H; Amathebula angezekile 2A no-C, Idatha eyengeziweA no-C). Ngomunye umehluko esifundazweni sase-OFF, iziguli ezinesifo sikaParkinson ezinomfutho wegazi uma ziqhathaniswa neziguli zokulawulwa kwezifo zikaParkinson zikhombisile ukuthi uphawu oluphakeme lwe-BOLD luyancipha ngokulinganayo ku-insula naku-claustrum kwesokudla (I-Fig. 2C no-D; Amathebula angezekile 2B no-D, Idatha eyengeziweB no-D). Kwakungekho okuhlukile kwesiginali kwe-BOLD ngesikhathi sokuchayeka ezindabeni ezibonakalayo zocansi nokungathathi hlangothi ezigulini ezinesifo sikaParkinson nge-hypersexuality phakathi kwezikhungo zemithi ye-OFF ne-ON.
Ukuhlaziywa kobuchopho kubuye kwaqinisekisa isifunda semiphumela yokuthakazelisa kwiziguli ezinesifo sikaParkinson nge-hypersexeness uma siqhathanisa nezinye izindaba zocansi nezinye izinto ezivuzayo futhi sikhombisa ukwanda kwesiginali BOLD okuthe xaxa ezikhathini zemithi ye-OFF ne-ON ezimeni zangaphakathi ze-cortex cortex (BA 9), nokwenza kusebenze okuhle kwe-lateralized ku-cortex engaphambili (BA 10) kanye ne-parahippocampal gyrus.
Umphumela we l-Umithi we-DOPA emsebenzini wobuchopho ezigulini ezinesifo sikaParkinson nge-hypersexuality
Eqenjini leziguli ezinesifo sikaParkinson esine-hypersexuality esifundeni sezokwelapha se-ON, ukwehla okubonwa esifundeni sase-OFF kanye nase-OFF nase-ON state ezimweni zokulawulwa kwezifo zeParkinson (kuncishiswe isibonakaliso se-BOLD ngesikhathi kuvezwa izindlela zocansi zokungathathi hlangothi ezibukwayo I-cingrate gyrus, parahippocampal gyrus, i-cuneus, i-insula ne-claustrum) yaqedwa (Amathebula angezekile 2B no-D, Idatha eyengeziweB no-D).
Umsebenzi wobuchopho ohlobene nezinye izinkokhelo ezibonakalayo zokuvuza ezigulini ezinesifo sikaParkinson nge-hypersexuality
Asitholanga okubalulekile ngaphakathi noma phakathi kokuhlukana kweqembu kweziguli ezinesifo sikaParkinson ezine-hypersexeness kanye ne-Parkinson's control control yeziguli kunoma yisiphi esinye isimo sesisekelo semus basus (izithombe ezingathathi hlangothi) (isib. Izidakamizwa ze-dopaminergic.
Ukuhlangana
Eqenjini leziguli ezinesifo sikaParkinson nge-hypersexeness, isifiso sobulili sokuchayeka embonweni wokubonelwa kwezocansi okuhlobene nesimo semithi ye-OFF, umehluko womsebenzi (ucansi kanye nokungathathi hlangothi) ku-posterior cingrate cortex (r = 0.78, P <0.01) kanye ne-ventral striatum (r = 0.80, P <0.01) (I-Fig. 3I-A no-B), nakwisimo sokwelashwa kwe-ON ngomsebenzi ku-cortex ye-anterior (r = 0.87, P <0.001) kanye ne-medial orbitofrontal cortex (r = 0.65, P <0.05) (I-Fig. 3C no-D). Akukho ukuhlangana okutholakele ezigulini ezinesifo sikaParkinson neqembu eliphakeme phakathi 'kokuthanda' izinkomba zocansi nomsebenzi wobuchopho ngesikhathi sokuchayeka ocansini okuphikisanayo nokungathathi hlangothi zombili ezifundeni zemithi ye-ON neye-OFF. Akukho ukuhlangana okutholakele phakathi kwezimpawu zesifiso nokuqhathaniswa komsebenzi eqenjini lokulawula izifo eParkinson kuzo zombili izifundazwe zemithi ye-ON ne-OFF (P > 0.1 kuzo zonke izimo).
Ezigulini ezinesifo sikaParkinson esine-hypersexeness, isifiso sobulili ngemuva kokuvezwa kwezithombe zobulili kuhlangana nokwanda kokuqalisa ku (A) i-cortex yangasemva kwangaphambilini kanye (B) I-ventral striatum esifundeni semithi ye-OFF kanye nokwenyuka kokusebenza ku (C) i-cortex engaphandle kwangaphakathi kanye (B) kanye ne-medial orbitof Pambal cortex ngesikhathi sesimo semithi ye-ON.
Ingxoxo
I-Hypersexuality ngumphumela ojwayelekile ongafuneki wokwelashwa kwe-dopaminergic kwisifo sikaParkinson, kwesinye isikhathi ongaholela emiphumeleni emibi yomphakathi efaka isehlukaniso, ukonakala kwedumela lomuntu ngisho nokuboshwa. Ucwaningo lwethu luhlose ukuhlola izindlela ezisebenzisa umuthi we-dopaminergic izidakamizwa ezixhuma ubuchwepheshe ezigulini ezinesifo sikaParkinson. Sisebenzise ukuhlolwa kokuziphatha kwesisusa socansi futhi sisebenzise i-paradigm esebenza kahle ye-MRI enemidwebo ejwayelekile yobulili (efana naleyo efakwa yimidiya enkulu) njengezifiso ezibonakalayo, futhi saqinisekisa ukuthi ukuvezwa kule mikhondo kwakwanele ukukhulisa isifiso sobulili seziguli ezinayo Isifo sikaParkinson nge-hypersexuality ngokusebenza kwezifunda zobuchopho ezixhumene nesisusa sobulili (bheka Ithebula 4 ngokufingqiwe kwemiphumela).
Isifinyezo semiphumela ekhombisa umehluko nokufana kokujwayelekile kusiginali BOLD yesigodi siyanda futhi sinciphise ezigulini ezinesifo sikaParkinson kanye futhi ngaphandle kwe-hypersexuality ezikhungweni zemithi ye-ON and OFF
| Isifo sikaParkinson nge-hypersexuality | Isifo sikaParkinson silawula iziguli | |||
|---|---|---|---|---|
| KUSUKELA futhi kuyakhuphuka | I-OFF iyancipha | KU kuncipha | KUSUKELA futhi kuyakhuphuka | KUValiwe naku-ON kuyancipha |
| I-Middle tempirit gyrus | Isthmus ye-cingulate gyrus | I-Middle tempirit gyrus | Isthmus ye-cingulate gyrus | |
| I-Middle occipital gyrus | I-Parahippocampal gyrus | I-Middle occipital gyrus | I-Parahippocampal gyrus | |
| Cuneus | Cuneus | |||
| I-Ventral striatum | IClaustrum | |||
| U-Amygdala | I-Insula | |||
| hypothalamus | ||||
| I-cortex ye-Anterior | ||||
| I-cortex engaphansi kwe-cingulate | ||||
| I-Orbitof Pambal cortex | ||||
| I-cortex ye-Anterior prefrontal | ||||
| Superior parietal lobule | ||||
| Ngaphansi kweparietal lobule | ||||
Ngokuvumelana nezifundo ezisebenzayo zokucatshangelwa kokukhuthaza ezocansi okubonakalayo kubantu abanempilo (Redouté et al., 2000; Arnow et al., 2002; Walter et al., 2008), ukuvezwa kwezimpawu zocansi ezibonakalayo ezivuselelwa njengezigaba zokusebenziswa kokubuka kwe-parieto-temporal-occipital ezifana ne-occipital gyrus kanye ne-gypus ephakathi yethempeli emaqenjini eziguli ezinesifo sikaParkinson ezine-hypersexuality kanye neziguli ezilawula izifo zeParkinson. Ezigulini ezinesifo sikaParkinson esine-hypersexeness, ukuvezwa kwezimpawu zokubuka ezocansi kuzo zombili izimo zomuthi we-ON ne-OFF kukhombise ukwanda kokuhlinzwa ku-cortex ye-orbitofrontal, i-anterior cingulate cortex, i-cortex ye-posterior, i-cortex ye-ventral, i-anterior prefrontal cortex, i-parietal lobule ephakeme, i-amygdala kanye i-hypothalamus, uma kuqhathaniswa neziguli ezilawula izifo ezinikezwa nguParkinson. Iziguli ezinesifo sikaParkinson nge-hypersexeness zikhombise ukukhula okukhulu kwesifiso sobulili nokuthandwa kokuqukethwe kocansi kulandela ukuvezwa kwezimpawu zocansi. Isifiso sabo sobulili sanda kakhulu ngenkathi BESEKHONA l-DOPA ngokuqhathaniswa nemithi ye-OFF ngemuva kokuchayeka kokuqukethwe kocansi. Indima ebalulekile ye-anterior cingrate cortex, posterior cingrate cortex, cyral striatum kanye ne-orbitofrontal cortex kugqozi locansi kwagcizelelwa iqiniso lokuthi ukwanda kokuqalisa kulezi zifunda kuhambisane nesifiso esikhulayo sobulili. Kodwa-ke, akukho ukuhlangana okutholakele phakathi kokusebenza kwengqondo yesifunda kanye nezikolo 'ukuthanda'.
Izifundo zezilwane zikhombisile ukuthi i-dopamine iyabandakanyeka ekuvuseleleni ezocansi futhi inxusa ukuthi kubangelwe yizinto ezibandakanya ezocansi ezindaweni ezibandakanya i-ventral striatum, hypothalamus, i-medial prefrontal cortex, i-amygdala ne-anterior cingrate cortex, nokuthi umbuso ozwela izidakamizwa ze-dopaminergic ungaholela ekuphishekeleni ucansi ngokweqile nokubikezela (Fiorino noPhillips, i-1999; INocjar nePanksepp, 2002; Afonso et al., 2009; I-Pfaus, i-2010; IStolzenberg neNuman, 2011). Ukuhlangenwe nakho okufanayo kanye nezidakamizwa ze-dopaminergic nomsebenzi wezocansi kuyadingeka ekuthuthukisweni kokuziphatha kocansi okuphoqelekile (Frohmader et al., 2011), ukubheka ukuqala kokubambezeleka kwe-hypersexeness kwisifo sikaParkinson kulandela ukwelashwa ngemithi ye-dopaminergic (UGiladi et al., 2007). Ngaphezu kwalokho, umsebenzi wakamuva ukhombisile ukuthi izidakamizwa zokuhlukumeza zingasebenza izinhlelo ezifanayo ze-neuronal njengomvuzo wokuya ocansini, ngokweqile okwenzeka ezifundeni kufaka phakathi i-hypothalamus ne-anterior cingulate cortex (Frohmader et al., 2010). Imiphumela yethu ethathwe kanye nomsebenzi wezilwane owedlule isekela imfundiso yokuvuselela izinzwa njengesihlaka sokuqonda izindlela zokusebenzisa umuthi we-dopaminergic ku-hypersexourse yesifo sikaParkinson. Umbono wokukhuthaza ukuvusa inkolelo ubamba ukuthi i-dopamine ishukumisela ukulandela imivuzo ngokufaka isikhumbuzo sokukhuthaza ukuthinta okuhlobene nemvuzo (njengezimpawu zokubuka ezocansi), ukuphishekela ukuqala ('ukufuna') ezocansi futhi esimweni se-hypersexuality, izinkomba zocansi zingabikwa ngesisusa sokuvuselela i-pathologicalI-Berridge et al., 2009). Ithiyori yokuzwela isikhuthazi iphinde ibambe ukuthi 'ukufuna' imivuzo, okuqondiswa yi-neurral ye-neuropircuitry ye-ventral striatum, kungakhula ngokuhamba kwesikhathi ngokuzimele komvuzo 'ukuthanda' njengoba umuntu ethuthukisa ukufuna umvuzo ophoqelelayo (I-Berridge et al., 2009), futhi kuyaphawuleka lapha ukuthi i-dopamine inyuse isifiso sokuvusa inkanuko evuselela inkanuko ('ifuna'), kepha hhayi ikalwe 'ukuthathwa' kwezithombe zocansi kwiziguli ezinesifo sikaParkinson ezine-hypersexuality.
Njengoba iningi (i-8 le-12) leziguli ezinesifo sikaParkinson esine-hypersexourse laline okungenani eyodwa eyengeziwe yokulawula ukuthinteka (isib. Ukugembula kwe-pathological, ukudla ukudla okufuywayo, njll.), Sasifuna ukuhlola ukuthi ngabe izinguquko ekuhlolweni kokuziphatha nasekusebenzeni kobuchopho kulandela umvuzo ukuvezwa kwenkomba kwakuqonde ngqo ocansini noma ukunwetshelwa kweminye imivuzo. Isifiso sokuzibika nokuthanda ukugembula, izidakamizwa nokudla bezingafani phakathi kwamaqembu eziguli ezinesifo sikaParkinson nge-hypersexuality kanye ne-Parkinson's control control iziguli ngaphambi nangemva kokukalwa kwe-ON and OFF. Ngokufanayo, asizange sibheke noma yimuphi umehluko phakathi kweziguli ezinesifo sikaParkinson nge-hypersexeness kanye ne-Parkinson's control control iziguli ekuphenduleni kwe-neural kwezinye izinkomba ezibonakalayo ezinomvuzo ekuhlaziyeni okusebenzayo kwe-MRI kubonisa ukuthi imiphumela yethu yokucabanga nayo yayiqonde ngqo ku-hypersexourse. Kodwa-ke, besifuna nokuthi sihlole umsebenzi othile wobuchopho ohlobene nezimpawu zokubuka ezocansi kuqhathaniswa neminye imivuzo. Okutholakele kwembula ukusebenza okuqinile kuwo wonke ama-ON nase-Off state scans ku-orbitof Pambal cortex, i-cterex ye-anterior cortex, i-cortex ye-posterior, i-cortex ye-ventral, i-cortex ye-anterior, i-dorsolateral prewardal cortex, i-parahippocampal gyrus ne-hypothalamus isisusa sobulili nesifiso, okungenani kumongo we-hypersexourse.
Lokhu kuthuthukisa okukhethiwe kwezintambo zocansi kuyaphawuleka. Sebenza kumamodeli wezilwane nguBerridge nozakwabo (UMahler noBerridge, 2009, 2012; I-DiFeliceantonio neBerridge, 2012) kukhombisile ukuthi ukujikeleza kwe-opioid okuvuselelayo ku-amygdala ne-striatum kungagxila kakhulu ku-cue-triggered 'bafuna' kakhulu emcimbini wokunqoba-konke. Ngaphansi kwalezi zimo, ikhebula elilodwa lomvuzo eliyintandokazi liba 'amandla kazibuthe' anamandla amakhulu adonsela konke ukuheha, ngokulahla ezinye izinkomba zemivuzo, ngisho nasezilwaneni ezibuye zikhangwe yileyo eminye imivuzo (UMahler noBerridge, 2009, 2012; I-DiFeliceantonio neBerridge, 2012). Ngokufanayo, izintambo zomvuzo wokuya ocansini zazihlotshaniswa nomsebenzi we-amygdala owenziwe ngcono kwezinye izinkomba zemivuzo kubantu abane-hypersexourse futhi kungenzeka ukuthi zaqondiswa ngokukhethekile ngokunyusa isikhuthazo esikhuthazayo ngendlela 'yokunqoba-konke-konke,' nakulabo bantu abane-co-morbid ukuphazamiseka kokulawula ukungathandeki.
Ukusebenza okwandisiwe ku-ventral striatum kungahlobene nokukhululwa kwe-dopamine ku-ventral striatum (Schott et al., 2008), iyahambisana nedatha ye-PET (O'Sullivan et al., 2011) nezifundo zangaphambilini ezibonisa ukukhishwa kwe-dopamine okwandisiwe okuhlobene nezinkomba zocansi ekuhambeni kwezilwane ezitholwayo (Fiorino noPhillips, i-1999). Izilonda ezise-hypothalamus nase-amygdala ziyaziwa ukuthi zithikameza ugqozi lwezocansi ezintanjeni zabesilisa nabesifazane, futhi ukusebenza kwe-hypothalamic ne-amygdala kulandelela ukuvuswa kocansi ezifundweni ze-MRI ezisebenzayo (Hamann et al., 2004). I-hypothalamus ikhonjiswe ukuthi idlala indima enkulu ekuziphatheni kobulili futhi kukholakala ukuthi ibandakanyeka engxenyeni ye-autonomic ye-arousal yezocansi (Allen et al., 1989; I-Kupfermann et al., 1991; IMeisel and Sachs, 1994; I-Georgiadis et al., 2010).
I-cortex ye-anterior ingenye indawo ehlangene exhunywe ezifundeni ze-forebrain futhi ilawula imisebenzi ethile ye-autonomic ne neuroendocrine (IStoléru et al., 1999). Izifundo ezedlule zixhume ukusebenza kwe-cortex ye-anterior cingex nge-penile tumescence (Redouté et al., 2000) kanye nengxenye egqugquzelayo yokuvuka ngocansi nesifiso (Redouté et al., 2000; Arnow et al., 2002; Karama et al., 2002; Walter et al., 2008). Izindawo zeParietal ne-cortex yangemuva yangaphandle nazo zixhunyaniswe nokucaciswa kwe-cue esifisweni somvuzo (Igalari et al., 2000). I-cortex ejikelezayo iye yaxhunyaniswa kwizilinganiso ezicacile zenjabulo nokulindelekile okulindelekile, futhi kukholakala ukuthi inendima ekulameni isipiliyoni somvuzo olandelanayo (I-Kringelbach, 2005). Ngaphezu kwalokho, ukwenziwa kusebenze kwe-orbitof Pambal cortex ne-preortal cortex kuye kwaphakanyiswa ukuthi kuhlotshaniswe nomuzwa omnandi womzimba omelwe ngaphakathi ngesikhathi sokuvuselela ucansi (IStoléru et al., 2003). Sithole ukuthi isifiso esikaliwe sobulili sihlangene nomsebenzi ezifundeni ze-cortical (kufaka phakathi i-anterior cingrate cortex kanye ne-orbitof Pambal cortex) ngaphezu kwe-ventral striatum, engahle ihambisane nombono wokuthi ukukhuthaza okusisisulu 'ngokufuna' akuhlangabezani ngokuqondile nokwazi, futhi ukuthi okucacile, okufunwa 'okudingayo' kudinga ukucutshungulwa okwengeziwe kwe-cortical yokuphuma kwe-ventral striatum (IBerridge noRobinson, i-1995).
Esifundweni sethu, umsebenzi wobuchopho obuthuthukisiwe ngemuva kokuchayeka ezithombeni zocansi awuzange uthonywe ukuphathwa kwe l-DOPA njengoba kusikiselwe ukwanda okufanayo kwe-BOLD isisindo kuma-ON nase-OFF emithini yezokwelapha. Noma kunjalo, ukungabikho kwe-acute lUmphumela we-DOPA awuqedi umphumela wokusebenzelana kwe-synergistic yesimo se-mesolimbic dopamine kanye nokuba khona kwezimpawu zocansi ekuvuseleleni 'ukufunwa' komvuzo wobulili eqenjini leziguli ezinesifo sikaParkinson nge-hypersexourse (I-Berridge, i-2012; Oyi et al., 2012). Iziguli ezinesifo sikaParkinson ezine-hypersexeness, ngisho nasesimweni se-OFF azinazo izidakamizwa ngokuphelele futhi zitholwa ngokomzwelo, futhi ezifundweni zezilwane, yize i-amphetamine eyingozi kanye nemiphumela yokuzwa ingezelela.Tindell et al., 2005), ukuzwela okubangelwa ukuphathwa kwe-amphetamine yangaphambilini kubangela imikhondo yomvuzo ibangele ukuphokophela ngokweqile komvuzo wabo ohlobene, noma ngabe amagundane azwisisiwe ahlolwa ezweni elingenazo izidakamizwa (I-Wyvell ne-Berridge, i-2001).
Kuyathakazelisa ukuthi eqenjini leziguli ezinesifo sikaParkinson nge-hypersexuality ngemuva kwesibindi lInselelo ye-DOPA, ukwehla kuyabonakala lapho i-OFF yabo izidakamizwa kanye nasesimweni se-OFF nase-ON esifundeni saseParkinson esilawula iziguli (sinciphise isibonakaliso se-BOLD ngesikhathi sokuchayeka ocansini nokungathathi hlangothi kokubonakalayo kokuthambekele ku-isthmus ye-cingate gyrus, parahippocampal gyrus, cuneus, insula ne-claustrum) zaqedwa (ngenxa yomphumela ofanayo wenselelo yezidakamizwa i-dopaminergic kumlutha we-cocaine, niyabo I-Volkow et al., 2010). Le miphumela iphakamisa ukuthi izidakamizwa ze-dopamine zingaqeda ukukhubazeka kwezifunda zobuchopho, ezingase zihambisane nezinguquko zepulasitiki emzamweni wokuvimbela ukushukumiseka kwe-hypersexourse. Noma kunzima ukuhumusha ukumbumbuluzwa noma ukuvimba ukudubula kwe-neuronal ku-BOLD isinali kuyanda noma kunciphisa kuma-voxels acushiwe (IGeorgopoulos et al., 1982; Batini et al., 1984), izidakamizwa ze-dopamine zingakhipha lokhu kuvimbela ngokusebenzisa imisebenzi yama-inhibitory interneurons esebenza ngaphakathi kwezijikelezo zasekhaya ze-neuronal ku-cortex ye-cerebral. Ukukhishwa kokuvinjwa kwe-neuronal ku-isthmus ye-cingrate gyrus, parahippocampal gyrus, cuneus, insula ne-claustrum lapho iziguli ziku-Dopaminergic yazo izidakamizwa kungahlotshaniswa nezinguquko zokuziphatha ezifanayo njengoba kulolu cwaningo kwakukhula okuhambisana nezimpawu zesifiso sobulili. Lo mbono usekelwa ukuqedwa ngokuphelele kwe-hypersexuality ngemuva kokuhoxa emithini ye-dopamine receptor agonist (UMamikonyan et al., 2008; Munhoz et al., 2009).
Ukuvinjwa kokukhipha amandla kwe-insula ngokusebenzisa izidakamizwa ze-dopamine kungaholela ekuvezweni kokuziphatha kobulili okuphathelene nokuziphatha, njengoba le ndawo yendawo yokuxhumana yakha ukuxhumana nezifunda ezibandakanyekile kumthethonqubo we-autonomic (I-Oppenheimer et al., 1992), iphathelene nemininingwane yokuhlwaya esetshenziswwe kakhulu nezizwe ezishukumisayo (IStoléru et al., 1999) futhi, kuhlanganiswe ne-cortex yesibili somatosensory, kubikwa ukuthi ubandakanyeka kwisifiso esibonakalayo sokubonisa ukuziphatha ngokweqile kobulili (IMouras et al., 2003). I-claustrum ikhonjiswe futhi ukuthi ibandakanyeka ekuphenduleni okungokomzwelo nokushukumisayo ezilwaneni (Hamamura et al., 1997) nabantu (Reiman et al., 1989) futhi kucatshangelwa ukuthi kuhlotshaniswa nokukhuthaza ucansi (Izimali et al., 2007). Ukuqanjwa kwamakhompiyutha ezifundeni ze-parahippocampal kubikwe kulandela ukwethulwa kweziqeshana zevidiyo eziveza ubulili; kodwa-ke, iqhaza elingaba khona lalezi zinto ezingasebenzi kahle aliqondakali kahle (Redouté et al., 2000).
Sengiphetha, lolu cwaningo lokuqala lokuhlola izindlela ezisebenzisa ukuqina kwe-hypersexuality kwisifo sikaParkinson, futhi okutholakele kuxhasa i-akhawunti ngokusekelwe kugqozi lokwedlulela olwenziwe ngokwedlulele. Ngaphezu kwalokho, okutholakele kunemithelela ethile maqondana namandla okuvezwa kwendlebe ngokufinyelela kwimidiya eningi ukuthonya ukuziphatha kocansi okwenzeka emzimbeni wesifo sikaParkinson. Ukugqugquzelwa yizinto ezivame ukwedlula zonke zabantu ezivame ukuba ne-hypersexourse uyakwazi ukunikeza umfutho oshukumisayo wokufuna ukuthola umvuzo ngokocansi ngokwanda futhi kunciphise ukusebenza kwe-cortex ye-cerebral, engahle iholele emiphumeleni eyingozi emphakathini nasengqondweni. Ukusetshenziswa kwemikhawulo yohlobo nobungako bokuchayeka ezindabeni ezibonakalayo ezixakile kungakhawulela ukuqala kokuziphatha ngokweqile okungajwayelekile noma okutenqenayo ezitokisini ezisengozini njengalezo ezithola izidakamizwa ze-dopaminergic.
Izimali
Lo msebenzi wesekwa yimali evela eParkinson's UK (J-0704).
Izinto ezengeziwe
Izinto ezengeziwe iyatholakala at Brain inthanethi.
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