Zerebrale Bildgebung bei Gangstörungen

Zusammenfassung

Gangstörungen gehören zu den häufigsten Leitsymptomen in der Neurologie. Im höheren Lebensalter tragen sie durch die assoziierten Stürze wesentlich zur Morbidität und Einschränkung der Lebensqualität bei. Bei zentralen Gangstörungen dient die strukturelle Bildgebung dem Nachweis fokaler Läsionen und der Korrelation zum klinischen Befund bei generalisierten Hirnerkrankungen. Nuklearmedizinische bildgebende Verfahren sind klinisch bei der Darstellung der prä- und postsynaptischen dopaminergen Funktion etabliert. Experimentelle Untersuchungen mit funktionell bildgebenden Verfahren haben in den letzten Jahren einen Einblick in die supraspinale Gangsteuerung beim Menschen ermöglicht und gezeigt, dass sich das neuronale Netzwerk während der Evolution trotz des Überganges zum Zweibeingang weitgehend erhalten hat. Die aktuellen Zielregionen für die tiefe Hirnstimulation bei Parkinsonsyndromen liegen teilweise in für die Lokomotion relevanten Regionen (Nucleus subthalamicus, Nucleus pedunculopontinus). Die Wirkung der Therapie kann durch Modulation des supraspinalen Lokomotionsnetzwerkes erklärt werden.

Summary

Gait disorders are among the most common symptoms in clinical neurology. Associated falls in the elderly contribute to morbidity and reduced quality of life. In central gait disorders, structural brain imaging is used to show focal lesions and allows for the correlation to clinical presentation in more generalized brain disorders. Imaging techniques from nuclear medicine are used for the demonstration of pre- and postsynaptic dopaminergic function. Recently, experiments using functional neuroimaging have shown a supraspinal network for locomotion control in humans. Interestingly, the network is similar to the feline network despite the transition to bipedal locomotion during evolution. Target regions for deep brain stimulation in Parkinson syndromes overlap with locomotor regions (subthalamic and pedunculopontine nuclei). Therapeutic effects can in part be explained by modulation of supraspinal locomotor control.

Schlüsselwörter

Funktionelle Bildgebung - Gangstörung - Lokomotion

Keywords

Functional imaging - gait disorders - locomotion

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