Evaluation Of The Effect Of Yishenzhuyu Therapy On Tonic And Dynamic Type PD Based On FMRI And Scale

Background:Rigidity and bradykinesia-dominant Parkinson’s disease (PD) is a clinical pattern of Parkinson’s disease. Comparing with tremor-dominant PD, it’s more difficult to diagnose at the onset and has higher disability rate, prognosis is also worse. This type of PD seriously affects the life quality of patients. Its common clinical features are myotonia, bradykinesia and so on. Now western medicines can relieve its motor symptoms partly, but long-term outcome is poor. To explore this disease, many doctors of Chinese medicine have maken efforts, but the unified view has not yet formed. Some clinical studies have proved that Chinese medicine has certain curative effect on this disease, especially on non-motor symptoms. Yishen Zhuyu therapy is also applied to treat this disease, but short of evidence when spreaded. Functional magnetic resonance imagine (fMRI) as a new radiological technology has a broad clinical applicational prospect, it provides a new method for Chinese medicine study.Objectives:1) To probe the clinical curative effect and mechanism of Yishen Zhuyu therapy on rigidity and bradykinesia-dominant PD.2) To observe the changes of the brain network of rigidity and bradykinesia-dominant PD.3) To study the relevance between PD related scales and brain network.Methods:This is a prospective and self-control study, nine patients are all from department of encephalopathy of Dongzhimen hospital and meet the requirements. They are treated by modified Peiyuan Jiejing decoction for 1 to 3 months. PD related scales concerning Chinese medical syndrome, motor symptoms, non-motor symptoms, life quality are evaluated at different time points. The fMRI data of patients before the treatment is also gathered. Nine healthy volunteers matching with the patients are collected for the comparison of the fMRI data. The assessment of clinical curative effect depending on scales uses paired t-test or wilcoxon signed ranks test. As to data of fMRI, the differences between the treatment group and normal control group, pretherapy and post-treatment are compared by t-test, the relevance between PD related scales and brain network is assessed by partial correlation analysis.Results:1) The grade of quantitative classification table of syndrome declines in 28 days significantly, while most results are meaningless. But the score of quantitative classification table of syndrome, MMSE, autonomic nerve scale, PSQI, NMSS, PDQ-39 trend to improve after treatment, so is UPDRSIII in 28 days.2) Compared to healthy volunteers, the brain network of rigidity and bradykinesia-dominant PD patients changes obviously, it involves the functional connections between multiple brain regions increase or decrease. And the decreasing functional connection between bilateral postcentral gyru and bilateral thalamus is outstanding.3) Compared with pretherapy, the functional connections between partial brain regions weaken after therapy, and amygdala is an important node in the network, no increased connection is found. The reduced connection between right amygdala and right putamen show that the treatment group is stronger than the normal control group before treatment.4) The relevance between quantitative classification table of syndrome and brain network, UPDRSIII and brain network is highly consistent. Both of them have positive correlation with the connections between right anterior cingulum and right thalamus, right anterior cingulum and left amygdala, left anterior cingulum and left amygdala, negative correlation with the connections between left precentral gyru and left postcentral gyru, right supplementary motor area, right precentral gyru. The connection between right precentral gyru and right supplementary motor area also has negative correlation with quantitative classification table of syndrome and UPDRSIII.5) The scores of NMSS and autonomic nerve scale have no linear correlation with sensorimotor cortex, they mainly show the linear correlation with the connections between internal brain regions of limbic system, also between limbic system and caudate or pallidum.6) The score of PDQ-39 has positive correlation with the connection between right anterior cingulum and right amygdale, positive correlation with the connections between left precentral gyru and right supplementary motor area, right postcentral gyru, this is consistent with quantitative classification table of syndrome and UPDRSIII. Besides, the score of PDQ-39 has linear correlation with the connections between internal brain regions of limbic system, also between limbic system and pallidum, sensorimotor cortex.Conclusions:1) Yishen Zhuyu therapy maybe modify the disorganized brain network to treat rigidity and bradykinesia-dominant PD, it has clinical curative effect.2) The brain network of rigidity and bradykinesia-dominant PD has changed compared to healthy volunteers, the decreasing functional connection between bilateral postcentral gyru and bilateral thalamus is outstanding. And it maybe relate with paresthesia, sensory-movement integration dysfunction of the patients.3) The dyskinesia of PD relate with the dysfunction connection between bilateral sensorimotor cortex. To make up dyskinesia, related brain regions of limbic system maybe compensate.4) The non-motor symptoms, autonomic nerve dysfunction of PD maybe relate with the dysfunction connection between limbic system and basal ganglia.