Yuhui Chen

Background: Postural abnormality (PA) is a key motor symptom in Parkinson's disease (PD) that leads to disability and death. However, the pathophysiology underlying PA is still unknown. Objective: The objective of this study was to explore the neural patterns behind PAs and measures toward functional restoration using repetitive transcranial magnetic stimulation (TMS) in PD. Methods: We included cross‐sectional (n = 181) and TMS‐based therapy‐response (n = 45) analyses of PD. Posture features, structural magnetic resonance imaging (MRI), and functional MRI data were collected. After regressing out covariates, brain maps of morphometry image and functional MRI data were compared to determine stimulation targets for the subsequent TMS sessions. Spearman's correlation analysis was conducted to explore relationships between posture features and MRI data. Results: PD patients with PA (PD_PA) showed a greater extent of brain atrophy and functional alterations in bilateral lingual gyri and precentral gyri than patients without PA (PD_NPA). Furthermore, the PD_PA group had decreased functional connectivity between the left lingual gyrus and the left precentral gyrus compared with the PD_NPA group. The degree of such alteration inversely correlated with posture features. After 10 sessions of excitatory neuromodulation over the bilateral lingual gyri and precentral gyri, the Verum TMS group showed significant improvement in PA. We also observed increased degree centrality of the left lingual gyrus and enhanced functional connectivity between the left lingual gyrus and left inferior parietal lobule. Those changes were correlated with the improvement of PAs. Conclusions: Our study identifies a specific visual‐motor integration circuitry involved in PAs of PD, where precentral gyrus and lingual gyrus are core nodes. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Introduction Axial postural abnormality (APA) contains various forms and the progression patterns and clinical predictors for each APA remain unknown. We aimed to investigate the evolution of APA and elucidate its relationships to clinical picture in Parkinson’s disease (PD). Methods 151 PD patients underwent anterior neck flexion (ANF), anterior trunk flexion (ATF) at thoracic and lumbar fulcrum, and lateral trunk flexion (LTF) assessments for 3 years. APA was assessed using a linear mixed-effects model. The cumulative incidence of APA progression was displayed using Kaplan-Meier curves with log-rank test to compare differences. Univariate and multivariate Cox proportional hazards analyses were performed to investigate risk factors for different types of APA progression. Results ANF and ATF (thoracic fulcrum) began to increase significantly at 1-year follow-up. Lumbar fulcrum (ATF) and LTF began increasing at the 2-year and 3-year follow-ups, respectively. The overall cumulative progression risks for four APAs were different, with ANF having a significantly higher risk than thoracic fulcrum (ATF) and lumbar fulcrum (ATF), followed by LTF. We identified predictors for ANF progression were disease duration and bradykinesia symptoms. Exercise status and bradykinesia symptoms were associated with progression of ATF (thoracic fulcrum), and Hoehn-Yahr stage was associated with progression of ATF (lumbar fulcrum). LTF progression was associated with levodopa equivalent daily dose and MDS-UPDRS III posture subitem. Conclusion The APA of PD patients follow a “top to down, sagittal to coronal plane” pattern. An increased APA is associated with motor symptoms. Regular physical activity can slow the deterioration of APA in PD.

Background: Non-invasive neuroregulation techniques have been demonstrated to improve certain motor symptoms in Parkinson’s disease (PD). However, the currently employed regulatory techniques primarily concentrate on stimulating single target points, neglecting the functional regulation of networks and circuits. The supplementary motor area (SMA) has a significant value in motor control, and its functionality is often impaired in patients with PD. The matching SMA-primary motor cortex (M1) paired transcranial magnetic stimulation (TMS) treatment protocol, which benefits patients by modulating the sequential and functional connections between the SMA and M1, was elucidated in this study.Methods: This was a single-center, double-blind, randomized controlled clinical trial. We recruited 78 subjects and allocated them in a 1:1 ratio by stratified randomization into the paired stimulation (n = 39) and conventional stimulation groups (n = 39). Each patient underwent 3 weeks of matching SMA-M1 paired TMS or sham-paired stimulation. The subjects were evaluated before treatment initiation, 3 weeks into the intervention, and 3 months after the cessation of therapy. The primary outcome measure in this study was the Unified Parkinson’s Disease Rating Scale III, and the secondary outcome measures included non-motor functional assessment, quality of life (Parkinson’s Disease Questionnaire-39), and objective assessments (electromyography and functional near-infrared spectroscopy).Discussion: Clinical protocols aimed at single targets using non-invasive neuroregulation techniques often improve only one function. Emphasizing the circuit and network regulation in PD is important for enhancing the effectiveness of TMS rehabilitation. Pairing the regulation of cortical circuits may be a potential treatment method for PD. As a crucial node in motor control, the SMA has direct fiber connections with basal ganglia circuits and complex fiber connections with M1, which are responsible for motor execution. SMA regulation may indirectly regulate the function of basal ganglia circuits. Therefore, the developed cortical pairing stimulation pattern can reshape the control of information flow from the SMA to M1. The novel neuroregulation model designed for this study is based on the circuit mechanisms of PD and previous research results, with a scientific foundation and the potential to be a means of neuroregulation for PD.Clinical trial registration: ClinicalTrials.gov, identifier [ChiCTR2400083325].

Background: Tui Na (Chinese massage) is a relatively simple, inexpensive, and non-invasive intervention, and has been used to treat stroke patients for many years in China. Tui Na acts on specific parts of the body which are called meridians and acupoints to achieve the role of treating diseases. Yet the underlying neural mechanism associated with Tui Na is not clear due to the lack of detection methods. Objective: Functional near-infrared spectroscopy (fNIRS) was used to explore the changes of sensorimotor cortical neural activity in patients with upper limb motor dysfunction of stroke and healthy control groups during Tui Na Hegu Point. Methods: Ten patients with unilateral upper limb motor dysfunction after stroke and eight healthy subjects received Tui Na. fNIRS was used to record the hemodynamic data in the sensorimotor cortex and the changes in blood flow were calculated based on oxygenated hemoglobin (Oxy-Hb), the task session involved repetitive Tui Na on Hegu acupoint, using a block design [six cycles: rest (20 seconds); Tui Na (20 seconds); rest (30 seconds)]. The changes in neural activity in sensorimotor cortex could be inferred according to the principle of neurovascular coupling, and the number of activated channels in the bilateral hemisphere was used to calculate the lateralization index. Result: 1. For hemodynamic response induced by Hegu acupoint Tui Na, a dominant increase in the contralesional primary sensorimotor cortex during Hegu point Tui Na of the less affected arm in stroke patients was observed, as well as that in healthy controls, while this contralateral pattern was absent during Hegu point Tui Na of the affected arm in stroke patients. 2. Concerning the lateralization index in stroke patients, a significant difference was observed between lateralization index values for the affected arm and the less affected arm (P < 0.05). Wilcoxon tests showed a significant difference between lateralization index values for the affected arm in stroke patients and lateralization index values for the dominant upper limb in healthy controls (P < 0.05), and no significant difference between lateralization index values for the less affected arm in stroke patients and that in healthy controls (P = 0.36). Conclusion: The combination of Tui Na and fNIRS has the potential to reflect the functional status of sensorimotor neural circuits. The changes of neuroactivity in the sensorimotor cortex when Tui Na Hegu acupoint indicate that there is a certain correlation between acupoints in traditional Chinese medicine and neural circuits.

Purpose: Insomnia is one of the most common diseases in elderly patients, which seriously affect the quality of life and psychological state of patients. The purpose of this study was to investigate the changes in the functional network pattern of the prefrontal cortex in patients with chronic insomnia disorder (CID) after taking drugs, using non-invasive and low-cost functional neuroimaging with multi-channel near-infrared spectroscopy (fNIRS).Methods: All subjects were assessed using the Pittsburgh Sleep Quality Index (PSQI), Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and fNIRS. The fNIRS assessment consists of two parts: the verbal fluency test (VFT) task state and the resting state, which assessed the differences in prefrontal activation and functional connectivity, respectively.Results: A total of 30 patients with chronic insomnia disorder (CID) and 15 healthy peers completed the study. During the VFT task, a significantly lower PFC activation was observed in patients with insomnia compared to the control group (P < 0.05). However, the PFC activation in patients taking medication was higher than in patients who did not receive medication. Functional connectivity analysis showed a weaker mean PFC channel connectivity strength in patients with CID who did not receive drug treatment. Drug treatment resulted in enhanced functional connectivity of the prefrontal lobe, especially the DLPFC and frontal poles.Conclusion: A weak prefrontal cortex response was detected in patients with CID when performing the VFT task, which could be enhanced by taking hypnotics. The weakened right prefrontal lobe network may play a role in the development of CID. fNIRS may serve as a potential tool to assess sleep status and guide drug therapy.