Insula as the Interface Between Body Awareness and Movement: A Neurofeedback-Guided Kinesthetic Motor Imagery Study in Parkinson’s Disease

作者：Sule Tinaz, Kiran Para, Ana Vives‐Rodriguez, Valeria Martinez‐Kaigi, Keerthana Nalamada, Mi̇ne Sezgi̇n, Dustin Scheinost, Michelle Hampson, Elan D. Louis, R. Todd Constable · 发表于：Frontiers in Human Neuroscience · 年份：2018 · DOI：10.3389/fnhum.2018.00496 · 被引用次数：68 · 研究领域：Psychosomatic Disorders and Their Treatments、Action Observation and Synchronization、Neurological disorders and treatments

Intentional movement is an internally driven process that requires the integration of motivational and sensory cues with motor preparedness. In addition to the motor cortical-basal ganglia circuits, the limbic circuits are also involved in the integration of these cues. Individuals with Parkinson's disease (PD) have a particular difficulty with internally generating intentional movements and maintaining the speed, size, and vigor of movements. This difficulty improves when they are provided with external cues suggesting that there is a problem with the internal motivation of movement in PD. The prevailing view attributes this difficulty in PD to the dysfunction of motor cortical-basal ganglia circuits. First, we argue that the standard cortical-basal ganglia circuit model of motor dysfunction in PD needs to be expanded to include the insula which is a major hub within the limbic circuits. We propose a neural circuit model highlighting the interaction between the insula and dorsomedial frontal cortex which is involved in generating intentional movements. The insula processes a wide range of sensory signals arising from the body and integrates them with the emotional and motivational context. In doing so, it provides the impetus to the dorsomedial frontal cortex to initiate and sustain movement. Second, we present the results of our proof-of-concept experiment demonstrating that the functional connectivity of the insula-dorsomedial frontal cortex circuit can be enhanced with ne...