Fox Michael D, Buckner Randy L, Liu Hesheng, Chakravarty M Mallar, Lozano Andres M, Pascual-Leone Alvaro
Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114; Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, MA 02129;
Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, MA 02129; Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114; Department of Psychology, Center for Brain Science, Harvard University, Cambridge, MA 02138;
Proc Natl Acad Sci U S A. 2014 Oct 14;111(41):E4367-75. doi: 10.1073/pnas.1405003111. Epub 2014 Sep 29.
Brain stimulation, a therapy increasingly used for neurological and psychiatric disease, traditionally is divided into invasive approaches, such as deep brain stimulation (DBS), and noninvasive approaches, such as transcranial magnetic stimulation. The relationship between these approaches is unknown, therapeutic mechanisms remain unclear, and the ideal stimulation site for a given technique is often ambiguous, limiting optimization of the stimulation and its application in further disorders. In this article, we identify diseases treated with both types of stimulation, list the stimulation sites thought to be most effective in each disease, and test the hypothesis that these sites are different nodes within the same brain network as defined by resting-state functional-connectivity MRI. Sites where DBS was effective were functionally connected to sites where noninvasive brain stimulation was effective across diseases including depression, Parkinson's disease, obsessive-compulsive disorder, essential tremor, addiction, pain, minimally conscious states, and Alzheimer's disease. A lack of functional connectivity identified sites where stimulation was ineffective, and the sign of the correlation related to whether excitatory or inhibitory noninvasive stimulation was found clinically effective. These results suggest that resting-state functional connectivity may be useful for translating therapy between stimulation modalities, optimizing treatment, and identifying new stimulation targets. More broadly, this work supports a network perspective toward understanding and treating neuropsychiatric disease, highlighting the therapeutic potential of targeted brain network modulation.
脑刺激作为一种越来越多地用于治疗神经和精神疾病的疗法,传统上分为侵入性方法,如深部脑刺激(DBS),和非侵入性方法,如经颅磁刺激。这些方法之间的关系尚不清楚,治疗机制仍不明确,而且给定技术的理想刺激部位往往不明确,这限制了刺激的优化及其在更多疾病中的应用。在本文中,我们确定了同时采用这两种刺激方式治疗的疾病,列出了每种疾病中被认为最有效的刺激部位,并检验了这样一个假设,即这些部位是静息态功能连接MRI所定义的同一脑网络中的不同节点。在包括抑郁症、帕金森病、强迫症、特发性震颤、成瘾、疼痛、微意识状态和阿尔茨海默病在内的多种疾病中,DBS有效的部位与非侵入性脑刺激有效的部位在功能上相互连接。缺乏功能连接确定了刺激无效的部位,相关性的正负与临床上发现兴奋性或抑制性非侵入性刺激是否有效有关。这些结果表明,静息态功能连接可能有助于在不同刺激方式之间转换治疗方法、优化治疗以及识别新的刺激靶点。更广泛地说,这项工作支持从网络角度理解和治疗神经精神疾病,突出了靶向脑网络调节的治疗潜力。