Cavaliere Carlo, Aiello Marco, Di Perri Carol, Amico Enrico, Martial Charlotte, Thibaut Aurore, Laureys Steven, Soddu Andrea
Coma Science Group, GIGA-Research, University and University Hospital of LiegeLiege, Belgium; NAPLab, IRCCS SDN Istituto di Ricerca Diagnostica e NucleareNaples, Italy.
NAPLab, IRCCS SDN Istituto di Ricerca Diagnostica e Nucleare Naples, Italy.
Front Cell Neurosci. 2016 Nov 3;10:257. doi: 10.3389/fncel.2016.00257. eCollection 2016.
Transcranial direct current stimulation (tDCS) is a non-invasive technique recently employed in disorders of consciousness, and determining a transitory recovery of signs of consciousness in almost half of minimally conscious state (MCS) patients. Although the rising evidences about its possible role in the treatment of many neurological and psychiatric conditions exist, no evidences exist about brain functional connectivity substrates underlying tDCS response. We retrospectively evaluated resting state functional Magnetic Resonance Imaging (fMRI) of 16 sub-acute and chronic MCS patients (6 tDCS responders) who successively received a single left dorsolateral prefrontal cortex (DLPFC) tDCS in a double-blind randomized cross-over trial. A seed-based approach for regions of left extrinsic control network (ECN) and default-mode network (DMN) was performed. tDCS responders showed an increased left intra-network connectivity for regions co-activated with left DLPFC, and significantly with left inferior frontal gyrus. Non-responders (NR) MCS patients showed an increased connectivity between left DLPFC and midline cortical structures, including anterior cingulate cortex and precuneus. Our findings suggest that a prior high connectivity with regions belonging to ECN can facilitate transitory recovery of consciousness in a subgroup of MCS patients that underwent tDCS treatment. Therefore, resting state-fMRI could be very valuable in detecting the neuronal conditions necessary for tDCS to improve behavior in MCS.
经颅直流电刺激(tDCS)是一种最近用于意识障碍治疗的非侵入性技术,在几乎一半的最低意识状态(MCS)患者中可促使意识体征出现短暂恢复。尽管有越来越多的证据表明其在治疗多种神经和精神疾病方面可能发挥作用,但关于tDCS反应背后的脑功能连接基质尚无证据。我们回顾性评估了16例亚急性和慢性MCS患者(6例tDCS反应者)的静息态功能磁共振成像(fMRI),这些患者在一项双盲随机交叉试验中先后接受了单次左侧背外侧前额叶皮质(DLPFC)tDCS治疗。采用基于种子点的方法对左侧外在控制网络(ECN)和默认模式网络(DMN)区域进行分析。tDCS反应者与左侧DLPFC共同激活区域的左侧网络内连接增加,与左侧额下回显著相关。无反应(NR)的MCS患者左侧DLPFC与中线皮质结构(包括前扣带回皮质和楔前叶)之间的连接增加。我们的研究结果表明,与属于ECN的区域先前具有高连接性可以促进接受tDCS治疗的MCS患者亚组中意识的短暂恢复。因此,静息态fMRI在检测tDCS改善MCS患者行为所需的神经元条件方面可能非常有价值。
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