Zhang Yanyang, Mao Zhiqi, Pan Longsheng, Ling Zhipei, Liu Xinyun, Zhang Jun, Yu Xinguang
Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China.
Department of Radiology, Chinese PLA General Hospital, Beijing, China.
Front Hum Neurosci. 2018 Mar 20;12:107. doi: 10.3389/fnhum.2018.00107. eCollection 2018.
Classical trigeminal neuralgia (TN) is a severe neuropathic facial pain disorder associated with increased risks of anxiety and depression. Converging evidence suggests that chronic pain pathophysiology involves dysfunctional pain-related and emotion-related networks. However, whether these systems are also among the culprit networks for TN remains unclear. Here, we aimed to assess TN-related anatomical and functional brain anomalies in pain-related and emotion-related networks. We investigated differences in gray matter (GM) volume and the related resting-state functional connectivity (rsFC) between 29 classical TN patients and 34 matched healthy controls. Relationships between brain measurement alterations, clinical pain and emotional states were identified. A longitudinal observation was further conducted to determine whether alterations in the brain could renormalize following pain relief. Reduced GM volumes in the bilateral amygdala, periaqueductal gray (PAG) and right insula were found in TN patients compared with healthy control subjects. Whole-brain rsFC analyses with the four above-mentioned anatomical regions as seeds identified three significantly altered functional circuits, including amygdala-DLPFC, amygdala-mPFC and amygdala-thalamus/putamen circuitry. The amygdala-DLPFC and amygdala-mPFC circuits were associated with clinical pain duration and emotional state ratings, respectively. Further longitudinal analysis found that rsFC strength abnormalities in two fronto-limbic circuits (left amygdala/left DLPFC and right amygdala/right PFC) were resolved after pain relief. Together, structural and functional deficits in pain-related and emotion-related networks were associated with TN patients, as demonstrated by our multimodal results. Pain relief had protective effects on brain functional connectivity within fronto-limbic circuits. Our study provides novel insights into the pathophysiology of TN, which may ultimately facilitate advances in TN intervention.
经典三叉神经痛（TN）是一种严重的神经性面部疼痛疾病，与焦虑和抑郁风险增加相关。越来越多的证据表明，慢性疼痛的病理生理学涉及功能失调的疼痛相关网络和情绪相关网络。然而，这些系统是否也是TN的罪魁祸首网络尚不清楚。在这里，我们旨在评估疼痛相关网络和情绪相关网络中与TN相关的解剖学和功能性脑异常。我们调查了29例经典TN患者和34例匹配的健康对照者之间灰质（GM）体积和相关静息态功能连接（rsFC）的差异。确定了脑测量改变、临床疼痛和情绪状态之间的关系。进一步进行纵向观察以确定疼痛缓解后脑改变是否可以恢复正常。与健康对照者相比，TN患者双侧杏仁核、导水管周围灰质（PAG）和右侧岛叶的GM体积减少。以上述四个解剖区域为种子进行全脑rsFC分析，确定了三个显著改变的功能回路，包括杏仁核-背外侧前额叶皮质（DLPFC）、杏仁核-内侧前额叶皮质（mPFC）和杏仁核-丘脑/壳核回路。杏仁核-DLPFC和杏仁核-mPFC回路分别与临床疼痛持续时间和情绪状态评分相关。进一步的纵向分析发现，疼痛缓解后，两个额-边缘回路（左侧杏仁核/左侧DLPFC和右侧杏仁核/右侧PFC）的rsFC强度异常得到解决。我们的多模态结果表明，疼痛相关网络和情绪相关网络中的结构和功能缺陷与TN患者有关。疼痛缓解对额-边缘回路内的脑功能连接具有保护作用。我们的研究为TN的病理生理学提供了新的见解，这可能最终促进TN干预的进展。
