Department of Neurology, UZ Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium.
Key Laboratory of Cognition and Personality, Faculty of Psychology, Southwest University, Chongqing, China.
Clin Neurophysiol. 2021 Apr;132(4):851-856. doi: 10.1016/j.clinph.2020.12.024. Epub 2021 Feb 3.
To explore the effects of low-frequency repetitive transcranial magnetic stimulation (LF rTMS) on cortico-striatal-cerebellar resting state functional connectivity in Parkinson's disease (PD), with and without dyskinesias.
Because there is increasing evidence of an involvement of the pre-supplementary motor area (pre-SMA) in the pathophysiology of levodopa induced dyskinesias, we targeted the right pre-SMA with LF rTMS in 17 PD patients. We explored the effects of one sham-controlled LF rTMS session on resting state functional connectivity of interconnected brain regions by using functional MRI, and how it is modified by levodopa. The clinical effect on motor function and dyskinesias was documented.
As expected, one LF rTMS session did not alleviate dyskinesias. However, real, and not sham LF rTMS significantly increased the functional connectivity with the right putamen in patients with dyskinesias. In patients without dyskinesias, the real LF rTMS session significantly decreased functional connectivity in the right putamen and the cerebellum. We found no effects on functional connectivity after levodopa ingestion.
One session of 1 Hz rTMS has opposing effects on pre-SMA functional connectivity depending on the PD patients' dyskinesia state.
Patients dyskinesias state determines the way LF rTMS affects functional connectivity in late stage PD.
探讨低频重复经颅磁刺激（LF rTMS）对伴有和不伴有运动障碍的帕金森病（PD）皮质纹状体小脑静息状态功能连接的影响。
由于越来越多的证据表明补充运动前区（pre-SMA）参与了左旋多巴诱导运动障碍的病理生理学过程，我们用 LF rTMS 对 17 名 PD 患者的右侧 pre-SMA 进行了靶向治疗。我们通过功能磁共振成像（fMRI）来探讨一次假刺激 LF rTMS 治疗对相互连接的脑区静息状态功能连接的影响，以及左旋多巴如何对其进行修饰。记录了对运动功能和运动障碍的临床影响。
正如预期的那样，一次 LF rTMS 治疗并不能减轻运动障碍。然而，真实的 LF rTMS 治疗而不是假刺激 LF rTMS 治疗显著增加了伴有运动障碍的患者右侧壳核的功能连接。在不伴有运动障碍的患者中，真实的 LF rTMS 治疗显著降低了右侧壳核和小脑的功能连接。我们没有发现 LF rTMS 治疗后对功能连接的影响。
一次 1 Hz rTMS 治疗对 pre-SMA 功能连接的影响因 PD 患者的运动障碍状态而异。
患者的运动障碍状态决定了 LF rTMS 影响晚期 PD 患者功能连接的方式。
