Beynel Lysianne, Campbell Ethan, Naclerio Maria, Galla Jeffrey T, Ghosal Angikar, Michael Andrew M, Kimbrel Nathan A, Davis Simon W, Appelbaum Lawrence G
Department of Psychiatry and Behavioral Science, Duke University School of Medicine, 200 Trent Drive, Box 3620 DUMC, Durham, NC 27710, USA.
Duke Institute for Brain Sciences, Duke University School of Medicine, 200 Trent Drive, Box 3620 DUMC, Durham, NC 27710, USA.
Brain Sci. 2021 Apr 13;11(4):494. doi: 10.3390/brainsci11040494.
While repetitive transcranial magnetic stimulation (rTMS) is widely used to treat psychiatric disorders, innovations are needed to improve its efficacy. An important limitation is that while psychiatric disorders are associated with fronto-limbic dysregulation, rTMS does not have sufficient depth penetration to modulate affected subcortical structures. Recent advances in task-related functional connectivity provide a means to better link superficial and deeper cortical sources with the possibility of increasing fronto-limbic modulation to induce stronger therapeutic effects. The objective of this pilot study was to test whether task-related, connectivity-based rTMS could modulate amygdala activation through its connectivity with the medial prefrontal cortex (mPFC). fMRI was collected to identify a node in the mPFC showing the strongest connectivity with the amygdala, as defined by psychophysiological interaction analysis. To promote Hebbian-like plasticity, and potentially stronger modulation, 5 Hz rTMS was applied while participants viewed frightening video-clips that engaged the fronto-limbic network. Significant increases in both the mPFC and amygdala were found for active rTMS compared to sham, offering promising preliminary evidence that functional connectivity-based targeting may provide a useful approach to treat network dysregulation. Further research is needed to better understand connectivity influences on rTMS effects to leverage this information to improve therapeutic applications.
虽然重复经颅磁刺激(rTMS)被广泛用于治疗精神疾病,但仍需要创新来提高其疗效。一个重要的局限性在于,虽然精神疾病与额颞叶功能失调有关,但rTMS没有足够的深度穿透能力来调节受影响的皮层下结构。任务相关功能连接的最新进展提供了一种方法,能够更好地将浅层和深层皮质源联系起来,从而有可能增强额颞叶调节,以产生更强的治疗效果。这项初步研究的目的是测试基于任务相关连接性的rTMS是否可以通过与内侧前额叶皮质(mPFC)的连接来调节杏仁核的激活。通过功能磁共振成像(fMRI)来确定mPFC中与杏仁核显示出最强连接的一个节点,这是由心理生理交互分析定义的。为了促进类似赫布可塑性,并可能实现更强的调节,在参与者观看激活额颞叶网络的恐怖视频片段时施加5Hz的rTMS。与假刺激相比,主动rTMS使mPFC和杏仁核均出现显著增加,这为基于功能连接的靶向治疗可能提供一种治疗网络功能失调的有效方法提供了有前景的初步证据。需要进一步的研究来更好地理解连接性对rTMS效果的影响,以便利用这些信息来改善治疗应用。