Li Yamei, Li Kuide, Feng Rongjian, Li Yi, Li Yufeng, Luo Hong, Yu Qian
Department of Rehabilitation Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, Sichuan, China.
Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
Brain Topogr. 2022 May;35(3):363-374. doi: 10.1007/s10548-022-00894-0. Epub 2022 Mar 14.
We aimed to identify neural mechanisms underlying clinical response to repetitive transcranial magnetic stimulation (rTMS) in post-stroke depression (PSD) by the Resting-state functional magnetic resonance imaging (rs-fMRI). Thirty-two depressed patients after ischemic stroke were randomized in a 1:1 ratio to receive 20 min of 5 Hz rTMS or sham over left dorsolateral prefrontal cortex (DLPFC) in addition to routine supportive treatments. The clinical outcome was measured by the 17-item Hamilton Depression Rating Scale (HDRS-17), while the imaging results were acquired from rs-fMRI, including regional homogeneity (ReHo), fractional amplitude of low-frequency fluctuation (fALFF) and seed-based dynamic functional connection (dFC). HRSD-17 scores were improved in the two groups after treatment (P < 0.01), while greater mood improvement was observed in the rTMS group (P < 0.05). Compared with the sham group, the rTMS group demonstrated regions with higher ReHo and fALFF values locating mainly in the left hemisphere and highly consistent with the default mode network (DMN) (p < 0.05). Using the medial prefrontal cortex (mPFC) and posterior cingulate cortex (PCC) as seeds, significant difference between the two groups in dFC within the DMN was found after treatment, including 10 connections with increased connectivity strength and 2 connections with reduced connectivity strength. The ReHo, fALFF and dFC values within DMN in the rTMS group were negatively correlated with the HDRS scores after treatment (P < 0.05). Our results indicated reductions in depressive symptoms following rTMS in PSD are associated with functional alterations of different depression-related areas within the DMN.
我们旨在通过静息态功能磁共振成像（rs-fMRI）确定中风后抑郁症（PSD）患者对重复经颅磁刺激（rTMS）临床反应的神经机制。32名缺血性中风后的抑郁症患者按1:1比例随机分组，除常规支持治疗外，分别接受20分钟的5Hz rTMS或左侧背外侧前额叶皮质（DLPFC）假刺激。临床疗效通过17项汉密尔顿抑郁量表（HDRS-17）进行评估，而影像学结果则通过rs-fMRI获得，包括局部一致性（ReHo）、低频振幅分数（fALFF）和基于种子点的动态功能连接（dFC）。治疗后两组的HRSD-17评分均有所改善（P < 0.01），而rTMS组的情绪改善更为显著（P < 0.05）。与假刺激组相比，rTMS组显示出ReHo和fALFF值较高的区域，主要位于左半球，且与默认模式网络（DMN）高度一致（P < 0.05）。以内侧前额叶皮质（mPFC）和后扣带回皮质（PCC）为种子点，治疗后发现两组在DMN内的dFC存在显著差异，包括10条连接强度增加的连接和2条连接强度降低的连接。rTMS组DMN内的ReHo、fALFF和dFC值与治疗后的HDRS评分呈负相关（P < 0.05）。我们的结果表明，PSD患者接受rTMS治疗后抑郁症状的减轻与DMN内不同抑郁相关区域的功能改变有关。
