Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada.
Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto, Canada.
Brain Stimul. 2022 May-Jun;15(3):683-694. doi: 10.1016/j.brs.2022.03.009. Epub 2022 Apr 18.
Deep brain stimulation (DBS) is an established treatment for certain movement disorders and has additionally shown promise for various psychiatric, cognitive, and seizure disorders. However, the mechanisms through which stimulation exerts therapeutic effects are incompletely understood. A technique that may help to address this knowledge gap is functional magnetic resonance imaging (fMRI). This is a non-invasive imaging tool which permits the observation of DBS effects in vivo.
The objective of this review was to provide a comprehensive overview of studies in which fMRI during active DBS was performed, including studied disorders, stimulated brain regions, experimental designs, and the insights gleaned from stimulation-evoked fMRI responses.
We conducted a systematic review of published human studies in which fMRI was performed during active stimulation in DBS patients. The search was conducted using PubMED and MEDLINE.
The rate of fMRI DBS studies is increasing over time, with 37 studies identified overall. The median number of DBS patients per study was 10 (range = 1-67, interquartile range = 11). Studies examined fMRI responses in various disease cohorts, including Parkinson's disease (24 studies), essential tremor (3 studies), epilepsy (3 studies), obsessive-compulsive disorder (2 studies), pain (2 studies), Tourette syndrome (1 study), major depressive disorder, anorexia, and bipolar disorder (1 study), and dementia with Lewy bodies (1 study). The most commonly stimulated brain region was the subthalamic nucleus (24 studies). Studies showed that DBS modulates large-scale brain networks, and that stimulation-evoked fMRI responses are related to the site of stimulation, stimulation parameters, patient characteristics, and therapeutic outcomes. Finally, a number of studies proposed fMRI-based biomarkers for DBS treatment, highlighting ways in which fMRI could be used to confirm circuit engagement and refine DBS therapy.
A review of the literature reflects an exciting and expanding field, showing that the combination of DBS and fMRI represents a uniquely powerful tool for simultaneously manipulating and observing neural circuitry. Future work should focus on relatively understudied disease cohorts and stimulated regions, while focusing on the prospective validation of putative fMRI-based biomarkers.
深部脑刺激（DBS）是治疗某些运动障碍的既定方法，并且对各种精神疾病、认知障碍和癫痫发作障碍也显示出良好的效果。然而，刺激发挥治疗作用的机制尚不完全清楚。一种可能有助于填补这一知识空白的技术是功能磁共振成像（fMRI）。这是一种非侵入性成像工具，可以在体内观察 DBS 的效果。
本综述的目的是提供在 DBS 期间进行 fMRI 的研究的全面概述，包括研究的疾病、刺激的脑区、实验设计以及从刺激诱发的 fMRI 反应中获得的见解。
我们对在 DBS 患者中进行主动刺激时进行 fMRI 的已发表的人类研究进行了系统回顾。使用 Pubmed 和 Medline 进行搜索。
随着时间的推移，fMRI-DBS 研究的数量不断增加，总共确定了 37 项研究。每项研究的 DBS 患者中位数为 10 名（范围 1-67 名，四分位距 11 名）。研究检查了各种疾病队列的 fMRI 反应，包括帕金森病（24 项研究）、原发性震颤（3 项研究）、癫痫（3 项研究）、强迫症（2 项研究）、疼痛（2 项研究）、妥瑞氏症（1 项研究）、重度抑郁症、厌食症和双相情感障碍（1 项研究）以及路易体痴呆（1 项研究）。最常刺激的脑区是丘脑底核（24 项研究）。研究表明，DBS 调节了大规模的脑网络，并且刺激诱发的 fMRI 反应与刺激部位、刺激参数、患者特征和治疗效果有关。最后，一些研究提出了 fMRI 为基础的 DBS 治疗生物标志物，强调了 fMRI 如何用于确认电路参与并改进 DBS 治疗。
文献综述反映了一个令人兴奋且不断发展的领域，表明 DBS 和 fMRI 的结合代表了一种同时操纵和观察神经回路的独特强大工具。未来的工作应侧重于相对研究较少的疾病队列和刺激区域，同时侧重于有前途的 fMRI 为基础的生物标志物的前瞻性验证。
