Clinical Neurophysiology Lab, Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
Department of Neurology, Rambam Health Care Campus, Haifa, Israel.
Sci Rep. 2022 Oct 12;12(1):17135. doi: 10.1038/s41598-022-21557-x.
MRI-based resting-state functional connectivity (rsFC) has been shown to predict response to pharmacological and non-pharmacological treatments for chronic pain, but not yet for motor cortex transcranial magnetic stimulation (M1-rTMS). Twenty-seven fibromyalgia syndrome (FMS) patients participated in this double-blind, crossover, and sham-controlled study. Ten daily treatments of 10 Hz M1-rTMS were given over 2 weeks. Before treatment series, patients underwent resting-state fMRI and clinical pain evaluation. Significant pain reduction occurred following active, but not sham, M1-rTMS. The following rsFC patterns predicted reductions in clinical pain intensity after the active treatment: weaker rsFC of the default-mode network with the middle frontal gyrus (r = 0.76, p < 0.001), the executive control network with the rostro-medial prefrontal cortex (r = 0.80, p < 0.001), the thalamus with the middle frontal gyrus (r = 0.82, p < 0.001), and the pregenual anterior cingulate cortex with the inferior parietal lobule (r = 0.79, p < 0.001); and stronger rsFC of the anterior insula with the angular gyrus (r = - 0.81, p < 0.001). The above regions process the attentional and emotional aspects of pain intensity; serve as components of the resting-state networks; are modulated by rTMS; and are altered in FMS. Therefore, we suggest that in FMS, the weaker pre-existing interplay between pain-related brain regions and networks, the larger the pain relief resulting from M1-rTMS.
基于磁共振成像的静息态功能连接(rsFC)已被证明可预测慢性疼痛的药物和非药物治疗反应,但尚未预测运动皮层经颅磁刺激(M1-rTMS)的反应。27 名纤维肌痛综合征(FMS)患者参与了这项双盲、交叉和假对照研究。在 2 周内进行了 10 天的 10 Hz M1-rTMS 治疗。在治疗系列之前,患者接受了静息态 fMRI 和临床疼痛评估。在接受主动治疗后,疼痛明显减轻,但假治疗组则无明显减轻。以下 rsFC 模式预测了主动治疗后临床疼痛强度的降低:默认模式网络与中额回之间的 rsFC 减弱(r=0.76,p<0.001),执行控制网络与额内侧前额叶皮质之间的 rsFC 增强(r=0.80,p<0.001),丘脑与中额回之间的 rsFC 增强(r=0.82,p<0.001),以及前扣带皮质与下顶叶之间的 rsFC 增强(r=0.79,p<0.001);以及前岛叶与角回之间的 rsFC 减弱(r= - 0.81,p<0.001)。上述区域处理疼痛强度的注意力和情绪方面;作为静息态网络的组成部分;受 rTMS 调节;并在 FMS 中发生改变。因此,我们认为在 FMS 中,与疼痛相关的大脑区域和网络之间预先存在的相互作用较弱,M1-rTMS 引起的疼痛缓解越大。
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