Department of Neurology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi 110029, India.
Department of NMR, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi 110029, India.
Behav Brain Res. 2023 Aug 24;452:114602. doi: 10.1016/j.bbr.2023.114602. Epub 2023 Jul 27.
Transcranial magnetic stimulation (TMS) can aid in alleviating clinical symptoms in Parkinson's disease (PD). To better understand the neural mechanism of the intervention, neuroimaging modalities have been used to assess the effects of rTMS.
To study the changes in cortical connectivity and motor performance with rTMS at supplementary motor area (SMA) in PD using clinical assessment tools and task-based functional MRI.
3000 pulses at 5 Hz TMS were delivered at the left SMA once a week for a total of 8 consecutive weeks in 4 sham sessions (week 1-4) and 4 real sessions (week 5 to week 8) in 16 subjects with PD. The outcomes were assessed with UPDRS, PDQ 39 and task-based fMRI at baseline, after sham sessions at week 4, and after real sessions at week 8. Visuo-spatial functional MRI task along with T1 weighted scans (at 3 Tesla) were used to evaluate the effects of rTMS intervention. Multivariate pattern analysis (MVPA) was used to analyse task-based fMRI using Conn toolbox.
Improvements (p < 0.05) were observed in UPDRS II, III, Mobility and ADL of PDQ39 after real sessions of rTMS. MVPA of task-based connectivity revealed clusters of activation in right hemispheric precentral area, superior frontal gyrus, middle frontal gyrus, thalamus and cerebellum (cluster threshold p=0.001).
Weekly rTMS sessions at SMA incurred clinical motor benefits as revealed by an improvement in clinical scales and dexterity performance. These benefits could be attributed to changes in connectivity remote brain regions in the motor network.
经颅磁刺激（TMS）可辅助缓解帕金森病（PD）的临床症状。为了更好地了解干预的神经机制，采用神经影像学手段来评估重复经颅磁刺激（rTMS）的效果。
使用临床评估工具和基于任务的功能磁共振成像（fMRI）来研究 rTMS 对 PD 患者辅助运动区（SMA）皮质连通性和运动表现的影响。
16 名 PD 患者在 4 次假刺激（第 1-4 周）和 4 次真刺激（第 5-8 周）中，每周在左侧 SMA 施加 5Hz 的 TMS 刺激 3000 次，每次脉冲 1 秒，共计 8 周。在基线、第 4 周假刺激后和第 8 周真刺激后，使用 UPDRS、PDQ-39 和基于任务的 fMRI 进行评估。使用视空间功能 fMRI 任务和 T1 加权扫描（3 Tesla）来评估 rTMS 干预的效果。使用 Conn 工具箱对基于任务的 fMRI 进行多变量模式分析（MVPA）。
rTMS 真刺激后，PD 的 UPDRS II、III、运动和日常生活活动（ADL）评分（p<0.05）均有改善。基于任务的连通性 MVPA 显示右侧大脑半球中央前回、额上回、额中回、丘脑和小脑的激活簇（簇阈值 p=0.001）。
SMA 的每周 rTMS 刺激可带来临床运动获益，表现为临床量表和灵巧性表现的改善。这些获益可能归因于运动网络中远程脑区连通性的改变。
