Ackermann Laura, Zeller Daniel, Odorfer Thorsten, Homola György A, Kampf Thomas, Pham Mirko, Aster Hans-Christoph, Sommer Claudia
Department of Neurology, University Hospital Würzburg, Josef-Schneider-Straße 11, Haus B1, 97080, Würzburg, Germany.
Department of Neuroradiology, University Hospital Würzburg, Josef-Schneider-Straße 11, Haus B1, 97080, Würzburg, Germany.
Pain Ther. 2025 Aug 30. doi: 10.1007/s40122-025-00770-2.
INTRODUCTION: Repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex (DLPFC) has been shown to reduce the symptoms of patients with fibromyalgia syndrome (FMS). We tested whether rTMS of the left DLPFC can reduce the main symptoms in FMS and whether TMS induces changes in brain functional and structural connectivity, cortical gray matter volume, and the metabolites/neurotransmitters GABA and combined glutamate/glutamine (Glx). METHODS: Twenty-seven women diagnosed with FMS according to the 2010 ACR criteria were included in a randomized controlled trial. They received either ten sessions of active or sham 10-Hz stimulation over 2 weeks embedded in a longitudinal neuroimaging setup, including one pre-treatment (T1), one post-treatment (T2), and one follow-up (T3) 3 T MRI scan. Pain and pain catastrophizing, depression, daily life/quality of life, and anxiety were assessed using standard questionnaires. RESULTS: Linear mixed-model analysis of clinical data showed a significant main effect of the main factor time but did not reveal group differences or group-time interactions, indicating a large placebo effect with symptom reduction in both groups. Fractional anisotropy (FA) values of the pontine crossing tract, the sagittal stratum, and the right cingulum in the active rTMS group increased between pre-TMS and the follow-up time points. Subgroup analysis of responders of the treatment group revealed higher functional connectivity between the left DLPFC and the right cerebellum. We did not find evidence for changes in the treatment group in the gray matter of the left DLPFC and for the concentrations of GABA and Glx, but a trend towards decreasing Glx levels for the factor time in all patients could be detected. CONCLUSIONS: While these results may be due to small sample size and short treatment duration, the findings of increased FA after active rTMS and higher functional connectivity between DLPFC and cerebellum in responders should be further explored. TRIAL REGISTRATION: Auswirkungen der nicht-invasiven Neuromodulation auf das Gehirn bei Fibromyalgiepatienten. DRKS-ID: DRKS00019051.
引言：经颅磁刺激（rTMS）左侧背外侧前额叶皮质（DLPFC）已被证明可减轻纤维肌痛综合征（FMS）患者的症状。我们测试了左侧DLPFC的rTMS是否能减轻FMS的主要症状，以及TMS是否会引起脑功能和结构连接性、皮质灰质体积以及代谢物/神经递质γ-氨基丁酸（GABA）和谷氨酸/谷氨酰胺（Glx）的联合变化。 方法：根据2010年美国风湿病学会（ACR）标准诊断为FMS的27名女性纳入一项随机对照试验。她们在为期2周的时间内接受了10次主动或假的10赫兹刺激，该过程嵌入在纵向神经成像设置中，包括一次治疗前（T1）、一次治疗后（T2）和一次随访（T3）的3T磁共振成像扫描。使用标准问卷评估疼痛和疼痛灾难化、抑郁、日常生活/生活质量以及焦虑情况。 结果：临床数据的线性混合模型分析显示主要因素时间有显著的主效应，但未揭示组间差异或组-时间交互作用，表明两组均有较大的安慰剂效应，症状均减轻。主动rTMS组中脑桥交叉束、矢状层和右侧扣带束的分数各向异性（FA）值在TMS前和随访时间点之间增加。治疗组反应者的亚组分析显示左侧DLPFC与右侧小脑之间的功能连接性更高。我们没有发现治疗组左侧DLPFC灰质以及GABA和Glx浓度有变化的证据，但在所有患者中可以检测到Glx水平随时间因素有下降趋势。 结论：虽然这些结果可能归因于样本量小和治疗持续时间短，但主动rTMS后FA增加以及反应者中DLPFC与小脑之间功能连接性更高的发现应进一步探索。 试验注册：非侵入性神经调节对纤维肌痛患者大脑的影响。 德国临床试验注册中心编号：DRKS00019051。
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