Changes in resting state functional connectivity after repetitive transcranial direct current stimulation applied to motor cortex in fibromyalgia patients
Changes in resting state functional connectivity after repetitive transcranial direct current stimulation applied to motor cortex in fibromyalgia patients
复制标题
DOI：
10.1186/s13075-016-0934-0
复制
发表时间：
2016-02-03
影响因子：
4.9
通讯作者：
DaSilva, Alexandre F.
中科院分区：
文献类型：
--
作者：
Cummiford, Chelsea M.;Nascimento, Thiago D.;DaSilva, Alexandre F.
背景：纤维肌痛（FM）是一种慢性、集中式疼痛，其特征是负责感觉和情绪处理的大脑网络的功能、化学和结构改变。经颅直流电刺激（tDCS）已成为治疗FM的潜在方法。tDCS可以改变刺激电极下方和远处大脑区域的功能连接（FC），尽管重复性tDCS的镇痛机制尚不清楚。本研究的目的是研究与临床相关的tDCS时间安排如何改变静息状态FC，以及这些变化如何与临床疼痛相关。方法：收集12例FM患者的静息状态功能磁共振成像数据，分别在基线、假治疗5天后，以及正极在左侧初级运动皮层（M1）上、正极在右侧眶上皮层上的真正tDCS 5天后。种子到全脑FC分析将种子区放置在双侧M1、初级体感觉皮质（S1）、丘脑腹侧外侧（VL）和腹侧后外侧（VPL）以及导水管周围灰质（PAG）。结果：M1-VL丘脑、s1 -前岛和VL丘脑- pag之间较强的基线FC预示假性和真性tDCS后更强的镇痛。假手术治疗（与基线相比）减少了VPL丘脑、S1和杏仁核之间的FC。真正的tDCS（与假治疗相比）减少了VL丘脑、内侧前额叶和补充运动皮质之间的FC。有趣的是，在假治疗和积极治疗后，VL/VPL丘脑与后岛、M1和S1之间FC的减少与临床疼痛的减少相关。结论：这些结果表明，虽然假性和真性tDCS可能都存在安慰剂反应，但重复性M1 tDCS会导致FC的明显变化，这种变化持续时间超过刺激期，并可能通过改变丘脑连通性产生镇痛。
Background: Fibromyalgia (FM) is a chronic, centralized pain condition characterized by alterations in the functional, chemical, and structural brain networks responsible for sensory and mood processing. Transcranial direct current stimulation (tDCS) has emerged as a potential treatment for FM. tDCS can alter functional connectivity (FC) in brain regions underneath and distant to the stimulating electrode, although the analgesic mechanisms of repetitive tDCS remain unknown. The aim of this study was to investigate how a clinically relevant schedule of tDCS sessions alters resting state FC and how these changes might relate to clinical pain.Methods: Resting state functional magnetic resonance imaging data were collected from 12 patients with FM at baseline, after 5 days of sham treatment, and after 5 days of real tDCS with the anode over the left primary motor cortex (M1) and the cathode over the right supraorbital cortex. Seed to whole-brain FC analyses were performed with seed regions placed in bilateral M1, primary somatosensory cortices (S1), ventral lateral (VL) and ventral posterolateral (VPL) thalami, and periaqueductal gray (PAG).Results: Stronger baseline FC between M1-VL thalamus, S1-anterior insula, and VL thalamus-PAG predicted greater analgesia after sham and real tDCS. Sham treatment (compared with baseline) reduced FC between the VPL thalamus, S1, and the amygdala. Real tDCS (compared with sham treatment) reduced FC between the VL thalamus, medial prefrontal, and supplementary motor cortices. Interestingly, decreased FC between the VL/VPL thalamus and posterior insula, M1, and S1 correlated with reductions in clinical pain after both sham and active treatments.Conclusions: These results suggest that while there may be a placebo response common to both sham and real tDCS, repetitive M1 tDCS causes distinct changes in FC that last beyond the stimulation period and may produce analgesia by altering thalamic connectivity.