Baseline Brain Metabolism in Resistant Depression and Response to Transcranial Magnetic Stimulation
Baseline Brain Metabolism in Resistant Depression and Response to Transcranial Magnetic Stimulation
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DOI：
10.1038/npp.2011.161
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发表时间：
2011-12-01
影响因子：
7.6
通讯作者：
Artiges, Eric
中科院分区：
文献类型：
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作者：
Martinot, Marie-Laure Paillere;Martinot, Jean-Luc;Artiges, Eric
对难治性抑郁症（TRD）患者的神经影像学研究报告了额叶和颞区的异常。我们试图确定这些区域的代谢是否可能与 TRD 患者对重复经颅磁刺激 (TMS) 的反应有关。对参与前额叶 10 Hz TMS 双盲、随机、假对照试验的 TRD 患者进行磁共振图像和使用 F-18-氟脱氧葡萄糖正电子发射断层扫描获得的基线静息态大脑葡萄糖摄取指数 (gluMI) 的分析。在随机接受主动 TMS 治疗的患者中，对 17 名有反应者（定义为抑郁评分降低 50%）和 14 名无反应者进行了刺激前葡萄糖代谢研究，并使用基于体素的分析与 39 名健康受试者进行了比较。相对于应答者，无应答者中，左侧眶额皮质 (OFC) 的 gluMI 较低，而左侧杏仁核和钩束的 gluMI 较高。 OFC 和杏仁核 gluMI 在无应答者中呈负相关，在应答者中呈正相关，在健康受试者中不相关。相对于健康受试者，有反应者和无反应者在右背外侧前额叶 (DLPFC)、右前扣带回 (ACC) 和左腹外侧前额叶皮质中均表现出较低的 gluMI。此外，无反应者的左侧 DLPFC、ACC、左侧和右侧岛叶的 gluMI 较低，而左侧杏仁核和钩回的 gluMI 较高。代谢减退的部分原因是灰质减少，而代谢亢进与结构变化无关。研究结果表明，额叶-颞叶-边缘异常的不同模式可以区分对前额磁刺激的反应者和无反应者。保留的 OFC 体积和杏仁核代谢可能是对 TMS 反应的先决条件。神经精神药理学 (2011) 36, 2710-2719; doi：10.1038/npp.2011.161； 2011 年 8 月 17 日在线发布
Neuroimaging studies of patients with treatment-resistant depression (TRD) have reported abnormalities in the frontal and temporal regions. We sought to determine whether metabolism in these regions might be related to response to repetitive transcranial magnetic stimulation (TMS) in patients with TRD. Magnetic resonance images and baseline resting-state cerebral glucose uptake index (gluMI) obtained using F-18-fluorodeoxyglucose positron emission tomography were analyzed in TRD patients who had participated in a double-blind, randomized, sham-controlled trial of prefrontal 10 Hz TMS. Among the patients randomized to active TMS, 17 responders, defined as having 50% depression score decrease, and 14 nonresponders were investigated for prestimulation glucose metabolism and compared with 39 healthy subjects using a voxel-based analysis. In nonresponders relative to responders, gluMI was lower in left lateral orbitofrontal cortex (OFC), and higher in left amygdala and uncinate fasciculus. OFC and amygdala gluMI negatively correlated in nonresponders, positively correlated in responders, and did not correlate in healthy subjects. Relative to healthy subjects, both responders and nonresponders displayed lower gluMI in right dorsolateral prefrontal (DLPFC), right anterior cingulate (ACC), and left ventrolateral prefrontal cortices. Additionally, nonresponders had lower gluMI in left DLPFC, ACC, left and right insula, and higher gluMI in left amygdala and uncus. Hypometabolisms were partly explained by gray matter reductions, whereas hypermetabolisms were unrelated to structural changes. The findings suggest that different patterns of frontal-temporal-limbic abnormalities may distinguish responders and nonresponders to prefrontal magnetic stimulation. Both preserved OFC volume and amygdala metabolism might precondition response to TMS. Neuropsychopharmacology (2011) 36, 2710-2719; doi: 10.1038/npp.2011.161; published online 17 August 2011