Modulating cortical connectivity in stroke patients by rTMS assessed with fMRI and dynamic causal modeling.
Modulating cortical connectivity in stroke patients by rTMS assessed with fMRI and dynamic causal modeling.
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DOI：
10.1016/j.neuroimage.2009.12.029
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发表时间：
2010-03
期刊：
影响因子：
5.7
通讯作者：
Fink GR
中科院分区：
文献类型：
--
作者：
Grefkes C;Nowak DA;Wang LE;Dafotakis M;Eickhoff SB;Fink GR
来自经颅磁刺激（TMS）研究的数据表明，两个半球的初级运动皮层之间的经胼胝体抑制机制可能有助于降低中风患者的运动表现。在这里，我们研究了潜在的调制皮质运动区之间的病理相互作用的手段，重复TMS使用功能性磁共振成像（fMRI）和动态因果模型（DCM）。11例亚急性脑卒中患者在症状发作后1 - 3个月进行全手握拳运动时进行扫描。在基线扫描后，患者在两个不同的位置接受抑制性1 Hz rTMS刺激：（i）顶点（对照刺激）和（ii）未受影响（对侧病变）半球的初级运动皮层（M1）。内源性和任务依赖性的有效连接的变化进行了评估DCM的双边网络，包括M1，外侧运动前皮质，和补充运动区（SMA）。结果表明，rTMS应用于对侧损伤M1显着改善的麻痹手的运动性能。连接性分析显示，行为的改善显着相关的减少的负面影响，起源于对侧损伤M1在麻痹的手运动。同时，只有在对侧病灶M1施加rTMS后，同侧病灶SMA和M1之间的内源性偶联才显著增强。因此，应用于对侧损伤M1的rTMS可用于瞬时重塑运动系统的受干扰功能网络架构。连接性分析表明，病理性经胼胝体影响（源于对侧病灶M1）的减少和SMA与M1之间同病灶有效连接的恢复是运动性能改善的基础。
Data derived from transcranial magnetic stimulation (TMS) studies suggest that transcallosal inhibition mechanisms between the primary motor cortex of both hemispheres may contribute to the reduced motor performance of stroke patients. We here investigated the potential of modulating pathological interactions between cortical motor areas by means of repetitive TMS using functional magnetic resonance imaging (fMRI) and dynamic causal modeling (DCM). Eleven subacute stroke patients were scanned 1–3 months after symptom onset while performing whole hand fist closure movements. After a baseline scan, patients were stimulated with inhibitory 1-Hz rTMS applied over two different locations: (i) vertex (control stimulation) and (ii) primary motor cortex (M1) of the unaffected (contralesional) hemisphere. Changes in the endogenous and task-dependent effective connectivity were assessed by DCM of a bilateral network comprising M1, lateral premotor cortex, and the supplementary motor area (SMA). The results showed that rTMS applied over contralesional M1 significantly improved the motor performance of the paretic hand. The connectivity analysis revealed that the behavioral improvements were significantly correlated with a reduction of the negative influences originating from contralesional M1 during paretic hand movements. Concurrently, endogenous coupling between ipsilesional SMA and M1 was significantly enhanced only after rTMS applied over contralesional M1. Therefore, rTMS applied over contralesional M1 may be used to transiently remodel the disturbed functional network architecture of the motor system. The connectivity analyses suggest that both a reduction of pathological transcallosal influences (originating from contralesional M1) and a restitution of ipsilesional effective connectivity between SMA and M1 underlie improved motor performance.
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影响因子：
11.2
作者：
Ameli, Mitra;Grefkes, Christian;Nowak, Dennis A.
通讯作者：
Nowak, Dennis A.
影响因子：
11.2
作者：
CHOLLET, F;DIPIERO, V;FRACKOWIAK, RSJ
通讯作者：
FRACKOWIAK, RSJ
影响因子：
2.9
作者：
Dum, RP;Strick, PL
通讯作者：
Strick, PL
影响因子：
4.7
作者：
Chen, WH;Mima, T;Shibasaki, H
通讯作者：
Shibasaki, H
影响因子：
8.3
作者：
BROTT, T;ADAMS, HP;WALKER, M
通讯作者：
WALKER, M