Affective Circuitry Alterations in Patients with Trigeminal Neuralgia
Affective Circuitry Alterations in Patients with Trigeminal Neuralgia
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DOI：
10.3389/fnana.2017.00073
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发表时间：
2017-09-05
影响因子：
2.9
通讯作者：
Hodaie, Mojgan
中科院分区：
文献类型：
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作者：
Hayes, Dave J.;Chen, David Q.;Hodaie, Mojgan
三叉神经痛（TN）是一种严重的慢性神经性面部疼痛疾病。情感相关的行为和结构的大脑变化已经注意到在慢性疼痛障碍，但尚未得到充分的研究在TN。我们检查了TN（37例患者：23例右侧TN，14例左侧TN）与年龄和性别匹配的健康对照相比对三个主要白色物质束的潜在影响，这些物质束负责携带情感相关信号，即，扣带、穹窿和内侧前脑束。使用了弥散磁共振成像（dMRI）、确定性多张量纤维束成像（用于纤维束建模）和模型驱动的感兴趣区域方法。我们还对这些通路的关键靶点（即，海马、扣带皮质亚区、中脑核和腹侧间脑）。假设包括：（1）成功建立了神经束模型;（2）与对照组相比，扣带回和内侧前脑束的白色微结构发生了改变（通过dMRI指标的变化，如各向异性分数以及平均、轴向和径向扩散率）;（3）穹窿的对照区无改变;（4）灰质体积相应减少。结果显示：（1）所有325条神经束均成功建模，尽管11条部分完成;（2）TN患者的扣带和内侧前脑束（MFB）发生改变，中间扣带（p = 0.001）和后扣带（p <0.0001）以及靠近腹侧被盖区（MFB-VTA）的MFB（p = 0.001）发生dMRI度量变化。右侧和左侧TN患者的后扣带回和MFB-VTA也显示出单侧差异;（3）在任何穹窿细分处均未观察到差异;（4）海马、后扣带回、中脑核和腹侧间脑的体积减少。总之，这些结果支持TN患者选择性改变情感回路的概念，这可能与该人群中的负面情绪和焦虑障碍的共病增加有关。
Trigeminal neuralgia (TN) is a severe chronic neuropathic facial pain disorder. Affect-related behavioral and structural brain changes have been noted across chronic pain disorders, but have not been well-studied in TN. We examined the potential impact of TN (37 patients: 23 with right-sided TN, 14 with left-sided TN), compared to age-and sex-matched healthy controls, on three major white matter tracts responsible for carrying affect-related signals-i.e., cingulum, fornix, and medial forebrain bundle. Diffusion magnetic resonance imaging (dMRI), deterministic multi-tensor tractography for tract modeling, and a model-driven region-of-interest approach was used. We also used volumetric gray matter analysis on key targets of these pathways (i.e., hippocampus, cingulate cortex subregions, nucleus accumbens, and ventral diencephalon). Hypotheses included: (1) successful modeling of tracts; (2) altered white matter microstructure of the cingulum and medial forebrain bundle (via changes in dMRI metrics such as fractional anisotropy, and mean, axial, and radial diffusivities) compared to controls; (3) no alterations in the control region of the fornix; (4) corresponding decreases in gray matter volumes. Results showed (1) all 325 tracts were successfully modeled, although 11 were partially complete; (2) The cingulum and medial forebrain bundle (MFB) were altered in those with TN, with dMRI metric changes in the middle (p = 0.001) and posterior cingulum (p < 0.0001), and the MFB near the ventral tegmental area (MFB-VTA) (p = 0.001). The posterior cingulum and MFB-VTA also showed unilateral differences between right-and left-sided TN patients; (3) No differences were noted at any fornix subdivision; (4) decreased volumes were noted for the hippocampus, posterior cingulate, nucleus accumbens, and ventral diencephalon. Together, these results support the notion of selectively altered affective circuits in patients with TN, which may be related to the experience of negative affect and the increased comorbidity of mood and anxiety disorders in this population.