Neural activity during attentional conflict predicts reduction in tinnitus perception following rTMS.
Neural activity during attentional conflict predicts reduction in tinnitus perception following rTMS.
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DOI：
10.1016/j.brs.2017.05.009
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发表时间：
2017-09
影响因子：
7.7
通讯作者：
Mennemeier MS
中科院分区：
文献类型：
--
作者：
James GA;Thostenson JD;Brown G;Carter G;Hayes H;Tripathi SP;Dobry DJ;Govindan RB;Dornhoffer JL;Williams DK;Kilts CD;Mennemeier MS
主观性特发性耳鸣是一种侵入性、分神性和潜在致残性疾病，其特征是声音幻觉。虽然耳鸣没有批准的药物治疗，最近的证据支持使用重复经颅磁刺激（rTMS）来缓解耳鸣症状。通过中颞上回（STG）传递的重复性经颅磁刺激可能会改变耳鸣意识和烦恼的评级，而不是响度，这是由于注意处理的改变。STG与调节注意力的前额皮质区域有相互联系。为了探讨STG刺激对注意力的假设影响，一组耳鸣患者参加了rTMS临床试验[n= 12,9名男性，平均（sd）年龄= 49岁]，在重复测量功能磁共振成像（fMRI）研究中接受了rTMS治疗前后的注意冲突任务。多源干扰任务（MSIT）是一项基于stroop的视觉注意冲突fMRI任务，用于绘制参与者在rTMS干预前（基线）和三个rTMS干预组（假手术、1Hz和10Hz）后（每组4次，每次1800次脉冲，通过后颞上回传递@110%的运动阈值）对注意冲突的神经加工。1Hz rTMS干预后，所有耳鸣严重程度指标（意识、响度和烦恼）均有所改善；然而，在耳鸣意识评分方面观察到最大和最显著的变化（严重程度比基线平均降低16%，p<0.01）。与43名健康成人的独立样本相比，MSIT在基线时引起耳鸣参与者的神经激活模式相似（r=0.801, p≤0.001）。自举重新采样的线性回归表明，MSIT在基线时双侧前额叶和双侧顶叶区域的增加与较差的治疗反应相对应。单个区域的活动解释了参与者治疗反应中37-67%的差异，左侧背外侧前额叶皮层的MSIT活动在基线解释了1hz刺激后耳鸣意识的最大减少。尽管基线时左背外侧前额叶皮层的活动也能预测耳鸣响度和烦恼的减少（约50%的方差解释），但这些症状更能被右侧枕叶中皮层预测（约70%的方差解释），这表明症状特异性治疗结果的神经预测因子可能是可分离的。这些治疗反应的候选神经反应性标志物在识别耳鸣患者是否会从rTMS干预中获益方面具有潜在的临床价值。
Subjective idiopathic tinnitus is an intrusive, distracting, and potentially disabling disorder characterized by phantom perception of sounds. Although tinnitus has no approved pharmacologic treatment, recent evidence supports the use of repetitive transcranial magnetic stimulation (rTMS) to alleviate tinnitus symptoms. Repetitive TMS delivered over the middle superior temporal gyrus (STG) may alter ratings of tinnitus awareness and annoyance more than loudness due to change in attentional processing. STG has reciprocal connections to regions of the prefrontal cortex that mediate attention. To probe the hypothesized influence of STG stimulation on attention, a subset of patients with tinnitus enrolled in an rTMS clinical trial [n=12, 9 male, mean (sd) age = 49 years] underwent an attentional conflict task before and after rTMS treatment in a repeated-measures functional magnetic resonance imaging (fMRI) study. The Multi-Source Interference Task (MSIT), a Stroop-based visual attentional conflict fMRI task, was used to map participants’ neural processing of attentional conflict prior to rTMS intervention (Baseline) and after three rTMS intervention arms: Sham, 1Hz, and 10Hz (four sessions per arm, 1800 pulses per session, delivered @110% of the motor threshold over the posterior superior temporal gyrus). All measures of tinnitus severity (awareness, loudness, and annoyance) improved with 1Hz rTMS intervention; however, the greatest and most robust changes were observed for ratings of tinnitus awareness (mean 16% reduction in severity from Baseline, p<0.01). The MSIT elicited a similar pattern of neural activation among tinnitus participants at Baseline compared to an independent sample of 43 healthy comparison adults (r=0.801, p≤0.001). Linear regression with bootstrap resampling showed that greater recruitment of bilateral prefrontal and bilateral parietal regions by MSIT at Baseline corresponded with poorer treatment response. Individual regions’ activities explained 37–67% variance in participant treatment response, with left dorsolateral prefrontal cortex’s MSIT activity at Baseline explaining the greatest reduction in tinnitus awareness following 1 Hz stimulation. Although left dorsolateral prefrontal cortex activity at Baseline also predicted reduction in tinnitus loudness and annoyance (~50% variance explained), these symptoms were more strongly predicted by right middle occipital cortex (~70% variance explained) – suggesting that the neural predictors of symptom-specific treatment outcomes may be dissociable. These candidate neural reactivity markers of treatment response have potential clinical value in identifying tinnitus sufferers who would or would not therapeutically benefit from rTMS intervention.
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