Towards understanding rTMS mechanism of action: Stimulation of the DLPFC causes network-specific increase in functional connectivity
Towards understanding rTMS mechanism of action: Stimulation of the DLPFC causes network-specific increase in functional connectivity
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DOI：
10.1016/j.neuroimage.2017.09.022
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发表时间：
2017-11-15
期刊：
影响因子：
5.7
通讯作者：
Windischberger, Christian
中科院分区：
文献类型：
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作者：
Tik, Martin;Hoffmann, Andre;Windischberger, Christian
经颅磁刺激（TMS）是一种功能强大的非侵入性脑活动调制技术。虽然确切的作用机制仍不清楚，但TMS应用于认知神经科学，以建立刺激与脑功能和行为结果的后续变化之间的因果关系。此外，TMS是FDA批准的精神疾病，特别是重度抑郁症的治疗剂。成功的重复TMS在这类疾病中通常应用于左背外侧前额叶皮层（DLPFC），因此治疗反应机制应该是基于功能网络的调制，特别是中皮层边缘奖励回路。然而，rTMS对DLPFC直接影响的机制证据很少。在这里，我们通过比较假对照研究中20个常见独立组件内的连接变化，显示了rTMS效应的特异性和时间演变。使用无偏的全脑静息状态网络（RSN）的方法，我们成功地证明，刺激左DLPFC调制前扣带皮层（ACC）连接在一个特定的中皮层边缘网络，而所有其他网络既不受rTMS也不假治疗。本研究的结果表明，TMS治疗反应的神经相关性也可追溯到健康大脑的DLPFC刺激，因此代表了刺激程序的直接影响。
Transcranial magnetic stimulation (TMS) is a powerful non-invasive technique for the modulation of brain activity. While the precise mechanism of action is still unknown, TMS is applied in cognitive neuroscience to establish causal relationships between stimulation and subsequent changes in cerebral function and behavioral outcome. In addition, TMS is an FDA-approved therapeutic agent in psychiatric disorders, especially major depression. Successful repetitive TMS in such disorders is usually applied over the left dorso-lateral prefrontal cortex (DLPFC) and treatment response mechanism was therefore supposed to be based on modulations in functional networks, particularly the meso-cortico-limbic reward circuit. However, mechanistic evidence for the direct effects of rTMS over DLPFC is sparse. Here we show the specificity and temporal evolution of rTMS effects by comparing connectivity changes within 20 common independent components in a sham-controlled study. Using an unbiased whole-brain resting-state network (RSN) approach, we successfully demonstrate that stimulation of left DLPFC modulates anterior cingulate cortex (ACC) connectivity in one specific meso-cortico-limbic network, while all other networks are neither influenced by rTMS nor by sham treatment. The results of this study show that the neural correlates of TMS treatment response are also traceable in DLPFC stimulation of healthy brains and therefore represent direct effects of the stimulation procedure.