Mapping mania symptoms based on focal brain damage
Mapping mania symptoms based on focal brain damage
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DOI：
10.1172/jci136096
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发表时间：
2020-10-01
影响因子：
15.9
通讯作者：
Fox, Michael D.
中科院分区：
文献类型：
--
作者：
Cotovio, Goncalo;Talmasov, Daniel;Fox, Michael D.
背景。虽然躁狂症是双相情感障碍的特征，但它也可能发生在局灶性脑损伤后。此类病例可以提供对导致躁狂症状的大脑区域的独特见解并确定治疗目标。方法。通过系统文献检索（n = 41）确定与躁狂症相关的病变位置，并将其映射到共同的大脑图谱上。使用规范的人类连接组数据（静息态功能 MRI，n = 1000）计算与每个病变位置功能连接的大脑区域网络，并与从与躁狂症无关的病变位置获得的数据（n = 79）进行对比。使用来自临床图表审查（n = 15）和对照病变（n = 490）的独立躁狂症病变队列评估可重复性。将结果与先前报道的诱发或缓解躁狂症状的脑刺激部位进行比较。结果。与躁狂症相关的病变位置是异质的，在所有甚至大多数病例中没有一个大脑区域受到损害。然而，这些病变位置显示出与右眶额皮质、右颞下回和右额极的独特功能连接模式。这种连接特征在独立的病变队列中是可重复的，并且与治疗性脑刺激对躁狂症状的效果一致。结论。与躁狂相关的脑部病变的特征是特定的大脑连接模式，可以深入了解躁狂症状的定位和潜在的治疗目标。
BACKGROUND. Although mania is characteristic of bipolar disorder, it can also occur following focal brain damage. Such cases may provide unique insight into brain regions responsible for mania symptoms and identify therapeutic targets.METHODS. Lesion locations associated with mania were identified using a systematic literature search (n = 41) and mapped onto a common brain atlas. The network of brain regions functionally connected to each lesion location was computed using normative human connectome data (resting-state functional MRI, n = 1000) and contrasted with those obtained from lesion locations not associated with mania (n = 79). Reproducibility was assessed using independent cohorts of mania lesions derived from clinical chart review (n=15) and of control lesions (n = 490). Results were compared with brain stimulation sites previously reported to induce or relieve mania symptoms.RESULTS. Lesion locations associated with mania were heterogeneous and no single brain region was lesioned in all, or even most, cases. However, these lesion locations showed a unique pattern of functional connectivity to the right orbitofrontal cortex, right inferior temporal gyrus, and right frontal pole. This connectivity profile was reproducible across independent lesion cohorts and aligned with the effects of therapeutic brain stimulation on mania symptoms.CONCLUSION. Brain lesions associated with mania are characterized by a specific pattern of brain connectivity that lends insight into localization of mania symptoms and potential therapeutic targets.