Brain Stimul:前扣带回皮质的功能连通性可预测rTMS在难治性抑郁症中的治疗结果

2020-08-21 MedSci原创 MedSci原创

重复经颅磁刺激(rTMS)是治疗耐药性抑郁症(TRD)的一线疗法。rTMS的作用机制尚不完全清楚,也没有生物标志物可以帮助临床实践预测rTMS的反应。本研究旨在证明rTMS后临床改善与膝下扣带皮层(s

重复经颅磁刺激(rTMS)是治疗耐药性抑郁症(TRD)的一线疗法。rTMS的作用机制尚不完全清楚,也没有生物标志物可以帮助临床实践预测rTMS的反应。本研究旨在证明rTMS后临床改善与膝下扣带皮层(sgACC)和喙前扣带(rACC)的功能连接(FC)变化有关,sgACC和rACC的FC可能作为治疗反应的潜在预测因子。

在开始rTMS前1周内收集50名TRD患者的静息状态功能磁共振成像(rs-fMRI)数据,以预测左背外侧前额叶皮层(DLPFC)对rTMS的后续反应。在完成rTMS后12周获得后续rs-fMRI,并将sgACC-和rACC相关FC模式的rTMS神经相关性与rTMS前的数据和健康参与者的rs-fMRI进行比较。

 

结果显示,治疗反应与基线测量的sgACC到右DLPFC的FC较低和rACC到左外侧顶叶皮层(IPL)的FC较高相关。使用sgACC-DLPFC和rACC-IPL连接性作为特征,应答者-非应答者分类准确率分别达到84%和76%(治疗结束)、88%和81%(3个月随访)。纵向rs-fMRI数据分析显示,sgACC和视觉皮层之间的超连接性已正常化到与健康参与者相当的水平。

综上所述,该研究结果表明,抑郁症的脑活动模式对rTMS的治疗反应具有预测性,rTMS后相关脑回路的脑活动纵向变化与抑郁症的治疗反应相关。靶向管理模式可能为提高rTMS对某些TRD患者的疗效提供可能。

 

原始出处:

 

Ruiyang GeJonathan Downar, et al., Functional connectivity of the anterior cingulate cortex predicts treatment outcome for rTMS in treatment-resistant depression at 3-month follow-up. Brain Stimul. Jan-Feb 2020;13(1):206-214. doi: 10.1016/j.brs.2019.10.012. 

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    2020-09-19 360611850
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    2020-08-23 freve
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