Effect of rTMS at SMA on task-based connectivity in PD,Behavioural Brain Research

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Effect of rTMS at SMA on task-based connectivity in PD
Behavioural Brain Research ( IF 2.6 ) Pub Date : 2023-07-27 , DOI: 10.1016/j.bbr.2023.114602
Priyanka Bhat ₁ , S Senthil Kumaran ₂ , Vinay Goyal ₁ , Achal K Srivastava ₁ , Madhuri Behari ₁

Affiliation

Background

Transcranial magnetic stimulation (TMS) can aid in alleviating clinical symptoms in Parkinson’s disease (PD). To better understand the neural mechanism of the intervention, neuroimaging modalities have been used to assess the effects of rTMS.

Objective

To study the changes in cortical connectivity and motor performance with rTMS at supplementary motor area (SMA) in PD using clinical assessment tools and task-based functional MRI.

Methodology

3000 pulses at 5 Hz TMS were delivered at the left SMA once a week for a total of 8 consecutive weeks in 4 sham sessions (week 1–4) and 4 real sessions (week 5 to week 8) in 16 subjects with PD. The outcomes were assessed with UPDRS, PDQ 39 and task-based fMRI at baseline, after sham sessions at week 4, and after real sessions at week 8. Visuo-spatial functional MRI task along with T1 weighted scans (at 3 Tesla) were used to evaluate the effects of rTMS intervention. Multivariate pattern analysis (MVPA) was used to analyse task-based fMRI using Conn toolbox.

Results

Improvements (p < 0.05) were observed in UPDRS II, III, Mobility and ADL of PDQ39 after real sessions of rTMS. MVPA of task-based connectivity revealed clusters of activation in right hemispheric precentral area, superior frontal gyrus, middle frontal gyrus, thalamus and cerebellum (cluster threshold p_FDR=0.001).

Conclusions

Weekly rTMS sessions at SMA incurred clinical motor benefits as revealed by an improvement in clinical scales and dexterity performance. These benefits could be attributed to changes in connectivity remote brain regions in the motor network.

中文翻译：

SMA 处的 rTMS 对 PD 中基于任务的连接的影响

背景

经颅磁刺激 (TMS) 可以帮助缓解帕金森病 (PD) 的临床症状。为了更好地了解干预的神经机制，神经影像学方法已被用来评估 rTMS 的效果。

客观的

使用临床评估工具和基于任务的功能 MRI，研究 PD 辅助运动区 (SMA) 的 rTMS 皮质连接和运动性能的变化。

方法

在 16 名 PD 受试者中，每周一次在左侧 SMA 处提供 3000 个 5 Hz TMS 脉冲，共连续 8 周，进行 4 次假治疗（第 1-4 周）和 4 次真实治疗（第 5 周至第 8 周）。在基线、第 4 周假手术后和第 8 周真实手术后，使用 UPDRS、PDQ 39 和基于任务的 fMRI 评估结果。使用视觉空间功能 MRI 任务以及 T1 加权扫描（3 特斯拉）评估 rTMS 干预的效果。使用 Conn 工具箱，使用多变量模式分析 (MVPA) 来分析基于任务的 fMRI。