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fMRI findings in MTBI patients with headaches following rTMS

Mild Traumatic Brain Injury (MTBI) patients with persistent headaches are known to have diminished supraspinal modulatory connectivity from their prefrontal cortices. Repetitive transcranial magnetic stimulation (rTMS) is able to alleviate MTBI-related headache (MTBI-HA). This functional magnetic re...

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Autores principales: Vaninetti, Michael, Lim, Mike, Khalaf, Aladdin, Metzger-Smith, Valerie, Flowers, Matthew, Kunnel, Alphonsa, Yang, Eric, Song, David, Lin, Lisa, Tsai, Alice, Lee, Roland, Golshan, Shahrokh, Leung, Albert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8100290/
https://www.ncbi.nlm.nih.gov/pubmed/33953315
http://dx.doi.org/10.1038/s41598-021-89118-2
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author Vaninetti, Michael
Lim, Mike
Khalaf, Aladdin
Metzger-Smith, Valerie
Flowers, Matthew
Kunnel, Alphonsa
Yang, Eric
Song, David
Lin, Lisa
Tsai, Alice
Lee, Roland
Golshan, Shahrokh
Leung, Albert
author_facet Vaninetti, Michael
Lim, Mike
Khalaf, Aladdin
Metzger-Smith, Valerie
Flowers, Matthew
Kunnel, Alphonsa
Yang, Eric
Song, David
Lin, Lisa
Tsai, Alice
Lee, Roland
Golshan, Shahrokh
Leung, Albert
author_sort Vaninetti, Michael
collection PubMed
description Mild Traumatic Brain Injury (MTBI) patients with persistent headaches are known to have diminished supraspinal modulatory connectivity from their prefrontal cortices. Repetitive transcranial magnetic stimulation (rTMS) is able to alleviate MTBI-related headache (MTBI-HA). This functional magnetic resonance imaging (fMRI) study assessed supraspinal correlates associated with the headache analgesic effect of rTMS at left prefrontal cortex (LPFC), hypothesizing real rTMS would significantly increase modulatory functions at LPFC in comparison to sham treatment. Subjects with MTBI-HA were randomized to receive either real or sham rTMS treatments and subjected to pre- and post-treatment resting state and evoked heat-pain fMRI as described in a prior study. Real rTMS consisted of 2000 pulses delivered at 10 Hz and 80% of the resting motor threshold at left dorsolateral prefrontal cortex, whereas sham treatment was delivered with same figure-of-eight coil turned 180 degrees. Follow-up fMRI was performed one-week post-treatment. All fMRI data was processed using BrainVoyager QX Software. 14 subjects receiving real and 12 subjects receiving sham treatments completed the study. The REAL group demonstrated significant (P < 0.02) decreases in headache frequency and intensity at one week following treatment. fMRI scans in the REAL group showed increased evoked heat pain activity (P < 0.002) and resting functional connectivity (P < 0.0001) at the LPFC after rTMS. Neither this significant analgesic effect nor these fMRI findings were seen in the sham group. Sham treatment was, however, associated with a decrease in resting state activity at the LPFC (P < 0.0001). This study correlates the demonstrated analgesic effect of rTMS in the treatment of MTBI-HA with enhanced supraspinal functional connectivity in the left prefrontal cortex, which is known to be involved in “top-down” pain inhibition along the descending midbrain-thalamic-cingulate pathway. Trial Registration: This study was registered on September 24, 2013, on ClinicalTrials.gov with the identifier: NCT01948947. https://clinicaltrials.gov/ct2/show/NCT01948947.
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spelling pubmed-81002902021-05-07 fMRI findings in MTBI patients with headaches following rTMS Vaninetti, Michael Lim, Mike Khalaf, Aladdin Metzger-Smith, Valerie Flowers, Matthew Kunnel, Alphonsa Yang, Eric Song, David Lin, Lisa Tsai, Alice Lee, Roland Golshan, Shahrokh Leung, Albert Sci Rep Article Mild Traumatic Brain Injury (MTBI) patients with persistent headaches are known to have diminished supraspinal modulatory connectivity from their prefrontal cortices. Repetitive transcranial magnetic stimulation (rTMS) is able to alleviate MTBI-related headache (MTBI-HA). This functional magnetic resonance imaging (fMRI) study assessed supraspinal correlates associated with the headache analgesic effect of rTMS at left prefrontal cortex (LPFC), hypothesizing real rTMS would significantly increase modulatory functions at LPFC in comparison to sham treatment. Subjects with MTBI-HA were randomized to receive either real or sham rTMS treatments and subjected to pre- and post-treatment resting state and evoked heat-pain fMRI as described in a prior study. Real rTMS consisted of 2000 pulses delivered at 10 Hz and 80% of the resting motor threshold at left dorsolateral prefrontal cortex, whereas sham treatment was delivered with same figure-of-eight coil turned 180 degrees. Follow-up fMRI was performed one-week post-treatment. All fMRI data was processed using BrainVoyager QX Software. 14 subjects receiving real and 12 subjects receiving sham treatments completed the study. The REAL group demonstrated significant (P < 0.02) decreases in headache frequency and intensity at one week following treatment. fMRI scans in the REAL group showed increased evoked heat pain activity (P < 0.002) and resting functional connectivity (P < 0.0001) at the LPFC after rTMS. Neither this significant analgesic effect nor these fMRI findings were seen in the sham group. Sham treatment was, however, associated with a decrease in resting state activity at the LPFC (P < 0.0001). This study correlates the demonstrated analgesic effect of rTMS in the treatment of MTBI-HA with enhanced supraspinal functional connectivity in the left prefrontal cortex, which is known to be involved in “top-down” pain inhibition along the descending midbrain-thalamic-cingulate pathway. Trial Registration: This study was registered on September 24, 2013, on ClinicalTrials.gov with the identifier: NCT01948947. https://clinicaltrials.gov/ct2/show/NCT01948947. Nature Publishing Group UK 2021-05-05 /pmc/articles/PMC8100290/ /pubmed/33953315 http://dx.doi.org/10.1038/s41598-021-89118-2 Text en © This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2021 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Vaninetti, Michael
Lim, Mike
Khalaf, Aladdin
Metzger-Smith, Valerie
Flowers, Matthew
Kunnel, Alphonsa
Yang, Eric
Song, David
Lin, Lisa
Tsai, Alice
Lee, Roland
Golshan, Shahrokh
Leung, Albert
fMRI findings in MTBI patients with headaches following rTMS
title fMRI findings in MTBI patients with headaches following rTMS
title_full fMRI findings in MTBI patients with headaches following rTMS
title_fullStr fMRI findings in MTBI patients with headaches following rTMS
title_full_unstemmed fMRI findings in MTBI patients with headaches following rTMS
title_short fMRI findings in MTBI patients with headaches following rTMS
title_sort fmri findings in mtbi patients with headaches following rtms
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8100290/
https://www.ncbi.nlm.nih.gov/pubmed/33953315
http://dx.doi.org/10.1038/s41598-021-89118-2
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