fMRI findings in MTBI patients with headaches following rTMS

Abstract 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 ma...

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Autores principales:	Michael Vaninetti, Mike Lim, Aladdin Khalaf, Valerie Metzger-Smith, Matthew Flowers, Alphonsa Kunnel, Eric Yang, David Song, Lisa Lin, Alice Tsai, Roland Lee, Shahrokh Golshan, Albert Leung
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/8939ce41de8f49908a7bb0e0109a7e90
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spelling	oai:doaj.org-article:8939ce41de8f49908a7bb0e0109a7e902021-12-02T15:37:58ZfMRI findings in MTBI patients with headaches following rTMS10.1038/s41598-021-89118-22045-2322https://doaj.org/article/8939ce41de8f49908a7bb0e0109a7e902021-05-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-89118-2https://doaj.org/toc/2045-2322Abstract 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 .Michael VaninettiMike LimAladdin KhalafValerie Metzger-SmithMatthew FlowersAlphonsa KunnelEric YangDavid SongLisa LinAlice TsaiRoland LeeShahrokh GolshanAlbert LeungNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Michael Vaninetti Mike Lim Aladdin Khalaf Valerie Metzger-Smith Matthew Flowers Alphonsa Kunnel Eric Yang David Song Lisa Lin Alice Tsai Roland Lee Shahrokh Golshan Albert Leung fMRI findings in MTBI patients with headaches following rTMS
description	Abstract 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 .
format	article
author	Michael Vaninetti Mike Lim Aladdin Khalaf Valerie Metzger-Smith Matthew Flowers Alphonsa Kunnel Eric Yang David Song Lisa Lin Alice Tsai Roland Lee Shahrokh Golshan Albert Leung
author_facet	Michael Vaninetti Mike Lim Aladdin Khalaf Valerie Metzger-Smith Matthew Flowers Alphonsa Kunnel Eric Yang David Song Lisa Lin Alice Tsai Roland Lee Shahrokh Golshan Albert Leung
author_sort	Michael Vaninetti
title	fMRI findings in MTBI patients with headaches following rTMS
title_short	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_sort	fmri findings in mtbi patients with headaches following rtms
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/8939ce41de8f49908a7bb0e0109a7e90
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fMRI findings in MTBI patients with headaches following rTMS

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