非侵入性脑刺激治疗卒中后功能障碍的潜在靶点：基于多模态神经影像的探索

文献信息

中文摘要

目的： 非侵入性脑刺激（NIBS）在卒中后功能障碍（PSDs）中显示出前景，但其疗效可能因刺激部位不一致而受限。
方法： 通过整合神经影像荟萃分析、病变-症状映射（LSM）和静息态功能连接（FC）分析，我们采用三条分析流程来探索失读症、失语症、失用症、共济失调、构音障碍、偏瘫、感觉异常和吞咽困难的潜在NIBS靶点。流程1通过使用Neurosynth Compose的基于坐标的荟萃分析，识别与每种PSD直接相关的皮层区域。流程2识别与neurosynth衍生的感兴趣区（ROI）表现出最大功能连接的皮层区域。流程3识别与既往大规模LSM研究中的ROI存在功能连接的皮层区域。在流程2和3中，使用来自100名健康受试者的静息态fMRI数据进行种子到体素FC分析，以ROI作为种子。将识别出的皮层靶点映射到头皮，并参照10-20系统和连续比例坐标进行定位。
结果： 为全部八种PSD识别出了潜在的皮层靶点和头皮位置。例如，对于偏瘫，已验证的靶点包括初级运动皮层、初级躯体感觉皮层和辅助运动区；新发现的靶点包括角回、额上回、顶下小叶、内侧前额叶皮层和楔前叶。
结论： 这种多模态方法系统地识别了精确的NIBS靶点，证实了已确立的部位，并揭示了新的区域，从而拓宽了卒中后恢复的神经调控策略。

英文摘要

AIMS: Noninvasive brain stimulation (NIBS) shows promise for poststroke deficits (PSDs), but efficacy may be limited by inconsistent stimulation sites.
METHODS: By integrating neuroimaging meta-analysis, lesion-symptom mapping (LSM), and resting-state functional connectivity (FC) analysis, we employed three analytical pipelines to explore potential NIBS targets for alexia, aphasia, apraxia, ataxia, dysarthria, hemiplegia, paresthesia, and dysphagia. Pipeline 1 identified cortical regions directly associated with each PSD via coordinate-based meta-analysis using Neurosynth Compose. Pipeline 2 identified cortical regions exhibiting maximal functional connectivity with neurosynth-derived regions of interest (ROI). Pipeline 3 identified cortical regions functionally connected to ROIs from a prior large-scale LSM study. During Pipeline 2 and 3, ROIs were used for seed-to-voxel FC analysis using resting-state fMRI data from 100 healthy subjects. Identified cortical targets were mapped onto the scalp and referenced by the 10-20 system and continuous proportional coordinates.
RESULTS: Potential cortical targets and scalp locations were identified for all eight PSDs. For instance, for hemiplegia, validated targets included primary motor and somatosensory cortices and supplementary motor area; novel targets included angular gyrus, superior frontal gyrus, inferior parietal lobule, medial prefrontal cortex, and precuneus.
CONCLUSIONS: This multimodal approach systematically identified precise NIBS targets, confirming established sites and revealing novel regions to broaden neuromodulation strategies for poststroke recovery.