背外侧前额叶皮层重复经颅磁刺激治疗偏头痛的神经环路特征
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作者单位:

1.杭州师范大学附属医院认知与脑疾病研究中心;2.杭州师范大学附属医院妇产科;3.浙江中医药大学附属金华中医院康复医学科;4.杭州师范大学附属医院放射科;5.杭州市第三人民医院神经内科

作者简介:

YAN Yong-Xing. Tel: 86-571-87823154, E-mail: yyxing20@126.com严永兴 Tel:0571-87823154,E-mail:yyxing20@126.com车先伟 Tel:0571-28867717,E-mail:xwcheswu@gmail.com

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中图分类号:

R747.2;R741.044;R318.04

基金项目:

浙江省自然科学基金(LY23C090002),浙江省精准精神病学重点实验室开放基金(2025A2)和浙江省医药卫生科技计划(2025HY0697)资助项目。


The Neural Circuit Characteristics of Repetitive Transcranial Magnetic Stimulation Over The Dorsolateral Prefrontal Cortex for The Treatment of Migraine
Author:
Affiliation:

1.Centre for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University;2.Department of Obstetrics, The Affiliated Hospital of Hangzhou Normal University;3.Department of Rehabilitation Medicine, Jinhua Hospital of TCM Affiliated to Zhejiang University of Traditional Chinese Medicine;4.Department of Radiology, The Affiliated Hospital of Hangzhou Normal University;5.Department of Neurology, Hangzhou Third People’s Hospital

Fund Project:

This work was supported by grants from the Zhejiang Provincial Natural Science Foundation of China (LY23C090002), the Open Research Fund of the Zhejiang Key Laboratory of Precision Psychiatry (2025A2), and the Medical and Health Science Program of Zhejiang Province (2025HY0697).

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    摘要:

    目的 偏头痛是全球范围内导致健康寿命损失的主要疾病之一。通过作用于背外侧前额叶皮层,重复经颅磁刺激技术为偏头痛患者提供了一种安全且前景广阔的治疗方案。然而,重复经颅磁刺激改善偏头痛症状的具体作用机制尚不明确,阐明该机制对提升其临床疗效具有重要指导意义。方法 本研究采用经颅磁刺激-脑电图同步记录技术,旨在揭示重复经颅磁刺激治疗偏头痛的神经可塑性及神经环路机制。研究一对比偏头痛患者(30例)与健康受试者(28例),探查其神经可塑性与神经环路活动的异常特征;研究二则在34例健康受试者中观察重复经颅磁刺激对这些异常特征及疼痛体验的调节作用。结果 偏头痛患者存在以N120波幅为指标的局部神经可塑性异常,且在初级躯体感觉皮层、后脑岛、前脑岛及中扣带皮层等疼痛处理脑区表现出异常升高的显著电流密度。单次背外侧前额叶重复经颅磁刺激干预可降低初级躯体感觉皮层、前脑岛及中扣带回的显著电流密度,且初级躯体感觉皮层和中扣带回的神经活动与疼痛感知程度呈相关性。结论 本研究从神经可塑性与神经环路两个维度为重复经颅磁刺激治疗偏头痛的机制提供了实证依据,这有助于深入理解其治疗原理,并为开发更有效的偏头痛治疗方案提供指导。

    Abstract:

    Objective Migraine is a leading neurological disorder and the fourth most common cause of years lived with disability worldwide, affecting nearly 116 million individuals. Although pharmacological treatments are available, their efficacy is often limited by side effects and variable response rates. Repetitive transcranial magnetic stimulation (rTMS) over the dorsolateral prefrontal cortex (DLPFC) offers a safe, non-invasive alternative for migraine management. However, the neurophysiological mechanisms, particularly how rTMS modulates local cortical excitability and distributed pain-related circuits, remain poorly understood. Elucidating these mechanisms is essential for optimizing treatment protocols and improving clinical outcomes.Methods This study employed concurrent TMS and EEG (TMS-EEG) to investigate neuroplastic and neurocircuitry mechanisms of DLPFC-rTMS in migraine. Study 1 compared 30 migraineurs and 28 healthy controls to identify abnormalities in TMS-evoked potentials (TEPs) and significant current density (SCD) within sensory-discriminative regions including the primary somatosensory cortex (S1) and posterior insula (pINS), cognitive-affective regions including the anterior insula (aINS) and midcingulate cortex (MCC), and a descending modulatory region, the periaqueductal gray (PAG). Study 2 used a single-blind, crossover, sham-controlled design in 34 healthy participants. Each participant received both active (10 Hz, 80% RMT, 1 500 pulses) and sham DLPFC-rTMS in counterbalanced order. TMS-EEG and cold pain tolerance were assessed before and after each session.Results In Study 1, migraineurs showed a significantly less negative N120 amplitude compared to healthy controls (P = 0.027, Cohen's d= 0.60), indicating local intracortical disinhibition. No group differences were observed for N40, P60, or P180 components. At the source level, migraineurs exhibited significantly higher SCD in the S1, pINS, aINS, and MCC (all Q<0.05), but not in the ventroposterior thalamus (vpTHAL), mediodorsal thalamus (mdTHAL), or PAG. In Study 2, active rTMS significantly reduced SCD from pre- to post-stimulation in the S1, aINS, and MCC (all Q<0.05). Sham stimulation also reduced SCD in the S1 (Q<0.05) but not in the aINS or MCC. Although no significant group-level analgesic effect was observed between active and sham conditions (P=0.107), correlation analyses revealed that greater SCD reductions in the S1 and MCC were significantly associated with higher post-rTMS pain tolerance (R=–0.487 and –0.495, both Q<0.01) and larger improvements in pain tolerance (R=–0.487 and –0.451, both Q<0.05). No such correlations were found following sham stimulation, suggesting that the behavioural relevance of neural changes is specific to active rTMS.Conclusion This study provides novel evidence that migraineurs exhibit both local neuroplastic abnormalities (reduced N120 amplitude) and hyperactivity in key pain-processing regions (S1, pINS, aINS, MCC). A single session of DLPFC-rTMS reduced hyperactivity in the aINS, MCC, and S1. Notably, greater reductions in the S1 and MCC were associated with improved pain tolerance. These findings identify distinct cortical circuitries, particularly within the cognitive-affective pain network, that may serve as potential biomarkers for optimizing rTMS treatment in migraine and other chronic pain conditions. Future studies should validate these results in patient populations experiencing spontaneous migraine attacks and explore multi-session or accelerated rTMS protocols.

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金晨霞,谭柏林,叶扬,何吉庆,王凌燕,高忠明,王宇俊,刘慧丽,严永兴,车先伟.背外侧前额叶皮层重复经颅磁刺激治疗偏头痛的神经环路特征[J].生物化学与生物物理进展,,():

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  • 收稿日期:2026-01-16
  • 最后修改日期:2026-06-01
  • 录用日期:2026-06-02
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