运动皮质抑制作为纤维肌痛的生物标志物:经颅磁刺激研究的荟萃分析。

Brain network and modulation Pub Date : 2022-04-01 Epub Date: 2022-06-29 DOI:10.4103/2773-2398.348254
Kevin Pacheco-Barrios, Daniel Lima, Danielle Pimenta, Eric Slawka, Alba Navarro-Flores, Joao Parente, Ingrid Rebello-Sanchez, Alejandra Cardenas-Rojas, Paola Gonzalez-Mego, Luis Castelo-Branco, Felipe Fregni
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引用次数: 8

摘要

纤维肌痛(FM)是一种常见的难治性慢性疼痛,具有多种临床表型。目前的诊断是基于综合征的识别,这可能是主观的,并导致诊断不足或过度。因此,纤维肌痛的诊断、表型和预后(治疗反应和随访)需要客观的生物标志物。潜在的生物标志物是经颅磁刺激(TMS)索引的皮质兴奋性的测量。然而,目前还没有对现有证据进行系统分析,以评估经颅磁刺激指标作为纤维肌痛生物标志物的作用。因此,本研究旨在评估纤维肌痛受试者皮质脊髓和皮质内运动兴奋性的证据,并评估经颅磁刺激指标作为FM反应生物标志物的预后作用。我们对PubMed/Medline、Embase和Cochrane Central数据库进行了系统的检索,以获取观察性研究和随机对照试验,这些研究使用经颅电刺激作为评估纤维肌痛的对象。三位审稿人独立选择和提取数据。然后,进行随机效应模型荟萃分析,比较观察性研究中的纤维肌痛和健康对照。同时,在随机对照试验中,比较积极治疗和虚假治疗。探讨经颅磁刺激指标变化与临床改善之间的相关性。采用标准化方法评估质量和证据确定性。我们纳入了15项研究(696名参与者,474名FM受试者)。主要发现有:(1)与对照组相比,纤维肌痛症患者表现出较少的皮质内抑制(平均差值(MD) = -0.40, 95%可信区间(CI) -0.69 ~ -0.11)和较高的静息运动阈值(MD = 6.90 μV, 95% CI 4.16 ~ 9.63 μV);(2)与安慰剂或假刺激相比,运动、普瑞巴林和非侵入性脑刺激等干预措施增加了皮质内抑制(MD = 0.19, 95% CI 0.10至0.29)和皮质沉默期(MD = 14.92 ms, 95% CI 4.86至24.98 ms);(3)皮质内兴奋性的变化与临床改善相关,较高的抑制程度与疼痛、抑郁和疼痛灾难化的减少中度相关;较低的促进与较少的疲劳适度相关。经颅磁刺激诱发的皮质内抑制和促进指标是纤维肌痛患者潜在的诊断和治疗反应的生物标志物。纤维肌痛皮层内抑制系统的破坏也为纤维肌痛具有神经性疼痛的一些神经生理特征提供了额外的证据。诱导感觉运动系统参与的治疗(例如,锻炼,运动意象和非侵入性脑刺激)可以恢复FM的皮质抑制性张力并诱导临床改善。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Motor cortex inhibition as a fibromyalgia biomarker: a meta-analysis of transcranial magnetic stimulation studies.

Motor cortex inhibition as a fibromyalgia biomarker: a meta-analysis of transcranial magnetic stimulation studies.

Motor cortex inhibition as a fibromyalgia biomarker: a meta-analysis of transcranial magnetic stimulation studies.

Motor cortex inhibition as a fibromyalgia biomarker: a meta-analysis of transcranial magnetic stimulation studies.

Fibromyalgia (FM) is a common and refractory chronic pain condition with multiple clinical phenotypes. The current diagnosis is based on a syndrome identification which can be subjective and lead to under or over-diagnosis. Therefore, there is a need for objective biomarkers for diagnosis, phenotyping, and prognosis (treatment response and follow-up) in fibromyalgia. Potential biomarkers are measures of cortical excitability indexed by transcranial magnetic stimulation (TMS). However, no systematic analysis of current evidence has been performed to assess the role of TMS metrics as a fibromyalgia biomarker. Therefore, this study aims to evaluate evidence on corticospinal and intracortical motor excitability in fibromyalgia subjects and to assess the prognostic role of TMS metrics as response biomarkers in FM. We conducted systematic searches on PubMed/Medline, Embase, and Cochrane Central databases for observational studies and randomized controlled trials on fibromyalgia subjects that used TMS as an assessment. Three reviewers independently selected and extracted the data. Then, a random-effects model meta-analysis was performed to compare fibromyalgia and healthy controls in observational studies. Also, to compare active versus sham treatments, in randomized controlled trials. Correlations between changes in TMS metrics and clinical improvement were explored. The quality and evidence certainty were assessed following standardized approaches. We included 15 studies (696 participants, 474 FM subjects). The main findings were: (1) fibromyalgia subjects present less intracortical inhibition (mean difference (MD) = -0.40, 95% confidence interval (CI) -0.69 to -0.11) and higher resting motor thresholds (MD = 6.90 μV, 95% CI 4.16 to 9.63 μV) when compared to controls; (2) interventions such as exercise, pregabalin, and non-invasive brain stimulation increased intracortical inhibition (MD = 0.19, 95% CI 0.10 to 0.29) and cortical silent period (MD = 14.92 ms, 95% CI 4.86 to 24.98 ms), when compared to placebo or sham stimulation; (3) changes on intracortical excitability are correlated with clinical improvements - higher inhibition moderately correlates with less pain, depression, and pain catastrophizing; lower facilitation moderately correlates with less fatigue. Measures of intracortical inhibition and facilitation indexed by TMS are potential diagnostic and treatment response biomarkers for fibromyalgia subjects. The disruption in the intracortical inhibitory system in fibromyalgia also provides additional evidence that fibromyalgia has some neurophysiological characteristics of neuropathic pain. Treatments inducing an engagement of sensorimotor systems (e.g., exercise, motor imagery, and non-invasive brain stimulation) could restore the cortical inhibitory tonus in FM and induce clinical improvement.

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