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U pacientov s nevralgiej trojnichnogo nerva (NTN), ne otvechayushchih na farmakoterapiyu, v kachestve al'ternativy mozhno primenyat' ritmicheskuyu transkranial'nuyu magnitnuyu stimulyaciyu (rTMS). Odnako effekt rTMS variabelen. Cel'yu issledovaniya byl poisk nejrovizualizacionnyh biomarkerov klinicheskoj effektivnosti navigacionnoj rTMS. Semnadcati pacientam s NTN (14 zhenshchin; mediana vozrasta — 56 let) provedeno 10 sessij vysokochastotnoj rTMS motornoj kory polushariya, kontrlateral'nogo lokalizacii boli. Provodili analiz korrelyacij funkcional'noj konnektivnosti (FK) i ob"ema serogo veshchestva golovnogo mozga (SVGM) so snizheniem intensivnosti boli. Pokazana polozhitel'naya korrelyaciya mezhdu snizheniem srednej intensivnosti boli i ob"emom SVGM v oblasti hvostatyh yader (p(unc) = 0,03), mozzhechka bilateral'no (p(unc) = 0,002) i kontrlateral'noj postcentral'noj izviline (p(unc) = 0,005); mezhdu snizheniem maksimal'noj intensivnosti boli i ob"emom SVGM v oblasti hvostatogo yadra kontrlateral'no boli (p(unc) = 0,04) i mozzhechka ipsilateral'no (p(unc) = 0,03). Prodemonstrirovana polozhitel'naya svyaz' snizheniya srednej intensivnosti boli s FK mezhdu talamusom (kontrlateral'no lokalizacii boli) i ipsilateral'noj postcentral'noj izvilinoj i pokryshkoj ostrovka (p(FWE) = 0,018), mezhdu poyasnoj koroj i perednimi otdelami poyasnoj kory ipsilateral'no boli (p(FWE) = 0,017), mezhdu kontrlateral'noj paraterminal'noj izvilinoj i mozzhechkom ipsilateral'no (p(FWE) = 0,018); otricatel'naya korrelyaciya dlya FK mezhdu kontrlateral'noj skorlupoj i zatylochnymi dolyami oboih polusharij (p(FWE) = 0,001). Poluchennye rezul'taty mogut stat' predposylkoj k razrabotke individual'nyh prediktorov effektivnosti rTMS u pacientov s hronicheskimi bolevymi sindromami.

vestnik rgmu

Strukturno-funkcional'nye biomarkery effektivnosti navigacionnoj ritmicheskoj transkranial'noj magnitnoj stimulyacii v lechenii nevralgii trojnichnogo nerva