RESUMEN
Novel methods that stimulate neuroplasticity are increasingly being studied to treat neurological and psychiatric conditions. We sought to determine whether real-time fMRI neurofeedback training is feasible in Huntington's disease (HD), and assess any factors that contribute to its effectiveness. In this proof-of-concept study, we used this technique to train 10 patients with HD to volitionally regulate the activity of their supplementary motor area (SMA). We collected detailed behavioral and neuroimaging data before and after training to examine changes of brain function and structure, and cognitive and motor performance. We found that patients overall learned to increase activity of the target region during training with variable effects on cognitive and motor behavior. Improved cognitive and motor performance after training predicted increases in pre-SMA grey matter volume, fMRI activity in the left putamen, and increased SMA-left putamen functional connectivity. Although we did not directly target the putamen and corticostriatal connectivity during neurofeedback training, our results suggest that training the SMA can lead to regulation of associated networks with beneficial effects in behavior. We conclude that neurofeedback training can induce plasticity in patients with Huntington's disease despite the presence of neurodegeneration, and the effects of training a single region may engage other regions and circuits implicated in disease pathology.
Asunto(s)
Enfermedad de Huntington/fisiopatología , Imagen por Resonancia Magnética , Corteza Motora/fisiopatología , Neurorretroalimentación/métodos , Plasticidad Neuronal , Adulto , Anciano , Mapeo Encefálico , Cognición/fisiología , Femenino , Sustancia Gris/diagnóstico por imagen , Sustancia Gris/patología , Humanos , Enfermedad de Huntington/diagnóstico por imagen , Enfermedad de Huntington/patología , Aprendizaje/fisiología , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Actividad Motora/fisiología , Corteza Motora/diagnóstico por imagen , Corteza Motora/patología , Neurorretroalimentación/fisiología , Plasticidad Neuronal/fisiología , Tamaño de los Órganos , Prueba de Estudio Conceptual , Hemorragia Putaminal/diagnóstico por imagen , Hemorragia Putaminal/fisiopatología , Volición/fisiologíaRESUMEN
We describe two patients (76- and 54-year-old females) with multiple hypertensive intracerebral hematomas occurring simultaneously. One patient had a right thalamic hematoma extending into the internal capsule and basal ganglia together with an other one in the left putamen. The other patient had two hematomas located ipsilaterally in the left putamen and thalamus. Their neurological examinations showed only unilateral deficits. Their magnetic resonance angiograms revealed no vascular malformations. Neuroradiological procedures are essential for the diagnosis of these multiple brain events.