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首页> 外文期刊>Biological psychiatry >Dysfunctions of cortical excitability in drug-naive posttraumatic stress disorder patients.
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Dysfunctions of cortical excitability in drug-naive posttraumatic stress disorder patients.

机译：未经药物治疗的创伤后应激障碍患者的皮质兴奋性功能障碍。

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BACKGROUND: The investigation of a wide set of transcranial magnetic stimulation (TMS)-related variables in both hemispheres might help to identify a pattern of cortical excitability changes in posttraumatic stress disorder (PTSD) patients, reflecting gamma-amino-butiric acid (GABA)/glutamate balance and dysfunction, and to determine whether some of these variables are related to clinical features. METHODS: In 20 drug-naive PTSD patients without comorbidity and 16 matched healthy control subjects we tested bilaterally with standard TMS procedures: resting motor threshold (RMT) to single-pulse TMS (reflecting ion channel function), paired-pulse short-latency intracortical inhibition (SICI; mainly reflecting GABA(A) function) and intracortical facilitation (ICF; mainly reflecting glutamatergic function), single-pulse cortical silent period (CSP; mainly reflecting GABA(B)-ergic function), and paired-pulse short-latency afferent inhibition (SAI; reflecting cholinergic mechanisms and their presynaptic GABA(A)-mediated modulation). RESULTS: The PTSD patients showed widespread impairment of GABA(A)-ergic SICI, which was reversed toward facilitation in both hemispheres in one-half of the patients, marked increase of glutamatergic ICF in the right hemisphere, and right-sided impairment of SAI. Illness duration and avoidance symptoms but not anxiety correlated with right-lateralized dysfunctions of cortical excitability. CONCLUSIONS: Although the neurobiological complexity of each TMS variable makes current results theoretical, the pattern of cortical excitability accompanying PTSD symptoms suggests a bilateral decrease of the GABA(A)-ergic function. This prevails in the right hemisphere, in association with a relative prevalence of the glutamatergic tone, a new finding that current neuroimaging investigations cannot provide due to the lack of reliable glutamate tracers. Results might help to disclose new pathophysiological aspects of PTSD symptoms, providing a rationale for future neuromodulatory strategies of treatment.
机译：背景：对两个半球中广泛的经颅磁刺激（TMS）相关变量的研究可能有助于确定创伤后应激障碍（PTSD）患者皮质兴奋性变化的模式，反映了γ-氨基丁酸（GABA） /谷氨酸平衡和功能障碍，并确定其中一些变量是否与临床特征有关。方法：我们在20例未合并药物的未合并PTSD的患者和16例匹配的健康对照受试者中，采用标准TMS程序进行了双边测试：静息运动阈值（RMT）至单脉冲TMS（反映离子通道功能），成对脉冲短潜伏期皮质内抑制（SICI;主要反映GABA（A）功能）和皮质内促进（ICF;主要反映谷氨酸能功能），单脉冲皮层静默期（CSP;主要反映GABA（B）-能动功能）和成对短脉冲潜伏期传入抑制（SAI;反映胆碱能机制及其突触前GABA（A）介导的调节）。结果：PTSD患者表现出广泛的GABA（A）-能动性SICI损伤，这在一半患者的两个半球均向促进方向逆转，右半球的谷氨酸能ICF明显增加，以及SAI的右侧损伤。疾病持续时间和回避症状与焦虑兴奋无关，与焦虑无关。结论：尽管每个TMS变量的神经生物学复杂性使当前的结果成为理论上，但伴随PTSD症状的皮层兴奋性模式提示GABA（A）的双功能降低。这在右半球普遍存在，与谷氨酸能的相对流行有关，这是由于缺乏可靠的谷氨酸示踪剂而无法提供当前神经影像学研究的新发现。结果可能有助于揭示PTSD症状的新病理生理方面，为将来的神经调节策略提供理论依据。

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