Study of central mechanisms of glossopharyngeal neuralgia based on resting-state functional MRI
Objective We used resting-state functional MRI(rs-fMRI)to explore the difference in regional homogeneity(ReHo)of spontaneous brain functional activity in patients with primary glossopharyngeal neuralgia(GPN)and healthy control subjects in the resting state and thus to explore the central pathogenesis of GPN from the perspective of brain function.Methods Clinical data and rs-fMRI images of 23 patients with right-sided primary GPN who were admitted to Department of Neurosurgery,Peking University People's Hospital from January 2020 to June 2023 were prospectively collected and compared with 23 healthy control subjects matched for age,sex,and education.We used SPM12 and RESTplus softwares to process the rs-fMRI images and calculate ReHo values for functional brain activity.A two-sample independent t-test was performed on the data to compare brain areas that were significantly different between the two groups of subjects.GPN patients were stratified and subgrouped according to the presence or absence of neurovascular compression.P values were corrected for multiple comparisons using the AlphaSim method.Pearson correlation analysis was used to further assess the correlation between ReHo values and clinical indicators including age,duration of disease,extent of pain(based on visual analogue scale,VAS)in the differential brain regions.Results Compared with healthy controls,GPN patients had significantly higher ReHo values(all P＜0.05)in the following brain regions:left thalamus,precentral gyrus,postcentral gyrus;right insula,superior temporal gyrus,middle temporal gyrus,precentral gyrus,postcentral gyrus.GPN patients had significantly lower ReHo values(both P＜0.05)in the bilateral anterior cingulate gyrus.Compared with GPN patients with neurovascular compression,GPN patients without neurovascular compression had significantly higher ReHo values in the bilateral precentral and postcentral gyrus(all P＜0.05)and lower ReHo values in the bilateral anterior cingulate gyrus(both P＜0.05).The change in ReHo values in the bilateral anterior cingulate gyrus was significantly negatively correlated with the VAS scale score(r=-0.47,P=0.024).Conclusions In patients with GPN,there are significant coordination abnormalities in several brain regions involved in pain processing,which are mainly manifested as abnormal synchronous excitation of the thalamus,insula,precentral gyrus,and postcentral gyrus involved in the upward transmission of pain and central processing,and weakening of the anterior cingulate gyrus with a downward inhibitory effect on pain.The imbalance between the excitability and inhibitability of the upward pain transmission pathway and the downward inhibitory pathway jointly cause abnormal pain regulation function in GPN patients,and the onset of GPN may be the result of both peripheral stimulation and central excitation.
Glossopharyngeal nerve diseasesResting-state functional magnetic resonance imagingRegional homogeneityCentral mechanisms
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