ObjectiveA third of patients with epilepsy continue to have seizures despite receiving adequate antiseizure medication. Transcranial direct current stimulation (tDCS) might be a viable adjunct treatment option, having been shown to reduce epileptic seizures in patients with focal epilepsy. Evidence for the use of tDCS in genetic generalized epilepsy (GGE) is scarce. We aimed to establish the feasibility of applying tDCS during fMRI in patients with GGE to study the acute neuromodulatory effects of tDCS, particularly on sensorimotor network activity.MethodsSeven healthy controls and three patients with GGE received tDCS with simultaneous fMRI acquisition while watching a movie. Three tDCS conditions were applied: anodal, cathodal and sham. Periods of 60 s without stimulation were applied between each stimulation condition. Changes in sensorimotor cortex connectivity were evaluated by calculating the mean degree centrality across eight nodes of the sensorimotor cortex defined by the Automated Anatomical Labeling atlas (primary motor cortex (precentral left and right), supplementary motor area (left and right), mid-cingulum (left and right), postcentral gyrus (left and right)), across each of the conditions, for each participant.ResultsSimultaneous tDCS-fMRI was well tolerated in both healthy controls and patients without adverse effects. Anodal and cathodal stimulation reduced mean degree centrality of the sensorimotor network (Friedman’s ANOVA with Dunn’s multiple comparisons test; adjusted p = 0.02 and p = 0.03 respectively). Mean degree connectivity of the sensorimotor network during the sham condition was not different to the rest condition (adjusted p = 0.94).ConclusionApplying tDCS during fMRI was shown to be feasible and safe in a small group of patients with GGE. Anodal and cathodal stimulation caused a significant reduction in network connectivity of the sensorimotor cortex across participants. This initial research supports the feasibility of using fMRI to guide and understand network modulation by tDCS that might facilitate its clinical application in GGE in the future.

中文翻译：

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遗传性全面性癫痫患者功能磁共振成像期间的经颅电刺激：试点和可行性研究

目的 尽管接受了足够的抗癫痫药物，三分之一的癫痫患者仍继续癫痫发作。经颅直流电刺激 (tDCS) 可能是一种可行的辅助治疗选择，已被证明可以减少局灶性癫痫患者的癫痫发作。使用经颅直流电刺激 (tDCS) 治疗遗传性全身性癫痫 (GGE) 的证据很少。我们的目的是确定在 GGE 患者的 fMRI 期间应用 tD​​CS 的可行性，以研究 tDCS 的急性神经调节作用，特别是对感觉运动网络活动的影响。方法 七名健康对照者和三名 GGE 患者在观看电影时接受 tDCS 并同时进行 fMRI 采集。应用三种 tDCS 条件：阳极、阴极和假手术。在每个刺激条件之间应用 60 秒无刺激的时间段。通过计算自动解剖标记图谱定义的感觉运动皮层八个节点的平均程度中心性（初级运动皮层（中央前左和右）、辅助运动区（左和右）、中扣带回）来评估感觉运动皮层连接性的变化（左和右）、中央后回（左和右）），针对每个参与者的每种情况。结果同步 tDCS-fMRI 在健康对照和患者中均具有良好的耐受性，没有不良反应。阳极和阴极刺激降低了感觉运动网络的平均程度中心性（弗里德曼方差分析与邓恩多重比较测试；调整p= 0.02 和p= 0.03 分别）。假手术条件下感觉运动网络的平均连接程度与休息条件没有不同（调整后p= 0.94）。 结论 在一小部分 GGE 患者中，在 fMRI 期间应用 tD​​CS 被证明是可行且安全的。阳极和阴极刺激导致参与者感觉运动皮层的网络连接显着减少。这项初步研究支持使用 fMRI 指导和理解 tDCS 网络调制的可行性，这可能有助于其未来在 GGE 中的临床应用。