Individualized Real-Time fMRI Neuromodulation for the Alleviation of Cranial Nerve IX and XII Neuropathy
Anthony Kaspa Allam1, Emmanouil Froudarakis2, T. Dorina Papageorgiou1
1Baylor College of Medicine, 2Foundation for Research and Technology, Institute of Molecular Biology and Biotechnology
Objective:
The goal is to alleviate lower cranial neuropathy following radiation (head and neck cancer treatment) for which no treatment is available. Current pharmacotherapeutics (steroids and opioids) cannot be tolerated, due to their side-effects and the drug-drug interactions.
Background:
The Papageorgiou lab has developed an individualized real-time fMRI closed-loop-neuromodulation (iRTfMRI-cNMT) to upregulate sensorimotor brain networks that regulate tongue motor and sensory control (TMSC). We elucidate the spatiotemporal mechanisms involved in the brain’s modularity when targeting sensorimotor networks.
Design/Methods:
Participants (n=30) underwent a two-day-study, consisting of iRTfMRI-cNMT and control-No-cNMT conditions. We decoded the cortical patterns generated by TMSC, interleaved with periods of tongue-rest (baseline) and swallow. Our innovation is the neuromodulation of the activity’s magnitude and extent in individualized networks. We quantify the BOLD magnitude for each network, using the area under the curve (AUC), variance, and dynamic causal modeling.
Results:
The mechanisms associated with sensorimotor iRTfMRI-cNMT-induced modulation are statistically significant: 1. 45% increase in the BOLD’s magnitude AUC; 2. 14% decrease in the BOLD’s intensity variance; and 3. 20% increase in the networks’ spatial expansion. We elucidated the dynamic brain states during TSMC: 1. a dominant state, characterized by TMSC in 95% of iRTfMRI-cNMT trials (76% of control trials); and 2. a non-dominant state identified as swallowing in 5% of cNMT trials (24% of control trials). The dominant state induced by cNMT was driven by: 1. Within (60%) motor (M1, motor cerebellum, basal ganglia) areas and motor to sensory (54%) networks; and 2. Within (47%) sensory (intraparietal lobule, insula, claustrum, sensory cerebellum, cingulate) areas and sensory to motor (52%) networks. iRTfMRI-cNMT increased consistency in the decoded networks’ spatial extents compared to control (94.3% vs. 89.6%, p<0.001).
Conclusions:
These findings show that modularity of the individualized networks via iRTfMRI-cNMT is a treatment intervention that can be used to treat neuropathic pain, but also other neurologic disorders.