Background:Chronic insomnia disorder (CID) is considered a major public health problem worldwide. Therefore, innovative and effective technical methods for studying the pathogenesis and clinical comprehensive treatment of CID are urgently needed.Methods:Real-time fMRI neurofeedback (rtfMRI-NF), a new intervention, was used to train 28 patients with CID to regulate their amygdala activity for three sessions in 6 weeks. Resting-state fMRI data were collected before and after training. Then, voxel-based degree centrality (DC) method was used to explore the effect of rtfMRI-NF training. For regions with altered DC, we determined the specific connections to other regions that most strongly contributed to altered functional networks based on DC. Furthermore, the relationships between the DC value of the altered regions and changes in clinical variables were determined.Results:Patients with CID showed increased DC in the right postcentral gyrus, Rolandic operculum, insula, and superior parietal gyrus and decreased DC in the right supramarginal gyrus, inferior parietal gyrus, angular gyrus, middle occipital gyrus, and middle temporal gyrus. Seed-based functional connectivity analyses based on the altered DC regions showed more details about the altered functional networks. Clinical scores in Pittsburgh sleep quality index, insomnia severity index (ISI), Beck depression inventory, and Hamilton anxiety scale decreased. Furthermore, a remarkable positive correlation was found between the changed ISI score and DC values of the right insula.Conclusions:This study confirmed that amygdala-based rtfMRI-NF training altered the intrinsic functional hubs, which reshaped the abnormal functional connections caused by insomnia and improved the sleep of patients with CID. These findings contribute to our understanding of the neurobiological mechanism of rtfMRI-NF in insomnia treatment. However, additional double-blinded controlled clinical trials with larger sample sizes need to be conducted to confirm the effect of rtfMRI-NF from this initial study.

Background and Objective There are indicates that raphe nuclei may be involved in the occurrence of chronic pain in Parkinson's disease (PD). In the study, we investigated the functional connectivity pattern of raphe nuclei in Parkinson's disease with chronic pain (PDP) to uncover its possible pathophysiology. Methods Fifteen PDP, who suffered from pain, lasted longer than 3 months, sixteen Parkinson's disease patients with no pain (nPDP) and eighteen matched normal health controls (NCs) were recruited. All subjects completed the King's Parkinson's Pain Scale (KPPS) besides Parkinson-related scale and demographics. We performed a seed-based resting-state analysis of functional magnetic resonance imaging to explore whole-brain functional connectivity of the raphe nuclei. Multiple regression model was used to explore the related factors of pain including disease duration, disease severity, Hamilton Depression Rating Scale, age, sex, levodopa equivalent dose and the strength of network functional connectivity. Results Compared with the nPDP, the PDP group showed stronger functional connectivity between raphe nuclei and pain-related brain regions, including parietal lobe, insular lobe, cingulum cortex and prefrontal cortex, and the functional connectivity values of those areas were significantly positively correlated with KPPS independent of the clinical variables. Compared with NCs, the combined PD groups showed decreased functional connectivity including prefrontal cortex and cingulum cortex. Conclusions Abnormal functional connectivity model of raphe nuclei may be partly involved in pathophysiological mechanism of pain in PD.

BACKGROUND:Patients with akinetic-rigid Parkinson's disease (AR-PD) are more prone to cognitive decline and depressive symptoms than tremor-dominant PD (TD-PD) patients. The right fronto-insular cortex (rFIC), as a key node of salience network, plays a critical role in the switching between central executive network and default mode network. In this study, we explored the functional connectivity mode of rFIC with triple-brain networks, namely default mode network, salience network, and central executive network, in two motor subtypes of PD.METHODS:We recruited 44 PD patients (including the TD-PD group and AR-PD group) and 18 age-matched healthy controls (HCs). We performed functional connectivity (FC) analysis of resting-state functional MRI.RESULTS:Compared with TD-PD, decreased FC were found in the right insular cortex and bilateral anterior cingulate gyrus in AR-PD. Compared with HCs, decreased FC in the bilateral insula, the anterior cingulate gyrus, the precentral gyrus, and the right medial frontal gyrus were found; therein, the FC value of rFIC-precentral gyrus was positively correlated with the Unified Parkinson's Disease Rating Scale-II score in AR-PD (p = 0.0482, r = 0.4162). While TD-PD showed decreased FC in the left insula as well as bilateral anterior cingulate gyrus when compared with HCs, and the FC value of the rFIC-left insula was positively correlated with its Hamilton Depression Rating Scale score (p = 0.02, r = 0.50).CONCLUSION:The functional connectivity mode of rFIC in AR-PD differed from that in TD-PD. The decreased rFIC FC with the other nodes of salience network might be a potential indicator for AR-PD patients prone to develop cognitive decline and depressive symptoms.