Estimulação Magnética Transcraniana profunda (EMTp) modula estruturas corticais mais profundas, como a Ínsula Posterior Superior (IPS) e o Córtex Cingulado Anterior (CCA) e tem sido usada para tratar condições não anteriormente sensíveis à EMT superficial. No entanto, até o momento, nenhum estudo avaliou os efeitos da EMTp na cognição após várias sessões de estimulação de maneira abrangente, especialmente em pacientes com disfunção cognitiva basal devido a lesões estruturais da SNC. Apresentamos resultados secundários de um estudo randomizado paralelo de três braços sobre os efeitos da EMTp ativa de 10Hz para o CCA ou IPS contra EMTp simulada na avaliação neuropsicológica de 98 pacientes com dor neuropática central submetidos a um curso de 12 semanas (16 sessões) de tratamento. Vários canais cognitivos foram avaliados em um desenho cego (atenção, controle inibitório, velocidade de processamento, flexibilidade mental, fluência verbal-fonêmica e semântica, memória operacional e episódica, cognição global e percepção visual) no início e após o último dia de estimulação. Nós observamos que não há efeitos do córtex Insular Posterior Superior (IPS) ou do Cíngulado Anterior (CCA) comparado com EMTp simulada na dor clínica, apesar do achado antinociceptivo significativo nos limiares térmicos após EMTp- IPS e um efeito ansiolítico significativo de EMTp- CCA comparado com estimulação simulada. Não encontramos efeitos significativos da estimulação ativa para o IPS ou para o CCA em comparação com a estimulação simulada em qualquer um dos domínios cognitivos. Os autores concluíram que a EMTp CCA/IPS de alta frequência e repetidas sessões de longa duração é segura em pacientes com lesões do SNC que apresentam lesões cerebrais estruturais e comprometimento cognitivo significantes / Deep-TMS (dTMS) modulates deeper cortical structures such as the posterior superior insular (PSI) and the anterior cingulate cortices (ACC) and has been used to treat conditions not previously responsive to superficial-TMS. However, to date no study has assessed the effects of dTMS on cognition after several sessions of stimulation in a comprehensive manner, especially in patients with baseline cognitive dysfunction due to SNC structural lesions. We present secondary outcome results form a three-arm parallel randomized trial on the effects of active10Hz dTMS to either the ACC or PSI against sham dTMS on neuropsychological assessment of 98 central neuropathic pain patients undergoing a 12-week (16 sessions) course of treatment. Several cognitive channels were assessed in a blinded design (attention, inhibitory control, processing speed, mental flexibility, verbal fluency-phonemic and semantic, working and episodic memory, global cognition and visual perception) at baseline and after the last day of stimulation. We observed that there were no effects of either posterior insular (PSI) or anterior cingulate cortex (ACC) compared to sham dTMS on clinical pain, despite the finding of a significant anti-nociceptive on thermal thresholds after PSI d- TMS and a significant anxiolytic effect of ACC d-TMS compared to sham stimulation. We found no significant effects of active stimulation to either the PSI or to the ACC compared to sham stimulation in any of the cognitive domains. Long-term repetitive-session high frequency ACC/PSI- dTMS is safe in patients with structural SNC lesions who have baseline significant structural brain lesions and cognitive impairment

Specific phobia of the animal subtype has been employed as a model disorder exploring the neurocircuitry of anxiety disorders, but evidence is lacking whether the detected neural response pattern accounts for all animal subtypes, nor across other phobia subtypes. The present study aimed at directly comparing two subtypes of specific phobia: snake phobia (SP) representing the animal, and dental phobia (DP) representing the blood-injection-injury subtype. Using functional magnetic resonance imaging (fMRI), brain activation and skin conductance was measured during phobogenic video stimulation in 12 DP, 12 SP, and 17 healthy controls. For SP, the previously described activation of fear circuitry structures encompassing the insula, anterior cingulate cortex and thalamus could be replicated and was furthermore associated with autonomic arousal. In contrast, DP showed circumscribed activation of the prefrontal and orbitofrontal cortex (PFC/OFC) when directly compared to SP, being dissociated from autonomic arousal. Results provide preliminary evidence for the idea that snake and dental phobia are characterized by distinct underlying neural systems during sustained emotional processing with evaluation processes in DP being controlled by orbitofrontal areas, whereas phobogenic reactions in SP are primarily guided by limbic and paralimbic structures. Findings support the current diagnostic classification conventions, separating distinct subtypes in DSM-IV-TR. They highlight that caution might be warranted though for generalizing findings derived from animal phobia to other phobic and anxiety disorders. If replicated, results could contribute to a better understanding of underlying neurobiological mechanisms of specific phobia and their respective classification.

Women exhibit greater habituation to painful stimuli than men. The neural mechanism underlying this sex difference is unknown. However, pain habituation has been associated with pain-evoked activity of the subgenual anterior cingulate cortex (sgACC), implicating a connection between the sgACC and the descending pain antinociceptive system. Therefore, the thesis hypothesis was that women have stronger connectivity than men between the sgACC and the descending antinociceptive system. Healthy subjects provided informed consent. 3T MRI images included anatomical diffusion-weighted imaging for structural connectivity analyses (SC) with probabilistic tractography and resting-state functional images for functional connectivity (FC) analyses. Women had stronger sgACC FC with nodes of the descending pain modulation system (raphe, PAG) and the medial thalamus. In contrast, men had stronger sgACC FC with nodes of the salience/attention network (anterior insula, TPJ) and stronger sgACC SC with the hypothalamus. These findings implicate a mechanism for pain habituation and its associated sex differences.

Women exhibit greater habituation to painful stimuli than men. The neural mechanism underlying this sex difference is unknown. However, pain habituation has been associated with pain-evoked activity of the subgenual anterior cingulate cortex (sgACC), implicating a connection between the sgACC and the descending pain antinociceptive system. Therefore, the thesis hypothesis was that women have stronger connectivity than men between the sgACC and the descending antinociceptive system. Healthy subjects provided informed consent. 3T MRI images included anatomical diffusion-weighted imaging for structural connectivity analyses (SC) with probabilistic tractography and resting-state functional images for functional connectivity (FC) analyses. Women had stronger sgACC FC with nodes of the descending pain modulation system (raphe, PAG) and the medial thalamus. In contrast, men had stronger sgACC FC with nodes of the salience/attention network (anterior insula, TPJ) and stronger sgACC SC with the hypothalamus. These findings implicate a mechanism for pain habituation and its associated sex differences.

Why is it that only some people who use drugs actually become addicted? In fact, addiction depends on a complicated process involving a confluence of risk factors related to biology, cognition, behaviour, and personality. Notably, all addictive drugs act on a neural system for reinforcement learning called the midbrain dopamine system, which projects to and regulates the brain's system for cognitive control, called frontal cortex and basal ganglia. Further, the development and expression of the dopamine system is determined in part by genetic factors that vary across individuals such that dopamine related genes are partly responsible for addiction-proneness. Taken together, these observations suggest that the cognitive and behavioral impairments associated with substance abuse result from the impact of disrupted dopamine signals on frontal brain areas involved in cognitive control: By acting on the abnormal reinforcement learning system of the genetically vulnerable, addictive drugs hijack the control system to reinforce maladaptive drug-taking behaviors. The goal of this research was to investigate this hypothesis by conducting a series of experiments that assayed the integrity of the dopamine system and its neural targets involved in cognitive control and decision making in young adults using a combination of electrophysiological, behavioral, and genetic assays together with surveys of substance use and personality. First, this research demonstrated that substance dependent individuals produce an abnormal Reward-positivity, an electrophysiological measure of a cortical mechanism for dopamine-dependent reward processing and cognitive control, and behaved abnormally on a decision making task that is diagnostic of dopamine dysfunction. Second, several dopamine-related neural pathways underlying individual differences in substance dependence were identified and modeled, providing a theoretical framework for bridging the gap between genes and behavior in drug addiction. Third, the neural mechanisms that underlie individual differences in decision making function and dysfunction were identified, revealing possible risk factors in the decision making system. In sum, these results illustrate how future interventions might be individually tailored for specific genetic, cognitive and personality profiles. / Graduate

Specific phobia of the animal subtype has been employed as a model disorder exploring the neurocircuitry of anxiety disorders, but evidence is lacking whether the detected neural response pattern accounts for all animal subtypes, nor across other phobia subtypes. The present study aimed at directly comparing two subtypes of specific phobia: snake phobia (SP) representing the animal, and dental phobia (DP) representing the blood-injection-injury subtype. Using functional magnetic resonance imaging (fMRI), brain activation and skin conductance was measured during phobogenic video stimulation in 12 DP, 12 SP, and 17 healthy controls. For SP, the previously described activation of fear circuitry structures encompassing the insula, anterior cingulate cortex and thalamus could be replicated and was furthermore associated with autonomic arousal. In contrast, DP showed circumscribed activation of the prefrontal and orbitofrontal cortex (PFC/OFC) when directly compared to SP, being dissociated from autonomic arousal. Results provide preliminary evidence for the idea that snake and dental phobia are characterized by distinct underlying neural systems during sustained emotional processing with evaluation processes in DP being controlled by orbitofrontal areas, whereas phobogenic reactions in SP are primarily guided by limbic and paralimbic structures. Findings support the current diagnostic classification conventions, separating distinct subtypes in DSM-IV-TR. They highlight that caution might be warranted though for generalizing findings derived from animal phobia to other phobic and anxiety disorders. If replicated, results could contribute to a better understanding of underlying neurobiological mechanisms of specific phobia and their respective classification.

Les fonctions exécutives (FE), et en particulier le Contrôle Inhibiteur (CI), jouent un rôle très important dans la réussite académique et professionnelle ainsi que dans la physiopathologie de nombreux troubles psychiatriques. L'adolescence est une période critique du développement du CI, ce dernier étant sous-tendu en particulier par la maturation tardive du cortex préfrontal jusqu’au début de l'âge adulte. Le premier objectif de cette thèse a été de cartographier les bases neurales du CI durant le développement et d'en évaluer leurs spécificités en les comparant avec celles de la mémoire de travail (MdT), une autre composante clef des FE. À partir d'une méta-analyse des études en IRMf du CI et de la MdT incluant 845 enfants, 1377 adolescents et 10235 adultes, nous avons identifié des modifications de l'activité fonctionnelle, à savoir le passage d'un réseau diffus à un réseau focal plus spécialisé avec l'âge, en accord avec un modèle dynamique du développement cérébral. Un large recouvrement de régions fronto-pariétales pour le CI et la MdT a également été détecté, ce qui soulève la question de la spécificité des processus et des tâches de ces deux FE. Par la suite, nous avons analysé l'effet à long terme du neuro-développement précoce sur le CI à partir de l'étude de la morphologie sulcale, un paramètre anatomique du cerveau déterminé lors de la vie fœtale. Dans un premier temps, nous avons montré, d'après une analyse longitudinale de 243 IRM, la stabilité du motif des sillons durant le développement. Nous avons par la suite établi que les polymorphismes sulcaux du cortex cingulaire antérieur et du sillon frontal inférieur contribuaient, de manière complémentaire, à l'efficience du CI chez l'enfant et également chez l'adulte. Enfin, nous nous sommes intéressés à l’entraînement cognitif au CI à l'adolescence, une période de très grande plasticité cérébrale et de sensibilité à l'environnement. Nous avons étudié chez 49 adolescents de 16-17 ans l'effet d'un entraînement intensif sur tablette tactile (25 sessions de 15 minutes par jour) au CI versus Contrôle Actif aux niveaux cognitif et cérébral (IRMf : tâches de stop-signal, de matrice de points, du réseau attentionnel et de gratification retardée). Nous avons en particulier évalué l'effet des facteurs neurodéveloppementaux précoces sur la réceptivité à l’entraînement au CI. Ces travaux s'inscrivent dans un nouveau champ de recherche interdisciplinaire à l'interface entre les neurosciences et la psychologie. Dans une perspective translationnelle éducative et thérapeutique, il vise à évaluer le plus finement possible, grâce à l'imagerie cérébrale anatomique et fonctionnelle, quelles interventions pédagogiques et thérapeutiques sont susceptibles d'aider au mieux le cerveau à surmonter des difficultés d'ordre cognitif. / Executive functions (EF), including Inhibitory Control (IC), play a major role in academic and professional achievement, as well as in the pathophysiology of many psychiatric disorders. Adolescence is a critical period in IC development as it is underlain by the protracted maturation of prefrontal cortex until early adulthood. The first objective of this thesis was to examine the neural bases of IC during development and to evaluate their specificities by comparing them with the working memory (WM), another key component of EF. Based on a meta-analysis of IC and WM fMRI studies including 845 children, 1377 adolescents and 10235 adults, we identified changes in functional activity with a shift from a diffuse to a more focal and specialized network with age. These results support the model of dynamic neurofunctional development. Moreover, a large overlap of fronto-parietal regions was found for IC and WM, which raises issues regarding the specificities of IC and WM processes and tasks. Second, we analyzed the long-term effect of early neurodevelopment on IC based on the sulcus morphology, an anatomical brain feature determined during fetal life. We showed, using a longitudinal analysis of 243 MRIs, that folding patterns are fixed from childhood to adulthood. Subsequently, we established that the sulcal polymorphisms of the anterior cingulate cortex and the inferior frontal sulcus complementary contributed to IC efficiency in both children and adults. Finally, we studied IC training in adolescence, a period of high brain plasticity and environmental sensitivity. We examined the effects of an intensive IC training (25 sessions of 15 minutes per day) versus active control training group on touchscreens in 49 adolescents (16-17 years-old) on cognitive and brain levels (fMRI: stop-signal, dot matrix, attentional network and delayed gratification tasks). We also assessed the effect of early neurodevelopmental factors on IC training receptivity. This thesis is part of a new field of interdisciplinary research, at the interface between neurosciences and psychology. It includes translational educational and therapeutic perspectives, with aims at evaluating as finely as possible, using anatomical and functional brain imaging, what pedagogical and therapeutic interventions are likely to help the brain to overcome cognitive difficulties.

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Bildgebende Studien haben gezeigt, dass bei schizophrenen Patienten Positivsymptome mit Veränderungen mesolimbischer Aktivierungsmuster unter Einbeziehung des Nucleus accumbens in Zusammenhang stehen. Hierbei ist von besonderem Interesse, dass der Nucleus accumbens Teil des Belohnungssystems ist, wobei die integrale „Bewertung“ belohnungsanzeigender Reize präfrontalen kortikalen Strukturen, insbesondere dem anterioren Zingulum, zuzurechnen ist. Bereits in der Antizipationsphase potentiell belohnender Reize, werden vermutlich zur Berechnung von Prädiktionsabweichungen dopaminerge Signale in der VTA generiert und modulieren den Nucleus accumbens. Es gibt zahlreiche Hinweise, dass glutamaterge Neurone des anterioren Zingulums die Dopaminausschüttung im Nucleus accumbens beeinflussen, und dass diese Modulation bei Erkrankungen wie der Schizophrenie beeinträchtigt ist. Ziel der vorliegenden Arbeit war es, mittels funktioneller Magnetresonanztomographie und Protonen Magnetresonanzspektroskopie, Hinweise über den Zusammenhang zwischen der glutamatergen Neurotransmission des ACC und belohnungsassoziierter Dopaminausschüttung im Nucleus accumbens bei 23 gesunden Probanden und bei 23 unmedizierten schizophrenen Patienten zu erlangen. Die Ergebnisse weisen darauf hin, dass die gegenseitige Modulation von anteriorem Zingulum und Nucleus accumbens bei schizophrenen Patienten gestört ist. Dieses und weitere Ergebnisse wurden im theoretischen Rahmen der NMDA-Rezeptor-Hypoaktivität und einer gestörten Balance zwischen Dopamin-D1- und Dopamin-D2-Rezeptor-Aktivität als pathophysiologische Korrelate schizophrener Erkrankungen diskutiert. / Imaging studies have demonstrated that for schizophrenic patients a correlation exists between positive symptoms and changes in the patterns of mesolimbic activity. Especially the changes in the ncl. accumbens (Nac) were interpreted in connection with the reward system. The signals indicating reward are thought to be processed by the anterior cingulum (ACC). These structures attribute meaning to the reward signals. In the anticipation phase of a potentially rewarding stimulus, dopaminergic signals from the VTA are generated in prediction of expected or aberrant outcome, thus modulating the Nac. Data indicate a direct modulation of the Nac. by glutamatergic neurons of the anterior cingulum. A major aim of this thesis is to establish a connection between the reward associated dopaminergic signals of the ncl. accumbens and the glutamatergic projections of the acc in unmedicated schizophrenic patients and healthy controls. The methods included measurements of proton magnetic resonance spectroscopy (1H-MRS) and functional MRI-scans done at a 3-Tesla tomograph. The paradigm applied was a modified version of the monetary incentive delay paradigm (Knutson et al. 2000). In healthy volunteers we found a significant negative correlation between the glutamate concentration in the ACC and the BOLD-contrast in the Nac (reward versus neutral), in contrast to the findings in schizophrenic patients. A significant higher BOLD-contrast was seen in the anticipation phase in healthy controls. The results were incorporated in a model of NMDA-R-Hypoaktivity. In addition to discussing the functional aspects for the structures involved the model was further expanded to include the hypothesis of a disturbed balance between dopamine-D1- and -D2-receptor activity and a dysfunctional hippocampal gating-process. The so constructed model suggests a profound striato-thalamo-cortical filter disturbance as the basis of the observed aberrations in the reward processing in schizophrenic disorders.

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