Реконфигурация динамики мозговой сети с помощью стимуляции спинного мозга на основе парестезии в герпесах, связанных с зостером, невралгии: данные анализа микросостояний ЭЭГ.

Reconfiguration of brain network dynamics by paresthesia-based spinal cord stimulation in herpes zoster-associated neuralgia: evidence from EEG microstate analysis.

BACKGROUND

Neuropathic pain is characterized by disrupted large-scale brain dynamics. While paresthesia-based spinal cord stimulation (SCS) offers superior efficacy compared to pharmacological interventions, its clinical potential is constrained by poorly understood central mechanisms. EEG microstate analysis provides a powerful framework for capturing rapid spatiotemporal brain dynamics, offering further insights to elucidate how SCS potentially reconfigures the organization of neural activity.

METHODS

We recruited patients with acute and chronic herpes zoster-associated neuralgia (HZAN) to investigate the modulatory effects of SCS. Using a Group (acute vs. chronic) × Condition (SCS-on vs. SCS-off) interaction design, we evaluated topographies, temporal metrics, and microstate-based functional connectivity to comprehensively characterize condition-dependent brain dynamics.

RESULTS

SCS significantly attenuated the temporal predominance (duration, coverage, and occurrence) of Microstate A (auditory/visual and arousal), accompanied by a reciprocal expansion of Microstate B (visual network). Transition dynamics were markedly reconfigured, specifically through increased transition probability from A to B and a decrease from C (salience) to A. Intriguingly, exploratory analysis indicated that the transition probability from A to B (SCS-off) was positively correlated with post-treatment VAS scores. Furthermore, microstate-based connectivity analysis captured four functional modulation trends: functional inflexibility, reversal, alignment, and shared modulation. Finally, frequency-specific Microstate-A subnetwork strength emerged as a robust predictor of SCS therapeutic efficacy, particularly in acute HZAN.

CONCLUSIONS

Paresthesia-based SCS potentially functions as a systemic reconfigurator of large-scale brain dynamics. By modulating and reconfiguring the aberrant spatiotemporal architecture and connectivity, SCS holds the potential to nudge the brain away from pathological entrapment toward a more adaptive and flexible functional mode. These results underscore the potential of microstate-based metrics as non-invasive biomarkers for optimizing individualized neuromodulation in HZAN.