经颅直流电刺激对最小意识状态患者脑功能网络的即刻效应研究

A study on resting state f MRI of brain function network in patients with minimally conscious state by transcranial direct current stimulation

目的:探讨经颅直流电刺激(tDCS)对最小意识状态(MCS)患者静息态脑功能网络功能连接强度(FCS)的影响。方法:纳入11例符合MCS诊断标准的患者,其中男9例,女2例;脑外伤10例,脑出血1例;平均年龄37.27±8.36岁,平均病程3.36±0.12个月。所有患者入组前均给予1次静息态功能性磁共振(rs-f MRI)扫描,随后固定tDCS的电极,阳极固定在左侧前额叶背外侧区,阴极固定在眶上区,并按照下列顺序进行研究。首先给予单次安慰tDCS刺激(20min),单次安慰刺激完成后进行第2次rs-f MRI扫描,然后给予单次真tDCS刺激(20min),单次真tDCS刺激结束后进行第3次rs-f MRI扫描,每次给予rs-f MRI评估同时应用昏迷恢复量表修订版(CRS-R)进行测评。结果:与治疗前比较,单次安慰tDCS治疗后各静息态脑功能网络功能连接强度差异无显著性意义(P>0.05);单次真tDCS治疗后听觉网路(右侧颞下回)、额顶网络(左侧角回及颞叶后部)的功能连接强度(FCS)显著增强(P<0.05)。单次真tDCS与单次安慰tDCS比较,默认网络(右侧楔前叶)、额顶网络(右侧角回、右侧中央后回)、感觉运动网络(双侧辅助运动区)功能连接强度显著增强(P<0.05)。结论:经颅直流电刺激对静息态脑功能连接产生显著影响,双侧大脑半球感觉运动网络、左侧额顶网络功能、意识水平相关的默认网络关键节点(右侧楔前叶)功能连接强度增强,可能是这种干预促进患者意识水平恢复的神经机制。

Objective： To investigate the effect of transcranial ity strength （FCS） of rest brain function network direct current stimulation （tDCS） on the fimctional connectiv- in patients with minimal conscious state （MCS） so as to ex- plore the mechanism of this treatment. Method： Eleven MCS-compliant patients were involved. Subjects were given an rs-fMRI assessment prior to the single tDCS treatment, followed by a 20-minute rain single sham-tDCS treatment at a time. After single- sham stimulation, a second time rs-fMRI assessment test will be given to subjects, followed by a real-tDCS treatment for 20-rninute min. Eventually, a third time rs-fMRI assessment test will be given to subjects. Result： Before treatment and after single sham-tDCS, no significant statistical difference was shown （P〉0.05）. After single real-tDCS, FCS of auditory network （right inferior temporal gyms） and the frontal-parietal network was significantly higher than that before treatment （P〈0.05）. After single real-tDCS, the default network （right precuneus）, the frontal-parietal network （right angular gyms and right postcentral gyms central back）, sensory motor network （bilateral supplementary motor area） FCS was significantly enhanced compared to that after sin- gle sham-tDCS （P〈0.05）. Conclusion： tDCS has a significant effect on MCS brain function network FCS by synchronous and non-syn- chronous regulatory effect （distant effect） to MCS brain function network. Single real-tDCS treatment can ad- just the left side of the top of the network to enhance the FCS and can adjust key nodes of consciousness lev- el related to the role in the recovery of consciousness.