重症脑损伤昏迷患者重复经颅磁刺激前后的局部脑电图变化

The local change of EEG in the severe brain injury patients after rTMS intervention

目的:探讨重症昏迷脑损伤患者经重复经颅磁刺激(rTMS)干预后脑电图(EEG)的前后变化,以期了解r TMS是否可以作为一种促醒治疗方法。方法:募集重症脑损伤患者10例,所有患者均处于昏迷状态(GCS<9),患者戴上TMS兼容电极帽,采用TMS兼容的EEG设备,在rTMS刺激前采集EEG20min;然后rTMS刺激左侧额叶背外侧区15min,刺激频率为15Hz,刺激强度80%运动阈值,未测出运动阈值者选择45%的最大输出强度;刺激结束后,继续采集EEG20min;观察rTMS刺激前后的EEG变化,分析Fp1、F3、C3、F7和T3总共5个通道的平均功率和慢波功率比在刺激前后间的差异。结果:相比于干预前,rTMS干预后的EEG波形分化会变好,平均功率呈下降趋势,其中在F3和C3通道上的差异具有显著性。5个通道的慢波比均显著降低。结论:rTMS刺激可以改善昏迷患者的EEG,也许可以作为脑损伤昏迷患者促醒的一种潜在治疗方法。

Objective:To explore the local change of EEG in the severe brain injury patients after the intervention of repetitive transcranial magnetic stimulation(r TMS)and then investigating the possibility of r TMS to be an awaking up treatment.Method:Ten coma patients after severe brain injury(GSC<9)were recruited to attend this study.EEG was gathered using TMS compatible EEG system before and after r TMS intervention.The procedure is as followings,the stimulating site is left dorsolateral frontal lobe,the frequency was 15 Hz,the intensity was 80%motor threshold(if no motor threshold,45%maximum intensity was chosen),the time of gathering EEG is no less than 20 min.The mean power and the rate of slow wave in Fp1、F3、C3、F7 and T3 channels were analyzed.Result:The EEG will be better after r TMS intervention.The mean power in five channels has decreasing trend and the difference in F3 and C3 is significant.The DTR in most channels is obviously decreased.Conclusion:r TMS can improve the EEG performance and may be a potential method to arouse awareness.