脊髓电刺激对慢性意识障碍患者脑电成分的调控效应(24例报告)

Analysis of the effects of spinal cord stimulation frequency on EEG regulation in patients with chronic disorders of consciousness(report of 24 cases)

目的研究脊髓电刺激(SCS)不同频率对慢性意识障碍(DOC)患者皮层脑电的调控效应,建立基于量化评价下的SCS刺激范式。方法纳入解放军总医院第七医学中心神经外科自2016年5月至2017年9月行SCS手术的24例慢性DOC患者,采用不同频率程控参数,记录刺激前与刺激后脑电图,使用频谱分析方法,提取额叶区域脑电不同频段的能量,比较其在不同刺激条件下的特征,并将脑电频谱变化与基线意识水平[分为微意识状态(MCS)组和植物状态(VS)组]、临床随访恢复情况(按照术后3个月随访时情况分为显效、有效、无效3组)做相关性分析。结果不同的SCS频率给患者的皮层脑电带来了不同的改变,且存在明显的个体差异性。从个体水平上观察,引起较明显积极脑电调控效应的频率为5 Hz(10/24)和70 Hz(10/24),比例超过其他频率刺激[20 Hz(5/24),50 Hz(3/24),100 Hz(4/24)]。MCS组相对VS组在SCS刺激下可产生更大的脑电频谱变化且在γ频段的差异具有统计学意义,但并未发现各频段脑电频谱变化值与临床随访恢复情况的相关性。结论低频刺激(如5 Hz)或高频刺激(如70 Hz)都能对慢性DOC患者脑电产生积极改变,其中5 Hz和70 Hz频率可作为临床刺激方案的优先选择。

Objective To study the effects of different frequencies of spinal cord stimulation(SCS)on cortical electroencephalogram in patients with chronic disorders of consciousness(DOC),and establish a SCS stimulation paradigm based on quantitative evaluation.Methods Twenty-four patients with chronic DOC who underwent SCS in the Department of Neurosurgery,the Seventh Medical Center,Chinese PLA General Hospital were treated with different frequency programmed parameters to record pre-and post-stimulation electroencephalogram.Spectrum analysis was used to extract the energy of different electroencephalogram bands in the frontal lobe region,and to compare their characteristics under different stimulation conditions.Correlation analysis was made between changes in brain electrical spectrum and baseline consciousness level[divided into 2 groups,minimally consciousness state(MCS)and vegetative state(VS)]and clinical follow-up recovery level(divided into 3 groups:markedly effective,effective and ineffective according to the situation during the 3-month follow-up after operation).Results Different SCS frequencies brought different changes to the patient’s cortical electroencephalogram,and there were significant individual differences.Observed at the individual level,the frequencies that cause more obvious positive electroencephalogram regulation effects are 5 Hz(10/24)and 70 Hz(10/24).The positive ratio exceeds other frequency stimuli(20 Hz 5/24,50 Hz 3/24,100 Hz 4/24).Compared with the VS group,the MCS group produced a larger electroencephalogram spectrum change under SCS stimulation and the difference in theγfrequency band was statistically significant.However,the correlation between the electroencephalogram spectrum changes in each frequency band and the recovery of clinical follow-up was not found.Conclusion Low-frequency stimulation(such as 5 Hz),or high-frequency stimulation(such as 70 Hz)can positively change the brain electrical power of chronic DOC patients,and the two specific frequencies of 5 Hz and 70 Hz should be the preferred choice for clinical stimulation.