脑电生物反馈治疗不同亚型注意缺陷多动障碍的效果比较

Comparison study of EEG biofeedback therapy on clinical efficacy of children with different subtypes of attention deficit hyperactivity disorder

目的使用视听整合连续测试(integrated visual and auditory continuous performance test,IVA-CPT)评估脑电生物反馈治疗三种不同亚型注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)儿童的疗效及差异。方法选取2018年7月至2020年9月在杭州市第七人民医院完成60次以上脑电生物反馈训练的ADHD患儿作为研究对象。根据治疗前IVA-CPT结果将所有患儿分为三种亚型:注意力缺陷型(n=21),冲动多动型(n=11),混合型(n=30)。采用SPSS 23.0比较三种亚型在训练前后症状改善的组间差异。结果(1)在反应控制方面(共9个项目),注意缺陷组治疗前、后比较均差异无统计学意义(均P>0.05)。而多动冲动组在视、听控制力、控制力总分、听觉谨慎商、听一致性、视觉谨慎商、视一致性的治疗前评分均显著低于治疗后(均P<0.05)。混合组在视、听控制力、控制力总分、听觉谨慎商、视一致性、在视觉谨慎商治疗前评分均显著低于治疗后(均P<0.05);在注意力方面(共9个项目),注意力缺陷组在听注意力、听警觉、视注意力、注意力总分、视警觉和视速度治疗前评分显著低于治疗后(均P<0.05)。多动冲动组在视注意力、注意力总分、视注意力商、听注意力和视速度上治疗前评分显著低于治疗后(均P<0.05)。混合组除听速度治疗前后差异无统计学意义外,其余8个项目治疗前评分均显著低于治疗后(均P<0.01、听注意力商P<0.05)。(2)经脑电生物反馈训练后,三组的治疗前后IVA-CPT评分改变量分别在视觉控制力[(-2.76±24.39)分,(19.55±19.94)分,(12.93±25.30)分](F=3.932,P=0.025)、控制力总分[(2.38±20.77)分,(21.27±15.86)分,(15.43±25.69)分](F=3.158,P=0.050)、注意力总分[(18.43±27.44)分,(11.36±11.40)分,(26.23±18.41)分](F=4.692,P=0.016)、听警醒[(20.23±42.65)分,(6.55±10.20)分,(33.63±36.30)分](F=7.160,P=0.002)、视警醒[(19.48±28.55)分,(5.27±10.62)分,(33.27±28.26)分](F=10.876,P<0.001)、视注意力商[(-2.24±23.67)分,(14.45±13.79)分,(12.83±21.91)分](F=3.669,P=0.031),差异具有统计学意义。经LSD事后比较发现,在视觉控制力、控制力总分两个项目上,注意力缺陷组的治疗前后变化均显著低于冲动多动组(均P<0.05)以及混合组(均P<0.05)。在注意力总分、听警醒、视警醒三个项目上,冲动多动组的治疗前后变化均显著低于混合组(P=0.050,P<0.05,P<0.01)。在视注意力商上,注意缺陷组的治疗前后变化均显著低于冲动多动组和混合组(均P<0.05)。结论脑电生物反馈对不同亚型ADHD患儿均存在临床疗效,但疗效有差异,应在标准TBR治疗方案的基础上针对不同亚型患儿制定个性化的脑电训练方案。

Objective To evaluate EEG biofeedback therapy on clinical efficacy of children with different subtypes of attention deficit hyperactivity disorder(ADHD)using the integrated visual and auditory integration continuous performance test(IVA-CPT).Methods Children with ADHD who completed more than 60 times of EEG biofeedback training in Hangzhou Seventh People's Hospital from July 2018 to September 2020 were selected as the research subjects.According to the results of IAV-CPT before treatment,all the children were divided into three subtypes:attention deficit type(n=21),impulse hyperactivity type(n=11),and mixed type(n=30).The differences of symptom improvement between the three subtypes before and after training were compared by SPSS 23.0 software.Results(1)In terms of response control(a total of 9 items),there was no statistical significance in the attention deficit group before and after treatment(all P>0.05).In the hyperactivity group,the scores of visual and auditory response control,full scale response control,auditory prudence and auditory consistency,visual focus quotient and visual consistency before treatment were significantly lower than those after treatment(all P<0.05).In the mixed group,the scores of visual and auditory response control,full scale response control,auditory prudence,visual consistency,and visual prudence before treatment were significantly lower than those after treatment(all P<0.05).In terms of attention(a total of 9 items),the scores of auditory vigilance,auditory attention,visual attention,full scale attention,visual vigilance and visual speed in the attention deficit group before treatment were significantly lower than those after treatment(all P<0.05).The scores of visual attention,full scale attention,visual focus quotient(all P<0.01),auditory attention and visual speed(all P<0.05)in hyperactivity group before treatment were significantly lower than those after treatment.In the mixed group,the scores of the other 8 items before treatment were significantly lower than those after treatment(all P<0.01,auditory focus quotient were P<0.05),except that the auditory speed had no statistical significance before and after treatment.(2)After EEG biofeedback training,the changes of IVA-CPT scores of the three groups before and after treatment(visual response control(-2.76±24.39),(19.55±19.94),(12.93±25.30),F=3.932,P=0.025),(full scale response control(2.38±20.77),(21.27±15.86),(15.43±25.69),F=3.158,P=0.050),(full scale attention(18.43±27.44),(11.36±11.40),(26.23±18.41),F=4.692,P=0.016),(auditory vigilance(20.23±42.65),(6.55±10.20),(33.63±36.30),F=7.160,P=0.002),(visual vigilance(19.48±28.55),(5.27±10.62),(33.27±28.26),F=10.876,P<0.001),(visual focus quotient(-2.24±23.67),(14.45±13.79),(12.83±21.91),F=3.669,P=0.031)were statistically significant.After LSD comparison,the changes of visual control and total control scores in the attention deficit group before and after treatment were significantly lower than those in the impulse hyperactivity group(all P<0.05)and the mixed group(all P<0.05).In the three items of total attention score,auditory vigilance and visual vigilance,the changes of impulsivity hyperactivity group before and after treatment were significantly lower than those of mixed group(P=0.050,P<0.05,P<0.01,respectively).The changes of visual attention quotient in the attention deficit group before and after treatment were significantly lower than those in the impulse hyperactivity group and the mixed group(all P<0.05).Conclusion EEG biofeedback has clinical efficacy in the three groups of subtypes of ADHD,but the efficacy is different,and individualized EEG training programs should be developed for different subtypes of children on the basis of standard TBR therapy protocol.