长时程重复高精度经颅直流电刺激对微意识状态患者意识恢复的影响

Effect of long-lasting repeated high-definition transcranial direct current stimulation on consciousness recovery in minimally conscious state patients

目的探讨长时程重复高精度经颅直流电刺激(high-definition transcranial direct current stimulation, HD-tDCS)调控楔前叶对微意识状态(minimally conscious state, MCS)患者意识恢复的影响。方法采用前瞻性病例对照研究设计,共纳入40例MCS患者,HD-tDCS组20例,对照组20例。对照组给予常规治疗,HD-tDCS组在常规治疗基础上应用HD-tDCS的治疗,刺激靶点为楔前叶,刺激电流为2 mA,单次刺激时间为20 min,每日2次,14 d,共28次。记录所有入组患者的性别、年龄、昏迷时长,入组患者基线(T0)、单次刺激(T1)、刺激第7天(T2)、第14天(T3)的修订版昏迷恢复量表(Coma Recovery Scale-Revised, CRS-R)及子量表评分。结果与对照组相比,HD-tDCS组在T3时CRS-R评分明显高于对照组,差异有统计学意义(P<0.05)。对照组内有2例MCS患者在T3时出现新的意识行为;与T0相比,CRS-R评分分值在T1、T2、T3均无明显提高。HD-tDCS组内有17例MCS患者HD-tDCS治疗后出现新的意识行为表现;与T0相比,HD-tDCS组MCS患者CRS-R评分分值在T1、T2、T3有不同程度的提高,差异有统计学意义(P<0.05),子量表中视觉、听觉、运动评分在T2、T3时显著升高,差异有统计学意义(P<0.01)。结论长时程重复HD-tDCS调控楔前叶,可以促进MCS患者在调控第14天时的意识恢复,特别是在视觉、听觉、运动等意识行为方面有显著的恢复。

Objective To assess the efficacy of long-lasting repeated high-definition transcranial direct current stimulation(HD-tDCS)over the precuneus on consciousness recovery in patients with minimally conscious state(MCS).Methods A prospective case-control study was carried out on 40 MCS patients admitted in the Fifth Affiliated Hospital of Zhengzhou University from June 2018 to January 2021.They were randomly divided into HD-tDCS group(n=20)and control group(n=20).The patients in the control group received routine treatment,while those in the HD-tDCS group were treated with HD-tDCS protocol over the precuneus(at 2 mA,for 20 min per time,twice per day for 14 d,with totally 28 sessions)on the basis of routine treatment.Gender,age,duration of consciousness,Coma Recovery Scale-Revised(CRS-R)scores before(T0),and at a single session(T1),7 d(T2),and 14 d(T3)were recorded and analyzed.Results The CRS-R score at T3 was significantly higher in the HD-tDCS group than the control group(P<0.05).In the control group,2 MCS patients demonstrated a new sign of consciousness at T3,and the CRS-R scores at T1,T2 and T3 were not significantly changed than those at T0.While in the HD-tDCS group,17 patients showed a new sign of consciousness,and the CRS-R scores at T1,T2,and T3 were obviously increased when compared with those at T0(P<0.05).And the scores of visual,auditory and motor subscales at T3 were also statistically elevated than the scores at baseline(P<0.01).Conclusion Long-lasting repeated HD-tDCS over the precuneus improves the recovery of consciousness in MCS patients at the 14 th day of neuromodulation,especially in the visual,auditory and motor aspects of conscious behaviors.