基于脑电非线性分析观察高频重复经颅磁刺激对卒中后认知功能的影响

The effect of high-frequency repetitive transcranial magnetic stimulation on cognitive function after stroke based on electroencephalogram nonlinear analysis

目的:结合脑电非线性分析技术,探讨高频重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)对卒中后认知障碍(post-stroke cognitive impairment,PSCI)患者的临床效果。方法:将40例PSCI患者随机分为rTMS组和对照组,每组20例。2组均给予基础药物及常规康复训练,rTMS组予以5 Hz rTMS,刺激靶点为左侧前额叶背外侧(dorsolateral prefrontal cortex,DLPFC),每日1次,每次20 min,共4周。于治疗前、治疗4周后采用蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)、Stroop色词测验(Stroop color-word test,SCWT)、连线测验A-B(trail making test,TMT)、P300检测评估患者认知功能,同时于安静闭眼状态下采集脑电信号,通过非线性参数关联维数(correlation dimension,D2)、近似熵(approximate entropy,ApEn)观察区域功能连接变化和其他脑区改变情况。结果:与对照组相比,治疗4周后,rTMS组患者MoCA评分明显增高(P<0.05);SCWT中卡片A耗时、卡片B耗时、干扰量耗时、干扰量正确数均明显下降(P<0.05);TMT中卡片A耗时、卡片B耗时、干扰量耗时明显下降(P<0.05);rTMS组P300潜伏期明显缩短(P<0.05);rTMS组D2值、ApEn值明显增加(P<0.05);rTMS组D2值在F4、O1、F8导联与对照组相比无统计学差异(P=0.074、0.179、0.120),其余导联均有统计学差异(P<0.05),ApEn值在FP1、FP2、F3、C4、P4、O2、F7、T3导联与对照组相比有统计学差异(P<0.05)。结论:高频rTMS治疗可有效改善PSCI患者认知功能,并影响局部神经环路,代偿认知功能。

Objective:To investigate the clinical effect of high frequency repetitive transcranial magnetic stimulation(rTMS)on cognitive function in patients with post-stroke cognitive impairment(PSCI)based on electroencephalogram(EEG)nonlinear analysis technology.Methods:Forty patients with PSCI were randomly divided into the rTMS group and the control group,with 20 cases in each group.Both groups were given routine drugs and cognitive rehabilitation training.On this basis,the rTMS group were stimulated with 5Hz rTMS to the dorsolateral prefrontal cortex(DLPFC)once a day for 20 min each time for 4 weeks.Before and 4 weeks after treatment,the cognitive function of the patients was assessed by Montreal cognitive assessment(MoCA),Stroop color-word test(SCWT),trail making test(TMT)and P300.At the same time,EEG signals were collected in the quiet state of closed eyes.The changes of functional connection in cognitive areas and other brain areas were observed through nonlinear analysis indexes including correlation dimension(D2)value and approximate entropy(ApEn)value.Results:Compared with the control group,the MoCA score of rTMS group was significantly higher after 4 weeks of treatment(P<0.05);in SCWT,the time consumption of card A,card B,the time consumption of interference and the correct number of interference decreased significantly(P<0.05);in TMT,the time consumption of card A,card B and the amount of interference decreased significantly(P<0.05);P300 latency was significantly shortened in rTMS group(P<0.05);in rTMS group,D2 value and ApEn value increased significantly(P<0.05).There was no significant difference in D2 value between rTMS group and control group in F4,O1 and F8 leads(P=0.074,0.179,0.120),there were significant differences in other leads(P<0.05),and there were significant differences in ApEn value between rTMS group and control group in FP1,FP2,F3,C4,P4,O2,F7 and T3 leads(P<0.05).Conclusion:High frequency rTMS treatment can effectively improve the cognitive function of patients with PSCI,affect the local neural circuit and compensate the cognitive function.