脑电信号在焦虑障碍疗效预测与治疗机制中的研究进展

Research progress on electroencephalography in the prediction of efficacy and therapeutic mechanism for anxiety disorders

焦虑障碍具有高患病率和高复发率的特点。选择性5-羟色胺再摄取抑制剂(SSRIs)和认知行为治疗(CBT)是焦虑障碍的一线治疗手段,然而部分患者对一线治疗应答不佳。探究治疗相关神经机制并寻找客观的疗效预测标志物,有助于指导临床决策。既往多项研究显示,焦虑障碍患者治疗前后的脑电(EEG)信号发生变化,且基线期EEG信号与治疗反应相关,故EEG信号可能具有疗效预测的价值。本文对EEG信号预测焦虑障碍的疗效以及治疗机制的相关研究进行综述,为焦虑障碍的个性化治疗提供参考。综述结果表明,治疗前对负性情绪面孔刺激表现出高反应的患者更可能从SSRIs和CBT治疗中获益;错误相关负波(ERN)和P1波幅在CBT治疗前后无明显改变,说明CBT可能未通过改善注意偏向以及行为监控缓解焦虑症状。基线期负性情绪刺激下的情绪感知相关的脑电指标,如晚期正电位(LPP)有望成为焦虑障碍疗效预测的电生理标志物。

Anxiety disorders are characterized by high prevalence and recurrence rate.Selective serotonin reuptake inhibitors(SSRIs)and cognitive behavioral therapy(CBT)are recommended as first-line treatments for anxiety disorders,while some patients do not response to either of these treatments.Therefore,exploring the neurobiological mechanisms associated with treatment response and valuable prognostic marker is of great value in guiding clinical decision making.Previous studies have reported an altered electroencephalogram(EEG)pattern in patients with anxiety disorders after treatment,and revealed a correlation between baseline EEG and treatment response,suggesting that EEG is of great value in predicting the treatment response in anxiety disorders.The purpose of this article is to delineate findings from a systematic review of the literature investigating the EEG signal in prognostic prediction and exploration of neurobiological mechanisms,so as to provide electrophysiological evidence for individualized treatment of anxiety disorders.Results of this review show that patients responding more strongly to negative emotional stimuli before treatment are more likely to benefit from SSRIs and CBT.After the CBT,no statistical difference is found in the amplitude of error-related negativity(ERN)and P1 component between pre-and post-procedure measurements,suggesting that CBT may not reduce anxiety symptoms by improving attention bias and behavioral monitoring.EEG indicators related to emotion perception under negative emotional stimuli at baseline,such as late positive potential(LPP),may be promising markers for predicting response to treatment in anxiety disorders.