重复经颅磁刺激对慢性意识障碍患者的促醒治疗研究

Effect of repetitive transcranial magnetic stimulation on consciousness recovery in patients with prolonged disorders of consciousness

摘要:

目的 探讨重复经颅磁刺激（rTMS）调控楔前叶对慢性意识障碍患者意识恢复的影响。方法 选取郑州大学第五附属医院神经外科2020年6月—2021年5月收治的慢性意识障碍患者11例，在常规治疗基础上应用楔前叶10 Hz rTMS治疗，单次刺激时间为14 min，每日2次，持续14 d，共28次。记录rTMS治疗前（T0）、治疗后（T1）及治疗结束后1个月（T2）的昏迷恢复量表修订版（CRS-R）评分；同时记录T0及T1时静息态脑电，分别使用频谱分析及功能连接性分析方法提取不同脑区脑电不同频段的能量及相干性。结果 与T0时相比，CRS-R评分在T1、T2时均提高（P<0.05）；额区alpha频段和顶区beta频段的能量在T1时提高，差异有统计学意义（P<0.05）；额-中央-顶区alpha和beta频段的相干性在T1时增强，差异有统计学意义（P<0.05）。结论 重复经颅磁刺激调控楔前叶能促进慢性意识障碍患者的意识恢复。重复经颅磁刺激调控楔前叶对慢性意识障碍患者静息态脑电产生的积极改变有助于解释意识恢复的神经机制。

Abstract:

Objective To investigate the effect of repetitive transcranial magnetic stimulation （rTMS） over the precuneus on consciousness recovery in patients with prolonged disorders of consciousness （pDOC）.Methods A total of 11 patients with pDOC who were admitted to Department of Neurosurgery， The Fifth Affiliated Hospital of Zhengzhou University， from June 2020 to May 2021 were enrolled， and in addition to conventional treatment， they were given 10 Hz rTMS over the precuneus for 14 minutes each time， twice a day for 14 days， with 28 sessions in total. Coma Recovery Scale-Revised （CRS-R） score was recorded before rTMS treatment （T0）， after rTMS treatment （T1）， and at 1 month after rTMS treatment （T2）； meanwhile， resting-state electroencephalogram （EEG） was recorded at T0 and T1， and spectrum analysis and functional connectivity analysis were used to extract the power and coherence of different EEG bands in different brain regions.Results CRS-R score at T1 and T2 was significantly higher than that at T0 （P <0.05）. There were significant increases in frontal alpha power and parietal beta power at T1 （P <0.05）， and the frontal-central-parietal coherence in alpha and beta bands significantly enhanced at T1 （P <0.05）.Conclusions This study shows that rTMS over the precuneus can improve the recovery of consciousness in pDOC patients， and the positive changes of resting-state EEG induced by rTMS may help to explain the neural mechanism of consciousness recovery.