低频重复经颅磁刺激对卒中后记忆障碍患者认知和P300的影响

目的 研究低频重复经颅磁刺激（rTMS）对卒中后记忆障碍（PSMD）患者认知及事件相关 电位P300 的影响。方法 前瞻性连续纳入2019 年9 月至2020 年6 月于徐州市中心医院康复科门诊或 住院诊疗的PSMD 患者50 例,采用随机数字表法分为刺激组和假刺激组各25 例。两组在常规药物及康 复治疗的基础上,刺激组予低频（1 Hz）rTMS 治疗,假刺激组予假rTMS 治疗,治疗4 周。治疗前及治疗 4 周后均对患者进行简易精神状态检查（MMSE）、蒙特利尔认知评估量表（MoCA）、Rivermead 行为记忆量 表（RBMT- Ⅱ）、改良Barthel 指数（MBI）及P300 的评定并进行组间治疗前后的比较。结果 治疗前两组 的MMSE、MoCA、RBMT- Ⅱ和MBI 之间的差异均无统计学意义（均P ＞ 0.05）,治疗4 周后刺激组MMSE 评分［（21.52±4.51）分］、MoCA 评分［（16.80±3.88）分］、RBMT- Ⅱ评分［（17.28±3.30）分］、MBI 评分 ［（64.60±14.21）分］、P300 潜伏期［（346.04±40.25）ms］,波幅［（10.76±3.44）μV］均优于假刺激组［分 别为MMSE 评分（18.28±4.56）分、MoCA 评分（13.92±4.58）分、RBMT- Ⅱ评分（14.52±3.81）分和MBI 评 分（52.80±13.93）分、P300 潜伏期（383.39±51.23）ms、波幅（7.28±3.00）μV］,治疗前后各量表及P300 参数的差值刺激组均优于假刺激组［MMSE、MoCA、RBMT- Ⅱ、MBI、P300 潜伏期和P300波幅差值分别 为：（4.68±1.63）分比（2.40±1.61）分,（4.82±1.56）分比（1.82±1.33）分,（5.04±1.21）分比（2.44±1.85）分, （21.80±7.62）比（13.20±6.60）,-45.52（-121.69,-0.67）ms比-21.10（-60.61,29.31）ms,5.36（2.08,8.21）μV 比1.18（0.12,2.08）μV;均P＜ 0.05］。结论 低频rTMS 可提高PSMD患者的记忆功能,更有助于日常生 活能力的恢复,P300 更客观地体现低频rTMS 改进记忆功能效果。     

经颅直流电刺激的研究进展

正经颅直流电刺激(transcranial direct current stimulation,tDCS)是一种通过阳性和阴性电极在头皮特定位点施加微弱电流(1~2 mA)调节大脑皮质兴奋性的非侵袭性技术。t DCS具有兴奋性刺激、抑制性刺激和伪刺激3种刺激模式,其刺激参数包括刺激位点、电流强度、刺激持续时间、     

重复经颅磁刺激对军人慢性精神分裂症患者阴性症状及认知功能的疗效分析

目的研究高频重复经颅磁刺激（rTMS）对军人慢性精神分裂症患者阴性症状及认知功能的疗效。方法将42例以阴性症状为主的住院军人慢性精神分裂症患者随机分为研究组（21例）和对照组（21例）。研究组在原有抗精神病药物种类及剂量不变的同时给予经左侧背外侧前额叶的4周共20次高频（15Hz）rTMS刺激,对照组采用假rTMS刺激。治疗前后对两组分别进行阳性和阴性症状量表（PANSS）、17项汉密尔顿抑郁量表（HAMD17）、治疗中出现的不良反应量表（TESS）评定及事件相关电位P300测定。结果研究组治疗后PANSS量表阴性症状因子分由（35.1±4.5）降至（25.5±4.1）,治疗后较治疗前显著下降（t=2.92,P〈0.05）,而对照组治疗前后则无变化（P〉0.05）,研究组疗效明显优于对照组（F=21.6,P〈0.05）;其它因子分及HAMD17治疗前、后均无变化。与治疗前比较,治疗后在CZ点,研究组P300的P2、P3波幅升高（P均〈0.05）;而对照组P300各项指标治疗前后变化均无统计学意义（P均〉0.05）。结论高频rTMS能有效治疗慢性精神分裂症患者的阴性症状,并改善认知功能。     

重复经颅磁刺激或经颅直流电刺激治疗脑卒中后吞咽困难疗效的Meta分析

目的系统评价重复经颅磁刺激或经颅直流电刺激对脑卒中后吞咽困难的疗效。方法应用计算机检索PubMed、Web of Science、Embase、中国知网、万方、维普数据库中自建库起至2023年5月收录的关于重复经颅磁刺激或经颅直流电刺激(试验组)治疗脑卒中后吞咽困难的随机对照试验研究(对照组采用常规治疗+假刺激或仅采用常规治疗), 筛选及应用Cochrane文献质量评估工具评估文献质量后提取有效数据, 以渗透误吸量表、纤维内镜吞咽困难程度量表、功能性由口进食等级量表评分为结局指标, 应用Reviewer Manager 5.4软件对提取数据进行Meta分析, 以均数差(MD)或标准化均数差(SMD)作为效应指标。结果共纳入12篇文献, 包含637例患者。Meta分析显示:与对照组相比, 试验组患者的渗透误吸量表评分明显降低, 差异有统计学意义(MD=-0.740, 95%CI:-1.020～-0.460, P<0.001);试验组患者的功能性由口进食等级量表评分明显升高, 差异有统计学意义(MD=0.680, 95%CI:0.220～1.130, P=0.003);试验组患者的纤...     

高频重复经颅磁刺激对早期帕金森病轻度认知功能障碍的疗效观察

目的 探讨高频重复经颅磁刺激(rTMS)治疗对早期帕金森病(PD)患者轻度认知功能障碍(MCI)的临床疗效.方法 将60例早期PD伴发MCI患者随机分为rTMS组和对照组,每组30例.以左前额叶背外侧皮质为刺激区域,rTMS组予以10 Hz高频rTMS,对照组予以伪刺激处理.比较两组治疗前后蒙特利尔认知评估量表(MoC...     

经颅直流电刺激在卒中后吞咽障碍康复治疗中的应用研究进展

卒中后吞咽障碍可能是由吞咽皮质中枢、皮质下行纤维、延髓吞咽中枢及锥体外系损伤所致,目前尚无特异性治疗方法,临床干预以直接训练和间接训练等康复治疗为主.经颅直流电刺激(transcranial direct current stimulation,tDCS)是通过直流电刺激来改变神经可塑性和皮质兴奋性,以改善各种神经、精...     

经颅直流电刺激的研究及应用★

经颅直流电刺激（Transcranial Direct Current Stimulation，tDCS）是一种非侵袭性的刺激脑方法，即不开颅将两个电极片放置于脑特定功能皮层对应的头皮区域，利用弱的电流经颅刺激目标区域引起脑的兴奋性的改变。此方法为一古老的研究方法，经过断断续续的研究和不断的新发现，近十年再次成为研究的热点，并取得的不小的成果。经颅直流电刺激作为一种能改变大脑兴奋性状态，无创的，简便，价廉，更为优越的是可设立假刺激组进行对照研究的刺激技术被广泛的探索和应用。tDCS的基本原理已经阐明，目前在进一步深层次探索其作用原理和寻找更为有效刺激程序的基础上进入临床试验阶段，尤其是在康复医学中有益的效果需要大量的临床试验来验证和进一步提高这种积极的治疗效果。本文概述了tDCS近十年的研究进展，包括其基本原理、刺激程序、优越性及不良作用，脑功能各个区域的研究，详细阐述了在脑卒中和脊髓神经系统疾病中的研究应用。     

经颅直流电刺激治疗难治性癫痫研究进展

经颅直流电刺激（tDCS）作为一种新兴的非侵入性神经调控技术,安全性较高,为无手术适应证或无法手术获益的难治性癫痫患者提供了选择,其中,阴极经颅直流电刺激通过抑制皮质兴奋性,恢复脑功能网络平衡,减少痫样放电和癫痫发作频率。但是由于各项研究之间存在异质性,其在癫痫治疗中的应用有待进一步探索。本文综述经颅直流电刺激原理及其治疗癫痫的潜在机制,以及近3年在癫痫临床应用中的进展,为经颅直流电刺激应用于难治性癫痫临床治疗的潜力和安全性提供依据。     

高频重复经颅磁刺激对老年抑郁症伴轻度认知功能损害患者的疗效

目的探讨高频重复经颅磁刺激（rTMs）对伴有轻度认知功能损害的老年抑郁症患者的疗效。方法将48例伴有轻度认知损害的老年抑郁症患者随机分为对照组和试验组。对试验组患者进行为期4周、频率为20Hz的rTMS治疗。在治疗前、治疗后和治疗后3个月分别进行汉密尔顿抑郁量表（HAMD）、简易精神状态量表（MMSE）,事件相关电位P300测试。结果治疗后,试验组HAMD评分低于对照组（t=-3．711,P=0．001）,3个月后差异仍有统计学意义（t=-3．978,P〈0．01）。治疗后,试验组的MMSE评分高于对照组（t=2．705,P=0．010）,3个月后差异仍有统计学意义t=2．934,P=0．006）。治疗后和治疗3个月后,和对照组相比,试验组Fz和Cz的P300波幅较大,差异有统计学意义（P〈0．01）。治疗后和治疗3个月后,试验组Fz和Cz的P300潜伏期短于对照组,差异均有统计学意义（P〈0．05）。结论rTMS治疗可同时改善伴轻度认知损害老年抑郁症患者的抑郁情绪和认知功能。     

Changes in spectroscopic biomarkers after transcranial direct current stimulation in children with perinatal stroke

Background

Perinatal stroke causes lifelong motor disability, affecting independence and quality of life. Non-invasive neuromodulation interventions such as transcranial direct current stimulation (tDCS) combined with intensive therapy may improve motor function in adult stroke hemiparesis but is under-explored in children. Measuring cortical metabolites with proton magnetic resonance spectroscopy (MRS) can inform cortical neurobiology in perinatal stroke but how these change with neuromodulation is yet to be explored.

Improved naming after transcranial direct current stimulation in aphasia

Transcranial direct current stimulation (tDCS) has been proposed as an adjuvant technique to improve functional recovery after ischaemic stroke. This study evaluated the effect of tDCS over the left frontotemporal areas in eight chronic non-fluent post-stroke aphasic patients. The protocol consisted of the assessment of picture naming (accuracy and response time) before and immediately after anodal or cathodal tDCS (2 mA, 10 minutes) and sham stimulation. Whereas anodal tDCS and sham tDCS failed to induce any changes, cathodal tDCS significantly improved the accuracy of the picture naming task by a mean of 33.6% (SEM 13.8%).     

Effects of transcranial direct current stimulation on cognitive dysfunction in multiple sclerosis

BackgroundAround 40%–70% of patients with multiple sclerosis (MS) may experience cognitive impairments during the course of their disease with detrimental effects on social and occupational activities. Transcranial direct current stimulation (tDCS has been investigated in pain, fatigue, and mood disorders related to MS, but to date, few studies have examined effects of tDCS on cognitive performance in MS.ObjectiveThe current study aimed to investigate the effects of a multi-session tDCS protocol on cognitive performance and resting-state brain electrical activities in patients with MS.MethodsTwenty-four eligible MS patients were randomly assigned to real (anodal) or sham tDCS groups. Before and after 8 consecutive daily tDCS sessions over the left dorsolateral prefrontal cortex (DLPFC), patients’ cognitive performance was assessed using the Cambridge Brain Sciences-Cognitive Platform (CBS-CP). Cortical electrical activity was also evaluated using quantitative electroencephalography (QEEG) analysis at baseline and after the intervention.ResultsCompared to the sham condition, significant improvement in reasoning and executive functions of the patients in the real tDCS group was observed. Attention was also improved considerably but not statistically significantly following real tDCS. However, no significant changes in resting-state brain activities were observed after stimulation in either group.ConclusionAnodal tDCS over the left DLPFC appears to be a promising therapeutic option for cognitive dysfunction in patients with MS. Larger studies are required to confirm these findings and to investigate underlying neuronal mechanisms.     

Effect of transcranial direct current stimulation on swallowing apraxia and cortical excitability in stroke patients

Background: Swallowing apraxia is characterized by impaired volitional swallowing but relatively preserved reflexive swallowing. Few studies are available on the effectiveness of behavioral therapy and management of the condition.

Objective: This study aimed to investigate the effect of transcranial direct current stimulation (tDCS) on swallowing apraxia and cortical activation in stroke patients.

Methods: The study included three inpatients (age 48–70 years; 1 male, 2 females; duration of stroke, 35–55 d) with post-stroke swallowing apraxia and six age-matched healthy subjects (age 45–65 years; 3 males, 3 females). Treatments were divided into two phases: Phase A and Phase B. During Phase A, the inpatients received three weeks of sham tDCS and conventional treatments. During Phase B, these patients received three weeks of anodal tDCS over the bilateral primary sensorimotor cortex (S₁M₁) of swallowing and conventional treatments. Swallowing apraxia assessments were measured in three inpatients before Phase A, before Phase B, and after Phase B. The electroencephalography (EEG) nonlinear index of approximate entropy (ApEn) was calculated for three patients and six healthy subjects.

Results: After tDCS, scores of swallowing apraxia assessments increased, and ApEn indices increased in both stimulated and non-stimulated areas.

Conclusions: Anodal tDCS might provide a useful means for recovering swallowing apraxia, and the recovery could be related to increased excitability of the swallowing cortex. Further investigations should explore the relationship between lesion size and/or lesion site and the prognosis of swallowing apraxia.

Clinical trial registry: http://www.chictr.org Registration Number: ChiCTR-TRC-14004955