P300与慢性意识障碍患者经颅直流电刺激响应的相关性研究

摘要 目的：利用两组加工深度递增式变化的事件相关电位（ERP）Oddball范式探讨经颅直流电刺激（tDCS）响应慢性意识障碍患者的电生理学特征。 方法：研究纳入17例无反应觉醒综合征（UWS）和30例微意识状态（MCS）患者,对其进行两组加工深度递增式变化范式的ERP检查,后在连续10个工作日内接受20次左侧前额叶背外侧（DLPFC）区域tDCS治疗,根据改良昏迷恢复量表（CRS-R）评估结果分为响应者和非响应者,分析干预响应者一般情况特征及电生理学特征。 结果：在UWS患者中,性别、年龄、病程、接受手术情况、CRS-R评分、P300出现情况均与tDCS响应性无关（P＞0.05）;而在MCS患者中,CRS-R评分（P=0.015）和反名-正名（DO）范式中P300出现情况（P=0.005）与tDCS响应性相关,而性别、年龄、病程、接受手术情况、纯音—正名（TO）范式中P300出现情况与响应性无关（P＞0.05）。 结论：更高的CRS-R评分和分层听觉ERP范式中P300的存在,特别是DO范式中的P300成分与MCS患者的tDCS响应性有关,推测是由于DO范式中P300成分代表患者残存的语义加工处理能力,因此具有优先恢复的能力。     

经颅直流电刺激对最小意识状态患者脑功能网络的即刻效应研究

目的:探讨经颅直流电刺激(tDCS)对最小意识状态(MCS)患者静息态脑功能网络功能连接强度(FCS)的影响。方法:纳入11例符合MCS诊断标准的患者,其中男9例,女2例;脑外伤10例,脑出血1例;平均年龄37.27±8.36岁,平均病程3.36±0.12个月。所有患者入组前均给予1次静息态功能性磁共振(rs-f MRI)扫描,随后固定tDCS的电极,阳极固定在左侧前额叶背外侧区,阴极固定在眶上区,并按照下列顺序进行研究。首先给予单次安慰tDCS刺激(20min),单次安慰刺激完成后进行第2次rs-f MRI扫描,然后给予单次真tDCS刺激(20min),单次真tDCS刺激结束后进行第3次rs-f MRI扫描,每次给予rs-f MRI评估同时应用昏迷恢复量表修订版(CRS-R)进行测评。结果:与治疗前比较,单次安慰tDCS治疗后各静息态脑功能网络功能连接强度差异无显著性意义(P0.05);单次真tDCS治疗后听觉网路(右侧颞下回)、额顶网络(左侧角回及颞叶后部)的功能连接强度(FCS)显著增强(P0.05)。单次真tDCS与单次安慰tDCS比较,默认网络(右侧楔前叶)、额顶网络(右侧角回、右侧中央后回)、感觉运动网络(双侧辅助运动区)功能连接强度显著增强(P0.05)。结论:经颅直流电刺激对静息态脑功能连接产生显著影响,双侧大脑半球感觉运动网络、左侧额顶网络功能、意识水平相关的默认网络关键节点(右侧楔前叶)功能连接强度增强,可能是这种干预促进患者意识水平恢复的神经机制。     

经颅直流电刺激对最小意识状态患者脑功能网络静息态调节效应的对照研究

目的 比较经颅直流电刺激（tDCS）单次治疗对最小意识障碍（MCS）患者静息态低频振幅(ALFF)的调节效应,以探讨该疗法的作用机制。 方法 收集11例MCS患者作为研究对象,其中男9例,女2例;脑外伤10例,脑出血1例;平均年龄（37.3±8.4）岁,平均病程（3.4±0.1）个月。所有患者入组前均给予1次静息态功能性磁共振（rs-fMRI）扫描;随后给予单次tDCS治疗,将阳极固定于患者左侧前额叶背外侧区,阴极固定在眶上区,并按照下列顺序进行实验。先给予单次安慰tDCS(sham-tDCS)治疗20min,结束后进行第2次rs-fMRI扫描;然后给予单次真tDCS(real-tDCS)治疗20min,结束后进行第3次rs-fMRI扫描。在每次进行rs-fMRI检查时还采用修订版昏迷恢复量表(CRS-R)对患者意识障碍程度进行评分。 结果 与治疗前比较,入选患者经单次sham-tDCS治疗后其CRS-R评分、静息态脑功能网络ALFF均无明显变化（P>0.05）;经单次real-tDCS治疗后,发现患者默认网路（左侧楔前叶）、额顶网络（左侧额叶、右侧顶上回）、感觉运动网络（左侧辅助运动区）、皮质下（右侧丘脑、双侧尾状核）ALFF显著增强(P<0.05);而额顶网络（右侧额叶）、听觉网络（双边颞叶）ALFF显著减弱(P<0.05);与单次sham-tDCS治疗后比较,入选患者经单次real-tDCS治疗后其默认网络（右侧前额叶）ALFF显著增强(P<0.05);凸显网络（左侧岛叶）、感觉运动网络（右侧中央前回）ALFF显著减弱(P<0.05)。 结论 MCS患者经单次tDCS治疗后,发现其静息态脑功能网络ALFF活动增强,表明tDCS对神经网络神经元兴奋性具有调节作用,这可能是促进MCS患者意识恢复的神经机制之一。     

经颅直流电刺激左侧背外侧前额叶改善卒中后血管性认知功能障碍的临床观察

目的:探究经颅直流电刺激(tDCS)左侧背外侧前额叶改善卒中后患者认知功能的影响,并进一步分析tDCS改善认知功能的可能机制。方法:将30例卒中后血管性认知功能障碍患者,随机分为试验组(n=15)和对照组(n=15),2组患者均接受常规康复治疗,试验组同步行tDCS真刺激,对照组行tDCS假刺激,治疗时间为4周。在治疗前后对患者统一进行认知神经量表评估(包括MoCA、MMSE及LOTCA量表),比较两组之间认知功能。结果:治疗前两组患者各项观察指标均无显著性差异(P0.05),试验组患者的MoCA、MMSE、LOTCA认知评定量表评分较治疗前增加(P0.05),对照组患者的MMSE、LOTCA认知评定量表评分较治疗前增加(P0.05)。治疗后试验组和对照组组间相比,MoCA、MMSE、LOTCA认知评定量表差异均有显著性意义(P0.05)。结论:tDCS阳极刺激左侧背外侧前额叶有助于改善脑卒中后血管性认知功能障碍患者的认知功能。     

词联导航训练法联合经颅直流电刺激改善失语症言语流畅度及命名能力的临床观察

目的:探讨词联导航训练法(word association navigation training,WANT)结合经颅直流电刺激(tDCS)改善慢性非流畅性失语症患者言语功能的治疗方案。方法:16例非流畅性失语症患者随机分为真刺激组(8例)和伪刺激组(8例)。真刺激组tDCS阳极置于左侧Broca区,阴极置于对侧肩部,电流强度为1.0mA,2次/天,20min/次,连续10d。伪刺激组每次tDCS刺激30s后停止。两组同时实施WANT训练。治疗前后进行西方失语症成套测试(WAB)、训练图片和未训练图片命名测试。结果:治疗前后两组WAB失语商(WAB-AQ)和图片命名测试得分均有显著提高(P0.05)。治疗后真刺激组训练图片命名得分和WAB中言语流畅度得分显著提高(P0.01)。未训练图片命名测试得分和WAB-AQ较伪刺激组改善明显(P0.05)。结论:词联导航训练法结合tDCS能更显著地改善慢性非流畅性失语症患者的言语流畅度和命名能力。     

tDCS预刺激增强脑卒中认知功能障碍患者认知康复疗效的临床研究

目的:探讨经颅直流电刺激(tDCS)预刺激联合认知训练对脑卒中认知功能障碍(PSCI)患者认知功能的影响。方法:脑卒中后认知功能障碍患者76例随机分为观察组和对照组各38例,2组均采用常规药物和康复训练,观察组先给予tDCS预刺激,再进行认知训练,对照组先行认知训练,再进行tDCS刺激。治疗前和治疗4周后,采用蒙特利尔认知功能评测量表(MoCA)、改良Barthel指数(MBI)、事件相关电位P300对患者进行评定。结果:治疗4周后,2组较治疗前的MoCA及MBI评均明显提高(均P<0.05),且观察组2项评分均高于对照组(均P<0.05);2组较治疗前的P300潜伏期均明显缩短(均P<0.05),波幅均明显增加(均P<0.05),且观察组2项指标均更优于对照组(均P<0.05)。结论:tDCS预刺激后给予认知训练方案对PSCI患者认知功能、ADL能力的改善作用优于先认知训练后tDCS刺激方案。     

前后语言区经颅直流电刺激对失语症图命名作用的比较

目的:探讨前后语言区经颅直流电刺激(transcranial direct current stimulation,tDCS)对左侧额颞或额颞顶脑卒中后失语症患者图命名的疗效,以及两个脑区tDCS治疗效果是否有差异。方法:对左侧额颞或额颞顶脑卒中后4周—6个月的失语症患者20例,随机分为前语言区(Broca区)tDCS组和后语言区(Wernicke区)tDCS组各10例。Broca区组阳极tDCS放置于左侧Broca区,Wernicke区组阳极tDCS放置于左侧Wernicke区。采用A-B和B-C-A设计,A期为tDCS假刺激+语言治疗;B期为tDCS+语言治疗;C期为洗脱期1周。所有患者随机进入A-B或B-C-A期治疗。每个治疗期5天,每天2次。结果:Wernicke区tDCS不但能提高治疗项,也能够提高非治疗项图命名成绩(P0.05);Broca区tDCS对图命名有改善,但未达到显著水平(P0.08)。结论:Wernicke区tDCS能更显著地改善脑卒中后额颞损伤失语症患者的图命名能力,其原因可能是后部语言区刺激涉及了Wernicke区及其邻近的语言相关脑区有关。     

经颅直流电刺激对早期未治疗帕金森病患者认知功能及听觉事件相关电位的影响

目的 观察经颅直流电刺激（tDCS）对早期未治疗帕金森病（PD）患者认知功能及听觉事件相关电位的影响。 方法 采用随机数字表法将56例早期未治疗PD患者分为tDCS组及对照组。tDCS组给予阳极刺激,电刺激强度为2.0mA;对照组给予伪刺激,即电刺激仪在刺激（电流强度为2.0mA）30s后自动停止电流输出,其他治疗参数同真刺激。2组患者均每天治疗20min,每天治疗1次。于治疗前、治疗8周后采用蒙特利尔认知评估量表（MoCA)评估2组患者认知功能情况,同时于上述时间点检测2组患者听觉事件相关电位P50及P300潜伏期和波幅。 结果 治疗8周后发现tDCS组患者视空间/执行功能、命名、注意、语言、抽象、延迟记忆、定向和MoCA总分分别为（4.47±0.53）分、（2.13±0.57）分、（5.44±0.99）分、（1.89±0.31）分、（1.17±0.42）分、（5.73±0.67）分、（5.28±0.69）分和（26.35±5.61）分,与组内治疗前及同期对照组间差异均具有统计学意义(P<0.05);tDCS组患者听觉事件相关电位P50波幅［(2.11±1.06)μV］较组内治疗前及同期对照组均明显降低,差异具有统计学意义（均P<0.05);tDCS组患者听觉事件相关电位P300潜伏期［(314.7±33.4)ms］和波幅［(10.74±2.89)μV］与组内治疗前及同期对照组间差异均具有统计学意义（均P<0.05）。 结论 tDCS治疗能显著改善早期未治疗PD患者认知功能,同时还能降低患者听觉事件相关电位P50波幅,缩短P300潜伏期,增加P300波幅,该疗法值得临床进一步推广、应用。     

经颅直流电刺激治疗脑卒中患者注意功能障碍的随机对照单盲研究

目的:观察经颅直流电刺激(tDCS)对脑卒中患者注意功能障碍的康复疗效。方法:选取2018年7月至2020年4月在中山大学附属第三医院康复医学科收治的脑卒中注意功能障碍患者40例,用随机数字表法将其分为试验组(n=20)和对照组(n=20)。两组患者均给予注意功能训练,与此同时,试验组给予左前额叶背外侧皮质(DLPFC)的2.0mA阳极t DCS刺激,对照组给予tDCS伪刺激,持续4周。治疗前、治疗4周后分别采用简易智力状态检查量表(MMSE)评估两组患者的整体认知功能;采用数字符号测验(DST)、数字广度(DS)和连线测验(TMT)评估两组患者的注意功能,分析比较两组数据。结果:治疗4周后,两组患者的MMSE、DST、DS和TMT评分均较治疗前显著改善(P0.05),且试验组的MMSE、DST、DS的倒背、TMT的B部分错误数评分均显著优于对照组,差异均具有显著性意义(P0.05);试验组的DS的顺背、TMT的A部分错误数、时间和B部分时间评分与对照组比较,差异无显著性意义(P0.05)。结论:tDCS可有效改善脑卒中患者的注意功能障碍,值得临床推广应用。     

双重任务训练联合经颅直流电刺激对早期帕金森病患者平衡功能的影响

目的 观察双重任务训练(DTT)联合经颅直流电刺激(tDCS)对早期帕金森病(PD)患者平衡功能的影响。方法 选取符合标准的早期PD患者54例,随机分为DTT组、tDCS组和联合组,每组各18例。三组患者均予常规康复训练,DTT组进行运动-认知DTT,tDCS组采用tDCS刺激左侧DLPFC,联合组在DTT同时进行tDCS。于训练前和训练8周后,采用Tecnobody平衡测试系统和单双任务10 m步行测试评估动静态平衡控制能力及ABC量表评估活动信心。结果 训练前三组患者动静态平衡控制能力、单双任务步速及ABC量表评分差异均无统计学意义(P>0.05),经过8周训练,三组患者上述相关指标均较训练前明显改善(P<0.05);组间比较,tDCS组稳定极限、单双任务步速及ABC量表评分明显高于DTT组(P<0.05),睁、闭眼状态下运动轨迹面积均显著低于DTT组(P<0.05),联合组上述指标改善效果较其他两组更优,差异有统计学意义(P<0.05)。结论 DTT联合tDCS能有效改善早期帕金森病患者平衡控制能力,增强患者活动时维持平衡的信心,该联合训练方案值得在...     

Prefrontal direct current stimulation modulates resting EEG and event-related potentials in healthy subjects: a standardized low resolution tomography (sLORETA) study

Prefrontal transcranial direct current stimulation (tDCS) with the anode placed on the left dorsolateral prefrontal cortex (DLPFC) has been reported to enhance working memory in healthy subjects and to improve mood in major depression. However, its putative antidepressant, cognitive and behavior action is not well understood. Here, we evaluated the distribution of neuronal electrical activity changes after anodal tDCS of the left DLPFC and cathodal tDCS of the right supraorbital region using spectral power analysis and standardized low resolution tomography (sLORETA). Ten healthy subjects underwent real and sham tDCS on separate days in a double-blind, placebo-controlled cross-over trial. Anodal tDCS was applied for 20 min at 2 mA intensity over the left DLPFC, while the cathode was positioned over the contralateral supraorbital region. After tDCS, EEG was recorded during an eyes-closed resting state followed by a working memory (n-back) task. Statistical non-parametric mapping showed reduced left frontal delta activity in the real tDCS condition. Specifically, a significant reduction of mean current densities (sLORETA) for the delta band was detected in the left subgenual PFC, the anterior cingulate and in the left medial frontal gyrus. Moreover, the effect was strongest for the first 5 min (p<0.01). The following n-back task revealed a positive impact of prefrontal tDCS on error rate, accuracy and reaction time. This was accompanied by increased P2- and P3- event-related potentials (ERP) component-amplitudes for the 2-back condition at the electrode Fz. A source localization using sLORETA for the time window 250-450 ms showed enhanced activity in the left parahippocampal gyrus for the 2-back condition. These results suggest that anodal tDCS of the left DLPFC and/or cathodal tDCS of the contralateral supraorbital region may modulate regional electrical activity in the prefrontal and anterior cingulate cortex in addition to improving working memory performance.     

Direct current stimulation for minimally conscious state北大核心CSCD

BACKGROUND AND OBJECTIVE Previous studies using transeranial direct current stimulation (tDCS)have demonstrated a tran- sient improvement in consciousness with tDCS applied to the left dorsolateral prefrontal cortex (DLPFC).This study assessed the effects of an extended,home-based program of tDCS stimulation in patients in a minimally consciousness state (MCS).     

Anodal Transcranial Direct Current Stimulation Reduces Secondary Hyperalgesia Induced by low Frequency Electrical Stimulation in Healthy Volunteers

The aim of the study was to determine whether transcranial direct current stimulation (tDCS) reduced pain and signs of central sensitization induced by low frequency electrical stimulation in healthy volunteers. Thirty-nine participants received tDCS stimulation under 4 different conditions: anodal tDCS of the primary motor cortex (M1), anodal tDCS of the dorsolateral prefrontal cortex (DLPFC), anodal tDCS over M1 and DLPFC concurrently, and sham tDCS. Participants were blind to the tDCS condition. The order of the conditions was randomized among participants. Pain ratings to pinpricks, the current level that evoked moderate pain, and pain induced by low frequency electrical stimulation were assessed in the forearm by an experimenter who was blind to the tDCS conditions. Anodal tDCS at M1 increased the current level that evoked moderate pain compared to sham and other conditions. Anodal tDCS of DLPFC completely abolished secondary hyperalgesia. Unexpectedly, however, concurrent anodal tDCS over M1 and DLPFC did not reduce pain or hyperalgesia more than M1 alone or DLPFC alone. Overall, these findings suggest that anodal tDCS over M1 suppresses pain, and that anodal tDCS over DLPFC modulates secondary hyperalgesia (a sign of central sensitization) in healthy participants.PerspectiveAnodal transcranial current stimulation (atDCS) at the left motor cortex and the dorsolateral prefrontal cortex increased the electrically-evoked pain threshold and reduced secondary hyperalgesia in healthy participants. Replication of this study in chronic pain populations may open more avenues for chronic pain treatment.     

Efficacy of Transcranial Direct Current Stimulation and Repetitive Transcranial Magnetic Stimulation for Treating Fibromyalgia Syndrome: A Systematic Review

Objective: To systematically review the literature to date applying repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) for patients with fibromyalgia syndrome (FMS). Method: Electronic bibliography databases screened included PubMed, Ovid MEDLINE, PsychINFO, CINAHL, and Cochrane Library. The keyword “fibromyalgia” was combined with (“transcranial” and “stimulation”) or “TMS” or “tDCS” or “transcranial magnetic stimulation” or “transcranial direct current stimulation”. Results: Nine of 23 studies were included; brain stimulation sites comprised either the primary motor cortex (M1) or the dorsolateral prefrontal cortex (DLPFC). Five studies used rTMS (high‐frequency‐M1: 2, low‐frequency‐DLPFC: 2, high‐frequency‐DLPFC: 1), while 4 applied tDCS (anodal‐M1: 1, anodal‐M1/DLPFC: 3). Eight were double‐blinded, randomized controlled trials. Most (80%) rTMS studies that measured pain reported significant decreases, while all (100%) tDCS studies with pain measures reported significant decreases. Greater longevity of significant pain reductions was observed for excitatory M1 rTMS/tDCS. Conclusion: Studies involving excitatory rTMS/tDCS at M1 showed analogous pain reductions as well as considerably fewer side effects compared to FDA apaproved FMS pharmaceuticals. The most commonly reported side effects were mild, including transient headaches and scalp discomforts at the stimulation site. Yearly use of rTMS/tDCS regimens appears costly ($11,740 to 14,507/year); however, analyses to apapropriately weigh these costs against clinical and quality of life benefits for patients with FMS are lacking. Consequently, rTMS/tDCS should be considered when treating patients with FMS, particularly those who are unable to find adequate symptom relief with other therapies. Further work into optimal stimulation parameters and standardized outcome measures is needed to clarify associated efficacy and effectiveness.     

The impact of transcranial direct current stimulation (tDCS) combined with modified constraint-induced movement therapy (mCIMT) on upper limb function in chronic stroke: a double-blind randomized controlled trial

Purpose: This pilot double-blind sham-controlled randomized trial aimed to determine if the addition of anodal tDCS on the affected hemisphere or cathodal tDCS on unaffected hemisphere to modified constraint-induced movement therapy (mCIMT) would be superior to constraints therapy alone in improving upper limb function in chronic stroke patients. Methods: Twenty-one patients with chronic stroke were randomly assigned to receive 12 sessions of either (i) anodal, (ii) cathodal or (iii) sham tDCS combined with mCIMT. Fugl–Meyer assessment (FMA), motor activity log scale (MAL), and handgrip strength were analyzed before, immediately, and 1 month (follow-up) after the treatment. Minimal clinically important difference (mCID) was defined as an increase of ≥5.25 in the upper limb FMA. Results: An increase in the FMA scores between the baseline and post-intervention and follow-up for active tDCS group was observed, whereas no difference was observed in the sham group. At post-intervention and follow-up, when compared with the sham group, only the anodal tDCS group achieved an improvement in the FMA scores. ANOVA showed that all groups demonstrated similar improvement over time for MAL and handgrip strength. In the active tDCS groups, 7/7 (anodal tDCS) 5/7 (cathodal tDCS) of patients experienced mCID against 3/7 in the sham group. Conclusion: The results support the merit of association of mCIMT with brain stimulation to augment clinical gains in rehabilitation after stroke. However, the anodal tDCS seems to have greater impact than the cathodal tDCS in increasing the mCIMT effects on motor function of chronic stroke patients.

• Implications for Rehabilitation

• The association of mCIMT with brain stimulation improves clinical gains in rehabilitation after stroke.

• The improvement in motor recovery (assessed by Fugl–Meyer scale) was only observed after anodal tDCS.

• The modulation of damaged hemisphere demonstrated greater improvements than the modulation of unaffected hemispheres.

     

Transcranial direct current stimulation: electrode montage in stroke

Neurophysiological and computer modelling studies have shown that electrode montage is a critical parameter to determine the neuromodulatory effects of transcranial direct current stimulation (tDCS). We tested these results clinically by systematically investigating optimal tDCS electrode montage in stroke. Ten patients received in a counterbalanced and randomised order the following conditions of stimulation (i) anodal stimulation of affected M1 (primary motor cortex) and cathodal stimulation of unaffected M1 ('bilateral tDCS'); (ii) anodal stimulation of affected M1 and cathodal stimulation of contralateral supraorbital area ('anodal tDCS'); (iii) cathodal stimulation of unaffected M1 and anodal stimulation of contralateral supraorbital area ('cathodal tDCS'); (iv) anodal stimulation of affected M1 and cathodal stimulation of contralateral deltoid muscle ('extra-cephalic tDCS') and (v) sham stimulation. We used the Jebsen-Taylor Test (JTT) as a widely accepted measure of upper limb function. Bilateral tDCS, anodal tDCS and cathodal tDCS were shown to be associated with significant improvements on the JTT. Placing the reference electrode in an extracephalic position and use of sham stimulation did not induce any significant effects. This small sham controlled cross-over clinical trial is important to provide additional data on the clinical effects of tDCS in stroke and for planning and designing future large tDCS trials in patients with stroke.     

Site-specific Effects of Transcranial Direct Current Stimulation on Sleep and Pain in Fibromyalgia: A Randomized, Sham-controlled Study

Objective: To investigate whether active anodal transcranial direct current stimulation (tDCS) (of dorsolateral prefrontal cortex [DLPFC] and primary motor cortex [M1]) as compared to sham treatment is associated with changes in sleep structure in fibromyalgia. Methods: Thirty‐two patients were randomized to receive sham stimulation or active tDCS with the anode centered over M1 or DLPFC (2 mA, 20 minutes for five consecutive days). A blinded evaluator rated the clinical symptoms of fibromyalgia. All‐night polysomnography was performed before and after five consecutive sessions of tDCS. Results: Anodal tDCS had an effect on sleep and pain that was specific to the site of stimulation: such as that M1 and DLPFC treatments induced opposite effects on sleep and pain, whereas sham stimulation induced no significant sleep or pain changes. Specifically, whereas M1 treatment increased sleep efficiency (by 11.8%, P = 0.004) and decreased arousals (by 35.0%, P = 0.001), DLPFC stimulation was associated with a decrease in sleep efficiency (by 7.5%, P = 0.02), an increase in rapid eye movement (REM) and sleep latency (by 47.7%, P = 0.0002, and 133.4%, P = 0.02, respectively). In addition, a decrease in REM latency and increase in sleep efficiency were associated with an improvement in fibromyalgia symptoms (as indexed by the Fibromyalgia Impact Questionnaire). Finally, patients with higher body mass index had the worse sleep outcome as indexed by sleep efficiency changes after M1 stimulation. Interpretation: Our findings suggest that one possible mechanism to explain the therapeutic effects of tDCS in fibromyalgia is via sleep modulation that is specific to modulation of primary M1 activity. ?     

标准化体位变换联合前庭刺激对严重意识障碍的促醒作用

目的:探讨标准化体位变换联合前庭神经刺激方案对重型颅脑损伤后严重意识障碍患者的促醒效果。方法:入选20例重型颅脑损伤后严重意识障碍患者,随机分入观察组与对照组各10例。2组患者均接受常规康复治疗,观察组在常规康复治疗基础上增加标准化的体位变换联合前庭神经刺激治疗方案进行治疗,使用脑电图(EEG)改良分级标准对治疗前、治疗2个月后患者脑电状态进行评估,同时使用昏迷恢复量表(CRS-R)分别于治疗前、治疗2个月后以及治疗后3个月随访对患者的意识状态进行评估,对比分析2组患者的脑功能改善情况。结果:治疗2个月后及3个月随访,2组CRS-R评分均较治疗前显著提高(P0.01,0.05);治疗2个月后,观察组CRS-R评分更高于对照组(P0.05),治疗后3个月随访,CRS-R评分组间差异无统计学意义。治疗2个月后,2组EEG分级均较治疗前显著改善(P0.05),但组间对比未见显著差异(P0.05)。结论:标准化体位变换联合前庭刺激治疗作为一种强化的专项治疗,能够更有效改善严重意识障碍患者的脑功能,是一种较好的颅脑损伤后意识障碍患者的促醒治疗方法。