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。

A study on resting state fMRI of brain function network in patients with minimally conscious state by transcranial direct current stimulation

Abstract Objective: To investigate the effect of transcranial direct current stimulation (tDCS) on the functional connectivity strength (FCS) of rest brain function network in patients with minimal conscious state (MCS) so as to explore the mechanism of this treatment. Method: Eleven MCS-compliant patients were involved. Subjects were given an rs-fMRI assessment prior to the single tDCS treatment, followed by a 20-minute min single sham-tDCS treatment at a time. After single-sham stimulation, a second time rs-fMRI assessment test will be given to subjects, followed by a real-tDCS treatment for 20-minute min. Eventually, a third time rs-fMRI assessment test will be given to subjects. Result: Before treatment and after single sham-tDCS, no significant statistical difference was shown (P>0.05). After single real-tDCS, FCS of auditory network (right inferior temporal gyrus) and the frontal-parietal network was significantly higher than that before treatment (P<0.05). After single real-tDCS, the default network (right precuneus), the frontal-parietal network (right angular gyrus and right postcentral gyrus central back), sensory motor network (bilateral supplementary motor area) FCS was significantly enhanced compared to that after single sham-tDCS (P<0.05). Conclusion: tDCS has a significant effect on MCS brain function network FCS by synchronous and non-synchronous regulatory effect (distant effect) to MCS brain function network. Single real-tDCS treatment can adjust the left side of the top of the network to enhance the FCS and can adjust key nodes of consciousness level related to the role in the recovery of consciousness.