TDCS modulates cortical excitability in patients with disorders of consciousness.
TDCS modulates cortical excitability in patients with disorders of consciousness.
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TDCS 调节意识障碍患者的皮质兴奋性
DOI：
10.1016/j.nicl.2017.01.025
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Li X
中科院分区：
文献类型：
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作者：
Bai Y;Xia X;Kang J;Yang Y;He J;Li X
据报道，经颅直流电刺激（tDCS）是一种很有希望改善意识障碍（DOC）患者意识的技术然而，目前还没有直接的电生理证据证明tDCS对DOC患者的疗效。因此，我们旨在测量tDCS在DOC患者中引起的皮质兴奋性变化，寻找支持tDCS治疗DOC患者疗效的电生理证据。在这项研究中，我们招募了16例DOC患者，包括9例植物人状态（VS）3和7例最低意识状态（MCS）4（6名女性和10名男性）。采用TMS-EEG评估左背外侧前额叶皮层阳极tDCS 20分钟后皮层兴奋性的变化。在4个时间间隔（0 - 100ms、100 - 200ms、200 - 300ms、300- 400ms），计算大脑整体兴奋性，量化颞叶皮层兴奋性。然后在显著改变的时间窗（额、左/右半球、中脑和后脑）中研究局部大脑兴奋性。与基线和假刺激相比，我们发现MCS患者的大脑整体兴奋性在早期时间窗（0-100和100-200 ms）增加；VS患者整体脑兴奋性在0 ~ 100 ms间期升高，在300 ~ 400 ms间期降低。结果表明，tDCS可有效调节DOC患者的皮质兴奋性；MCS和vs患者在时间和空间域的兴奋性变化不同，TDCS可以改变DOC患者的大脑兴奋性。采用颅磁-脑电图（TMS-EEG）评价DOC患者皮层兴奋性的变化。TDCS可引起DOC患者明显的皮质兴奋性改变。TDCS诱导的中脑区和中脑区兴奋性时空变化不同。
Transcranial direct current stimulation (tDCS)1 has been reported to be a promising technique for consciousness improvement for patients with disorders of consciousness (DOC).2 However, there has been no direct electrophysiological evidence to demonstrate the efficacy of tDCS on patients with DOC. Therefore, we aim to measure the cortical excitability changes induced by tDCS in patients with DOC, to find electrophysiological evidence supporting the therapeutic efficacy of tDCS on patients with DOC. In this study, we enrolled sixteen patients with DOC, including nine vegetative state (VS)3 and seven minimally conscious state (MCS)4 (six females and ten males). TMS-EEG was applied to assess cortical excitability changes after twenty minutes of anodal tDCS of the left dorsolateral prefrontal cortex. Global cerebral excitability were calculated to quantify cortical excitability in the temporal domain: four time intervals (0–100, 100–200, 200–300, 300-400 ms). Then local cerebral excitability in the significantly altered time windows were investigated (frontal, left/right hemispheres, central, and posterior). Compared to baseline and sham stimulation, we found that global cerebral excitability increased in early time windows (0–100 and 100-200 ms) for patients with MCS; for the patients with VS, global cerebral excitability increased in the 0-100 ms interval but decreased in the 300-400 ms interval. The local cerebral excitability was significantly different between MCS and VS. The results indicated that tDCS can effectively modulate the cortical excitability of patients with DOC; and the changes in excitability in temporal and spatial domains are different between patients with MCS and those with VS. TDCS was used to alter cerebral excitability in patients of DOC. TMS-EEG was used to evaluate cortical excitability changes in patients of DOC. TDCS could induce significant cortical excitability changes in patients of DOC. TDCS induced different temporal-spatial excitability changes between MCS and VS.