Clinical utility of brain stimulation modalities following traumatic brain injury: current evidence.
Clinical utility of brain stimulation modalities following traumatic brain injury: current evidence.
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DOI：
10.2147/ndt.s65816
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发表时间：
2015
影响因子：
3.2
通讯作者：
Fregni F
中科院分区：
文献类型：
--
作者：
Li S;Zaninotto AL;Neville IS;Paiva WS;Nunn D;Fregni F
创伤性脑损伤（TBI）仍然是造成残疾的主要原因，也是世界范围内的一个主要公共卫生问题。本文综述了脑外伤的神经生理学，以及脑刺激促进脑外伤恢复的临床应用的基本原理和证据现状，特别是在意识、认知功能、运动损伤和精神疾病方面。我们讨论了不同的脑刺激技术的机制，包括主要的非侵入性和侵入性刺激。到目前为止，大多数非侵入性脑刺激干预都是非靶向性的，并且主要集中在创伤性脑损伤后的慢性恢复阶段。在急性期，关于脑刺激改善功能结局的有效性和安全性的现有证据有限。比较不同技术的研究，经颅直流电刺激是目前设计合理的临床试验数量最多的干预手段，但总数仍然较少。我们认识到需要进行更大规模的目标神经可塑性调节研究，以充分探索脑刺激在不同恢复阶段对TBI恢复的影响。
Traumatic brain injury (TBI) remains the main cause of disability and a major public health problem worldwide. This review focuses on the neurophysiology of TBI, and the rationale and current state of evidence of clinical application of brain stimulation to promote TBI recovery, particularly on consciousness, cognitive function, motor impairments, and psychiatric conditions. We discuss the mechanisms of different brain stimulation techniques including major noninvasive and invasive stimulations. Thus far, most noninvasive brain stimulation interventions have been nontargeted and focused on the chronic phase of recovery after TBI. In the acute stages, there is limited available evidence of the efficacy and safety of brain stimulation to improve functional outcomes. Comparing the studies across different techniques, transcranial direct current stimulation is the intervention that currently has the higher number of properly designed clinical trials, though total number is still small. We recognize the need for larger studies with target neuroplasticity modulation to fully explore the benefits of brain stimulation to effect TBI recovery during different stages of recovery.