Effects of 10 Hz Repetitive Transcranial Magnetic Stimulation of the Left Dorsolateral Prefrontal Cortex in Disorders of Consciousness.
Effects of 10 Hz Repetitive Transcranial Magnetic Stimulation of the Left Dorsolateral Prefrontal Cortex in Disorders of Consciousness.
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DOI：
10.3389/fneur.2017.00182
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发表时间：
2017
影响因子：
3.4
通讯作者：
He J
中科院分区：
文献类型：
--
作者：
Xia X;Bai Y;Zhou Y;Yang Y;Xu R;Gao X;Li X;He J
虽然重复性经颅磁刺激（rTMS）已被应用于治疗意识障碍（DOC）患者，但尚未提出标准化的刺激方案，其治疗效果也不一致。评估rTMS在改善持续性最低意识状态（MCS）或无反应性清醒综合征（UWS）（以前称为植物人状态（VS））患者的意识方面的疗效。对选定的受试者进行前瞻性单盲研究。共纳入16例慢性DOC患者（5例MCS和11例VS/UWS）。所有患者在左背外侧前额叶皮层（DLPFC）接受10 Hz的rTMS，每天一次，连续20天。每天一次的刺激包括1000次脉冲（10次10赫兹的脉冲，重复10次，每次间隔60秒，每次11分钟和40秒）。主要结果测量是JFK昏迷恢复量表-修订（CRS-R）量表总分的变化。其他措施是干预结束后护理人员的印象，使用临床整体印象改善（CGI-I）量表进行评估。所有5例MCS患者和11例VS/UWS患者中的4例CRS-R评分均升高，所有参与者的CRS-R评分均较基线显著升高（p = 0.007）。然而，MCS患者的改善更为显著（p = 0.042），而VS/UWS患者的改善更为显著（p = 0.066）。根据CGI-I评分，2例患者明显改善，2例改善，6例轻度改善，6例无变化，无恶化。CGI-I结果与CRS-R评分的升高有良好的一致性。应用10hz多时段rTMS治疗左DLPFC对DOC患者，特别是MCS患者的康复有很大的帮助。需要更大样本量的队列进一步验证。
While repetitive transcranial magnetic stimulation (rTMS) has been applied in treatment of patients with disorders of consciousness (DOC), a standardized stimulation protocol has not been proposed, and its therapeutic effects are inconsistently documented. To assess the efficacy of rTMS in improving consciousness in patients with persistent minimally conscious state (MCS) or unresponsive wakefulness syndrome (UWS), previously known as vegetative state (VS). A prospective single-blinded study, with selected subjects, was carried out. In total, 16 patients (5 MCS and 11 VS/UWS) with chronic DOC were included. All patients received active 10 Hz rTMS at the left dorsolateral prefrontal cortex (DLPFC), at one session per day, for 20 consecutive days. A single daily session of stimulation consisted of 1,000 pulses (10 s of 10 Hz trains; repeated 10 times with an inter-train interval of 60 s; and 11 min and 40 s for total session). The main outcome measures were changes in the total score on the JFK Coma Recovery Scale-Revised (CRS-R) scale. Additional measures were the impressions of caregivers after the conclusion of the interventions, which were assessed using the Clinical Global Impression-Improvement (CGI-I) scale. The CRS-R scores were increased in all 5 MCS patients and 4 of 11 VS/UWS patients, while a significant enhancement of CRS-R scores was observed compared to the baseline in all participants (p = 0.007). However, the improvement was more notable in MCS patients (p = 0.042) than their VS/UWS counterparts (p = 0.066). Based on the CGI-I scores, two patients improved considerably, two improved, six minimally improved, six experienced no change, and none deteriorated. Good concordance was seen between the CGI-I result and the increases in CRS-R scores. Treatment of 10 Hz multisession rTMS applied to the left DLPFC is promising for the rehabilitation of DOC patients, especially those in MCS. Further validation with a cohort of a larger sample size is required.