Koski Lisa, Kolivakis Theodore, Yu Camilla, Chen Jen-Kai, Delaney Scott, Ptito Alain
1 Department of Psychology, McGill University Health Center (MUHC), Department of Neurology/Neurosurgery and Department of Psychology, McGill University, and Mental Illness and Addiction Axis, Research Institute of the MUHC, McGill University , Montreal, Quebec, Canada .
J Neurotrauma. 2015 Jan 1;32(1):38-44. doi: 10.1089/neu.2014.3449.
Mild traumatic brain injury (mTBI) is typically followed by various postconcussive symptoms (PCS), including headache, depression, and cognitive deficits. In 15-25% of cases, PCS persists beyond the usual 3-month recovery period, interfering with activities of daily living and responding poorly to pharmacotherapy. We tested the safety, tolerability, and efficacy of repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) for alleviating PCS. Fifteen eligible patients with mTBI and PCS > 3 months postinjury consented to 20 sessions of rTMS (20 × 5-sec trains; 10 Hz at 110% threshold), with clinical and functional magnetic resonance imaging (fMRI) assessments before and after intervention and clinical assessment at 3-month follow-up. Primary outcomes were tolerability, safety, and efficacy, as measured with the PCS Scale. Secondary outcomes included the Cognitive Symptoms Questionnaire, neuropsychological test performance, and working memory task-associated activity as assessed with fMRI. Twelve patients completed all sessions. Three withdrew because of worsening symptoms or for an unrelated event. Stimulation intensity was increased gradually across sessions, and all subjects tolerated the protocol by the sixth session. Commonly reported side effects among completers were increased headache (n = 3) and greater sleep disturbance (n = 3). Participants also reported positive outcomes such as less sleep disturbance (n = 3), and better mental focus (n = 3). On average, PCS scores declined by 14.6 points (p = 0.009) and fMRI task-related activation peaks in the DLPFC increased after rTMS. rTMS is safe, tolerated by most patients with mTBI, and associated with both a reduction in severity of PCS and an increase in task-related activations in DLPFC. Assessment of this intervention in a randomized, control trial is warranted.
轻度创伤性脑损伤（mTBI）通常会伴随各种脑震荡后症状（PCS），包括头痛、抑郁和认知缺陷。在15%至25%的病例中，PCS会持续超过通常的3个月恢复期，干扰日常生活活动，并且对药物治疗反应不佳。我们测试了经颅磁刺激（rTMS）作用于左侧背外侧前额叶皮质（DLPFC）以减轻PCS的安全性、耐受性和疗效。15名符合条件的mTBI患者且PCS在受伤后超过3个月，同意接受20次rTMS治疗（20次，每次5秒脉冲串；10赫兹，强度为阈值的110%），在干预前后进行临床和功能磁共振成像（fMRI）评估，并在3个月随访时进行临床评估。主要结局是用PCS量表测量的耐受性、安全性和疗效。次要结局包括认知症状问卷、神经心理学测试表现以及用fMRI评估的与工作记忆任务相关的活动。12名患者完成了所有疗程。3名患者因症状恶化或发生无关事件而退出。各疗程的刺激强度逐渐增加，所有受试者到第六个疗程时都能耐受该方案。完成治疗者中常见的副作用是头痛加剧（n = 3）和睡眠障碍加重（n = 3）。参与者还报告了积极的结果，如睡眠障碍减轻（n = 3）和精神注意力改善（n = 3）。平均而言，rTMS治疗后PCS评分下降了14.6分（p = 0.009），DLPFC中与fMRI任务相关的激活峰值增加。rTMS是安全的，大多数mTBI患者能够耐受，并且与PCS严重程度降低以及DLPFC中与任务相关的激活增加有关。有必要在随机对照试验中对这种干预措施进行评估。
