Liu Anli, Bryant Andrew, Jefferson Ashlie, Friedman Daniel, Minhas Preet, Barnard Sarah, Barr William, Thesen Thomas, O'Connor Margaret, Shafi Mouhsin, Herman Susan, Devinsky Orrin, Pascual-Leone Alvaro, Schachter Steven
NYU Comprehensive Epilepsy Center, USA; NYU School of Medicine, USA; Berenson Allen Center for Non-invasive Brain Stimulation, Division of Cognitive Neurology, USA.
NYU Comprehensive Epilepsy Center, USA; NYU Graduate School of Psychology, USA.
Epilepsy Behav. 2016 Feb;55:11-20. doi: 10.1016/j.yebeh.2015.10.032. Epub 2015 Dec 22.
Depression and memory dysfunction significantly impact the quality of life of patients with epilepsy. Current therapies for these cognitive and psychiatric comorbidities are limited. We explored the efficacy and safety of transcranial direct current stimulation (TDCS) for treating depression and memory dysfunction in patients with temporal lobe epilepsy (TLE).
Thirty-seven (37) adults with well-controlled TLE were enrolled in a double-blinded, sham-controlled, randomized, parallel-group study of 5 days of fixed-dose (2 mA, 20 min) TDCS. Subjects were randomized to receive either real or sham TDCS, both delivered over the left dorsolateral prefrontal cortex. Patients received neuropsychological testing and a 20-minute scalp EEG at baseline immediately after the TDCS course and at 2- and 4-week follow-up.
There was improvement in depression scores immediately after real TDCS, but not sham TDCS, as measured by changes in the Beck Depression Inventory (BDI change: -1.68 vs. 1.27, p<0.05) and NDDI-E (-0.83 vs. 0.9091, p=0.05). There was no difference between the groups at the 2- or 4-week follow-up. There was no effect on delayed or working memory performance. Transcranial direct current stimulation was well-tolerated and did not increase seizure frequency or interictal discharge frequency. Transcranial direct current stimulation induced an increase in delta frequency band power over the frontal region and delta, alpha, and theta band power in the occipital region after real stimulation compared to sham stimulation, although the difference did not reach statistical significance.
This study provides evidence for the use of TDCS as a safe and well-tolerated nonpharmacologic approach to improving depressive symptoms in patients with well-controlled TLE. However, there were no changes in memory function immediately following or persisting after a stimulation course. Further studies may determine optimal stimulation parameters for maximal mood benefit.
抑郁症和记忆功能障碍显著影响癫痫患者的生活质量。目前针对这些认知和精神共病的治疗方法有限。我们探讨了经颅直流电刺激（TDCS）治疗颞叶癫痫（TLE）患者抑郁症和记忆功能障碍的疗效及安全性。
37名TLE病情得到良好控制的成年人参与了一项为期5天的固定剂量（2毫安，20分钟）TDCS双盲、假刺激对照、随机平行组研究。受试者被随机分配接受真正的或假的TDCS，均通过左侧背外侧前额叶皮层进行。患者在基线时、TDCS疗程结束后立即以及在2周和4周随访时接受神经心理学测试和20分钟的头皮脑电图检查。
通过贝克抑郁量表（BDI变化：-1.68对1.27，p<0.05）和NDDI-E（-0.83对0.9091，p=0.05）测量，真正的TDCS后抑郁症评分立即改善，但假刺激组没有。在2周或4周随访时两组之间没有差异。对延迟或工作记忆表现没有影响。经颅直流电刺激耐受性良好，没有增加癫痫发作频率或发作间期放电频率。与假刺激相比，真正刺激后经颅直流电刺激导致额叶区域的δ频段功率以及枕叶区域的δ、α和θ频段功率增加，尽管差异未达到统计学意义。
本研究为使用TDCS作为一种安全且耐受性良好的非药物方法来改善TLE病情得到良好控制患者的抑郁症状提供了证据。然而，在刺激疗程后立即或持续存在的记忆功能方面没有变化。进一步的研究可能会确定最大情绪受益的最佳刺激参数。
