经颅直流电刺激在颞叶内侧癫痫和海马硬化中的应用。
Transcranial Direct Current Stimulation in Mesial Temporal Lobe Epilepsy and Hippocampal Sclerosis.
机构信息
Clinical Neurophysiology Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Av. Insurgentes Sur 3877, Col. La Fama, Tlalpan, Ciudad de México 14269, Mexico; Dresden International University, Division of Health Care Sciences, Center for Clinical Research and Management Education, Freiberger Straße 37, 01067 Dresden, Germany.
Clinical Neurophysiology Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Av. Insurgentes Sur 3877, Col. La Fama, Tlalpan, Ciudad de México 14269, Mexico.
出版信息
Brain Stimul. 2017 Jan-Feb;10(1):28-35. doi: 10.1016/j.brs.2016.08.013. Epub 2016 Aug 31.
BACKGROUND
Transcranial direct current stimulation (tDCS) has been evaluated in medication refractory epilepsy patients. The results have been inconclusive and protocols have varied between studies.
OBJECTIVE
To evaluate the safety and efficacy of two protocols of tDCS in adult patients with mesial temporal lobe epilepsy and hippocampal sclerosis (MTLE-HS).
METHODS
This is a randomized placebo-controlled, double-blinded clinical trial, with 3 arms, 3 sessions, 5 sessions and placebo stimulation. Frequency of seizures (SZs), interictal epileptiform discharges (IEDs) and adverse effects (AEs) were registered before and after treatment, and at 30 and 60 days follow-up. Descriptive statistics, k-related samples, Friedman's test, and relative risk (RR) estimation were used for analysis.
RESULTS
We included twenty-eight subjects (3d n = 12, 5d n = 8, placebo n = 8), 16/28 (57%) men, age 37.8(±10.9) years old. There was a significant reduction of the frequency of SZs at one (p = 0.001) and two (p = 0.0001) months following cathodal tDCS compared to baseline in the 3 arms (p = 0.0001). The mean reduction of SZ frequency at two months in both active groups was significantly higher than placebo (-48% vs. -6.25%, p < 0.008). At 3 days (-43.4% vs. -6.25%, p < 0.007) and 5 days (-54.6% vs. -6.25%, p < 0.010) individual groups showed a greater reduction of SZs. A significant IED reduction effect was found between baseline and immediately after interventions (p = 0.041) in all groups. Side effects were minor.
CONCLUSIONS
Cathodal tDCS technique of 3 and 5 sessions decreased the frequency of SZs and IEDs (between baseline and immediately post-tDCS) in adult patients with MTLE-HS compared to placebo tDCS.
背景
经颅直流电刺激（tDCS）已在药物难治性癫痫患者中进行了评估。结果尚无定论，并且研究之间的方案也有所不同。
目的
评估两种 tDCS 方案在伴有内侧颞叶癫痫和海马硬化（MTLE-HS）的成年患者中的安全性和有效性。
方法
这是一项随机安慰剂对照、双盲临床试验，有 3 个组，即 3 次治疗组、5 次治疗组和安慰剂刺激组。在治疗前后以及治疗后 30 和 60 天，记录癫痫发作频率（SZs）、间发性癫痫样放电（IEDs）和不良反应（AEs）。采用描述性统计、k 相关样本、Friedman 检验和相对风险（RR）估计进行分析。
结果
我们纳入了 28 名受试者（3 次治疗组 n=12、5 次治疗组 n=8、安慰剂组 n=8），其中 16/28（57%）为男性，年龄 37.8（±10.9）岁。与基线相比，3 个组在 1 个月（p=0.001）和 2 个月（p=0.0001）时 SZ 频率均显著降低（p=0.0001）。在 2 个月时，两个活性组的 SZ 频率的平均降低均显著高于安慰剂组（-48%对-6.25%，p<0.008）。在 3 天（-43.4%对-6.25%，p<0.007）和 5 天（-54.6%对-6.25%，p<0.010）时，个体组显示出更大的 SZ 降低。所有组在基线和干预后即刻均显示出 IED 显著减少（p=0.041）。不良反应轻微。
结论
与安慰剂 tDCS 相比，3 次和 5 次治疗的阴极 tDCS 技术降低了伴有 MTLE-HS 的成年患者的 SZ 频率和 IEDs（与基线相比和即刻后 tDCS）。
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