经颅直流电刺激在意识障碍中的应用:综述
Transcranial direct current stimulation in disorders of consciousness: a review.
作者信息
Zhang Ye, Song Weiqun
机构信息
a Department of Rehabilitation Medicine , Xuan Wu Hospital, Capital Medical University , Beijing , China.
出版信息
Int J Neurosci. 2018 Mar;128(3):255-261. doi: 10.1080/00207454.2017.1381094. Epub 2017 Oct 3.
It is a challenge to evaluate and treat the patients with disorders of consciousness (DOC) in the clinic. Due to the huge costs of prolonged intensive care, the management of these patients raises great financial strain on families and important ethical questions. To date, several studies have attempted to specifically detect pharmacologic or non-pharmacologic effectiveness, and until now, there are no evidence-based guidelines about the treatment of patients with DOC. Recently, because of ethical and procedural limitations on the use of invasive stimulation techniques, non-invasive brain stimulation, such as the transcranial direct current stimulation (tDCS), has been investigated for improving the level of consciousness in patients with DOC. This paper briefly reviewed the key clinical investigations using tDCS with the aim of better understanding the pathophysiological mechanism of DOC or improving the level of consciousness in patients with DOC. In conclusion, some beneficial results of tDCS protocols have been shown in patients with DOC, especially targeting the left dorsolateral prefrontal cortex in minimally conscious state. However, these investigations must be continued in larger controlled, randomized, blinded and prospective studies in order to transpose these preliminary data to clinical effects. Furthermore, an encouraging perspective for the future is the combination of neurophysiological or functional neuroimaging techniques with non-invasive brain stimulation to evaluate neuro-modulatory effects of stimulation in patients with DOC.
在临床上,评估和治疗意识障碍(DOC)患者是一项挑战。由于长期重症监护的巨大成本,这些患者的管理给家庭带来了巨大的经济压力,并引发了重要的伦理问题。迄今为止,已有多项研究试图专门检测药物或非药物治疗的效果,而到目前为止,尚无关于DOC患者治疗的循证指南。最近,由于侵入性刺激技术在使用上存在伦理和程序限制,非侵入性脑刺激,如经颅直流电刺激(tDCS),已被用于研究改善DOC患者的意识水平。本文简要回顾了使用tDCS的关键临床研究,旨在更好地理解DOC的病理生理机制或提高DOC患者的意识水平。总之,tDCS方案在DOC患者中已显示出一些有益结果,特别是针对最低意识状态下的左侧背外侧前额叶皮层。然而,这些研究必须在更大规模的对照、随机、双盲和前瞻性研究中继续进行,以便将这些初步数据转化为临床效果。此外,未来一个令人鼓舞的前景是将神经生理学或功能性神经影像学技术与非侵入性脑刺激相结合,以评估刺激对DOC患者的神经调节作用。