Zaninotto Ana Luiza, El-Hagrassy Mirret M, Green Jordan R, Babo Maíra, Paglioni Vanessa Maria, Benute Glaucia Guerra, Paiva Wellingson Silva
Speech and Feeding Disorders Lab, MGH Institute of Health Professions (MGH IHP), Boston, USA.
Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School (HMS), Boston, USA.
Dement Neuropsychol. 2019 Apr-Jun;13(2):172-179. doi: 10.1590/1980-57642018dn13-020005.
Traumatic brain injury (TBI) is a major cause of chronic disability. Less than a quarter of moderate and severe TBI patients improved in their cognition within 5 years. Non-invasive brain stimulation, including transcranial direct current stimulation (tDCS), may help neurorehabilitation by boosting adaptive neuroplasticity and reducing pathological sequelae following TBI.
we searched MEDLINE/PubMed and Web of Science databases. We used Jadad scale to assess methodological assumptions.
the 14 papers included reported different study designs; 2 studies were open-label, 9 were crossover randomized clinical trials (RCTs), and 3 were parallel group RCTs. Most studies used anodal tDCS of the left dorsolateral prefrontal cortex, but montages and stimulation parameters varied. Multiple studies showed improved coma recovery scales in disorders of consciousness, and improved cognition on neuropsychological assessments. Some studies showed changes in neurophysiologic measures (electroencephalography (EEG) and transcranial magnetic stimulation (TMS), correlating with clinical findings. The main methodological biases were lack of blinding and randomization reports.
tDCS is a safe, non-invasive neuromodulatory technique that can be given as monotherapy but may be best combined with other therapeutic strategies (such as cognitive rehabilitation and physical therapy) to further improve clinical cognitive and motor outcomes. EEG and TMS may help guide research due to their roles as biomarkers for neuroplasticity.
创伤性脑损伤（TBI）是导致慢性残疾的主要原因。不到四分之一的中重度TBI患者在5年内认知功能得到改善。非侵入性脑刺激，包括经颅直流电刺激（tDCS），可能通过增强适应性神经可塑性和减少TBI后的病理后遗症来帮助神经康复。
我们检索了MEDLINE/PubMed和科学网数据库。我们使用Jadad量表来评估方法学假设。
纳入的14篇论文报告了不同的研究设计；2项研究为开放标签，9项为交叉随机临床试验（RCT），3项为平行组RCT。大多数研究使用左侧背外侧前额叶皮层的阳极tDCS，但电极组合和刺激参数各不相同。多项研究表明，意识障碍患者的昏迷恢复量表有所改善，神经心理学评估中的认知功能也有所改善。一些研究显示神经生理学指标（脑电图（EEG）和经颅磁刺激（TMS））发生变化，与临床结果相关。主要的方法学偏倚是缺乏盲法和随机化报告。
tDCS是一种安全的非侵入性神经调节技术，可作为单一疗法使用，但可能最好与其他治疗策略（如认知康复和物理治疗）相结合，以进一步改善临床认知和运动结果。EEG和TMS可能因其作为神经可塑性生物标志物的作用而有助于指导研究。
