Zhang Xu, Liu Baohu, Li Nan, Li Yuanyuan, Hou Jun, Duan Guoping, Wu Dongyu
Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China.
Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China.
Front Neurosci. 2020 May 20;14:386. doi: 10.3389/fnins.2020.00386. eCollection 2020.
Many post-traumatic patients with minimally conscious state are complicated by psychomotor inhibition state (PIS), which impedes further rehabilitation. The treatment of PIS is not satisfactory. This pilot study aimed to investigate effects of anodal transcranial direct current stimulation (A-tDCS) on PIS in post-traumatic patients and examine the altered cortical activation after tDCS using non-linear electroencephalogram (EEG).
The study included 10 patients with post-traumatic PIS. An A-B design was used. The patients received 4 weeks of sham tDCS during Phase A, and they received A-tDCS over the prefrontal area and left dorsolateral prefrontal cortex (DLPFC) for 4 weeks (40 sessions) during Phase B. Conventional treatments were administered throughout both phases. JFK Coma Recovery Scale-Revised (CRS-R), apathy evaluation scale (AES), and the EEG non-linear indices of approximate entropy (ApEn) and cross approximate entropy (C-ApEn) were measured before Phase A, before Phase B, and after Phase B.
After A-tDCS treatment, CRS-R and AES were improved significantly. ApEn and C-ApEn results showed that the local cortical connection of bilateral sensorimotor areas with their peripheral areas could be activated by affected painful stimuli, while bilateral cerebral hemispheres could be activated by the unaffected painful-stimuli condition. Linear regression analysis revealed that the affected sensorimotor cortex excitability and unaffected local and distant cortical networks connecting the sensorimotor area to the prefrontal area play a major role in AES improvement.
A-tDCS over the prefrontal area and left DLPFC improves PIS. The recovery might be related to increased excitability in local and distant cortical networks connecting the sensorimotor area to the prefrontal area. Thus, tDCS may be an alternative treatment for post-traumatic PIS.
许多创伤后处于最小意识状态的患者并发精神运动抑制状态（PIS），这阻碍了进一步的康复。PIS的治疗效果并不理想。这项初步研究旨在调查阳极经颅直流电刺激（A-tDCS）对创伤后患者PIS的影响，并使用非线性脑电图（EEG）检查tDCS后皮质激活的变化。
该研究纳入了10例创伤后PIS患者。采用A-B设计。患者在A阶段接受4周的假tDCS，在B阶段接受前额叶区域和左侧背外侧前额叶皮质（DLPFC）的A-tDCS治疗4周（40次）。在两个阶段均给予常规治疗。在A阶段前、B阶段前和B阶段后测量JFK昏迷恢复量表修订版（CRS-R）、淡漠评估量表（AES）以及近似熵（ApEn）和交叉近似熵（C-ApEn）的EEG非线性指标。
A-tDCS治疗后，CRS-R和AES显著改善。ApEn和C-ApEn结果表明，双侧感觉运动区域与其周边区域的局部皮质连接可被受影响的疼痛刺激激活，而双侧大脑半球可被未受影响的疼痛刺激条件激活。线性回归分析显示，受影响的感觉运动皮质兴奋性以及连接感觉运动区域与前额叶区域的未受影响的局部和远距离皮质网络在AES改善中起主要作用。
前额叶区域和左侧DLPFC的A-tDCS可改善PIS。恢复可能与连接感觉运动区域与前额叶区域的局部和远距离皮质网络兴奋性增加有关。因此，tDCS可能是创伤后PIS的一种替代治疗方法。
