Wang Li, Liu Chunyan, Hou Yue, Zhan Shuqin, Zhang Zhang, Wang Jiaojian, Wang Yuping
Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neuromodulation, Beijing, China; Beijing Institute of Brain Disorders, Capital Medical University, China.
School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China.
Sleep Med. 2020 Oct;74:254-261. doi: 10.1016/j.sleep.2020.07.026. Epub 2020 Aug 4.
To explore the neurophysiological mechanism of clinically effective transcutaneous spinal cord direct current stimulation (tsDCS) on idiopathic restless legs syndrome (RLS), structural magnetic resonance imaging (sMRI), and resting-state functional MRI (rs-fMRI) were applied to reveal the structural and functional changes in idiopathic RLS patients after tsDCS.
Thirty idiopathic RLS patients and 20 gender- and age-matched healthy controls (HC) were enrolled. All patients were randomly divided into anodal treatment group and sham treatment group and were treated with tsDCS for 2 weeks. The international RLS Rating Scale (IRLS-RS) and Pittsburgh Sleep Quality Index (PSQI) were used to evaluate the severity of RLS and sleep quality respectively. The sMRI and rs-fMRI data of anodal treatment group and HC were collected. Voxel-based morphology (VBM) and resting-state functional connectivity analysis were used to assess the change of cortical gray matter volume (GMV) and corresponding functional connectivity (FC) respectively in anodal treatment group after tsDCS treatment.
Sham treatment group showed no significant change in IRLS-RS and PSQI scores after tsDCS, while significant decrease scores were observed in anodal treatment group, and the improvement sustained up to 2 weeks. Anodal treatment group showed significant regional decrease of GMV in bilateral cuneus compared to the HC. After tsDCS treatment, the GMV in the bilateral cuneus and left ventral post central gyrus (PoCG_L) decreased significantly. The FC between bilateral cuneus and left primary visual cortex (V1_L), and between right cuneus (Cune_R) and right lingual gyrus (LG_R) increased significantly after tsDCS, whereas the FC between PoCG_L and supplementary motor area (SMA) decreased significantly. The changed FC between PoCG_L and SMA, between Cune_R and V1_L were correlated with the changed IRLS-RS.
Disturbance of sensorimotor network and visual processing network may be involved in the pathogenesis of RLS. tsDCS probably can regulate FC in the sensorimotor cortex and visual processing cortex to relieve the symptom of RLS. Continuous tsDCS may improve the symptoms of RLS patients for a long time. tsDCS probably could provide a potential non-pharmacologic treatment for idiopathic RLS patients.
为探究临床有效的经皮脊髓直流电刺激（tsDCS）治疗特发性不宁腿综合征（RLS）的神经生理机制，应用结构磁共振成像（sMRI）和静息态功能磁共振成像（rs-fMRI）揭示特发性RLS患者经tsDCS治疗后的结构和功能变化。
纳入30例特发性RLS患者和20例年龄、性别匹配的健康对照（HC）。所有患者随机分为阳极为刺激组和假刺激组，接受tsDCS治疗2周。采用国际RLS评定量表（IRLS-RS）和匹兹堡睡眠质量指数（PSQI）分别评估RLS严重程度和睡眠质量。收集阳极为刺激组和HC的sMRI和rs-fMRI数据。采用基于体素的形态学分析（VBM）和静息态功能连接分析分别评估阳极为刺激组经tsDCS治疗后皮质灰质体积（GMV）和相应功能连接（FC）的变化。
假刺激组经tsDCS治疗后IRLS-RS和PSQI评分无显著变化，而阳极为刺激组评分显著降低，且改善持续至2周。与HC相比，阳极为刺激组双侧楔叶GMV显著降低。经tsDCS治疗后，双侧楔叶和左侧中央后回腹侧（PoCG_L）的GMV显著降低。tsDCS治疗后，双侧楔叶与左侧初级视觉皮层（V1_L）之间以及右侧楔叶（Cune_R）与右侧舌回（LG_R）之间的FC显著增加，而PoCG_L与辅助运动区（SMA）之间的FC显著降低。PoCG_L与SMA之间、Cune_R与V1_L之间FC的变化与IRLS-RS的变化相关。
感觉运动网络和视觉处理网络的紊乱可能参与RLS的发病机制。tsDCS可能通过调节感觉运动皮层和视觉处理皮层的FC来缓解RLS症状。持续的tsDCS可能长期改善RLS患者的症状。tsDCS可能为特发性RLS患者提供一种潜在的非药物治疗方法。
