一项探索联合金刚烷胺和重复经颅磁刺激作为 TBI 后意识障碍患者干预措施的优势的初步试验。
A Pilot Trial Examining the Merits of Combining Amantadine and Repetitive Transcranial Magnetic Stimulation as an Intervention for Persons With Disordered Consciousness After TBI.
机构信息
The Department of Veterans Affairs (VA), Center for Innovation in Complex Chronic Healthcare & Research Service, Edward Hines Jr VA Hospital, Hines, Illinois (Drs Bender Pape, Herrold, Livengood, Guernon, Walsh, Kletzel, and Pacheco); Departments of Physical Medicine and Rehabilitation (Drs Bender Pape and Livengood), Neurological Surgery (Dr Rosenow), Radiology (Mr Higgins and Dr Parrish), and Psychiatry and Behavioral Sciences (Dr Herrold), Northwestern University Feinberg School of Medicine, Chicago, Illinois; Research Department, Marianjoy Rehabilitation Hospital-part of Northwestern Medicine, Wheaton, Illinois (Dr Guernon); Department of Psychiatry, Biostatistical Research Center, Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago (Drs R. Bhaumik and D. K. Bhaumik); Cooperative Studies Program Coordinating Center, Research Service, Edward Hines Jr VA Hospital, Hines, Illinois (Dr D. K. Bhaumik); Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington (Ms Weaver and Dr Mallinson); Department of Neurology, Edward Hines Jr VA Hospital, Hines, Illinois, and Department of Neurology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois (Dr Patil); Chicago Medical School, Rosalind Franklin University of Science and Medicine, and Department of Radiology and Nuclear Medicine, Captain James A Lovell Federal Health Care Center, North Chicago, Illinois (Dr Conneely).
出版信息
J Head Trauma Rehabil. 2020 Nov-Dec;35(6):371-387. doi: 10.1097/HTR.0000000000000634.
OBJECTIVE
Report pilot findings of neurobehavioral gains and network changes observed in persons with disordered consciousness (DoC) who received repetitive transcranial magnetic stimulation (rTMS) or amantadine (AMA), and then rTMS+AMA.
PARTICIPANTS
Four persons with DoC 1 to 15 years after traumatic brain injury (TBI).
DESIGN
Alternate treatment-order, within-subject, baseline-controlled trial.
MAIN MEASURES
For group and individual neurobehavioral analyses, predetermined thresholds, based on mixed linear-effects models and conditional minimally detectable change, were used to define meaningful neurobehavioral change for the Disorders of Consciousness Scale-25 (DOCS) total and Auditory-Language measures. Resting-state functional connectivity (rsFC) of the default mode and 6 other networks was examined.
RESULTS
Meaningful gains in DOCS total measures were observed for 75% of treatment segments and auditory-language gains were observed after rTMS, which doubled when rTMS preceded rTMS+AMA. Neurobehavioral changes were reflected in rsFC for language, salience, and sensorimotor networks. Between networks interactions were modulated, globally, after all treatments.
CONCLUSIONS
For persons with DoC 1 to 15 years after TBI, meaningful neurobehavioral gains were observed after provision of rTMS, AMA, and rTMS+AMA. Sequencing and combining of treatments to modulate broad-scale neural activity, via differing mechanisms, merits investigation in a future study powered to determine efficacy of this approach to enabling neurobehavioral recovery.
目的
报告接受重复经颅磁刺激（rTMS）或金刚烷胺（AMA）以及随后 rTMS+AMA 治疗的意识障碍（DoC）患者的神经行为改善和网络变化的初步发现。
参与者
4 名创伤性脑损伤（TBI）后 1 至 15 年的 DoC 患者。
设计
交替治疗顺序、个体内、基线对照试验。
主要措施
对于组和个体神经行为分析，使用基于混合线性效应模型和条件最小可检测变化的预定阈值，来定义意识障碍量表 25 项（DOCS）总分和听觉语言测量的有意义的神经行为变化。静息态功能连接（rsFC）默认模式和其他 6 个网络进行了检查。
结果
75%的治疗阶段观察到 DOCS 总分的有意义改善，rTMS 后观察到听觉语言改善，rTMS+AMA 之前的 rTMS 增加了一倍。rsFC 反映了语言、突显和感觉运动网络的神经行为变化。所有治疗后，网络间的相互作用都被调节。
结论
对于 TBI 后 1 至 15 年的 DoC 患者，rTMS、AMA 和 rTMS+AMA 治疗后观察到有意义的神经行为改善。通过不同的机制来调节广泛的神经活动的治疗顺序和组合，值得在未来的研究中进一步探讨，以确定这种方法对促进神经行为恢复的疗效。
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