Department of Neuroscience, Section of Rehabilitation, University of Padova, via Giustiniani 3, 35128, Paduas, Italy.
Department of Neurosciencse and Padova Neuroscience Center, University of Padova, 35131, Padua, Italy.
Eur Arch Psychiatry Clin Neurosci. 2021 Feb;271(1):199-210. doi: 10.1007/s00406-020-01214-y. Epub 2020 Nov 25.
Fibromyalgia syndrome (FMS) is a complex pain disorder, characterized by diffuse pain and cognitive disturbances. Abnormal cortical oscillatory activity may be a promising biomarker, encouraging non-invasive neurostimulation techniques as a treatment. We aimed to modulate abnormal slow cortical oscillations by delivering transcranial alternating current stimulation (tACS) and physiotherapy to reduce pain and cognitive symptoms. This was a double-blinded, randomized, crossover trial conducted between February and September 2018 at the Rehabilitation Unit of a teaching Hospital (NCT03221413). Participants were randomly assigned to tACS or random noise stimulation (RNS), 5 days/week for 2 weeks followed by ad hoc physiotherapy. Clinical and cognitive assessments were performed at T (baseline), T (after stimulation), T (1 month after stimulation). Electroencephalogram (EEG) spectral topographies recorded from 15 participants confirmed slow-rhythm prevalence and provided tACS tailored stimulation parameters and electrode sites. Following tACS, EEG alpha1 ([8-10] Hz) activity increased at T (p = 0.024) compared to RNS, pain symptoms assessed by Visual Analog Scale decreased at T (T vs T p = 0.010), self-reported cognitive skills and neuropsychological scores improved both at T and T (Patient-Reported Outcomes in Cognitive Impairment, T-T, p = 0.024; Everyday memory questionnaire, T compared to RNS, p = 0.012; Montréal Cognitive Assessment, T vs T, p = 0.048 and T vs T, p = 0.009; Trail Making Test B T-T, p = 0.034). Psychopathological scales and other neuropsychological scores (Trail Making Test-A; Total Phonemic Fluency; Hopkins Verbal Learning Test-Revised; Rey-Osterrieth Complex Figure) improved both after tACS and RNS but earlier improvements (T) were registered only after tACS. These results support tACS coupled with physiotherapy in treating FMS cognitive symptoms, pain and subclinical psychopathology.
纤维肌痛综合征（FMS）是一种复杂的疼痛障碍，其特征为弥漫性疼痛和认知障碍。皮质振荡活动异常可能是一种很有前途的生物标志物，这促使人们采用非侵入性神经刺激技术作为一种治疗方法。我们旨在通过经颅交流电刺激（tACS）和物理治疗来调节异常的慢皮质振荡，以减轻疼痛和认知症状。这是一项于 2018 年 2 月至 9 月在一所教学医院的康复科进行的双盲、随机、交叉试验（NCT03221413）。参与者被随机分配接受 tACS 或随机噪声刺激（RNS），每周 5 天，持续 2 周，然后进行特定的物理治疗。在 T（基线）、T（刺激后）、T（刺激后 1 个月）进行临床和认知评估。从 15 名参与者记录的脑电图（EEG）频谱地形图证实了慢节律的普遍性，并提供了 tACS 定制的刺激参数和电极位置。在 tACS 之后，与 RNS 相比，T 时的 EEGα1（[8-10] Hz）活动增加（p = 0.024），T 时的疼痛症状（视觉模拟量表）下降（T 与 T 相比，p = 0.010），自我报告的认知技能和神经心理学评分在 T 和 T 时均提高（认知障碍患者报告的结果，T 与 T 相比，p = 0.024；日常记忆问卷，T 与 RNS 相比，p = 0.012；蒙特利尔认知评估，T 与 T 相比，p = 0.048 和 T 与 T 相比，p = 0.009；T-T 时的 Trail Making Test B，p = 0.034）。在 tACS 和 RNS 后，心理病理量表和其他神经心理学评分（Trail Making Test-A；总语音流畅度；Hopkins 言语学习测试修订版；Rey-Osterrieth 复杂图形）均有所改善，但仅在 tACS 后才出现更早的改善（T）。这些结果支持将 tACS 与物理治疗相结合，用于治疗纤维肌痛综合征的认知症状、疼痛和亚临床心理病理学。
