Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States; GIGA-Institute and Neurology Department, University of Liège and University Hospital of Liège, Liège, Belgium.
Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States.
Burns. 2021 May;47(3):525-537. doi: 10.1016/j.burns.2020.06.005. Epub 2020 Jun 20.
Burn survivors experience myriad associated symptoms such as pain, pruritus, fatigue, impaired motor strength, post-traumatic stress, depression, anxiety, and sleep disturbance. Many of these symptoms are common and remain chronic, despite current standard of care. One potential novel intervention to target these post burn symptoms is transcranial direct current stimulation (tDCS). tDCS is a non-invasive brain stimulation (NIBS) technique that modulates neural excitability of a specific target or neural network. The aim of this work is to review the neural circuits of the aforementioned clinical sequelae associated with burn injuries and to provide a scientific rationale for specific NIBS targets that can potentially treat these conditions. We ran a systematic review, following the PRISMA statement, of tDCS effects on burn symptoms. Only three studies matched our criteria. One was a feasibility study assessing cortical plasticity in chronic neuropathic pain following burn injury, one looked at the effects of tDCS to reduce pain anxiety during burn wound care, and one assessed the effects of tDCS to manage pain and pruritus in burn survivors. Current literature on NIBS in burn remains limited, only a few trials have been conducted. Based on our review and results in other populations suffering from similar symptoms as patients with burn injuries, three main areas were selected: the prefrontal region, the parietal area and the motor cortex. Based on the importance of the prefrontal cortex in the emotional component of pain and its implication in various psychosocial symptoms, targeting this region may represent the most promising target. Our review of the neural circuitry involved in post burn symptoms and suggested targeted areas for stimulation provide a spring board for future study initiatives.
烧伤幸存者会经历多种相关症状,如疼痛、瘙痒、疲劳、运动力量受损、创伤后应激、抑郁、焦虑和睡眠障碍。尽管目前的标准护理方法已经存在,但这些症状中的许多仍然是常见的且持续存在的慢性症状。一种针对这些烧伤后症状的潜在新型干预方法是经颅直流电刺激(tDCS)。tDCS 是一种非侵入性脑刺激(NIBS)技术,可以调节特定目标或神经网络的神经兴奋性。这项工作的目的是回顾与烧伤相关的上述临床后遗症的神经回路,并为特定的 NIBS 靶点提供科学依据,这些靶点有可能治疗这些病症。我们按照 PRISMA 声明进行了一项系统综述,以评估 tDCS 对烧伤症状的影响。只有三项研究符合我们的标准。一项是评估烧伤后慢性神经性疼痛皮质可塑性的可行性研究,一项是研究 tDCS 对减轻烧伤伤口护理时疼痛焦虑的影响,另一项是评估 tDCS 对烧伤幸存者疼痛和瘙痒的管理效果。目前关于烧伤的 NIBS 文献仍然有限,只有少数试验已经进行。基于我们的综述和其他患有类似症状的人群的研究结果,选择了三个主要领域:前额叶区域、顶叶区域和运动皮层。基于前额叶皮层在疼痛的情绪成分中的重要性及其在各种心理社会症状中的影响,针对该区域可能代表最有前途的目标。我们对烧伤后症状涉及的神经回路以及建议的刺激靶向区域的综述为未来的研究计划提供了跳板。
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