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用于轻度创伤性脑损伤康复的神经调节:一项系统综述

Neuromodulation for Mild Traumatic Brain Injury Rehabilitation: A Systematic Review.

作者信息

Buhagiar Francesca, Fitzgerald Melinda, Bell Jason, Allanson Fiona, Pestell Carmela

机构信息

School of Psychological Science, University of Western Australia, Perth, WA, Australia.

Curtin Health Innovation Research Institute, Curtin University, Sarich Neuroscience Research Institute, Nedlands, WA, Australia.

出版信息

Front Hum Neurosci. 2020 Dec 11;14:598208. doi: 10.3389/fnhum.2020.598208. eCollection 2020.

Abstract

Mild traumatic brain injury (mTBI) results from an external force to the head or body causing neurophysiological changes within the brain. The number and severity of symptoms can vary, with some individuals experiencing rapid recovery, and others having persistent symptoms for months to years, impacting their quality of life. Current rehabilitation is limited in its ability to treat persistent symptoms and novel approaches are being sought to improve outcomes following mTBI. Neuromodulation is one technique used to encourage adaptive neuroplasticity within the brain. To systematically review the literature on the efficacy of neuromodulation in the mTBI population. A systematic review was conducted using Medline, Embase, PsycINFO, PsycARTICLES and EBM Review. Preferred Reporting Items for Systematic Reviews and the Synthesis Without Meta-analysis reporting guidelines were used and a narrative review of the selected studies was completed. Fourteen articles fulfilled the inclusion criteria which were published in English, investigating an adult sample and using a pre- and post-intervention design. Studies were excluded if they included non-mild TBI severities, pediatric or older adult populations. Thirteen of fourteen studies reported positive reductions in mTBI symptomatology following neuromodulation. Specifically, improvements were reported in post-concussion symptom ratings, headaches, dizziness, depression, anxiety, sleep disturbance, general disability, cognition, return to work and quality of life. Normalization of working memory activation patterns, vestibular field potentials, hemodynamics of the dorsolateral prefrontal cortex and excessive delta wave activity were also seen. The studies reviewed had several methodological limitations including small, heterogenous samples and varied intervention protocols, limiting generalisability. Further research is required to understand the context in which neuromodulation may be beneficial. While these positive effects are observed, limitations included unequal representation of neuromodulation modalities in the literature, and lack of literature describing the efficacy of neuromodulation on the development or duration of persistent mTBI symptoms. Better clarity regarding neuromodulation efficacy could have a significant impact on mTBI patients, researchers, clinicians, and policy makers, facilitating a more productive post-mTBI population. Despite the limitations, the literature indicates that neuromodulation warrants further investigation. PROSPERO registration number: CRD42020161279.

摘要

轻度创伤性脑损伤(mTBI)是由头部或身体受到外力作用导致脑内神经生理变化引起的。症状的数量和严重程度各不相同,一些人能迅速康复,而另一些人则会持续出现症状数月至数年,影响他们的生活质量。目前的康复治疗在治疗持续性症状方面能力有限,因此正在寻求新的方法来改善mTBI后的治疗效果。神经调节是一种用于促进脑内适应性神经可塑性的技术。为了系统评价关于神经调节对mTBI人群疗效的文献。使用Medline、Embase、PsycINFO、PsycARTICLES和EBM Review进行了系统评价。采用系统评价的首选报告项目和非Meta分析报告指南,并对所选研究进行了叙述性综述。十四篇文章符合纳入标准,这些文章以英文发表,研究对象为成人样本,并采用干预前后设计。如果研究包括非轻度TBI严重程度、儿科或老年人群,则将其排除。十四项研究中的十三项报告称,神经调节后mTBI症状有积极改善。具体而言,在脑震荡后症状评分、头痛、头晕、抑郁、焦虑、睡眠障碍、总体残疾、认知、恢复工作和生活质量方面均有改善。还观察到工作记忆激活模式、前庭场电位、背外侧前额叶皮质血流动力学和过度δ波活动的正常化。所综述的研究有几个方法学上的局限性,包括样本量小、异质性大以及干预方案不同,限制了研究结果的普遍性。需要进一步研究以了解神经调节可能有益的背景。虽然观察到了这些积极效果,但局限性包括文献中神经调节方式的代表性不均衡,以及缺乏描述神经调节对持续性mTBI症状发展或持续时间疗效的文献。对神经调节疗效有更清晰的认识可能会对mTBI患者、研究人员、临床医生和政策制定者产生重大影响,促进mTBI后人群更有成效。尽管存在局限性,但文献表明神经调节值得进一步研究。PROSPERO注册号:CRD42020161279。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/232e/7759622/820b7dc654ac/fnhum-14-598208-g0001.jpg

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