Department of Neurology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, China.
Department of Neurology, First People's Hospital of Yuhang District, Hangzhou, Zhejiang 310003, China.
Chin Med J (Engl). 2021 Feb 25;134(7):765-776. doi: 10.1097/CM9.0000000000001377.
Reviving patients with prolonged disorders of consciousness (DOCs) has always been focused and challenging in medical research. Owing to the limited effectiveness of available medicine, recent research has increasingly turned towards neuromodulatory therapies, involving the stimulation of neural circuits. We summarised the progression of research regarding neuromodulatory therapies in the field of DOCs, compared the differences among different studies, in an attempt to explore optimal stimulation patterns and parameters, and analyzed the major limitations of the relevant studies to facilitate future research.
We performed a search in the PubMed database, using the concepts of DOCs and neuromodulation. Inclusion criteria were: articles in English, published after 2002, and reporting clinical trials of neuromodulatory therapies in human patients with DOCs.
Overall, 187 published articles met the search criteria, and 60 articles met the inclusion criteria. There are differences among these studies regarding the clinical efficacies of neurostimulation techniques for patients with DOCs, and large-sample studies are still lacking.
Neuromodulatory techniques were used as trial therapies for DOCs wherein their curative effects were controversial. The difficulties in detecting residual consciousness, the confounding effect between the natural course of the disease and therapeutic effect, and the heterogeneity across patients are the major limitations. Large-sample, well-designed studies, and innovations for both treatment and assessment are anticipated in future research.
在医学研究中，一直以来，对长时间意识障碍（DOC）患者的复苏都是重点和难点。由于现有药物的疗效有限，最近的研究越来越倾向于神经调节疗法，包括对神经回路的刺激。我们总结了神经调节疗法在 DOC 领域的研究进展，比较了不同研究之间的差异，试图探索最佳的刺激模式和参数，并分析了相关研究的主要局限性，以促进未来的研究。
我们在 PubMed 数据库中使用 DOC 和神经调节的概念进行了检索。纳入标准为：英文文章、发表于 2002 年以后、报告了神经调节疗法在意识障碍患者中的临床试验。
总体而言，符合检索条件的已发表文章有 187 篇，符合纳入标准的文章有 60 篇。这些研究在神经刺激技术对意识障碍患者的临床疗效方面存在差异，且缺乏大样本研究。
神经调节技术被用作意识障碍的试验治疗方法，其疗效存在争议。检测残余意识的困难、疾病自然病程与治疗效果之间的混杂效应以及患者之间的异质性是主要的局限性。未来的研究需要大样本、精心设计的研究以及治疗和评估方面的创新。
