基于家庭的经颅交流电刺激(tACS)远程监测用于治疗晕船综合征

Remotely Monitored Home-Based Neuromodulation With Transcranial Alternating Current Stimulation (tACS) for Mal de Débarquement Syndrome.

作者信息

Cha Yoon-Hee, Riley Jeff, Gleghorn Diamond, Doudican Benjamin

机构信息

Department of Neurology, University of Minnesota, Minneapolis, MN, United States.

Laureate Institute for Brain Research, Tulsa, OK, United States.

出版信息

Front Neurol. 2021 Dec 9;12:755645. doi: 10.3389/fneur.2021.755645. eCollection 2021.

Abstract

To determine whether remotely-monitored transcranial alternating current stimulation (tACS) may be a viable and safe treatment option for Mal de Débarquement Syndrome (MdDS). Mal de Débarquement Syndrome is a neurotological disorder characterized by persistent oscillating vertigo that is triggered by entrainment to passive oscillatory motion such as occurs during water-based travel. Treatment options for MdDS are limited, variably effective, and can be undone by further travel. This was a remotely-monitored open-label optional extension phase of a double-blind randomized onsite study of tACS for medically refractory MdDS. The primary goal was to determine safety, feasibility, and blinded participant feedback. The secondary goal was to determine efficacy. Thirteen participants (all women), aged 22-67 years, experiencing a duration of illness of 11-72 months, were a subset of 24 individuals who participated in an on-site study of tACS. They had either not responded to the on-site protocol or had relapsed after travel home. Treatment accessories and a tablet controlled tACS stimulator (Pulvinar XCSITE-100) were mailed to participants. Three teaching sessions were performed via webcam followed by on-going remote monitoring of treatment logs and participants' reports through a daily on-line diary and weekly questionnaires. Treatment continued until an effective protocol was administered for 4 weeks and then tapered over 4 weeks. Participants completed a blinded feedback survey and a debriefing interview at the completion of the entire study. Treatment duration ranged from 4 to 31 weeks followed by a 4-week taper accounting for 578 verified sessions. Of the 13 total participants, seven agreed or agreed strongly in the blinded survey that tACS treatment was beneficial; 2) Twelve were comfortable utilizing tACS on their own; 3) Eleven preferred stimulation above their individual alpha frequency; 4) Side effects were generally mild and typical of tACS. In the debriefing interview completed 2-9 months after the last stimulation, five participants reported doing "great," with no to minimal symptoms, four reported doing "good," with moderate symptoms, and four reported no change compared to pre-study baseline. Remotely-monitored tACS may be a safe treatment option for MdDS with the potential for lasting outcomes, increased accessibility, and reduction in travel-related treatment reversal.

摘要

为确定远程监测的经颅交流电刺激(tACS)是否可能是一种针对晕船后综合征(MdDS)可行且安全的治疗选择。晕船后综合征是一种神经耳科疾病,其特征为持续的振荡性眩晕,这种眩晕由被动振荡运动引发,比如在水上旅行期间发生的那种运动。MdDS的治疗选择有限,效果各异,而且进一步旅行可能会使病情复发。这是一项针对药物难治性MdDS的tACS双盲随机现场研究的远程监测开放标签可选延长期。主要目标是确定安全性、可行性以及盲态下参与者的反馈。次要目标是确定疗效。13名参与者(均为女性),年龄在22至67岁之间,病程为11至72个月,他们是参与tACS现场研究的24名个体的一个子集。他们要么对现场方案无反应,要么回家旅行后病情复发。治疗配件和一台由平板电脑控制的tACS刺激器(Pulvinar XCSITE - 100)被邮寄给参与者。通过网络摄像头进行了三次教学课程,随后通过每日在线日记和每周问卷对治疗日志及参与者报告进行持续远程监测。治疗持续进行,直到有效的方案实施4周,然后在4周内逐渐减少剂量。在整个研究结束时,参与者完成了一次盲态反馈调查和一次汇报访谈。治疗持续时间为4至31周,随后是4周的逐渐减量期,共计578次经核实的治疗疗程。在总共13名参与者中,7人在盲态调查中同意或强烈同意tACS治疗有益;2)12人对自行使用tACS感到放心;3)11人更喜欢高于其个体阿尔法频率的刺激;4)副作用一般较轻,是tACS的典型副作用。在最后一次刺激后2至9个月完成的汇报访谈中,5名参与者报告情况“很好”,症状轻微或没有症状,4名报告“不错”,有中度症状,4名报告与研究前基线相比没有变化。远程监测的tACS可能是一种针对MdDS的安全治疗选择,具有产生持久疗效、增加可及性以及减少与旅行相关的治疗逆转的潜力。

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