多疗程前额叶经颅直流电刺激（tDCS）及同步认知康复训练对自闭症谱系障碍（ASD）患者的神经生理和行为影响：一项双盲、随机对照功能性近红外光谱（fNIRS）研究。
Neurophysiological and behavioral effects of multisession prefrontal tDCS and concurrent cognitive remediation training in patients with autism spectrum disorder (ASD): A double-blind, randomized controlled fNIRS study.
作者信息
Han Yvonne M Y, Chan Melody M Y, Shea Caroline K S, Lai Oscar Long-Hin, Krishnamurthy Karthikeyan, Cheung Mei-Chun, Chan Agnes S
机构信息
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; University Research Facility in Behavioral and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong SAR, China.
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.
出版信息
Brain Stimul. 2022 Mar-Apr;15(2):414-425. doi: 10.1016/j.brs.2022.02.004. Epub 2022 Feb 15.
BACKGROUND
The clinical effects and neurophysiological mechanisms of prefrontal tDCS and concurrent cognitive remediation training in individuals with autism spectrum disorder (ASD) remain unclear.
OBJECTIVE
This two-armed, double-blind, randomized, sham-controlled trial aimed to investigate the beneficial effects of tDCS combined with concurrent cognitive remediation training on adolescents and young adults with ASD.
METHODS
Participants were randomly assigned to either active or sham tDCS groups and received 1.5 mA prefrontal tDCS with left dorsolateral prefrontal cortex (dlPFC) cathode placement and right supraorbital region anode placement for 20 minutes over two consecutive weeks. tDCS was delivered concurrently with a computerized cognitive remediation training program. Social functioning and its underlying cognitive processes, as well as prefrontal resting-state functional connectivity (rsFC), were measured.
RESULTS
The results from 41 participants indicated that multisession prefrontal tDCS, compared to sham tDCS, significantly enhanced the social functioning of ASD individuals [F(1,39) = 4.75, p = .035, η = 0.11]. This improvement was associated with enhanced emotion recognition [F(1,39) = 8.34, p = .006, η = 0.18] and cognitive flexibility [F(1,39) = 4.91, p = .033, η = 0.11]. Specifically, this tDCS protocol optimized information processing efficiency [F(1,39) = 4.43, p = .042, η = 0.10], and the optimization showed a trend to be associated with enhanced rsFC in the right medial prefrontal cortex (ρ = 0.339, pFDR = .083).
CONCLUSION
Multisession tDCS with left dlPFC cathode placement and right supraorbital region anode placement paired with concurrent cognitive remediation training promoted social functioning in individuals with ASD. This appeared to be associated with the enhancement of the functional connectivity of the right medial PFC, a major hub for flexible social information processing, allowing these individuals to process information more efficiently in response to different social situations.
TRIAL REGISTRATION
ClinicalTrials.gov (ID: NCT03814083).
背景
经颅直流电刺激（tDCS）前额叶以及同时进行认知康复训练对自闭症谱系障碍（ASD）个体的临床效果和神经生理机制尚不清楚。
目的
这项双臂、双盲、随机、假刺激对照试验旨在研究tDCS联合同时进行的认知康复训练对患有ASD的青少年和年轻人的有益效果。
方法
参与者被随机分配到主动tDCS组或假刺激tDCS组，并接受1.5毫安的前额叶tDCS，阴极置于左侧背外侧前额叶皮质（dlPFC），阳极置于右侧眶上区域，连续两周，每次20分钟。tDCS与计算机化认知康复训练程序同时进行。测量社交功能及其潜在的认知过程，以及前额叶静息态功能连接（rsFC）。
结果
41名参与者的结果表明，与假刺激tDCS相比，多疗程前额叶tDCS显著增强了ASD个体的社交功能[F(1,39) = 4.75，p = .035，η = 0.11]。这种改善与情绪识别增强[F(1,39) = 8.34，p = .006，η = 0.18]和认知灵活性增强[F(1,39) = 4.91，p = .033，η = 0.11]有关。具体而言，这种tDCS方案优化了信息处理效率[F(1,39) = 4.43，p = .042，η = 0.10]，并且这种优化显示出与右侧内侧前额叶皮质rsFC增强相关的趋势（ρ = 0.339，pFDR = .083）。
结论
阴极置于左侧dlPFC、阳极置于右侧眶上区域的多疗程tDCS与同时进行的认知康复训练相结合，可促进ASD个体的社交功能。这似乎与右侧内侧前额叶皮质（灵活社交信息处理的主要枢纽）功能连接的增强有关，使这些个体能够更有效地处理信息以应对不同的社交情境。
试验注册
ClinicalTrials.gov（标识符：NCT03814083）。
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