Han Jinying, Chen Chen, Zheng Shuang, Zhou Ting, Hu Shunyin, Yan Xiaoxiang, Wang Changqing, Wang Kai, Hu Yajuan
Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, China.
Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei 230032, China.
Brain Sci. 2022 Aug 18;12(8):1095. doi: 10.3390/brainsci12081095.
High-definition transcranial direct current stimulation (HD-tDCS) has been shown to play an important role in improving consciousness in patients with disorders of consciousness (DOCs), but its neuroelectrophysiological evidence is still lacking. To better explain the electrophysiological mechanisms of the effects of HD-tDCS on patients with DOCs, 22 DOC patients underwent 10 anodal HD-tDCS sessions of the left dorsolateral prefrontal cortex (DLPFC). This study used the Coma Recovery Scale-Revised (CRS-R) to assess the level of consciousness in DOC patients. According to whether the CRS-R score increased before and after stimulation, DOC patients were divided into a responsive group and a non-responsive group. By comparing the differences in resting-state EEG functional connectivity between different frequency bands and brain regions, as well as the relationship between functional connectivity values and clinical scores, the electrophysiological mechanism of the clinical effects of HD-tDCS was further explored. The change of the phase locking value (PLV) on the theta frequency band in the left frontal-parietooccipital region was positively correlated with the change in the CRS-R scores. As the number of interventions increased, we observed that in the responsive group, the change in PLV showed an upward trend, and the increase in the PLV appeared in the left frontal-parietooccipital region at 4-8 Hz and in the intra-bifrontal region at 8-13 Hz. In the non-responsive group, although the CRS-R scores did not change after stimulation, the PLV showed a downward trend, and the decrease in the PLV appeared in the intra-bifrontal region at 8-13 Hz. In addition, at the three-month follow-up, patients with increased PLV in the intra-bifrontal region at 8-13 Hz after repeated HD-tDCS stimulation had better outcomes than those without. Repeated anodal stimulation of the left DLPFC with HD-tDCS resulted in improved consciousness in some patients with DOCs. The increase in functional connectivity in the brain regions may be associated with the improvement of related awareness after HD-tDCS and may be a predictor of better long-term outcomes.
高清晰度经颅直流电刺激（HD-tDCS）已被证明在改善意识障碍（DOC）患者的意识方面发挥重要作用，但其神经电生理证据仍然缺乏。为了更好地解释HD-tDCS对DOC患者影响的电生理机制，22例DOC患者接受了10次左侧背外侧前额叶皮质（DLPFC）阳极HD-tDCS治疗。本研究使用昏迷恢复量表修订版（CRS-R）评估DOC患者的意识水平。根据刺激前后CRS-R评分是否增加，将DOC患者分为反应组和无反应组。通过比较不同频段和脑区静息态脑电图功能连接性的差异，以及功能连接值与临床评分之间的关系，进一步探讨了HD-tDCS临床效果的电生理机制。左侧额顶枕区θ频段锁相值（PLV）的变化与CRS-R评分的变化呈正相关。随着干预次数的增加，我们观察到，在反应组中，PLV的变化呈上升趋势，PLV的增加出现在4-8Hz的左侧额顶枕区和8-13Hz的双额区内。在无反应组中，虽然刺激后CRS-R评分没有变化，但PLV呈下降趋势，PLV的下降出现在8-13Hz的双额区内。此外，在三个月的随访中，重复HD-tDCS刺激后双额区内8-13Hz处PLV增加的患者比未增加的患者预后更好。用HD-tDCS对左侧DLPFC进行重复阳极刺激可使一些DOC患者的意识得到改善。脑区功能连接性的增加可能与HD-tDCS后相关意识的改善有关，并且可能是更好的长期预后的预测指标。
