评估脊髓刺激对意识障碍患者的影响：一项 TMS-EEG 研究。
Evaluating the effect of spinal cord stimulation on patient with disorders of consciousness: A TMS-EEG study.
机构信息
Zhuhai UM Science & Technology Research Institute, Zhuhai, 519031, China.
Medical School of Chinese PLA, Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China; Department of Neurosurgery, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, China.
出版信息
Comput Biol Med. 2023 Nov;166:107547. doi: 10.1016/j.compbiomed.2023.107547. Epub 2023 Sep 29.
OBJECTIVE
The application of spinal cord stimulation (SCS) in the treatment of disorders of consciousness (DOC) has attracted attention, but its effect on brain activity is still unknown. Transcranial magnetic stimulation combined with EEG (TMS-EEG) can measure cortical activity, which can evaluate the effect of SCS on DOC.
METHODS
We record 20 DOC patients' CRS-R values and TMS-EEG data before and after one-session SCS (Pre-SCS and Post-SCS). 20 DOC patients including 10 patients with unresponsive wakefulness syndrome (UWS) and 10 patients with minimally conscious states (MCS). TMS evoked potential (TEP) was used to measure the changes of cortical activity in DOC patients between Pre-SCS and Post-SCS. Firstly, we used the global mean field potential (GMFP) and fast perturbational complexity index (PCIst) to compare the temporal changes of patients' cortical activity. Then, we obtained the frequency feature (natural frequency, NF) based on the TEP time-frequency analysis, and compared the changes of natural frequency between Pre-SCS and Post-SCS. Finally, the study explored the relationship between the patient's baseline CRS-R values and changes of TMS evoked cortical activity in time and frequency domains.
RESULTS
After SCS, MCS and UWS groups almost have no changes of CRS-R values (MCS: 9.9 ± 1.52 at Pre-SCS, 10.2 ± 1.48 at Post-SCS; UWS: 5.6 ± 1.26 at Pre-SCS, 5.7 ± 1.34 at Post-SCS). MCS group showed significant increases of GMFP amplitude (around 100 ms and 300 ms) and PCIst values at Post-SCS (p < 0.05). UWS group had no significant changes (p > 0.05). Besides, SCS induced the significant increases of natural frequency for MCS group(p < 0.05), but not for UWS group. At last, the study found that all patient's baseline CRS-R values were significantly correlated with ΔPCIst (r = 0.67, p < 0.005), and ΔNF (r = 0.72, p < 0.001).
CONCLUSIONS
SCS can modulate cortical activity of DOC patient, including temporal complexity and natural frequency. The changes of cortical activity caused by SCS are related to patients' consciousness level. TMS-EEG can evaluate the effect of SCS on DOC patients.
目的
脊髓刺激（SCS）在意识障碍（DOC）治疗中的应用引起了关注，但它对大脑活动的影响仍不清楚。经颅磁刺激结合脑电图（TMS-EEG）可以测量皮质活动，从而可以评估 SCS 对 DOC 的影响。
方法
我们记录了 20 例 DOC 患者 SCS 前后的 CRS-R 值和 TMS-EEG 数据（Pre-SCS 和 Post-SCS）。20 例 DOC 患者包括 10 例无反应性觉醒综合征（UWS）患者和 10 例最小意识状态（MCS）患者。TMS 诱发电位（TEP）用于测量 SCS 前后 DOC 患者皮质活动的变化。首先，我们使用全局平均场电位（GMFP）和快速扰动复杂度指数（PCIst）来比较患者皮质活动的时间变化。然后，我们基于 TEP 时频分析获得了频率特征（固有频率，NF），并比较了 Pre-SCS 和 Post-SCS 之间自然频率的变化。最后，研究探讨了患者基线 CRS-R 值与 TMS 诱发皮质活动在时间和频率域变化之间的关系。
结果
SCS 后，MCS 和 UWS 组的 CRS-R 值几乎没有变化（MCS：Pre-SCS 时为 9.9±1.52，Post-SCS 时为 10.2±1.48；UWS：Pre-SCS 时为 5.6±1.26，Post-SCS 时为 5.7±1.34）。MCS 组在 Post-SCS 时 GMFP 振幅（约 100ms 和 300ms）和 PCIst 值显著增加（p<0.05）。UWS 组无显著变化（p>0.05）。此外，SCS 诱导 MCS 组的自然频率显著增加（p<0.05），但 UWS 组无显著变化（p>0.05）。最后，研究发现所有患者的基线 CRS-R 值与ΔPCIst（r=0.67，p<0.005）和ΔNF（r=0.72，p<0.001）均呈显著相关。
结论
SCS 可调节 DOC 患者的皮质活动，包括时间复杂性和自然频率。SCS 引起的皮质活动变化与患者的意识水平有关。TMS-EEG 可评估 SCS 对 DOC 患者的治疗效果。
Zotero 插件