纤维肌痛症中神经网络与症状的调节：基于家庭的经颅直流电刺激的随机双盲多组解释性临床试验。
Modulation of neural networks and symptom correlated in fibromyalgia: A randomized double-blind multi-group explanatory clinical trial of home-based transcranial direct current stimulation.
机构信息
Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
出版信息
PLoS One. 2024 Nov 13;19(11):e0288830. doi: 10.1371/journal.pone.0288830. eCollection 2024.
BACKGROUND
Transcranial direct current stimulation (tDCS) might modulate neural activity and promote neural plasticity in patients with fibromyalgia (FM). This multi-group randomized clinical trial compared home-based active tDCS (HB-a-tDCS) on the left dorsolateral prefrontal cortex (l-DLPFC) or home-based sham tDCS (HB-s-tDCS), and HB-a-tDCS or HB-s-tDCS on the primary motor cortex (M1) in the connectivity analyses in eight regions of interest (ROIs) across eight resting-state electroencephalography (EEG) frequencies.
METHODS
We included 48 women with FM, aged 30 to 65, randomly assigned to 2:1:2:1 to receive 20 sessions during 20 minutes of HB-a-tDCS 2mA or HB-s-tDCS, over l-DLPFC or M1, respectively. EEG recordings were obtained before and after treatment with eyes open (EO) and eyes closed (EC).
RESULTS
In the EC condition, comparing pre to post-treatment, the HB-a-tDCS on l-DLPFC decreased the lagged coherence connectivity in the delta frequency band between the right insula and left anterior cingulate cortex (ACC) (t = -3.542, p = .048). The l-DLPFC HB-a-tDCS compared to HB-s-tDCS decreased the lagged coherence connectivity in the delta frequency band between the right insula and left ACC (t = -4.000, p = .017). In the EO condition, the l-DLPFC HB-a-tDCS compared to M1 HB-s-tDCS increased the lagged coherence connectivity between the l-DLPFC and left ACC in the theta band (t = -4.059, p = .048). Regression analysis demonstrated that the HB-a-tDCS effect on the l-DLPFC was positively correlated with sleep quality. On the other hand, the HB-a-tDCS on l-DLPFC and HB-s-tDCS on M1 were positively correlated with pain catastrophizing.
CONCLUSIONS
These results show that HB-a-tDCS affects the neural connectivity between parts of the brain that control pain's emotional and attentional aspects, which are most noticeable at lower EEG frequencies in a rest state. This effect on neural oscillations could serve as a neural marker associated with its efficacy in alleviating fibromyalgia symptoms.
CLINICAL TRIAL REGISTRATION
identifier [NCT03843203].
背景
经颅直流电刺激（tDCS）可能调节纤维肌痛（FM）患者的神经活动并促进神经可塑性。本多组随机临床试验比较了左背外侧前额叶皮层（l-DLPFC）上的基于家庭的主动 tDCS（HB-a-tDCS）与基于家庭的假刺激 tDCS（HB-s-tDCS），以及初级运动皮层（M1）上的 HB-a-tDCS 或 HB-s-tDCS 在 8 个静息状态脑电图（EEG）频率的 8 个感兴趣区域（ROI）中的连接分析。
方法
我们纳入了 48 名年龄在 30 至 65 岁之间的 FM 女性患者，随机分为 2:1:2:1 组，分别接受 20 次 20 分钟的 HB-a-tDCS 2mA 或 HB-s-tDCS，分别作用于 l-DLPFC 或 M1。在睁眼（EO）和闭眼（EC）状态下进行治疗前后的 EEG 记录。
结果
在 EC 状态下，与治疗前相比，l-DLPFC 的 HB-a-tDCS 降低了右岛叶和左前扣带回皮质（ACC）之间 delta 频段的滞后相干连接（t = -3.542，p =.048）。与 HB-s-tDCS 相比，l-DLPFC 的 HB-a-tDCS 降低了右岛叶和左 ACC 之间 delta 频段的滞后相干连接（t = -4.000，p =.017）。在 EO 状态下，与 M1 HB-s-tDCS 相比，l-DLPFC 的 HB-a-tDCS 增加了左 ACC 之间的 theta 频段的滞后相干连接（t = -4.059，p =.048）。回归分析表明，l-DLPFC 的 HB-a-tDCS 对睡眠质量的影响呈正相关。另一方面，l-DLPFC 的 HB-a-tDCS 和 M1 的 HB-s-tDCS 与疼痛灾难化呈正相关。
结论
这些结果表明，HB-a-tDCS 影响控制疼痛情绪和注意力方面的大脑部分之间的神经连接，在静息状态下低频 EEG 下最为明显。这种对神经振荡的影响可能作为与其缓解纤维肌痛症状的疗效相关的神经标记。
临床试验注册号
标识符 [NCT03843203]。
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