经颅直流电刺激对脑外伤患者精神运动抑制状态的治疗作用

关键词：经颅直流电刺激  脑外伤  精神运动抑制  非线性动力学

Keywords:transcranial direct current stimulation  traumatic brain injury  psychomotor inhibition  nonlinear dynamics

摘要：

      摘要 目的：明确经颅直流电刺激（tDCS）对改善脑外伤患者精神运动抑制状态的治疗作用。 方法：对1例脑外伤后精神运动抑制状态的患者进行前额叶和左侧前额叶背外侧皮质（DLPFC）各2w的阳极tDCS治疗。分别在治疗前后进行JFK改良昏迷恢复量表、淡漠量表、行为反应量表评估及脑电非线性分析（近似熵指数）检查。 结果：tDCS治疗后，JFK改良昏迷恢复量表评分改善，但差异无显著性意义（P=0.07）；淡漠量表和行为反应量表评分结果明显改善（P＜0.001）。脑电非线性分析结果显示：治疗后患者双侧额、颞、顶部导联近似熵指数普遍提高（P＜0.01）。 结论：应用阳极tDCS刺激前额叶和左侧DLPFC可以改善该例脑外伤后患者精神运动抑制状态，其恢复机制可能与双侧半球的皮层兴奋性广泛提高相关。tDCS可能成为脑外伤后精神运动抑制的可选治疗手段。

Abstract:

      Abstract Objective: To investigate effects of transcranial direct current stimulation (tDCS) on psychomotor inhibition in patients with traumatic brain injury (TBI). Method: A TBI patient with psychomotor inhibition received anodal tDCS over the prefrontal lobe and the left dorsal lateral prefrontal cortex (DLPFC) for two weeks, respectively. JFK coma recovery scale-revised (CRS-R), Apathy Evaluation Scale (AES), Behavior Response Scale (BRS) were measured before and after the treatment. The EEG nonlinear index of approximate entropy (ApEn) was also calculated before and after the treatment. Result: After the treatment, there was no significant difference for the CRS-R score compared with that before the treatment (P=0.07). However, AES and BRS scores improved significantly(P＜0.001). ApEn indices increased in bilateral frontal, temporal and parietal areas. Conclusion: Anodal tDCS over the prefrontal lobe and left DLPFC could improve psychomotor inhibition, and the recovery might be related to increased excitability in wide areas of bilateral hemisphere. tDCS may be an alternative treatment for psychomotor inhibition after TBI.