经颅直流电刺激与功能性电刺激的不同时序组合对脑卒中偏瘫患者脑功能连接的即时影响

关键词：经颅直流电刺激  功能性电刺激  近红外脑功能成像  脑卒中  下肢运动功能

Keywords:transcranial direct current stimulation  functional electrical stimulation  functional near infrared spectroscopy  stroke  lower limb function

摘要：

      摘要 目的：探究功能性近红外光谱技术(functional near-infrared spectroscopy， fNIRS)动态观察经颅直流电刺激(transcranial direct current stimulation， tDCS)与功能性电刺激(functional electrical stimulation， FES)的不同时序组合治疗对脑卒中偏瘫患者初级运动皮质(primary motor cortex， M1)脑功能连接的即时影响。 方法：采用自身对照，将15例符合入选标准的脑卒中偏瘫患者，依次给予单纯tDCS治疗、单纯FES治疗、tDCS和FES同步治疗、先tDCS后FES时序治疗，每种干预各1次，洗脱期为2天。干预前后进行fNIRS检测，静息态脑功能连接(resting state functional connectivity， RSFC)采用相关分析和基于图论的复杂网络分析。利用NIRS-SPM工具包计算不同干预下氧合血红蛋白的脑激活图。 结果：发现单纯FES治疗、tDCS+FES同步治疗、tDCS_FES时序治疗下激活脑区显著于单纯tDCS治疗(P=0.023)，而tDCS_FES时序治疗下脑区激活显著于单纯FES治疗和tDCS+FES同步治疗组(P<0.05)。相关分析发现不同治疗方法下运动区相关皮质FC均较干预前增多，依次为tDCS_FES时序治疗、单纯FES治疗、FES+tDCS同步治疗、单纯tDCS治疗。图论分析显示单纯tDCS或FES治疗在局部/全局网络效率、小世界方面程度相似，tDCS+FES同步治疗可一定程度改善脑区连接效率优于单纯电刺激治疗，tDCS_FES时序治疗在改善脑区域连接效率方面最明显。 结论：tDCS或FES的单纯或联合治疗均能不同程度增强患者的脑功能连接和效率，提高患者的运动皮质兴奋性，但建议临床多采用tDCS_FES时序治疗，有助于促进运动区脑神经功能连接。

Abstract:

      Abstract Objective： By using functional near infrared spectroscopy (fNIRS)， we investigate the short-term effects of different time sequences of transcranial direct current stimulation (tDCS) and functional electrical stimulation (FES) on functional connectivity of the primary motor cortex (M1) in post-stroke patients with hemiplegia. Method： In a self-controlled study， 15 stroke survivors who met the inclusion criteria were successively treated with tDCS alone， FES alone， simultaneous treatment with tDCS and FES(tDCS+FES)， and sequential treatment with tDCS followed by FES(tDCS_FES). Each intervention was performed once and with 2 days washout period. The fNIRS was measured before and after intervention. Resting state functional connectivity (RSFC) was analyzed by Pearson correlation analysis and complex network analysis was based on Graph Theoretical Network Analysis. NIRS-SPM provided activation maps of oxyhemoglobin (HbO2) between different intervention methods. Result： It was significantly higher activation maps in FES alone， tDCS+FES simultaneous treatment and tDCS_FES sequential treatment than tDCS alone (P=0.023). And the activation maps in tDCS_FES sequential treatment was significantly higher than that in FES alone and tDCS+FES simultaneous treatment (P<0.05). Correlation analysis showed that the FCs in related motor cortex increased after different treatment methods than before， tDCS_FES sequential treatment， FES alone treatment， FES+tDCS simultaneous treatment and tDCS alone treatment， respectively. Graph theory analysis showed the local/global network efficiency and small world were similar between tDCS and FES alone. The simultaneous treatment of tDCS+FES can improve the brain connectivity efficiency to a certain extent， which was better than that of electrical stimulation alone. The sequential treatment of tDCS_FES was most obviously in improving the connectivity efficiency. Conclusion： The single or combination treatment of tDCS and FES could enhance the brain functional connectivity and efficiency， and improve the motor cortical excitability. However， it was recommended to use tDCS_FES sequential treatment in the clinical application， which would promote the recovery of cerebral nerve function connectivity.