Assessment Effects of Repetitive Transcranial Magnetic Stimulation in Patients with Disorders of Consciousness by EEG
Bai Yang1, Xia Xiaoyu2, Wang Yong3, He Jianghong2, Li Xiaoli4*
1(Medical School, Hangzhou Normal University, Hangzhou 311121, China) 2(Department of Neurosurgery, The 7th Medical Center of PLA General Hospital, Beijing 100700, China) 3(Institute of Electrical Engineering, Yanshan University, Qinhuangdao 066004, Hebei, China) 4(State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China)
摘要近年来,研究表明重复经颅磁刺激(rTMS)可以有效调控颅脑损伤后意识障碍患者的意识状态,但是最小意识状态患者和植物状态患者在调控中的临床反应存在显著差异。通过脑电活动和脑功能网络,评估rTMS对意识障碍患者的调控,探索rTMS对意识障碍患者脑调控的潜在机理。共纳入24名意识障碍患者参加rTMS的真假调控实验。在调控前后记录分析64导联脑电信号的相对功率谱能量,相位锁值以及功能网络特征用研究,以评估脑功能活动的变化。结果发现,rTMS可以显著调控最小意识状态患者的Gamma活动:谱能量和功能连接显著增强,这种增强主要发生在前额-中央区以及前额-顶叶部位。基于图论的功能网络分析表明,rTMS可显著降低最小意识状态患者的功能网络平均路径(1.32±0.31 vs 1.08±0.22),提高网络集聚系数(0.95±0.15 vs 1.12±0.21)和小世界特性(0.76±0.24 vs 1.06±0.32)。研究结果表明,rTMS并不能明显调控植物状态患者的脑电Gamma活动。由于Gamma活动在人类意识和认知活动中至关重要,该研究能为rTMS对意识障碍患者的临床康复应用提供潜在的评估方法和理论。
Abstract：Recently, repetitive transcranial magnetic stimulation (rTMS) has been demonstrated to improve consciousness in patients with disorders of consciousness. However, there is significant difference of brain responses to rTMS between patients in minimally conscious state (MCS) and vegetative state (VS). This study aims to investigate the different effects of rTMS on the patients with disorders of consciousness, by measuring the EEG activity and functional connectivity. Twenty-four patients with disorders of consciousness were enrolled in real and sham rTMS sessions. The EEG (62 channels) was recorded before and immediately after rTMS. Relative power, phase-locking value and functional network properties were evaluated to assess brain changes induced by rTMS. After rTMS modulation, a significant increase power of Gamma band and enhanced functional connectivity were found in patients in MCS. And the enhanced connectivity was mainly located within fronto-central and fronto-parietal regions. In addition, network features derived from the graph theoretical analysis showed decrease of average path length (1.32±0.31 vs 1.08±0.22), increase of clustering coefficient (0.95±0.15 vs 1.12±0.21) and small-world characteristic (0.76±0.24 vs 1.06±0.32) in patients in MCS. No significant alterations were observed in gamma band for patients in VS. Given the role of high gamma activity in human consciousness and cognition. These results provided potential methods and mechanisms of evaluation rTMS effects in conscious rehabilitation of patients with disorders of consciousness.
白洋, 夏小雨, 王勇, 何江弘, 李小俚. 基于脑电的意识障碍重复经颅磁刺激调控评估[J]. 中国生物医学工程学报, 2019, 38(6): 687-694.
Bai Yang, Xia Xiaoyu, Wang Yong, He Jianghong, Li Xiaoli. Assessment Effects of Repetitive Transcranial Magnetic Stimulation in Patients with Disorders of Consciousness by EEG. Chinese Journal of Biomedical Engineering, 2019, 38(6): 687-694.
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