左背外侧前额叶阳极经颅直流电刺激对脑卒中后抑郁症的疗效观察
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摘要
目的:观察左背外侧前额叶阳极经颅直流电刺激对脑卒中后抑郁症的疗效。方法:将40例脑卒中患者随机分成治疗组与对照组各20例,观察治疗4周。治疗组在常规康复治疗的基础上在第1周及第2周每日增加阳极经颅直流电刺激左背外侧前额叶治疗,对照组只进行常规的康复治疗训练。在经颅直流电刺激介入前及第1周、第2周、第4周后分别应用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、改良Barthel指数(MBI)、工具性日常生活能力量表(IADL)评定患者心理及日常生活能力改善效果。结果:治疗组患者经颅直流电刺激(t DCS)治疗1周、2周后的HAMA、HAMD评分均明显低于对照组,而且差异具有显著性意义(P<0.05);且在刺激结束2周后的随访对比中明显要优于对照组。结论:阳极经颅直流电刺激左背外侧前额叶对脑卒中后抑郁症可减轻或消除脑卒中患者的抑郁或者焦虑情绪,提高患者的日常生存质量。
Objective: To observe the effect of anodal transcranial direct current stimulation over the left dorsolateral prefrontal cortex on depression after stroke.Method: Forty depression stroke patients were randomly divided into treatment group and control group in a four weeks program. Besides the routine rehabilitation therapy,treatment group accepted transcranial direct current stimulation daily in the first 2 weeks. The control group accepted routine rehabilitation training only. Hamilton depression scale(HAMD), Hamilton anxiety scale(HAMA), modified Barthel index(MBI), instrumental daily life ability scale(IADL) were used to evaluate the patient's psychological state and daily life ability at the end of 0,1,2,4 week of the course.Result: The treatment group patients after 1 and 2 weeks treatment with the t DCS stimulated, Hamilton anxiety rating scale and Hamilton depression rating scale were significantly lower than the control group(P<0.05);And after two weeks follow up,the scores of the assessments were still better in the treatment group than the control group.Conclusion: Anodal transcranial direct current stimulation over left dorsolateral prefrontal cortex in patients with depression after stroke can reduce their depression or anxiety, and improve their daily life quality.
Objective: To observe the effect of anodal transcranial direct current stimulation over the left dorsolateral prefrontal cortex on depression after stroke.Method: Forty depression stroke patients were randomly divided into treatment group and control group in a four weeks program. Besides the routine rehabilitation therapy,treatment group accepted transcranial direct current stimulation daily in the first 2 weeks. The control group accepted routine rehabilitation training only. Hamilton depression scale(HAMD), Hamilton anxiety scale(HAMA), modified Barthel index(MBI), instrumental daily life ability scale(IADL) were used to evaluate the patient's psychological state and daily life ability at the end of 0,1,2,4 week of the course.Result: The treatment group patients after 1 and 2 weeks treatment with the t DCS stimulated, Hamilton anxiety rating scale and Hamilton depression rating scale were significantly lower than the control group(P<0.05);And after two weeks follow up,the scores of the assessments were still better in the treatment group than the control group.Conclusion: Anodal transcranial direct current stimulation over left dorsolateral prefrontal cortex in patients with depression after stroke can reduce their depression or anxiety, and improve their daily life quality.
引文
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[24]Knotkova H,Portenoy RK,Cruciani RA.Transcranial direct current stimulation(t DCS)relieved itching in a patien with chronic neuropathic pain[J].Clin J Pain,2013,29(7):621-622.
[25]Ferrucci R,Bortolomasi M,Vergari M,et al.Transcranial direct current stimulation in severe,drug-resistant major depression[J].J Affect Disord,2009,118(1-3):215-219.
[26]Grimm S,Beck J,Schuepbach D,et al.Imbalance between left and right dorsolateral prefrontal cortex in major depression is linked to negative emotional judgment:an f M-RI study in severe major depressive disorder[J].Biol Psychiatry,2008,63(4):369-376.
[27]Williams NR,Taylor JJ,Lamb K,et al.Role of functional imaging in the development and refinement of invasive neuromodulation for psychiatric disorders[J].World J Radiol,2014,6(10):756-778.
[28]冯正直,涂静.背外侧-腹内侧前额叶皮层神经回路异常介导抑郁的研究进展[J].第三军医大学学报,2011,22(33):2327-2329.
[2]Boyko M,Kutz R,Gruenbaum BF,et al.The influence of aging on poststroke depression using a rat model via middle cerebral artery occlusion[J].Cogn Affect Behav Neurosci,2013,13(4):847-859.
[3]李晓彤,吕祥兄.脑卒中后抑郁的临床分析[J].现代实用医学,2010,18(11):1272-1273.
[4]白智华.脑卒中后抑郁的诊治进展[J].武警医学院学报,2010,17(11):911-913,917.
[5]Terroni L,Amaro E,Iosifescu DV,et al.Stroke lesion in cortical neural circuits and post-stroke incidence of major depressive episode:a 4-month prospective study[J].World J Biol Psychiatry,2011,12(7):539-548.
[6]Rajkowska G,Miguel-Hidalgo JJ,Wei J,et al.Morphometric evidence for neuronal and glial prefrontal cell pathology in major depression[J].Biol Psychiatry,1999,45(9):1085-1098.
[7]Ruff CC,Ugazio G,Fehr E.Changing social norm compliance with noninvasive brain stimulation[J].Science,2013,342(6157):482-484.
[8]Normann C,Schmitz D,Fürmaier A,et al.Long-term plasticity of visually evoked potentials in humans is altered in major depression[J].Biol Psychiatry,2007,62(5):373-380.
[9]Bueno VF,Brunoni AR,Boggio PS,et al.Mood and cognitive effects of transcranial direct current stimulation in poststroke depression[J].Neurocase,2011,17(4):318-322.
[10]Valiengo L,Casati R,Bolognini N,et al.Transcranial direct current stimulation for the treatment of post-stroke depression in aphasic patients:a case series[J].Neurocase,2016,22(2):225-228.
[11]Valiengo LC,Goulart AC,de Oliveira JF,et al.Transcranial direct current stimulation for the treatment of post-stroke depression:results from a randomised,sham-controlled,double-blinded trial[J].J Neurol Neurosurg Psychiatry,2017,88(2):170-175.
[12]中华医学会第四届全国脑血管学术会议.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379.
[13]王玉龙.康复功能评定学[M].北京:人民卫生出版社,2008.322-327.328-330.368-372.384-387.
[14]Wagner T,Fregni F,Fecteau S,et al.Transcranial direct current stimulation:a computer-based human model study[J].Neuroimage,2007,35(3):1113-1124.
[15]George MS,Ketter TA,Post RM.Prefrontal cortex dysfunction in clinical depression[J].Depression,1994,2:59-72.
[16]Dawson ME,Schell AM,Catania JJ.Autonomic correlates of depression and clinical improvement following electroconvulsive shock therapy[J].Psychophysiology,1977,14(6):569-578.
[17]李丽,董奇.抑郁症的脑神经结构和功能改变研究[J].中国临床心理学杂志,2006,14(1):106-108.
[18]Nitsche MA,Kuo MF,Karrasch R,et al.Serotonin affects transcranial direct current-induced neuroplasticity in humans[J].Biol Psychiatry,2009,66(5):503-508.
[19]Henriques JB,Davidson RJ.Decreased responsiveness to reward in depression.Cogn[J].Emot,2000,14:711-724.
[20]徐伟,周燕.卒中后抑郁研究进展[J].医学综述,2009,15(1):88-92.
[21]郑婷,王春雪.卒中后抑郁的临床研究现状[J].中国卒中杂志2008,3(9):676-677.
[22]Narushima K,Kosier JT,Robinson RG.A reappraisal of poststroke depression,intra-and inter-hemispheric lesion location using meta-analysis[J].J Neuropsychiatry Clin Neurosci,2003,15(4):422-430.
[23]Kim JS,Choi-Kwon S.Poststroke depression and emotional incontinence:correlation with lesion location[J].Neurology,2000,54(9):1805-1810.
[24]Knotkova H,Portenoy RK,Cruciani RA.Transcranial direct current stimulation(t DCS)relieved itching in a patien with chronic neuropathic pain[J].Clin J Pain,2013,29(7):621-622.
[25]Ferrucci R,Bortolomasi M,Vergari M,et al.Transcranial direct current stimulation in severe,drug-resistant major depression[J].J Affect Disord,2009,118(1-3):215-219.
[26]Grimm S,Beck J,Schuepbach D,et al.Imbalance between left and right dorsolateral prefrontal cortex in major depression is linked to negative emotional judgment:an f M-RI study in severe major depressive disorder[J].Biol Psychiatry,2008,63(4):369-376.
[27]Williams NR,Taylor JJ,Lamb K,et al.Role of functional imaging in the development and refinement of invasive neuromodulation for psychiatric disorders[J].World J Radiol,2014,6(10):756-778.
[28]冯正直,涂静.背外侧-腹内侧前额叶皮层神经回路异常介导抑郁的研究进展[J].第三军医大学学报,2011,22(33):2327-2329.