Pubblicazioni

Effect of transcranial direct current stimulation on paroxysmal sympathetic hyperexcitability with acquired brain injury and cortical excitability: a randomized, double-blind, sham-controlled pilot study

Liu, M.; Li, Y.; Zhao, J.; Liu, B.; Duan, G.; Guo, Q.; Ye, Z.; Zhang, X.; Wang, C.; Wu, D.

Abstract:

Paroxysmal sympathetic hyperexcitation (PSH) refers to a clinical syndrome characterized by a sudden increase in sympathetic excitability caused by severe brain injury. This study aims to investigate the effectiveness and practicality of combining transcranial direct current stimulation (tDCS) with medication to treat PSH and employ non-linear electroencephalography (EEG) to assess changes in cortical activation post-intervention. 40 PSH patients were randomly assigned to receive either active tDCS or sham tDCS treatment over an 8-week period. The tDCS stimulation targeted the prefrontal area, left frontal-temporal-parietal cortex, right frontal-temporal-parietal cortex, and left dorsolateral prefrontal cortex. Both patient groups also underwent medication and other conventional therapies. The Paroxysmal Sympathetic Hyperactivity Assessment Measure (PSH-AM), Coma Recovery Scale-Revised (CRS-R), medication dosage, and approximate entropy (ApEn) index were assessed before and after treatment. The active tDCS group exhibited more substantial improvements in changes of PSH-AM, changes of CRS-R, and medication reduction ratios compared to the sham tDCS group after the treatment. After treatment and during follow-up, a significantly greater number of patients in the active tDCS group demonstrated clinically important differences compared to the sham tDCS group. The active tDCS group showed significantly higher ApEn indices in the less affected frontal lobe compared to the control group. No significant differences in ApEn indices were noted in the sham tDCS group before and after treatment. Regression analysis revealed that the group (active tDCS/sham tDCS) was the primary factor associated with improving PSH-AM. Therefore, we believe that in patients with PSH, combining tDCS with medication therapy demonstrated superior clinical efficacy compared to medication therapy alone. Electrophysiological results also indicated enhanced cortical excitability. Therefore, this single-center pilot study suggests that multi-target, multi-session tDCS combined with medication may be an effective treatment protocol for PSH.

Patologie/Applicazioni:

• Stimolazione elettrica transcranica (TES)

Anno:

2025

Tipo di pubblicazione:

Articolo

Parola chiave:

tDCS; stimolazione elettrica transcranica

Testata scientifica:

BMC - Springer nature

Mese:

02

Nota:

Lo studio analizza l'efficacia della stimolazione transcranica a corrente diretta (tDCS) nel trattamento dell'iperattività simpatica parossistica (PSH) nei pazienti con lesioni cerebrali acquisite. Il trial randomizzato e controllato ha coinvolto 40 pazienti suddivisi in due gruppi: uno sottoposto a tDCS attiva e l'altro a stimolazione placebo, in combinazione con terapie farmacologiche. La tDCS è stata applicata in aree cerebrali mirate per otto settimane, con valutazioni basate sulla Paroxysmal Sympathetic Hyperactivity Assessment Measure (PSH-AM), la Coma Recovery Scale-Revised (CRS-R) e analisi EEG tramite entropia approssimata (ApEn). I risultati hanno mostrato un miglioramento significativo nei pazienti trattati con tDCS attiva, con riduzione della sintomatologia PSH, minore necessità di farmaci e maggiore attivazione corticale, in particolare nella corteccia frontale meno compromessa. L'analisi EEG ha confermato un aumento dell'eccitabilità corticale nei pazienti trattati con tDCS rispetto al gruppo di controllo. Inoltre, il follow-up ha evidenziato il mantenimento dei benefici terapeutici. Lo studio suggerisce che la combinazione di tDCS e terapia farmacologica potrebbe rappresentare un'opzione terapeutica efficace per i pazienti con PSH, migliorando i sintomi in modo più rapido rispetto ai soli farmaci. Tuttavia, si riconoscono limiti come il campione ridotto e la durata limitata del follow-up, richiedendo ulteriori ricerche su larga scala per confermare i risultati e ottimizzare il protocollo terapeutico.

DOI:

10.1186/s12984-025-01583-2