目的 评估经颅直流电刺激(tDCS)治疗卒中后运动性失语患者抑郁状态(PSD)的临床疗效和安全性。方法 2018年1月至12月，卒中后抑郁并发运动性失语患者60例随机分为对照组(n = 30)和实验组(n = 30)。两组均接受常规药物和康复治疗。实验组接受左背外侧前额叶阳极tDCS治疗，对照组接受伪刺激。治疗前，治疗后1周、2周和3周，采用医院版卒中后失语抑郁问卷(SADQ-H)、失语患者抑郁量表(ADRS)进行评定，治疗前后采用改良Barthel指数(MBI)进行评定。试验结束或退出试验时填写安全性调查表。结果 对照组3例、实验组2例退出。两组SADQ-H和ADRS评分均随时间而下降(F时间 > 100.643, P < 0.001)，实验组SADQ-H评分低于对照组(F组别 = 6.891, P = 0.011)，ADRS两组间无显著性差异(F组别 = 2.925, P = 0.093)，SADQ-H和ADRS评分交互效应显著(F交互 > 13.642, P < 0.001)。实验组治疗前后MBI差值显著高于对照组(t = 7.016, P < 0.001)。两组不良反应发生率无统计学差异(P = 0.5)。结论 tDCS对卒中后抑郁并发运动性失语患者有效，无明显不良反应。
Objective To observe the clinical efficacy and safety of transcranial direct current stimulation (tDCS) on post-stroke depression (PSD) with Broca's aphasia. Methods From January to December, 2018, 60 patients with PSD and Broca's aphasia were randomly divided into control group (n = 30) and trial group (n = 30). Both groups accepted routine medicine and rehabilitation. The trial group accepted tDCS, anode over left dorsal lateral prefrontal cortex, while the control group accepted sham stimulation. They were assessed with Stroke Aphasic Depression Questionnaire Hospital Version (SADQ-H) and Aphasic Depression Rating Scale (ADRS) before treatment and one, two and three weeks after treatment. They were also assessed with modified Barthel Index (MBI) before and three weeks after treatment. The adverse effects were investigated with questionnaire as the patients finished treatment or withdrew. Results There were three patients withdrawing in the control group, and two in the trial group. The scores of SADQ-H and ADRS decreased with time in both groups (Ftime > 100.643, P < 0.001), and the score of SADQ-H was lower in the trial group than in the control group (Fgroup = 6.891, P = 0.011), but no significant difference was found between two groups in the scores of ADRS (Fgroup = 2.925, P = 0.093). There was significance of interaction between group and time (F > 13.642, P < 0.001). The difference of MBI was more in the trial group than in the control group (t = 7.016, P < 0.001). There was no significant difference in the incidence of adverse effects between the two groups (P = 0.5). Conclusion tDCS is effective on PSD in patients with Broca's aphasia, without obvious adverse effects.
1 BenjaminE J, ViraniS S, CallawayC W, et al. Heart Disease and Stroke Statistics—2018 Update: a report from the American Heart Association [J]. Circulation, 2018, 137(12): e67-e492.
2 TowfighiA, OvbiageleB, El HusseiniN, et al. Poststroke depression: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association [J]. Stroke, 2017, 48(2): e30-e43.
3 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders [M]. 5th ed. Arlington, VA: American Psychiatric Association, 2013: 181-183.
4 中华医学会精神科分会. CCMD-3中国精神障碍分类与诊断标准[M]. 济南:山东科学技术出版社, 2001.
5 王少石,周新雨,朱春燕. 卒中后抑郁临床实践的中国专家共识[J]. 中国卒中杂志, 2016, 11(8): 685-693.
6 ParikhR M, RobinsonR G, LipseyJ R, et al. The impact of poststroke depression on recovery in activities of daily living over a 2-year follow-up [J]. Arch Neurol, 1990, 47(7): 785.
7 BilgeC, Ko?erE, Ko?erA, et al. Depression and functional outcome after stroke: the effect of antidepressant therapy on functional recovery [J]. Eur J Phys Rehabil Med, 2008, 44: 13-18.
8 DasJ, G K R. Post stroke depression: the sequelae of cerebral stroke [J]. Neurosci Biobehav Rev, 2018, 90: 104-114.
9 TownendE, BradyM, McLaughlanK. Exclusion and inclusion criteria for people with aphasia in studies of depression after stroke: a systematic review and future recommendations [J]. Neuroepidemiology, 2007, 29(1-2): 1-17.
10 BakerC, WorrallL, RoseM, et al. A systematic review of rehabilitation interventions to prevent and treat depression in post-stroke aphasia [J]. Disabil Rehabil, 2018, 40(16): 1870-1892.
11 WoodsA J, AntalA, BiksonM, et al. A technical guide to tDCS, and related non-invasive brain stimulation tools [J]. Clin Neurophysiol, 2016, 127(2): 1031-1048.
12 LefaucheurJ, AntalA, AyacheS S, et al. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS) [J]. Clin Neurophysiol, 2017, 128(1): 56-92.
13 李泓钰,王强,王静,等. 经颅直流电刺激对卒中后抑郁的疗效[J]. 中国康复理论与实践, 2018, 24(5): 565-570.
14 ValiengoL C L, GoulartA C, de OliveiraJ F, 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.
15 ValiengoL, CasatiR, BologniniN, 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.
16 LooC K, AlonzoA, MartinD, et al. Transcranial direct current stimulation for depression: 3-week, randomised, sham-controlled trial [J]. Brit J Psychiat, 2012, 200(1): 52-59.
17 BrunoniA R, AmaderaJ, BerbelB, et al. A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation [J]. Int J Neuropsychoph, 2011, 14(8): 1133-1145.
18 KauhanenM L, KorpelainenJ T, HiltunenP, et al. Aphasia, depression, and non-verbal cognitive impairment in ischaemic stroke [J]. Cerebrovasc Dis, 2000, 10(6): 455-461.
19 ShehataG A, El MistikawiT, RishaA S K, et al. The effect of aphasia upon personality traits, depression and anxiety among stroke patients [J]. J Affect Disorders, 2015, 172: 312-314.
20 刘艳君,马艳玲,叶娜,等. 卒中后失语患者抑郁测评量表应用现状[J]. 中国医刊, 2017, 52(9): 20-24.
21 王维清. 卒中后失语患者抑郁问卷(医院版)的修订及标准化研究[D]. 广州:南方医科大学, 2010.
22 BenaimC, CaillyB, PerennouD, et al. Validation of the Aphasic Depression Rating Scale [J]. Stroke, 2004, 35(7): 1692-1696.
23 朱明预,余凤琼,张骏,等. 经颅直流电刺激的研究进展[J]. 中国神经精神疾病杂志, 2017(6): 382-385.
24 BoggioP S, RigonattiS P, RibeiroR B, et al. A randomized, double-blind clinical trial on the efficacy of cortical direct current stimulation for the treatment of major depression [J]. Int J Neuropsychoph, 2008, 11(2): 249-254.
25 LooC K, HusainM M, McDonaldW M, et al. International randomized-controlled trial of transcranial direct current stimulation in depression [J]. Brain Stimul, 2018, 11(1): 125-133.
