经颅磁刺激与经颅超声刺激在意识障碍中的临床应用专家共识

Expert consensus on clinical application of transcranial magnetic stimulation and transcranial ultrasound stimulation in disorders of consciousness

  • 摘要: 意识障碍(DoC)是心脏骤停、颅脑外伤、脑卒中等严重脑损伤后的常见临床问题,主要包括昏迷、无反应觉醒综合征/植物状态(UWS/VS)、微意识状态(MCS)及脱离微意识状态(EMCS)等。经颅磁刺激(TMS)和经颅超声刺激(TUS)是近年来备受关注的无创神经调控技术。TMS可通过调节皮层兴奋性、突触可塑性及脑网络功能连接对意识相关神经网络产生调控作用,TUS具有较好的空间聚焦和深部调控能力,可对丘脑等意识相关脑区及丘脑-皮层环路进行干预。本共识围绕TMS和TUS在急慢性DoC中的临床应用,针对患者选择、治疗前评估、刺激靶点及方案、疗效评价和安全管理等关键问题形成专家意见,并对个体化、多靶点及闭环神经调控等方向进行展望,以促进TMS和TUS在DoC领域的规范、合理和安全应用。

     

    Abstract: Disorders of consciousness (DoC) are common clinical problems after severe brain injuries such as cardiac arrest, traumatic brain injury and stroke, mainly including coma, unresponsive wakefulness syndrome/vegetative state (UWS/VS), minimally conscious state (MCS), and emergence from minimally conscious state (EMCS). Transcranial magnetic stimulation (TMS) and transcranial ultrasound stimulation (TUS) have emerged as promising non-invasive neuromodulation techniques. TMS modulates consciousness-related neural networks by regulating cortical excitability, synaptic plasticity, and functional brain network connectivity. Meanwhile, TUS offers superior spatial focality and deep targeting capabilities, enabling intervention in consciousness-related regions such as the thalamus and the thalamocortical circuits. This consensus statement addresses the clinical application of TMS and TUS in both acute and prolonged DoC, providing expert recommendations on key issues including patient selection, pre-treatment assessment, stimulation targets and protocols, efficacy evaluation, and safety management. Furthermore, it outlines future directions involving individualized, multi-target, and closed-loop neuromodulation strategies, aiming to promote the standardized, rational, and safe application of TMS and TUS in the field of DoC.

     

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