综合神经康复包括EEG-神经反馈治疗右侧丘脑-中脑脑出血后单侧空间忽视：一例病例报告

文献信息

中文摘要

背景/目的： 单侧空间忽视（USN）是一种致残性注意综合征，发生于皮质或皮质下卒中后，包括丘脑病变。基于EEG的神经反馈（EEG-NF）可能支持皮质自我调节，但在空间忽视中的证据仍然有限。本病例报告描述了一名右侧丘脑出血性卒中后发生USN的患者在接受包括EEG-NF在内的多学科康复后的临床、神经心理、功能和电生理（定量EEG，qEEG）演变。方法：一名70岁患者接受了为期3周的住院多学科康复计划，包括物理治疗、言语和吞咽治疗、常规认知刺激以及15次辅助EEG-NF治疗。基线和治疗后评估包括临床、神经心理、忽视特异性、功能、情感和静息态qEEG测量。在具备合适心理测量参数时，使用可靠变化指数检查个体变化，并结合已发表的常模和临床阈值。结果：康复后，蒙特利尔认知评估总原始分从20增加到24，达到已发表的最小临床重要差异，但未达到最小可检测变化。额叶评估成套测验从8增加到12；根据意大利常模数据对年龄和教育进行调整后，两项评分仍低于常模临界值。忽视特异性测量显示空间不对称性降低、对侧靶标检测增加，以及Catherine Bergego量表从17降至5，表明从中度生态忽视转变为轻度生态忽视。功能独立性改善，功能独立性测量（FIM）总分和认知评分以及改良Barthel指数评分出现可靠变化。探索性qEEG分析显示条件依赖的频谱和连接变化，但结果异质性大且具有假设生成性。EEG-NF完成且无不良事件。结论：辅助EEG-NF方案按计划完成，无不良事件。临床改善不能特异性地归因于神经反馈，因为所有康复组成部分是同时进行的。需要对照研究来阐明其具体贡献以及所观察到的卒中后空间忽视改善的持久性。

英文摘要

Background/Objectives: Unilateral Spatial Neglect (USN) is a disabling attentional syndrome occurring after cortical or subcortical stroke, including thalamic lesions. EEG-based neurofeedback (EEG-NF) may support cortical self-regulation, but evidence in spatial neglect remains limited. This case report describes the clinical, neuropsychological, functional, and electrophysiological (quantitative EEG, qEEG) evolution of a patient with USN after a right thalamic hemorrhagic stroke who underwent multidisciplinary rehabilitation including EEG-NF. Methods: A 70-year-old patient underwent a 3-week inpatient multidisciplinary rehabilitation program including physiotherapy, speech and swallowing therapy, conventional cognitive stimulation, and 15 adjunctive EEG-NF sessions. Baseline and post-treatment assessments included clinical, neuropsychological, neglect-specific, functional, affective, and resting-state qEEG measures. Individual change was examined using the Reliable Change Index when suitable psychometric parameters were available, together with published normative and clinical thresholds. Results: After rehabilitation, the Montreal Cognitive Assessment total raw score increased from 20 to 24, reaching the published minimal clinically important difference but not the minimal detectable change. The Frontal Assessment Battery increased from 8 to 12; after adjustment for age and education according to Italian normative data, both scores remained below the normative cut-off. Neglect-specific measures showed reduced spatial asymmetry, increased contralesional target detection, and a Catherine Bergego Scale reduction from 17 to 5, indicating a shift from moderate to mild ecological neglect. Functional independence improved, with reliable change in Functional Independence Measure (FIM) total and cognitive scores and Modified Barthel Index scores. Exploratory qEEG analyses showed condition-dependent spectral and connectivity changes, but findings were heterogeneous and hypothesis-generating. EEG-NF was completed without adverse events. Conclusions: The adjunctive EEG-NF protocol was completed as planned, with no adverse events. Clinical improvement cannot be attributed specifically to neurofeedback because all rehabilitation components were delivered concurrently. Controlled studies are needed to clarify its specific contribution and the durability of the observed improvements in post-stroke spatial neglect.